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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Fink HA, Lederle FA, Roth CS, Bowles CA, Nelson DB, Haas MA. The accuracy of physical examination to detect abdominal aortic aneurysm. Arch Intern Med 2000;160:833-6. Observational-Dx 200 patients The provide more detailed information on the accuracy of abdominal palpation for AAA. The overall accuracy of abdominal palpation for detecting AAA was as follows: sensitivity, 68% (95% confidence interval [CI], 60%-76%); specificity, 75% (95% CI, 68%-82%); positive likelihood ratio, 2.7 (95% CI, 2.0-3.6); negative likelihood ratio 0.43 (95% CI, 0.33-0.56). Interobserver pair agreement for AAA vs no AAA between the first and second examinations was 77% (? = 0.53). Sensitivity increased with AAA diameter, from 61% for AAAs of 3.0 to 3.9 cm, to 69% for AAAs of 4.0 to 4.9 cm, 72% for AAAs of 4.0 cm or larger, and 82% for AAAs of 5.0 cm or larger. Sensitivity in subjects with an abdominal girth less than 100 cm (40-in waistline) was 91% vs 53% for girth of 100 cm or greater (P<.001). When girth was 100 cm or greater and the aorta was palpable, sensitivity was 82%. When girth was less than 100 cm and the AAA was 5.0 cm or larger, sensitivity was 100% (12 examinations). Factors independently associated with correct examination findings included AAA diameter (odds ratio [OR], 1.95 per centimeter increase; 95% CI, 1.06-3.58); abdominal girth (OR, 0.90 per centimeter increase; 95% CI, 0.87-0.94); and the examiner's assessment that the abdomen was not tight (OR, 2.68; 95% CI, 1.17-6.13) 2
2. Lederle FA, Simel DL. The rational clinical examination. Does this patient have abdominal aortic aneurysm? JAMA 1999;281:77-82. Review/Other-Dx 15 studies To provide a review of physical examination as value added to detect abnormal widening of the aortic pulsation. When results from these studies are pooled, the sensitivity of abdominal palpation increases significantly with AAA diameter (P<.001), ranging from 29% for AAAs of 3.0 to 3.9 cm to 50% for AAAs of 4.0 to 4.9 cm and 76% for AAAs of 5.0 cm or greater. Positive and negative likelihood ratios with 95% confidence intervals (CIs) using a cutoff point for AAAs of 3.0 cm or greater are 12.0 (95% CI, 7.4-19.5) and 0.72 (95% CI, 0.65-0.81), respectively, and for AAAs of 4.0 cm or greater are 15.6 (95% CI, 8.6-28.5) and 0.51 (95% CI, 0.38-0.67). The positive predictive value of palpation for AAA of 3.0 cm or greater in these studies was 43%. 4
3. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. [Review] [1308 refs]. Circulation. 113(11):e463-654, 2006 Mar 21. Review/Other-Dx N/A Practice Guidelines for the management of patients with peripheral arterial disease -lower extremity, renal, mesenteric, and abdominal aortic. No results stated in abstract. 4
4. Claridge R, Arnold S, Morrison N, van Rij AM. Measuring abdominal aortic diameters in routine abdominal computed tomography scans and implications for abdominal aortic aneurysm screening. J Vasc Surg. 65(6):1637-1642, 2017 06. Review/Other-Dx 3246 computed tomography (CT) scans To determine the prevalence and relevance of incidental abdominal aortic aneurysm (AAA) on routine abdominal computed tomography (CT) and to audit the performance of radiologists to identify and report AAA. A total of 3332 scans were performed, of which 86 scans were excluded, resulting in a total cohort of 3246. There were 187 incidental AAAs detected with a prevalence of 5.8%. The prevalence was 8.7% in men and 3.1% in women. Whereas the prevalence increased with age, a significant number were detected in those younger than 65 years, with a prevalence of 1.5%. Of the 187 AAAs, 122 (65%) were reported by radiologists: 100% reporting rate in AAAs =50 mm, 87% in AAAs =40 to 49 mm, and 52% in AAAs =30 to 39 mm. Of these, 15% were specifically recommended for referral to a vascular service. Of the incidentally detected AAAs, 72% were considered to be clinically relevant, which is an overall 4.1% prevalence of AAAs with an ability to benefit. In addition, all 3246 subjects avoided the need for further AAA screening. 4
5. van Walraven C, Wong J, Morant K, Jennings A, Jetty P, Forster AJ. Incidence, follow-up, and outcomes of incidental abdominal aortic aneurysms. J Vasc Surg. 52(2):282-9.e1-2, 2010 Aug. Observational-Dx 79,121 abdominal CT, US, and MRI studies To determine how incidental AAA monitoring influenced patient outcomes. In 79,121 abdominal images, we identified 812 incidental AAAs (1.0% of all studies) or 364 incidental AAAs annually (95% confidence interval [CI], 349-379). Patients were elderly (mean age, 74 years), and AAAs were a mean diameter of 4.0 cm. For 174 inpatients, AAAs were noted in only 51 patients (29%) and only 25 (15%) were communicated to the family physician. Of 329 patients who were observed beyond their first recommended follow-up scan, only 51 (16%) were monitored appropriately throughout their entire follow-up; the median proportion of follow-up time with recommended monitoring was 56% (interquartile range, 32%-82%). Elective AAA repair was done in 98 patients (13%), the probability of which was significantly increased when AAA monitoring frequency was compliant with that recommended in practice guidelines. Six patients (0.8%) were admitted with aortic rupture, the probability of which was independent of AAA monitoring. 3
6. Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg. 1991; 13(3):452-458. Review/Other-Dx N/A To define and classify arterial aneurysms and recommend standards for describing the causes, manifestations, treatment, and outcome criteria that are important when publishing data on aneurysmal disease. N/A 4
7. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. Journal of Vascular Surgery. 67(1):2-77.e2, 2018 01. Review/Other-Dx N/A To provide practice guidelines on the care of patients with an abdominal aortic aneurysm using the Grading of Recommendations Assessment, Development, and Evaluation system. Along with providing guidance regarding the management of patients throughout the continuum of care, we have revised a number of prior recommendations and addressed a number of new areas of significance. New guidelines are provided for the surveillance of patients with an AAA, including recommended surveillance imaging at 12-month intervals for patients with an AAA of 4.0 to 4.9 cm in diameter. We recommend endovascular repair as the preferred method of treatment for ruptured aneurysms. Incorporating knowledge gained through the Vascular Quality Initiative and other regional quality collaboratives, we suggest that the Vascular Quality Initiative mortality risk score be used for mutual decision-making with patients considering aneurysm repair. We also suggest that elective EVAR be limited to hospitals with a documented mortality and conversion rate to open surgical repair of 2% or less and that perform at least 10 EVAR cases each year. We also suggest that elective open aneurysm repair be limited to hospitals with a documented mortality of 5% or less and that perform at least 10 open aortic operations of any type each year. To encourage the development of effective systems of care that would lead to improved outcomes for those patients undergoing emergent repair, we suggest a door-to-intervention time of <90 minutes, based on a framework of 30-30-30 minutes, for the management of the patient with a ruptured aneurysm. We recommend treatment of type I and III endoleaks as well as of type II endoleaks with aneurysm expansion but recommend continued surveillance of type II endoleaks not associated with aneurysm expansion. Whereas antibiotic prophylaxis is recommended for patients with an aortic prosthesis before any dental procedure involving the manipulation of the gingival or periapical region of teeth or perforation of the oral mucosa, antibiotic prophylaxis is not recommended before respiratory tract procedures, gastrointestinal or genitourinary procedures, and dermatologic or musculoskeletal procedures unless the potential for infection exists or the patient is immunocompromised. Increased utilization of color duplex ultrasound is suggested for postoperative surveillance after EVAR in the absence of endoleak or aneurysm expansion. 4
8. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 35(41):2873-926, 2014 Nov 01. Review/Other-Tx N/A Guidance document on the diagnosis, methods for imaging, and treatment of aortic diseases. No results in abstract. 4
9. Sakalihasan N, Michel JB, Katsargyris A, et al. Abdominal aortic aneurysms. [Review]. Nat Rev Dis Prim. 4(1):34, 2018 10 18. Review/Other-Dx N/A To give a contemporary overview of the pathogenesis, diagnosis, treatment and outcome of patients with AAA, but will only briefly touch upon aneurysms in other arteries, such as thoracic aneurysms. No results in abstract 4
10. Wanhainen A, Verzini F, Van Herzeele I, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2019;57:8-93. Review/Other-Dx N/A To assist physicians in selecting the best management strategy for the care of patients with aneurysms of the abdominal aorta and iliac artery. No abstract available 4
11. Lo RC, Schermerhorn ML. Abdominal aortic aneurysms in women. [Review]. J Vasc Surg. 63(3):839-44, 2016 Mar. Review/Other-Tx N/A To summarize what is currently known about the effect of gender on AAA presentation, treatment, and outcomes, and review current controversies over screening recommendations and threshold for repair in women. No results stated in abstract. 4
12. Collard M, Sutphin PD, Kalva SP, et al. ACR Appropriateness Criteria® Abdominal Aortic Aneurysm Follow-up (Without Repair). J Am Coll Radiol 2019;16:S2-S6. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for abdominal aortic aneurysm follow-up (without repair). No results stated in abstract. 4
13. Francois CJ, Skulborstad EP, Majdalany BS, et al. ACR Appropriateness Criteria® Abdominal Aortic Aneurysm: Interventional Planning and Follow-Up. J Am Coll Radiol 2018;15:S2-S12. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for abdominal Aortic aneurysm: interventional planning and follow-up. No results stated in abstract. 4
14. Long A, Rouet L, Lindholt JS, Allaire E. Measuring the maximum diameter of native abdominal aortic aneurysms: review and critical analysis. [Review]. Eur J Vasc Endovasc Surg. 43(5):515-24, 2012 May. Review/Other-Dx 23 studies from 29 articles To review the different methods used to measure AAA maximum diameter, with ultrasound (US) or computed tomography (CT). Review showed a wide range of definitions and practices. The mean value of the quality score was 2.52 in screening studies, 1.66 in guidelines for screening, 2.81 in follow-up studies and 1.63 in studies describing decision for intervention. 4
15. Lederle FA, Wilson SE, Johnson GR, et al. Variability in measurement of abdominal aortic aneurysms. Abdominal Aortic Aneurysm Detection and Management Veterans Administration Cooperative Study Group. J Vasc Surg 1995;21:945-52. Observational-Dx 806 measurements To report interobserver and intraobserver variability of computed tomography (CT) measurements of abdominal aortic aneurysm (AAA) diameter and agreement between CT and ultrasonography observed in the course of a large, multicenter, randomized trial on the management of small AAAs. For interobserver pairs of local and central CT measurements of AAA diameter (n = 806), the difference was 0.2 cm or less in 65% of pairs, but 17% differed by at least 0.5 cm. For intraobserver pairs of central CT remeasurements (n = 70), 90% differed by 0.2 cm or less, 70% were within 0.1 cm, and only one differed by 0.5 cm. Of 258 ultrasound-measured and central CT pairs, the difference was 0.2 cm or less in 44% and at least 0.5 cm in 33%. Ultrasound measurements were smaller than central CT measurements by an average of 0.27 cm (p < 0.0001). Local CT and ultrasound measurements showed a marked preference for recording by half centimeter. 2
