Source of errors and accuracy of a two-dimensional/three-dimensional fusion road map for endovascular aneurysm repair of abdominal aortic aneurysm.
OBJECTIVE
To evaluate the accuracy and source of errors using a two-dimensional (2D)/three-dimensional (3D) fusion road map for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm.


METHODS
A rigid 2D/3D road map was tested in 16 patients undergoing EVAR. After 3D/3D manual registration of preoperative multidetector computed tomography (CT) and cone beam CT, abdominal aortic aneurysm outlines were overlaid on live fluoroscopy/digital subtraction angiography (DSA). Patient motion was evaluated using bone landmarks. The misregistration of renal and internal iliac arteries were estimated by 3 readers along head-feet and right-left coordinates (z-axis and x-axis, respectively) before and after bone and DSA corrections centered on the lowest renal artery. Iliac deformation was evaluated by comparing centerlines before and during intervention. A score of clinical added value was estimated as high (z-axis < 3 mm), good (3 mm ≤ z-axis ≤ 5 mm), and low (z-axis > 5 mm). Interobserver reproducibility was calculated by the intraclass correlation coefficient.


RESULTS
The lowest renal artery misregistration was estimated at x-axis = 10.6 mm ± 11.1 and z-axis = 7.4 mm ± 5.3 before correction and at x-axis = 3.5 mm ± 2.5 and z-axis = 4.6 mm ± 3.7 after bone correction (P = .08), and at 0 after DSA correction (P < .001). After DSA correction, residual misregistration on the contralateral renal artery was estimated at x-axis = 2.4 mm ± 2.0 and z-axis = 2.2 mm ± 2.0. Score of clinical added value was low (n = 11), good (n= 0), and high (n= 5) before correction and low (n = 5), good (n = 4), and high (n = 7) after bone correction. Interobserver intraclass correlation coefficient for misregistration measurements was estimated at 0.99. Patient motion before stent graft delivery was estimated at x-axis = 8 mm ± 5.8 and z-axis = 3.0 mm ± 2.7. The internal iliac artery misregistration measurements were estimated at x-axis = 6.1 mm ± 3.5 and z-axis = 5.6 mm ± 4.0, and iliac centerline deformation was estimated at 38.3 mm ± 15.6.


CONCLUSIONS
Rigid registration is feasible and fairly accurate. Only a partial reduction of vascular misregistration was observed after bone correction; minimal DSA acquisition is still required.
Department of Radiology, University of Montreal Hospital Center, Montreal, Quebec, Canada; Department of Radiology, Radio-Oncology and Nuclear Medicine and Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada; University of Montreal Hospital Research Center, Montreal, Quebec, Canada.
Claude
C
Kauffmann
Department of Radiology, University of Montreal Hospital Center, Montreal, Quebec, Canada.
Frédéric
F
Douane
Department of Radiology, University of Montreal Hospital Center, Montreal, Quebec, Canada; Department of Radiology, Radio-Oncology and Nuclear Medicine and Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada; University of Montreal Hospital Research Center, Montreal, Quebec, Canada.
Eric
E
Therasse
University of Montreal Hospital Research Center, Montreal, Quebec, Canada.
Simon
S
Lessard
Department of Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada.
Stephane
S
Elkouri
Department of Radiology, University of Montreal Hospital Center, Montreal, Quebec, Canada.
Patrick
P
Gilbert
Department of Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada.
Nathalie
N
Beaudoin
Siemens, Healthcare Sector, Forchheim, Germany.
Marcus
M
Pfister
Department of Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada.
Jean François
JF
Blair
Department of Radiology, University of Montreal Hospital Center, Montreal, Quebec, Canada; Department of Radiology, Radio-Oncology and Nuclear Medicine and Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada; University of Montreal Hospital Research Center, Montreal, Quebec, Canada. Electronic address: gilles.soulez.chum@ssss.gouv.qc.ca.
Gilles
G
Soulez
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D061330:Multidetector Computed Tomography / Q000379:methods*; D064847:Multimodal Imaging / Q000379:methods; D010363:Pattern Recognition, Automated / Q000379:methods; D012077:Renal Artery / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique