Accuracy of fully automated iliac artery tortuosity measurements in patients with abdominal aortic aneurysm using deep learning

European Journal of Radiology, vol. 195, pp. 112609

Abstract

OBJECTIVE: To externally validate the accuracy of deep learning-based iliac artery tortuosity assessment (PRAEVAorta 2, Bordeaux, France) in computed tomography angiography of patients with abdominal aortic aneurysms. DESIGN: Retrospective, multi-center validation study. METHODS: Data from the ZEnith alPHa for aneurYsm Repair Registry (ZEPHYR) were used. Tortuosity measurements from PRAEVAorta 2 were benchmarked against manual reference measurements from an internationally recognized core laboratory (Syntactx, New York, USA). All PRAEVAorta 2 reports were visually inspected by two observers for plausibility of the segmentation of the iliac arteries. Scans with obvious segmentation errors were excluded. Qualitative and quantitative analysis of potential risk factors for segmentation failures were conducted. The core laboratory performed manual tortuosity measurements using standard multiplanar reconstructions. RESULTS: In total, 270 CTA scans from the ZEPHYR database fulfilled the inclusion criteria and were available for analysis. 21.1 % of scans demonstrated obvious segmentation errors upon initial review and were excluded from this analysis. Most common risk factors for segmentation failure were internal iliac artery occlusions and overlapping aneurysms in the distal infrarenal aorta and proximal common iliac arteries. In the remaining 213 scans, the median iliac tortuosity measured by the core laboratory was 1.34 (IQR 1.23-1.45) while PRAEVAorta 2 reported a median tortuosity of 1.25 (IQR 1.19-1.33). The analysis showed an excellent Pearson correlation of 0.95 (95 % CI: 0.94-0.96) with a moderate to good Intraclass Correlation (ICC) of 0.73 (95 % CI: 0.69-0.77) and a bias of -0.09 in Bland-Altman analysis. CONCLUSION: PRAEVAorta 2 successfully provided fully automated measurements of the iliac artery tortuosity in most cases, highlighting its potential as a valuable tool for both research and clinical applications. However, a critical review of automatically provided reports by an experienced observer remains essential.

Authors 28

1. Alexandru Barb corresponding

   Heidelberg University · University Hospital Heidelberg

   Affiliation as printed

   Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany. Electronic address: Alexandru.Barb@med.uni-heidelberg.de

2. Christian Uhl corresponding Aachen Department of Vascular Surgery

   RWTH Aachen University

   Affiliation as printed

   Department of Vascular Surgery, RWTH Aachen, Templergraben 55, 52062 Aachen, Germany. Electronic address: ChristianUhl@gmx.at

3. Louisa Bornhak corresponding

   Heidelberg University · University Hospital Heidelberg

   Affiliation as printed

   Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany. Electronic address: Louisa.Bornhak@med.uni-heidelberg.de

4. Edris El‐Sanosy corresponding

   Heidelberg University · University Hospital Heidelberg

   Affiliation as printed

   Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany. Electronic address: Edris.el-sanosy@gmx.de

5. Matthias Fink corresponding

   Heidelberg University · University Hospital Heidelberg

   Affiliation as printed

   Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany. Electronic address: Matthias.fink@uni-heidelberg.de

6. Dittmar Böckler corresponding

   Heidelberg University · University Hospital Heidelberg

   Affiliation as printed

   Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany. Electronic address: Dittmar.Boeckler@med.uni-heidelberg.de

7. Johannes Hatzl corresponding

   Heidelberg University · University Hospital Heidelberg

   Affiliation as printed

   Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany. Electronic address: Johannes.hatzl@med.uni-heidelberg.de

8. Kak Khee Yeung

   Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences

   Affiliation as printed

   Department of Vascular Surgery, Amsterdam UMC, Location VU Medical Center, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands (the)

9. Bram Fioole

   Maasstad Ziekenhuis

   Affiliation as printed

   Department of Vascular Surgery, Maasstad Hospital, Rotterdam, Netherlands (the)

10. Eric L.G. Verhoeven

    Paracelsus Medizinische Privatuniversität

    Affiliation as printed

    Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany

11. Geert Lauwers

    Ziekenhuis Oost-Limburg

    Affiliation as printed

    Department of Vascular and Thoracic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium

12. Tilo Kölbel

    University Medical Center Hamburg-Eppendorf

    Affiliation as printed

    German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany

13. Jan Jacob Wever

    Haga Hospital

    Affiliation as printed

    Departments of Vascular Surgery and Interventional Radiology, Haga Hospital, The Hague, Netherlands (the)

14. Dierk Scheinert

    University Hospital Leipzig

    Affiliation as printed

    Department of Angiology, University Hospital Leipzig, Leipzig, Germany

15. Wouter Van den Eynde

    Imelda Hospital

    Affiliation as printed

    Department of Vascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium

16. Barend M.E. Mees

    Maastricht University Medical Centre

    Affiliation as printed

    Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, Netherlands (the)

17. Frank E. G. Vermassen

    Ghent University Hospital

    Affiliation as printed

    Department of Vascular Surgery, Ghent University Hospital, Ghent, Belgium

18. Hubert Schelzig

    Düsseldorf University Hospital · Heinrich Heine University Düsseldorf

    Affiliation as printed

    Department of Vascular and Endovascular Surgery, Heinrich-Heine-University Medical Center Düsseldorf, Düsseldorf, Germany

19. Philippe W.M. Cuypers

    Catharina Ziekenhuis

    Affiliation as printed

    Department of Vascular Surgery, Catharina Hospital, Eindhoven, Netherlands (the)

20. Αthanasios Katsargyris

    Amsterdam University Medical Centers · Amsterdam Cardiovascular Sciences

    Affiliation as printed

    Department of Vascular Surgery, Amsterdam UMC, Location VU Medical Center, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands (the)

21. Fiona Rohlffs

    Maasstad Ziekenhuis

    Affiliation as printed

    Department of Vascular Surgery, Maasstad Hospital, Rotterdam, Netherlands (the)

22. Giuseppe Panuccio

    Maasstad Ziekenhuis

    Affiliation as printed

    Department of Vascular Surgery, Maasstad Hospital, Rotterdam, Netherlands (the)

23. Hans van Overhagen

    Paracelsus Medizinische Privatuniversität

    Affiliation as printed

    Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany

24. Randolph G. Statius van Eps

    Paracelsus Medizinische Privatuniversität

    Affiliation as printed

    Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany

25. Hugo T.C. Veger

    Paracelsus Medizinische Privatuniversität

    Affiliation as printed

    Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany

26. Lukas Carolus van Dijk

    Paracelsus Medizinische Privatuniversität

    Affiliation as printed

    Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany

27. Jürgen Verbist

    University Medical Center Hamburg-Eppendorf

    Affiliation as printed

    German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany

28. Geert Willem H. Schurink

    Klinikum Frankfurt Höchst

    Affiliation as printed

    Section of Vascular and Endovascular Surgery, Klinikum Frankfurt Höchst, Frankfurt, Germany