16. Fadel BM, Mohty D, Kazzi BE, et al. Ultrasound imaging of the abdominal aorta: A comprehensive review. J Am Soc Echocardiogr 2021;34:1119-36. Review/Other-Dx N/A To demonstrate the usefulness of ultrasound imaging for the detection and evaluation of disorders that involve the AA, detail the abnormalities that are detected or further assessed, and outline its value for echocardiographers, sonographers, and radiologists. No results in abstract 4
17. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010;121:e266-369. Review/Other-Dx N/A To assist healthcare providers in clinical decision making by describing a range of generally acceptable approaches for diagnosis, management, and prevention of specific diseases or conditions. This guideline includes diseases involving any or all parts of the thoracic aorta with the exception of aortic valve diseases5 and includes the abdominal aorta when contiguous thoracic aortic diseases are present. No abstract available. 4
18. Ihara T, Komori K, Yamamoto K, Kobayashi M, Banno H, Kodama A. Three-dimensional workstation is useful for measuring the correct size of abdominal aortic aneurysm diameters. Ann Vasc Surg. 27(2):154-61, 2013 Feb. Review/Other-Dx 141 patients To measure maximum major-axis diameters using a three-dimensional (3D) workstation and compare them with the traditional maximum minor-axis diameters measured using thin-slice axial CT. The mean traditional maximum minor-axis diameter was 51.2 +/- 8.2 mm, whereas the mean maximum major-axis diameter on CPR was 54.7 +/- 10.1 mm. Sixty eight patients had a mean aneurysm size of <50 mm when measured by the traditional minor-axis diameter. Among these patients, five (7.4%) had a major-axis diameter >55 mm on CPR. 4
19. Dugas A, Therasse E, Kauffmann C, et al. Reproducibility of abdominal aortic aneurysm diameter measurement and growth evaluation on axial and multiplanar computed tomography reformations. Cardiovasc Intervent Radiol. 35(4):779-87, 2012 Aug. Observational-Dx 40 patients with AAA examined by MDCT To compare different methods measuring abdominal aortic aneurysm (AAA) maximal diameter (Dmax) and its progression on multidetector computed tomography (MDCT) scan. Dmax, as measured on axial slices at baseline and follow-up (FU) MDCTs, was greater than that measured using the orthogonal method (p = 0.046 for baseline and 0.028 for FU), whereas Dmax measured with the orthogonal method was greater those using all other measurement methods (p-value range: <0.0001–0.03) but anteroposterior diameter (p = 0.18 baseline and 0.10 FU). The greatest interobserver ICCs were obtained for the orthogonal and transverse methods (0.972) at baseline and for the orthogonal and sagittal MPR images at FU (0.973 and 0.977). Interobserver ICC of the orthogonal method to document AAA progression was greater (ICC = 0.833) than measurements taken on axial images (ICC = 0.662–0.780) and single-plane MPR images (0.772–0.817). 3
20. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
21. Ruff A, Patel K, Joyce JR, Gornik HL, Rothberg MB. The use of pre-existing CT imaging in screening for abdominal aortic aneurysms. Vasc Med. 21(6):515-519, 2016 12. Observational-Dx 142 patients To evaluate the sensitivity of CT imaging of the abdomen for the detection of AAA when performed for other clinical indications. Of 142 patients with both a CT scan and an AAA on ultrasound, 127 (89.4%) were noted to have an AAA in the report of a CT scan performed within the 3 years prior to the ultrasound. An additional 10 films demonstrated an AAA that was not mentioned in the report. The sensitivity of pre-existing CT scans for AAA screening was 97.2% (137/141) [95% CI: 93.4-99.0%]; 123 (86.6%) of these positive findings were reported in the findings narrative and 120 (84.5%) were reported in the radiologist's final impression. 3
22. Al-Thani H, El-Menyar A, Shabana A, Tabeb A, Al-Sulaiti M, Almalki A. Incidental abdominal aneurysms: a retrospective study of 13,115 patients who underwent a computed tomography scan. Angiology. 65(5):388-95, 2014 May. Review/Other-Dx 13,115 patients To evaluate the frequency and outcomes of abdominal aortic aneurysm (AAA) in Qatar. Of the 13,115 patients screened, 61 (0.5%) patients had abdominal aneurysms. Most (82%) patients with AAA were male with mean age of 67 ± 12 years. The incidence of AAA substantially increased with age. Cardiovascular risk factors were prevalent among patients with AAA. The main location of AAA was infrarenal (67%), followed by thoracoabdominal (23%). The mean AAA diameter was 5.3 ± 2.5 cm. The rate of AAA rupture was 8% with a mortality rate of 60%; 80% of these were infrarenal, and 80% of them had a diameter of =5.5 cm. Overall mortality was 33%. 4
23. Khashram M, Jones GT, Roake JA. Prevalence of abdominal aortic aneurysm (AAA) in a population undergoing computed tomography colonography in Canterbury, New Zealand. Eur J Vasc Endovasc Surg. 50(2):199-205, 2015 Aug. Review/Other-Dx 4,644 patients To determine the prevalence of abdominal aortic aneurysm (AAA) in a population undergoing a computed tomography colonography (CTC) for gastrointestinal symptoms. Included were 4,893 scans on 4,644 patients (1,933 men [41.6%], 2,711 women [58.4%]) with a median age of 69.3 years (range 17.0-97.0 years). There were 309 scans on 289 patients (75.4% men) who had either an aneurysm or a previous aortic graft with a median age of 79.6 years (range 57.0-96.0 years). Of these, 223 had a native AAA >/=30 mm. The prevalence of AAA rose with age from 1.3% in men aged 55-64 years, to 9.1% in 65-74 year olds, 16.8% in 75-84 year olds, and 22.0% in >/=85 year olds. The corresponding figures in women were 0.4%, 2%, 3.9%, and 6.2%, respectively. 4
