Abstract
PurposeIncreased arterial tortuosity has been suggested as a predisposing factor for carotid artery dissection, which is an important risk factor for development of extracranial carotid artery aneurysms (ECAA). Prior to comparison with non-ECAA controls, the optimal measurement technique should be defined. This study describes the difference between software packages in terms of reproducibility and absolute outcome of arterial tortuosity measurements in ECAA patients.MethodsCT-angiography analysis was performed on 12 ECAA patients selected from our registry, using four software packages: 3mensio Vascular, TeraRecon, Vital Images, and Aycan OsiriX PRO. The tortuosity index (TI) was calculated from the skull base until the carotid bifurcation and aortic arch, and was defined as the centerline’s true length divided by the straight line distance. Intraclass correlation coefficients (ICC) with 95% confidence intervals were calculated to quantify inter- and intra-observer variability within one software package, and differences in measured TI between packages.ResultsInter-observer agreement was nearly perfect for 3mensio, excellent for Vital Images and OsiriX, and substantial for TeraRecon, with ICC 0.99 (0.96–1.0), 0.90 (0.69–0.97), 0.84 (0.53–0.95), and 0.72 (0.28–0.91), respectively. Intra-observer agreement ranged from ICC 1.0 for 3mensio to 0.91 for TeraRecon. Agreements in TI ranged from ICC 0.99 (0.98–1.0) for 3mensio vs. OsiriX, to 0.95 (0.82–0.98) for 3mensio vs. TeraRecon. Median time needed to complete one round of measurements was highest for OsiriX (p = 0.013).ConclusionsCarotid artery tortuosity measurements are reproducible and comparable between current commercially available software packages, with high intra-observer agreement. Although the reproducibility differed per software packages, all packages scored an acceptable inter-observer agreement.
Highlights
Increased arterial tortuosity has been suggested as a predisposing factor for carotid artery dissection [1,2,3], which is in turn an important etiological risk factor for extracranial carotid artery aneurysm (ECAA) formation [4]
Experts in the field have suggested that most ECAA have a relative elongated inflow and outflow track, no validated data exist about arterial tortuosity in ECAA patients
The agreement between both observers was nearly perfect for measurements performed with 3mensio, excellent for Vital Images and OsiriX, and substantial for TeraRecon
Summary
Increased arterial tortuosity has been suggested as a predisposing factor for carotid artery dissection [1,2,3], which is in turn an important etiological risk factor for extracranial carotid artery aneurysm (ECAA) formation [4]. Experts in the field have suggested that most ECAA have a relative elongated inflow and outflow track, no validated data exist about arterial tortuosity in ECAA patients. Little is known about the natural clinical course and risk factors for adverse outcome of ECAA patients [5]. If increased arterial tortuosity would exist in ECAA patients, it may aid in individual patient’s risk prediction for adverse outcome. Severe tortuosity affects planning and performing interventions for aneurysm exclusion when indicated [6]
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