O-118 - VARIABILITY AND REPRODUCIBILITY IN ULTRASOUND ABDOMINAL AORTIC DIAMETER MEASUREMENTS: A SYSTEMATIC REVIEW AND METHODS COMPARISON

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Bissacco D. (Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico ~ Milano ~ Italy) , Mandigers T. (Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico ~ Milano ~ Italy) , Savaré L. (MOX - Laboratory for Modeling and Scientific Computing, Department of Mathematics, Politecnico di Milano ~ Milano ~ Italy) , Domanin M. (Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico ~ Milano ~ Italy) , D'Oria M. (Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ~ Trieste ~ Italy) , Ieva F. (MOX - Laboratory for Modeling and Scientific Computing, Department of Mathematics, Politecnico di Milano ~ Milano ~ Italy) , Van Herwaarden J.A. (Department of Vascular Surgery, University Medical Center Utrecht ~ Utrecht ~ Netherlands) , Mani K. (Department of Surgical Sciences, Section of Vascular Surgery ~ Uppsala ~ Sweden) , Wanhainen A. (Department of Surgical Sciences, Section of Vascular Surgery ~ Uppsala ~ Sweden) , Trimarchi S. (Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico ~ Milano ~ Italy)
Introduction:
There is a lack of evidence regarding the most preferred method of maximum antero-posterior abdominal aortic aneurysm diameter measurement using ultrasound (US). The aim of the present systematic review was to assess which US method of maximum abdominal aortic aneurysm (AAA) diameter measurement can be considered most accurate and reproducible according to the available evidence.
Methods:
PubMed, Scopus, and Web of Science were systematically searched for eligible studies reporting intra- and interobserver variability of maximum non-ruptured, atherosclerotic AAA diameter measurements using an antero-posterior evaluation with an outer-to-outer (OTO), inner-to-inner (ITI), and/or leading edge-to-leading edge (LELE) caliper placement. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed. The Newcastle-Ottawa Scale was used to assess the methodological quality of included studies.
Results:
First database searching revealed 1532 articles. After duplicate removal and application of the inclusion and exclusion criteria, 21 studies were included in the qualitative analysis. Of these, 15 were included in the quantitative analysis. Studies were published between 1991 and 2021 and showed great heterogeneity in the type of US scanner and transducer used, the gender of participants, and observer professions, expertise, and training. The median study size was 50 participants (range 10 - 215). The median number of observers was 3 (range 1 - 24). A test of homogeneity of means confirmed that measurements of included studies share a common mean of interobserver reproducibility coefficients for the three different US methods (OTO: p = .603, ITI: p = .099, and LELE: p = .782). A fixed-effects model was applied to obtain a single estimate of the mean and standard deviation of the coefficients, θmle (sd), for each US method (OTO: .452 (.030), ITI: 1.060 (.684), and LELE: .768 (.415)). The interobserver reproducibility coefficient for OTO resulted to be lower than both ITI and LELE (p = .001, and p = .005, respectively), whereas no significant difference was detected between the ITI and LELE method (p = .094).
Conclusion:
Measuring maximum antero-posterior AAA diameter using US could be most accurate and reproducible with the OTO method as compared to the ITI and LELE method. These findings may serve future guideline recommendations and improve AAA detection in screening programs.
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