24. Liisberg M, Diederichsen AC, Lindholt JS. Abdominal ultrasound-scanning versus non-contrast computed tomography as screening method for abdominal aortic aneurysm - a validation study from the randomized DANCAVAS study. BMC med. imaging. 17(1):14, 2017 02 14. Experimental-Dx 533 patients To validate non-contrast-enhanced computed tomography (nCT) compared to ultrasound sonography (US) as a screening method for abdominal aortic aneurysm (AAA) screening. Due to logistics, 533 underwent both nCT and US. In four patients, aortae could not be visualized with US, and two of these had an AAA (>30 mm) as diagnosed by nCT. Using nCT 30 (5.7%, 95% CI: 4.2;7.5%) AAA were found. US failed to detect 9 of these, but diagnosed 3 other cases, resulting prevalence by US was 4.5% (95% CI: 3.0;6.6%). Additionally, 5 isolated iliac aneurysms (=20 mm) (0.9%, 95% CI: 0.3;2.2%) were discovered by nCT. US performed reasonably, with sensitivity ranging from 57.1–70.4%, specificity however, ranged higher 99.2–99.6%. Comparably nCT performed with sensitivity ranging from 82.6–88.9%, nCTs specificity however ranged from 97.7–98. 4%. Analysis showed good correlations with no tendency to increasing variance with increasing diameter, and no significant differences between nCT and US with means varying slightly in both axis. 2
25. Goldstein SA, Evangelista A, Abbara S, et al. Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging: endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. [Review]. J Am Soc Echocardiogr. 28(2):119-82, 2015 Feb. Review/Other-Dx N/A To summarize the fundamental role of the major noninvasive imaging techniques and the clinical acumen and suspicion, knowledge of imaging modalities for the assessment and management of the often life threatening diseases of the aorta. No results in abstract 4
26. Hallett RL, Ullery BW, Fleischmann D. Abdominal aortic aneurysms: pre- and post-procedural imaging. [Review]. Abdominal Radiology. 43(5):1044-1066, 2018 05. Review/Other-Dx N/A To discuss the current role of imaging in the assessment of AAA patients prior to intervention, in evaluation of procedural complications, and in long-term follow-up of EVAR patients. No results provided 4
27. Rengier F, Geisbusch P, Vosshenrich R, et al. State-of-the-art aortic imaging: part I - fundamentals and perspectives of CT and MRI. Vasa 2013;42:395-412. Review/Other-Dx N/A To describe the imaging principles of CT and MRI with regard to aortic disease, show how both technologies can be applied in every day clinical practice, offer exciting perspectives. No results stated in abstract. 4
28. Evangelista A.. Imaging aortic aneurysmal disease. [Review]. Heart. 100(12):909-15, 2014 Jun. Review/Other-Dx N.A. To review imaging aortic aneurysmal disease. No results stated in abstract. 4
29. Agrawal MD, Oliveira GR, Kalva SP, Pinho DF, Arellano RS, Sahani DV. Prospective Comparison of Reduced-Iodine-Dose Virtual Monochromatic Imaging Dataset From Dual-Energy CT Angiography With Standard-Iodine-Dose Single-Energy CT Angiography for Abdominal Aortic Aneurysm. AJR Am J Roentgenol. 207(6):W125-W132, 2016 Dec. Experimental-Dx 66 consecutively registered patients with abdominal aortic aneurysm To compare the image quality of reduced-iodine-dose single-source dual-energy CT angiography (CTA) with that of standard-iodine-dose single-energy CTA in examinations of patients with abdominal aortic aneurysm and to assess the effect of the concentration of iodinated contrast medium on intravascular enhancement and image quality of reduced-iodine-dose CTA. All 66 dual-energy CTA examinations were rated diagnostic with mean image quality and image noise scores of 4.8 and 4.5 for reader 1 and 3.8 and 3.4 for reader 2 compared with single-energy CTA results of 4.5 and 4.2 for reader 1 and 4.5 and 4.1 for reader 2. Low-energy virtual monochromatic images (40-60 keV) from reduced-iodine-dose (28%) dual-energy CTA had significantly higher intravascular aortic attenuation (26-185%) and contrast-to-noise ratio (CNR) (20-25%) than standard-iodine-dose single-energy CTA images (p < 0.0001). No significant difference was found between patients who received 270 and those who received 320 mg I/mL with respect to intravascular aortic attenuation (p = 0.6331) or CNR (p = 0.9775). 2
30. Patino M, Parakh A, Lo GC, et al. Virtual Monochromatic Dual-Energy Aortoiliac CT Angiography With Reduced Iodine Dose: A Prospective Randomized Study. AJR Am J Roentgenol. 212(2):467-474, 2019 02. Experimental-Dx 52 patients with abdominal aortoiliac aneurysm; 16.2 g (270 mg I/mL) Group = 26 and 16.0 g (320 mg I/mL) Group = 26 To assess the feasibility of performing abdominopelvic aortoiliac CT angiography (CTA) with 16.0 g of iodine contrast medium acquired with low-energy (40 and 50 keV) virtual monochromatic (VMC) images with rapid-kilovoltage-switching dual-energy CT. All DECTA examinations (n = 52) were rated diagnostic with image quality scores comparable to those of 120-kVp single-energy CTA (40 keV, 4.2-4.4; 50 keV, 4.6-4.8; SECTA, 4.4-4.5). Intravascular attenuation was uniform in all reduced-iodine DECTA examinations and was significantly higher on 40- and 50-keV images than on standard-iodine-dose SECTA images (720 ± 125 HU and 482 ± 82 HU vs 303 ± 65 HU) (p < 0.01). There was no difference in intravascular attenuation between the 16.2-g and the 16.0-g doses (p = 0.82). Sensitivity and specificity for endoleak detection were 78.9-94.7% and 100%. Total dose-length product was lower for DECTA (788 ± 166 mGy · cm) than for SECTA (1114 ± 468 mGy · cm). 1
31. Truijers M, Kurvers HA, Bredie SJ, Oyen WJ, Blankensteijn JD. In vivo imaging of abdominal aortic aneurysms: increased FDG uptake suggests inflammation in the aneurysm wall. J Endovasc Ther. 2008; 15(4):462-467. Observational-Dx 34 patients; 17 with AAA; 17 controls To study the potential of integrated PET/CT to identify aneurysm wall inflammation. AAAs showed significantly higher FDG uptake than the normal-sized aorta in age-matched controls (SUV 2.52+/-0.52 vs 1.78+/-0.45, respectively; P<0.001). The level of FDG uptake did not correlate with maximal aneurysm diameter (r=0.09; 95% CI -0.42 to 0.56; P=0.7). FDG-PET/CT is a promising technique to identify inflammation of the aneurysm wall. Irrespective of aneurysm diameter, asymptomatic AAAs show more FDG uptake and more inflammatory activity in the wall than the non-dilated abdominal aorta of sex/age-matched controls. 4
