External Validation of Fully-Automated Infrarenal Maximum Aortic Aneurysm Diameter Measurements in Computed Tomography Angiography Scans Using Artificial Intelligence (PRAEVAorta 2).

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE Journal of Endovascular Therapy Pub Date : 2024-11-13 DOI:10.1177/15266028241295563
Johannes Hatzl, Christian Uhl, Alexandru Barb, Daniel Henning, Jonathan Fiering, Edris El-Sanosy, Philippe W M Cuypers, Dittmar Böckler
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Abstract

Purpose: This study investigates the accuracy of fully-automated maximum aortic diameter measurements in abdominal aortic aneurysm (AAA) patients using artificial intelligence software (PRAEVAorta 2, Nurea, Bordeaux, France).

Materials and methods: This is a multicenter, retrospective validation study using prospectively collected data from the Zenith alpha for aneurysm Repair Registry (ZEPHYR). Automated measurements of PRAEVAorta 2 are compared with measurements of an internationally recognized core laboratory (Syntactx, New York, New York State). The reviewers at the core laboratory were measurement technologists trained to and utilizing established measurement standards, overseen by vascular surgeons and radiologists. The data set comprised 871 computed tomography angiography scans from the ZEPHYR registry with 347 patients who underwent endovascular aneurysm repair (EVAR) with the Zenith Alpha Endovascular Abdominal Graft (Cook Medical, Bloomington, Indiana) in Germany, Belgium, and The Netherlands between 2016 and 2019.

Results: The analysis demonstrated excellent correlation of the measurements (r=0.97) with an intraclass correlation (ICC) of 0.972 (95% confidence interval [CI]=0.968-0.976) across all scans. For preoperative computed tomography (CT) scans, ICC was 0.953 (95% CI=0.941-0.963), and for postoperative scans, ICC was 0.979 (95% CI=0.975-0,983), respectively. In total, 95.4% of measurements were within the clinically acceptable range of 5 mm in absolute difference. In total, 10% of scans demonstrated obvious segmentation errors, mainly due to failure in detecting vessel segments (renal arteries, aortic bifurcation) or due to mis-detecting the outer border of the AAA (duodenum, inferior vena cava, aortic branches) and were excluded from the analysis.

Conclusion: In this study, the maximum AAA diameter could be accurately measured fully-automatically by PRAEVAorta 2 (Nurea) in most cases demonstrating that artificial intelligence (AI) software could serve as an important adjunct for research and clinical practice. However, critical review of the generated reports by an experienced observer and cautious use is warranted to identify flawed segmentations.

Clinical impact: This multicenter, retrospective validation study assessed the accuracy of fully-automated maximum infrarenal aortic aneurysm diameter measurements. It was demonstrated, that 95.4% of measurements were within the clinically acceptable range of 5 mm in absolute difference, positioning the software as a potential adjunct for clinical practice and research. It is also highlighted however, that critical review of the measurements is obligatory, due to a 10% segmentation error rate.

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利用人工智能对计算机断层扫描血管造影扫描中的全自动腱鞘下主动脉瘤最大直径测量进行外部验证(PRAEVAorta 2)。
目的:本研究使用人工智能软件(PRAEVAorta 2,Nurea,法国波尔多)对腹主动脉瘤(AAA)患者进行全自动最大主动脉直径测量的准确性进行研究:这是一项多中心、回顾性验证研究,使用的是 Zenith alpha 动脉瘤修复注册中心 (ZEPHYR) 收集的前瞻性数据。PRAEVAorta 2 的自动测量结果与国际公认的核心实验室(纽约州纽约市 Syntactx)的测量结果进行了比较。核心实验室的审查人员是经过培训并采用既定测量标准的测量技术人员,由血管外科医生和放射科医生监督。数据集包括 ZEPHYR 登记的 871 份计算机断层扫描血管造影扫描,其中 347 名患者在 2016 年至 2019 年期间在德国、比利时和荷兰使用 Zenith Alpha 血管内腹腔移植器(Cook Medical,Bloomington,Indiana)进行了血管内动脉瘤修补术(EVAR):分析表明,所有扫描的测量结果具有极佳的相关性(r=0.97),类内相关性(ICC)为 0.972(95% 置信区间 [CI]=0.968-0.976)。术前计算机断层扫描 (CT) 扫描的 ICC 为 0.953(95% 置信区间 [CI]=0.941-0.963),术后扫描的 ICC 为 0.979(95% 置信区间 [CI]=0.975-0,983)。总共有 95.4% 的测量值绝对差值在 5 毫米的临床可接受范围内。共有10%的扫描显示出明显的分割误差,主要是由于未能检测到血管节段(肾动脉、主动脉分叉)或由于错误检测到AAA的外缘(十二指肠、下腔静脉、主动脉分支)而被排除在分析之外:在这项研究中,PRAEVAorta 2(Nurea)可以在大多数情况下全自动准确测量 AAA 的最大直径,这表明人工智能(AI)软件可以作为研究和临床实践的重要辅助工具。不过,有经验的观察者应对生成的报告进行严格审查,并谨慎使用,以识别有缺陷的分割:这项多中心、回顾性验证研究评估了全自动最大主动脉瘤直径测量的准确性。结果表明,95.4% 的测量结果在绝对差值 5 毫米的临床可接受范围内,因此该软件有望成为临床实践和研究的辅助工具。但同时也强调,由于分割错误率为 10%,因此必须对测量结果进行严格审查。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
期刊最新文献
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