Stent Graft Sizing for Endovascular Abdominal Aneurysm Repair Using Open Source Image Processing Software

An important step to reach a favorable outcome of abdominal endovascular aneurysm repair (EVAR) is preoperative sizing of the stent graft using computed tomography angiography (CTA) images of the abdominal aorta. A variety of costly image processing software options is available to obtain the necessary aortic measurements. A package that can be used for EVAR sizing is OsiriX Lite®—an open source, freely downloadable image processing option. This study assesses the concurrent validity of OsiriX Lite® when compared with commercially available 3Mensio Vascular® and Siemens Syngo.via®. CTA scans of 20 patients that underwent EVAR for abdominal aneurysm were selected, 10 elective and 10 ruptured. For each scan, 6 observers determined 20 parameters needed for proper stent graft sizing, 2 using Osirix Lite®, 3 using 3Mensio Vascular®, and 1 using Siemens Syngo.via®. For each parameter, an intraclass correlation coefficient (ICC) and a P-value were calculated. Interrater agreement was interpreted using the Koo and Li Guidelines. Time needed to perform EVAR planning was compared. Overall interrater agreement between the 3 sizing options was found to be either “good” or “moderate” for 16 out of 20 parameters (80%). Time needed to perform EVAR planning was not significantly different for Osirix Lite® (568 sec) when compared with 3Mensio Vascular® (603 sec) or Siemens Syngo.via® (659 sec) with a P-value of 0.88. The authors conclude that Osirix Lite® is an accurate and time-effective image processing option for preoperative sizing of an EVAR stent graft when matched to 3Mensio Vascular® and Siemens Syngo.via®. •A number of different software options is available for preoperative sizing of an endovascular aneurysm repair (EVAR) stent.•OsiriX Lite® is a DICOM-viewer and image processer that can be operated for free.•When compared with the commercial options 3Mensio Vascular® and Siemens Syngo.via®, OsiriX Lite® is safe and accurate in EVAR planning.