32. Murakami M, Morikage N, Samura M, Yamashita O, Suehiro K, Hamano K. Fluorine-18-fluorodeoxyglucose positron emission tomography-computed tomography for diagnosis of infected aortic aneurysms. Ann Vasc Surg. 28(3):575-8, 2014 Apr. Review/Other-Dx 11 cases To examine the usefulness of FDG-PET/CT in the diagnosis of infected aneurysms in suspected cases (based on clinical symptoms, CT findings, and presence of inflammatory markers in the blood such as white blood cells and C-reactive protein) of infected aortic aneurysms. Patients with a final diagnosis of infected aortic aneurysms showed a maximum standard uptake value (SUVmax) of >4.46, whereas infection-free cases had an SUVmax of <2.59 (mean 6.5 +/- 1.8 vs. 1.9 +/- 0.5; P < 0.001). 4
33. Jalalzadeh H, Indrakusuma R, Planken RN, Legemate DA, Koelemay MJ, Balm R. Inflammation as a Predictor of Abdominal Aortic Aneurysm Growth and Rupture: A Systematic Review of Imaging Biomarkers. [Review]. Eur J Vasc Endovasc Surg. 52(3):333-42, 2016 Sep. Review/Other-Dx 7 studies; 202 AAA patients To determine which inflammatory imaging biomarkers are associated with AAA growth and rupture. Seven studies were included, comprising 202 AAA patients. 18F-fluoro-deoxy-glucose positron emission tomography (18F-FDG PET-CT) was evaluated in six studies. Magnetic resonance imaging with ultrasmall superparamagnetic particles of iron oxide (USPIO-MRI) was evaluated in one study. Two of six 18F-FDG PET-CT studies reported a significant negative correlation (r=.383, p = .015) or a significant negative association (p = .04). Four of six 18F-FDG PET-CT studies reported no significant association between 18F-FDG uptake and AAA growth. The single study investigating USPIO-MRI demonstrated that AAA growth was three times higher in patients with focal USPIO uptake in the AAA wall compared to patients with diffuse or no USPIO uptake in the wall (0.66 vs. 0.24 vs. 0.22 cm/y, p = .020). In the single study relating 18F-FDG uptake results to AAA rupture, the association was not significant. 4
34. Hartung MP, Grist TM, Francois CJ. Magnetic resonance angiography: current status and future directions. J Cardiovasc Magn Reson 2011;13:19. Review/Other-Dx N/A To discuss the current state of both contrast-enhanced and non-contrast enhanced MRA. No results provided 4
35. Hope MD, Hope TA, Zhu C, et al. Vascular Imaging With Ferumoxytol as a Contrast Agent. AJR 2015;205:W366-73. Review/Other-Dx 102 patients underwent MRA with ferumoxytol To summarize more than 3 years of clinical experience with ferumoxytol-enhanced MRA for a range of indications and anatomic regions. No results in abstract 4
36. Nguyen KL, Yoshida T, Kathuria-Prakash N, et al. Multicenter Safety and Practice for Off-Label Diagnostic Use of Ferumoxytol in MRI. Radiology 2019;293:554-64. Observational-Dx 3215 patients (4240 ferumoxytol injections) To report multicenter safety data for off-label diagnostic ferumoxytol use. Between January 2003 and October 2018, 3215 patients (median age, 58 years; range, 1 day to 96 years; 1897 male patients) received 4240 ferumoxytol injections for MRI. Ferumoxytol dose ranged from 1 to 11 mg per kilogram of body weight (=510 mg iron; rate =45 mg iron/sec). There were no systematic changes in vital signs after ferumoxytol administration (P > .05). No severe, life-threatening, or fatal AEs occurred. Eighty-three (1.9%) of 4240 AEs were related or possibly related to ferumoxytol infusions (75 mild [1.8%], eight moderate [0.2%]). Thirty-one AEs were classified as allergiclike reactions using ACR criteria but were consistent with minor infusion reactions observed with parenteral iron. 4
37. van Hout MJ, Scholte AJ, Juffermans JF, et al. How to Measure the Aorta Using MRI: A Practical Guide. J Magn Reson Imaging 2020;52:971-77. Review/Other-Dx N/A To provide recommendations for clinicians on aortic measurements in the adult population using MRI, with an emphasis on the thoracic aorta. No abstract available. 4
38. Elefteriades JA, Mukherjee SK, Mojibian H. Discrepancies in Measurement of the Thoracic Aorta: JACC Review Topic of the Week. J Am Coll Cardiol 2020;76:201-17. Review/Other-Dx N/A To explore discrepant measurements of the ascending aorta encountered by clinicians within a single modality or between modalities that impede, complicate, and impair appropriate clinical assessment-including key issues of presence or absence of aortic growth, rate of growth, and need for surgical intervention. No results provided 4
39. Schulz-Menger J, Bluemke DA, Bremerich J, et al. Standardized image interpretation and post-processing in cardiovascular magnetic resonance - 2020 update : Society for Cardiovascular Magnetic Resonance (SCMR): Board of Trustees Task Force on Standardized Post-Processing. J Cardiovasc Magn Reson 2020;22:19. Review/Other-Dx N/A To recommend requirements and standards for image interpretation and post-processing enabling qualitative and quantitative evaluation of CMR images. No results provided 4
40. Zhu C, Tian B, Leach JR, et al. Non-contrast 3D black blood MRI for abdominal aortic aneurysm surveillance: comparison with CT angiography. European Radiology. 27(5):1787-1794, 2017 May.Eur Radiol. 27(5):1787-1794, 2017 May. Observational-Dx 28 patients with AAAs To 1) validate non-contrast MRI for measuring AAA diameter, and 2) to assess ILT with CTA and MRI. Strong agreement between CTA and non-contrast MRI was shown for AAA diameter (intra-class coefficient > 0.99). Both approaches had excellent inter-observer reproducibility (ICC > 0.99). ILT appeared homogenous on CTA, whereas MRI revealed compositional variations. Patients with AAAs =5.5 cm and <5.5 cm had a variety of distributions of old/fresh ILT types. 1
