title: The Need for Standardized Methods for Measuring the Aorta: Multimodality Core Lab Experience From the GenTAC Registry.
abstract: OBJECTIVE
  This study sought to evaluate variability in aortic measurements with multiple imaging modalities in clinical centers by comparing with a standardized measuring protocol implemented in a core laboratory.
  
  
  BACKGROUND
  In patients with aortic disease, imaging of thoracic aorta plays a major role in risk stratifying individuals for life-threatening complications and in determining timing of surgical intervention. However, standardization of the procedures for performance of aortic measurements is lacking.
  
  
  METHODS
  To characterize the diversity of methods used in clinical practice, we compared aortic measurements performed by echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) at the 6 GenTAC (National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions) clinical centers to those performed at the imaging core laboratory in 965 studies. Each center acquired and analyzed their images according to local protocols. The same images were subsequently analyzed blindly by the core laboratory, on the basis of a standardized protocol for all imaging modalities. Paired measurements from clinical centers and core laboratory were compared by mean of differences and intraclass correlation coefficient (ICC).
  
  
  RESULTS
  For all segments of the ascending aorta, echocardiography showed a higher ICC (0.84 to 0.93) than CT (0.84) and MRI (0.82 to 0.90), with smaller mean of differences. MRI showed higher ICC for the arch and descending aorta (0.91 and 0.93). In a mixed adjusted model, the different imaging modalities and clinical centers were identified as sources of variability between clinical and core laboratory measurements, whereas age groups or diagnosis at enrollment were not.
  
  
  CONCLUSIONS
  By comparing core laboratory with measurements from clinical centers, our study identified important sources of variability in aortic measurements. Furthermore, our findings with regard to CT and MRI suggest a need for imaging societies to work toward the development of unifying acquisition protocols and common measuring methods.
authors.affiliation: MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, DC. Electronic address: Federico.asch@medstar.net.
authors.forename: Federico M
authors.initials: FM
authors.lastname: Asch
authors.affiliation: MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, DC.
authors.forename: Eugene
authors.initials: E
authors.lastname: Yuriditsky
authors.affiliation: University of Texas, Houston, Houston, Texas.
authors.forename: Siddharth K
authors.initials: SK
authors.lastname: Prakash
authors.affiliation: Weill Cornell Medical College, New York, New York.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Roman
authors.affiliation: Weill Cornell Medical College, New York, New York.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Weinsaft
authors.affiliation: MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, DC.
authors.forename: Gaby
authors.initials: G
authors.lastname: Weissman
authors.affiliation: MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, DC.
authors.forename: Wm Guy
authors.initials: WG
authors.lastname: Weigold
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Shaine A
authors.initials: SA
authors.lastname: Morris
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: William J
authors.initials: WJ
authors.lastname: Ravekes
authors.affiliation: Oregon Health & Science University, Portland, Oregon.
authors.forename: Kathryn W
authors.initials: KW
authors.lastname: Holmes
authors.affiliation: Oregon Health & Science University, Portland, Oregon.
authors.forename: Michael
authors.initials: M
authors.lastname: Silberbach
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Rita K
authors.initials: RK
authors.lastname: Milewski
authors.affiliation: RTI International, Rockville, Maryland.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Kroner
authors.affiliation: RTI International, Rockville, Maryland.
authors.forename: Ryan
authors.initials: R
authors.lastname: Whitworth
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Weill Cornell Medical College, New York, New York.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.affiliation: MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, DC.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Weissman
mesh_terms: D000293:Adolescent; D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000235:genetics; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000235:genetics; D001019:Aortic Rupture / Q000000981:diagnostic imaging* / Q000235:genetics; D001027:Aortography / Q000592:standards*; D032921:Consensus; D004452:Echocardiography / Q000592:standards*; D005260:Female; D006801:Humans; D059021:Laboratory Proficiency Testing / Q000592:standards*; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards*; D014481:United States; D055815:Young Adult
keywords: CT; MRI; aortic measurements; core laboratory; echocardiography; standardization