title: Manual, semiautomated, and fully automated measurement of the aortic annulus for planning of transcatheter aortic valve replacement (TAVR/TAVI): analysis of interchangeability.
abstract: BACKGROUND
  Preprocedural 3-dimensional CT imaging of the aortic annular plane plays a critical role for transcatheter aortic valve replacement (TAVR) planning; however, manual reconstructions are complex. Automated analysis software may improve reproducibility and agreement between readers but is incompletely validated.
  
  
  METHODS
  In 110 TAVR patients (mean age, 81 years; 37% female) undergoing preprocedural multidetector CT, automated reconstruction of the aortic annular plane and planimetry of the annulus was performed with a prototype of now commercially available software (syngo.CT Cardiac Function-Valve Pilot; Siemens Healthcare, Erlangen, Germany). Fully automated, semiautomated, and manual annulus measurements were compared. Intrareader and inter-reader agreement, intermodality agreement, and interchangeability were analyzed. Finally, the impact of these measurements on recommended valve size was evaluated.
  
  
  RESULTS
  Semiautomated analysis required major correction in 5 patients (4.5%). In the remaining 95.5%, only minor correction was performed. Mean manual annulus area was significantly smaller than fully automated results (P < .001 for both readers) but similar to semiautomated measurements (5.0 vs 5.4 vs 4.9 cm(2), respectively). The frequency of concordant recommendations for valve size increased if manual analysis was replaced with the semiautomated method (60% agreement was improved to 82.4%; 95% confidence interval for the difference [69.1%-83.4%]).
  
  
  CONCLUSIONS
  Semiautomated aortic annulus analysis, with minor correction by the user, provides reliable results in the context of TAVR annulus evaluation.
authors.affiliation: Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Junyang
authors.initials: J
authors.lastname: Lou
authors.affiliation: Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Desk J1-4, 9500 Euclid Avenue, Cleveland, OH, USA; Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Obuchowski
authors.affiliation: Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Amar
authors.initials: A
authors.lastname: Krishnaswamy
authors.affiliation: Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Desk J1-4, 9500 Euclid Avenue, Cleveland, OH, USA.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Popovic
authors.affiliation: Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Desk J1-4, 9500 Euclid Avenue, Cleveland, OH, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Flamm
authors.affiliation: Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
authors.affiliation: Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Lars G
authors.initials: LG
authors.lastname: Svensson
authors.affiliation: Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Desk J1-4, 9500 Euclid Avenue, Cleveland, OH, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bolen
authors.affiliation: Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Desk J1-4, 9500 Euclid Avenue, Cleveland, OH, USA.
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
authors.affiliation: Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Desk J1-4, 9500 Euclid Avenue, Cleveland, OH, USA.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Halliburton
authors.affiliation: Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA; Cardiovascular Imaging, Imaging Institute, Cleveland Clinic, Desk J1-4, 9500 Euclid Avenue, Cleveland, OH, USA. Electronic address: schoenp1@ccf.org.
authors.forename: Paul
authors.initials: P
authors.lastname: Schoenhagen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D001027:Aortography / Q000379:methods; D006801:Humans; D008875:Middle Aged; D010363:Pattern Recognition, Automated / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface
keywords: Aortic annulus; Aortic stenosis; Computed tomography; Semi-automated analysis; TAVI; TAVR