41. Rubano E, Mehta N, Caputo W, Paladino L, Sinert R. Systematic review: emergency department bedside ultrasonography for diagnosing suspected abdominal aortic aneurysm. Acad Emerg Med 2013;20:128-38. Review/Other-Dx 7 studies To provide a systematic review of the literature for the operating characteristics of emergency department (ED) ultrasonography for AAA. The initial search strategy identified 1,238 articles; application of inclusion/exclusion criteria resulted in seven studies with 655 patients. The weighted average prevalence of AAA in symptomatic patients over the age of 50 years is 23%. On history, 50% of AAA patients will lack the classic triad of hypotension, back pain, and pulsatile abdominal mass. The sensitivity of abdominal palpation for AAA increases as the diameter of the AAA increases. The pooled operating characteristics of ED US for the detection of AAA were sensitivity 99% (95% confidence interval [CI] = 96% to 100%) and specificity 98% (95% CI = 97% to 99%). 4
42. Guirguis-Blake JM, Beil TL, Senger CA, Whitlock EP. Ultrasonography screening for abdominal aortic aneurysms: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2014;160:321-9. Review/Other-Dx N/A To systematically review evidence about the benefits and harms of ultrasonography screening for AAAs in asymptomatic primary care patients. Reviews of 4 RCTs involving 137,214 participants demonstrated that 1-time invitation for AAA screening in men aged 65 years or older reduced AAA rupture and AAA-related mortality rates for up to 10 and 15 years, respectively, but had no statistically significant effect on all-cause mortality rates up to 15 years. Screening was associated with more overall and elective surgeries but fewer emergency operations and lower 30-day operative mortality rates at up to 10- to 15-year follow-up. One RCT involving 9342 women showed that screening had no benefit on AAA-related or all-cause mortality rates. 4
43. Owens DK, Davidson KW, Krist AH, et al. Screening for Abdominal Aortic Aneurysm: US Preventive Services Task Force Recommendation Statement. JAMA. 322(22):2211-2218, 2019 12 10. Review/Other-Dx N/A To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the effectiveness of 1-time and repeated screening for AAA, the associated harms of screening, and the benefits and harms of available treatments for small AAAs (3.0-5.4 cm in diameter) identified through screening. No results stated in abstract. 4
44. NICE Guideline Updates Team. Imaging techniques to diagnose abdominal aortic aneurysms: Abdominal aortic aneurysm: diagnosis and management: Evidence review B. London: National Institute for Health and Care Excellence (UK); 2020. Review/Other-Tx N/A To determine: • which imaging technique is most accurate in providing a definitive diagnosis of unruptured or ruptured abdominal aortic aneurysms (AAA) • which imaging technique is most accurate in determining the size of unruptured AAA • which imaging techniques are most acceptable to patients and clinicians, taking into account the safety profiles of the approaches No abstract available 4
45. Blaivas M, Theodoro D. Frequency of incomplete abdominal aorta visualization by emergency department bedside ultrasound. Acad Emerg Med 2004;11:103-5. Observational-Dx 207 patients To determine how often emergency physicians (EPs) scanning the abdominal aorta (AA) of nonfasted emergency department (ED) patients are able to visualize the entire AA. Ultrasounds of 207 patients were completed. In 35 patients (17%), a portion of the AA less than one third its length was not seen. In 17 patients (8%), a significant portion of the AA (at least one third its length) could not be visualized and therefore could have potentially concealed an AAA. In four patients, the AA could not be seen at all. There were 29 AAAs discovered (14%), and none were missed. 4
46. Matthews EO, Pinchbeck J, Elmore K, Jones RE, Moxon JV, Golledge J. The reproducibility of measuring maximum abdominal aortic aneurysm diameter from ultrasound images. Ultrasound J 2021;13:13. Observational-Dx 50 AAA patients assessed by US To investigate the reproducibility of different methods of measuring AAA diameter from ultrasound images. Intra-observer reproducibility coefficients (AP LETLE 2.2 mm; AP ITI 2.4 mm; AP OTO 2.6 mm) were smaller than inter-observer reproducibility coefficients (AP LETLE 4.6 mm: AP ITI 4.5; and AP OTO 4.8 mm). There was no statistically significant difference in intra-observer reproducibility of three types of measurements performed in the AP plane. Measurements obtained in the TV plane had statistically significant worse intra-observer reproducibility than those performed in the AP plane. 3
47. Borgbjerg J, Bogsted M, Lindholt JS, Behr-Rasmussen C, Horlyck A, Frokjaer JB. Superior Reproducibility of the Leading to Leading Edge and Inner to Inner Edge Methods in the Ultrasound Assessment of Maximum Abdominal Aortic Diameter. European Journal of Vascular & Endovascular Surgery. 55(2):206-213, 2018 Feb. Observational-Dx 18 radiologists To determine reproducibility of caliper placement in relation to the aortic wall with the three principal methods: leading to leading edge (LTL), inner to inner edge (ITI), and outer to outer edge (OTO).To assess the mean difference between the OTO, ITI, and LTL diameters and estimate the impact of using either of these methods on abdominal aortic aneurysm (AAA) prevalence in a screening program. to determine reproducibility of caliper placement in relation to the aortic wall with the three principal methods: leading to leading edge (LTL), inner to inner edge (ITI), and outer to outer edge (OTO). The secondary aim was to assess the mean difference between the OTO, ITI, and LTL diameters and estimate the impact of using either of these methods on abdominal aortic aneurysm (AAA) prevalence in a screening program. 3
