Accurate preoperative planning for abdominal aortic aneurysm using fully automated measurement software: A randomized controlled trial

Sizing, the first step of endovascular aneurysm repair (EVAR), is essential for a successful procedure. This study evaluated the precision and reproducibility of EVAR sizing facilitated by a novel fully automated software, DetecMicro, in comparison to conventional manual and semi-automatic software. A total of 18 surgeons, consisting of 9 junior residents and 9 vascular surgery specialists, participated in a prospective single-center randomized controlled trial with three parallel arms, stratified based on clinical experience. Each surgeon conducted three repeated measurements for 450 parameters (360 diameter and 90 length parameters). Intra- and inter-observer variability were analyzed using the intraclass correlation coefficient (ICC). Subsequently, the stent size based on the measured results was assessed to determine the impact of measurement errors on stent selection. The reliability of virtual stent implantation (VSI) using DetecMicro was evaluated by comparing it with postoperative models. Compared to PACS and 3mensio, the DetecMicro group exhibited superior accuracy, with 90.39% of diameter measurements and 97.60% of length measurements falling within clinically acceptable ranges, [-2 mm, + 2 mm] and [-5 mm, + 5 mm], respectively. Intra-observer and inter-observer repeatability with DetecMicro demonstrated efficacy, with a mean ICC exceeding 0.9. In the DetecMicro group, clinical experience had a negligible impact on the aforementioned results. VSI, when compared with actual postoperative models, limited errors to within 2 mm. The integration of DetecMicro's measurement and VSI functions holds promise as a reliable tool for preoperative planning in EVAR treatment.