Preliminary intraobserver and interobserver variability in wall stress and rupture risk assessment of abdominal aortic aneurysms using a semiautomatic finite element model

Abstract

We investigated the intraobserver and interobserver variability of using semiautomatic finite element analysis to calculate the von Mises stress and peak wall rupture risk (PWRR) in patients with an abdominal aortic aneurysm (AAA) in longitudinal studies. Four independent observers made 3-dimensional (3D) reconstructions, with minimal manual adjustments, of small AAAs (<5.0 cm) in 17 patients and processed finite element analysis. We used semiautomatic diagnostic software with a finite element model (A4research, VASCOPS GmbH, Graz, Austria). The finite element method was used to calculate von Mises stress and PWRR, which are indicators for wall stress. The differences of each pair of measurements of von Mises stress and PWRR were plotted against their mean and the difference of the mean, according to Bland-Altman analysis. The intraobserver variability had an overall mean percentage difference of 6.86% ± 6.46% for the von Mises stress and 7.70% ± 6.26% for PWRR. The interobserver variability for the four observers showed an overall mean percentage difference of 7.09% ± 6.16% for the von Mises stress and 9.47% ± 8.18% for the PWRR measurement. No significant differences were found (P < .05), for the von Mises stress and PWRR for all observers. The von Mises stress and PWRR of small AAAs calculated in this semiautomatic finite element analysis program show good interobserver and intraobserver variability. It is suitable for clinical use to evaluate mechanical aortic wall characteristics and to compare it with other current methods such as maximum aortic diameter measurements.