48. Chiu KW, Ling L, Tripathi V, Ahmed M, Shrivastava V. Ultrasound measurement for abdominal aortic aneurysm screening: a direct comparison of the three leading methods. Eur J Vasc Endovasc Surg 2014;47:367-73. Observational-Dx 50 US images To evaluate the accuracy, reproducibility, and repeatability of three methods: inner-to-inner (ITI), leading-to-leading edge (LTL), and outer-to-outer (OTO).To determine whether aneurysm size or grade of operator had any effect on either intra- or inter-observer variability. All three methods have high repeatability and reproducibility when static images are used. The inter-observer reproducibility coefficients between assessors were 0.48 cm, 0.35 cm, and 0.34 cm for ITI, LTL and OTO, respectively. The intra-observer repeatability coefficients between assessors were 0.30 cm, 0.20 cm, and 0.19 cm for ITI, LTL and OTO, respectively. The mean difference between CT and OTO, LTL, and ITI was 1 mm, 3 mm, and 5 mm, respectively (all underestimations) (p < .0001). 1
49. Gurtelschmid M, Bjorck M, Wanhainen A. Comparison of three ultrasound methods of measuring the diameter of the abdominal aorta. Br J Surg. 101(6):633-6, 2014 May. Experimental-Dx 127 consecutive patients To determine the variability of the three methods, differences between them, and the consequences on prevalence estimates. The variability was 2.7 (95 per cent limits of agreements +/- 5.4) mm for the OTO, 2.3 (+/- 4.6) mm for the ITI and 2.0 (+/- 4.0) mm for the LELE method. The corresponding coefficients of variability were 6.4, 6.1 and 5.0 per cent. The difference was 4.1 mm between ITI and OTO (P < 0.001), 2.0 mm between ITI and LELE (P < 0.001), and 2.1 mm between LELE and OTO (P < 0.001). 2
50. Hartshorne TC, McCollum CN, Earnshaw JJ, Morris J, Nasim A. Ultrasound measurement of aortic diameter in a national screening programme. Eur J Vasc Endovasc Surg 2011;42:195-9. Observational-Dx 60 random images of aorta To investigate the reliability and reproducibility of inner to inner (ITI) versus outer to outer (OTO) ultrasound measurement of AAA diameter. The mean (range) diameter for all 60 aortas by ITI was 3.91 cm (1.39-6.80) and by OTO was 4.18 cm (1.63-7.09), a significant mean difference of 0.27 cm (95% CI: 0.23-0.32 cm). The reproducibility coefficients for differences between technicians were 0.30 cm (95% CI: 0.24-0.36) for ITI and 0.42 cm (95% CI: 0.35-0.49) for OTO indicating significantly better repeatability using ITI. Finally, 15 images were measured twice in random order by all screeners and sonographers. For AAAs > 5 cm, repeatability was significantly better with ITI than OTO (0.14 vs. 0.21; p = 0.016). 3
51. Beales L, Wolstenhulme S, Evans JA, West R, Scott DJ. Reproducibility of ultrasound measurement of the abdominal aorta. [Review]. Br J Surg. 98(11):1517-25, 2011 Nov. Review/Other-Dx N/A To examine potential observer bias and variability in ultrasound measurements. Variation in intraobserver repeatability and interobserver reproducibility was identified. Six studies reported intraobserver repeatability coefficients for AP aortic diameter measurements of 1.6-4.4 mm. These were below the 5-mm level regarded as acceptable by the UK and USA AAA screening programmes. Five studies had interobserver reproducibility below the level of 5 mm. Four studies, however, reported poor reproducibility (range from -2 to +5.2 to -10.5 to +10.4); these differences may have had a significant clinical impact on screening and surveillance. 4
52. Thapar A, Cheal D, Hopkins T, Ward S, Shalhoub J, Yusuf SW. Internal or external wall diameter for abdominal aortic aneurysm screening? Ann R Coll Surg Engl 2010;92:503-5. Observational-Dx 50 AAA patients To determine the clinical significance of the difference between these two measurements. The median difference between internal and external diameter was 6 mm (IQR 6-7) for scientist 1 and 7 mm (IQR 5-8) for scientist 2. This was statistically significant (P < 0.0002). External wall diameter displayed less interobserver variability (3 mm vs 6 mm). 3
53. AIUM practice guideline for the performance of diagnostic and screening ultrasound examinations of the abdominal aorta in adults. J Ultrasound Med 2011;30:121-6. Review/Other-Dx N/A Practice guideline for the performance of diagnostic and screening ultrasound examinations of the abdominal aorta in adults. No abstract available. 4
54. Foo FJ, Hammond CJ, Goldstone AR, et al. Agreement between computed tomography and ultrasound on abdominal aortic aneurysms and implications on clinical decisions. Eur J Vasc Endovasc Surg 2011;42:608-14. Observational-Dx 44 patients (Group I); 79 patients (Group II) To investigate the discrepancy between US and CT, implications on clinical decisions and question at which stage CT be used. Mean difference between imaging modalities was 0.21 cm (±0.39 cm, p < 0.001). Limits of agreement were -0.55 to 0.96 cm, exceeding clinical acceptability. Mean difference was higher and significant in group I (0.39 cm, p < 0.001) compared to group II (0.10 cm, p > 0.05). Seventy-percent of group I patients had CT scans revealing diameters of =5.5 cm. Inter-observer bias was not significant. 2
55. Manning BJ, Kristmundsson T, Sonesson B, Resch T. Abdominal aortic aneurysm diameter: a comparison of ultrasound measurements with those from standard and three-dimensional computed tomography reconstruction. J Vasc Surg. 2009; 50(2):263-268. Observational-Dx 109 patients To define the relationship between commonly used CT measurement techniques and those based on current reporting standards and to compare the values obtained with diameter measured using US. The mean of each series of readings on CT was significantly larger than the mean US-anteroposterior measurement (P<.001), and they also differed significantly from each other (P<.001). The CT-perpendicular to the centerline of flow diameter was larger than CT-anteroposterior and CT-perpendicular to the maximal ellipse by mean values of 3.0 +/- 6.6 and 5.9 +/- 6.0 mm, respectively. The CT-maximal ellipse diameter was larger than CT-perpendicular to the centerline of flow by a mean of 2.4 +/- 5 mm. The US-anteroposterior diameter was smaller than CT-anteroposterior diameter by 4.2 +/- 4.9 mm, CT-maximal ellipse by 9.6 +/- 8.0 mm, CT-perpendicular to the maximal ellipse by 1.3 +/- 5 mm, and smaller than CT-perpendicular to the centerline of flow by 7.3 +/- 7.0 mm. Aneurysm size did not significantly affect these differences. 78% of 120 pairs of intraobserver CT measurements and 65% of interobserver CT measurements differed by <2 mm. CT-based measurements of aneurysm size tend to be larger than the US-anteroposterior measurement. CT-perpendicular to the centerline of flow diameters are consistently larger than CT-perpendicular to the maximal ellipse as well as CT-anteroposterior measurements. These differences should be considered when applying evidence from previous trials to clinical decisions. 3
