Discrepancies in determination of abdominal aortic aneurysms maximum diameter and growth rate, using axial and orhtogonal computed tomography measurements

Purpose: Maximum diameter and growth rate of abdominal aortic aneurysms (AAAs) which are currently used as the only variables to set the indication for elective repair are recorded through computed tomography (CT) measurements on an axial plane or on an orthogonal plane that is perpendicular to vessel centerline, interchangeably. We will attempt to record possible discrepancies between the two methods, identify whether such differences could influence therapeutic decisions and determine in which cases this should be expected. Materials and methods: We retrospectively reviewed sixty CT-scans performed in thirty-nine patients. Three-dimensional reconstruction of AAAs has been performed and differences in maximum diameter measured on axial and orthogonal planes were recorded. A measure for asymmetry was introduced termed ShapeIndex defined as the value of section minor over major axis and was related with differences in maximum diameter recordings. Growth rates were also determined using both axial and orthogonal measurements. Results: Axial measurements overestimate maximum diameter by 2 ± 2.7 mm (P < 0.001) with a range of 0–12.3 mm. Overall, 20% of the CTs had an axial maximum diameter >5.5 cm indicating the need for intervention whereas, orthogonal diameter was below that threshold. Asymmetry of the axial sections with ShapeIndex ≤ 0.8 was found to be related to an overestimation of maximum diameter by >5 mm. There were no significant differences in growth rates when determined using orthogonal or axial measurements in both examinations (median growth rate: 2.3 mm and 3.3 mm respectively P = 0.2). However there were significant differences when orthogonal measurements were used at initial and axial measurements used at follow-up examination or vice versa (median growth rate: 4.9 mm and 0.9 mm respectively P < 0.001). Conclusions: Although the mean difference between measurements is low there is a wide range among cases, mainly observed in asymmetrical AAAs. ShapeIndex may identify those which are more likely to be misestimated. CT measurements performed to establish AAA growth rates should consistently use either the axial or orthogonal technique to avoid inaccuracies from occurring