56. Sprouse LR, 2nd, Meier GH, 3rd, Lesar CJ, et al. Comparison of abdominal aortic aneurysm diameter measurements obtained with ultrasound and computed tomography: Is there a difference? J Vasc Surg 2003;38:466-71; discussion 71-2. Observational-Dx 334 patients with concurrent baseline US and CT measurements To assess the paired differences in AAA diameter measurements obtained with CT and US in a large national endograft trial. A total of 334 concurrent measurements were available at baseline after endovascular repair. CT(max) was greater than US(max) in 95% (n = 312), and mean CT(max) (5.69 +/- 0.89 cm) was significantly larger (P <.001) than mean US(max) (4.74 +/- 0.91 cm). The correlation coefficient between CT(max) and US(max) was 0.705, but the difference between the two was less than 1.0 cm in only 51%. There was less discrepancy between CT(max) and US(max) for small AAA (0.7 cm, 15.3%) compared with medium (0.9 cm, 17.9%) and large (1.46 cm, 20.3%) AAA; however, the difference was not statistically significant. LOA between CT(max) and US(max) (-0.45-2.36 cm) exceeded the limits of clinical acceptability (-0.5-0.5 cm). Poor LOA was also found in each subgroup based on AAA size. 3
57. Bredahl K, Sandholt B, Lonn L, et al. Three-dimensional ultrasound evaluation of small asymptomatic abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 49(3):289-96, 2015 Mar. Observational-Dx 122 consecutive US examinations To determine any differences in paired size estimation associated with three 3D-US derived methods using 3D-CT as the gold standard. In all, 122 consecutive US examinations were performed. Patients were excluded because of inadequate AAA size (n = 11) and for technical reasons (n = 11). Thus, 100 patients (F/M; 20/80) with a median maximum AAA diameter of 46 (range 31-55) mm were analysed. The mean US dual plane diameter and the 3D-US centreline diameter were 2.6 mm and 1.8 mm smaller than the mean 3D-CT centreline diameter, respectively (p = .003). The inter-observer reproducibility coefficient was 3.7 mm for the US dual plane diameter and 3.2 mm for the 3D-US centreline diameter (p = 0.222). For the partial volume, the reproducibility was 8-12%, corresponding to a diameter variability of ±3 mm. The median time used for post-processing of the 3D-US acquisition was 72 (range 46-108) seconds per examination. 1
58. Lowe C, Ghulam Q, Bredahl K, et al. Three-dimensional Ultrasound in the Management of Abdominal Aortic Aneurysms: A Topical Review. [Review]. Eur J Vasc Endovasc Surg. 52(4):466-474, 2016 Oct. Review/Other-Dx N/A To introduce clinicians to the current concepts of 3D ultrasound, review the current literature, and highlight avenues for further research in this new and exciting field of vascular imaging. No results provided 4
59. van Essen JA, Gussenhoven EJ, van der Lugt A, et al. Accurate assessment of abdominal aortic aneurysm with intravascular ultrasound scanning: validation with computed tomographic angiography. J Vasc Surg 1999;29:631-8. Observational-Dx 16 patients To assess the accuracy of intravascular ultrasound (IVUS) parameters of abdominal aortic aneurysm, used for endovascular grafting, in comparison with computed tomographic angiography (CTA). IVUS results identified 31 of 32 renal arteries and four of five accessory renal arteries. A comparison of the length measurements of the aneurysm and the proximal and distal neck obtained with IVUS and CTA revealed a correlation of 0.99 (P <.001), with a coefficient of variation of 9%. IVUS results tended to underestimate the length as compared with the CTA results (0.48 +/- 0.52 cm; P <.001). A comparison of the lumen diameter measurements of the proximal and distal neck derived from IVUS and CTA showed a correlation of 0.93 (P <.001), with a coefficient of variation of 9%. IVUS results tended to underestimate aneurysm neck diameter as compared with CTA results (0.68 +/- 1.76 mm; P =.006). Interobserver agreement of IVUS length and diameter measurements showed a good correlation (r = 1.0; P <.001), with coefficients of variation of 3% and 2%, respectively, and no significant differences (0.0 +/- 0.16 cm and 0.06 +/- 0.36 mm, respectively). The longitudinal IVUS images displayed the important vascular structures and improved the spatial insight in aneurysmal anatomy. 3
60. Garret HE, Jr., Abdullah AH, Hodgkiss TD, Burgar SR. Intravascular ultrasound aids in the performance of endovascular repair of abdominal aortic aneurysm. J Vasc Surg 2003;37:615-8. Observational-Dx 78 patients To assess the accuracy of aortic measurements with intravascular ultrasound scan (IVUS) compared with computed tomographic (CT) scan and to assess the role of IVUS in the performance of endovascular repair of abdominal aortic aneurysms (AAAs). IVUS measurements of the phantom standard agreed closely with CT scan measurements. However, stent graft size initially selected with CT measurement was altered in 28% of cases on the basis of intraoperative IVUS measurements. No type I endoleaks were encountered in our series, and no aortic cuffs were necessary for endoleak repair. 4
61. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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