Laci I, Spahiu A. Concurrent validity of radiography and ultrasound examination for the diagnosis of aortic 

aneurisms in Albanian patients (Original research). SEEJPH 2016, posted: 25 March 2016. DOI 

10.4119/UNIBI/SEEJPH-2016-98 

 

1 
 

ORIGINAL  RESEARCH 

 

Concurrent validity of radiography and ultrasound examination for the 

diagnosis of aortic aneurisms in Albanian patients    

 

 
Ilirian Laci

1
, Alketa Spahiu

2
 

 
1
 Radiology and Nuclear Medicine Service, University Hospital Center “Mother Teresa”, 

Tirana, Albania; 
 

2
 Statistics Service, University Hospital Center “Mother Teresa”, Tirana, Albania.  

 

 

 

 

Corresponding author: Dr. Ilirian Laci   

Address: Rr. “Dibres”, No. 370, Tirana, Albania;  

Telephone: +355672072668; E-mail: ilirianlaci@yahoo.com 

 

 

 

  



Laci I, Spahiu A. Concurrent validity of radiography and ultrasound examination for the diagnosis of aortic 

aneurisms in Albanian patients (Original research). SEEJPH 2016, posted: 25 March 2016. DOI 

10.4119/UNIBI/SEEJPH-2016-98 

 

2 
 

Abstract 

 

Aim: The aim of our study was to assess the concurrent validity of radiography and 

ultrasound examination among patients diagnosed with aortic aneurisms in Albania, a 

transitional country in South Eastern Europe.    

Methods: This study included 75 consecutive patients diagnosed with aortic aneurisms 

(thoracic and/or abdominal) admitted at the University Hospital Centre “Mother Teresa” in 

Tirana during 2012-2014 (56 men and 19 women). For each patient, computerized 

tomography (CT) scan with contrast was used to confirm the diagnosis of aortic aneurisms. In 

addition to the CT scan (“gold standard” for the diagnosis of aneurisms), in 37 patients, 

radiography and ultrasound examination were simultaneously performed in order to assess 

the validity of these techniques. Furthermore, demographic data and other relevant clinical 

information were collected for each study participant. 

Results: In 18 patients with thoracic aneurisms pertinent to ascendant aorta where 

radiography and ultrasound were simultaneously performed, ultrasound was able to diagnose 

5 (27.8%) cases which were not detected through radiography (P=0.038). Conversely, in 16 

patients with abdominal aneurisms where radiography and ultrasound were simultaneously 

performed, ultrasound was able to diagnose 4 (25.0%) cases which were not detected through 

radiography (P=0.034). The remaining three patients diagnosed with thoracic-abdominal 

aneurisms were not detected either by ultrasound examination or radiography.       

Conclusions: In this sample of Albanian patients diagnosed with aortic aneurisms (N=75), 

overall, 9 (24.3%) subjects were detected through ultrasound examination but not 

radiography (P<0.001). Findings from this study provide valuable clues about the concurrent 

validity and predictive value of these two key examinations for the diagnosis of aortic 

aneurisms.      

 

Keywords: Albania, aneurism, CT scan, predictive value, radiography, ultrasonography, 

ultrasound, validity.  

 

Conflicts of interest: None.   

   



Laci I, Spahiu A. Concurrent validity of radiography and ultrasound examination for the diagnosis of aortic 

aneurisms in Albanian patients (Original research). SEEJPH 2016, posted: 25 March 2016. DOI 

10.4119/UNIBI/SEEJPH-2016-98 

 

3 
 

Introduction  

Aortic aneurysms are defined as enlargements (dilations) of the aorta which is caused by a 

chronic weakness (thinness) of the arterial wall. Under these conditions, there is a high risk 

for ruptures, as well as for other unfavourable cardiovascular events in subjects with aortic 

aneurisms (1-3).  

In the United Kingdom, in patients with aortic aneurisms of a size about 40-55 mm, only 16% 

of deaths have been linked to surgical interventions or ruptures, whereas 50% of deaths have 

been linked to other cardiovascular events including myocardial infarction and stroke (4).  

Aortic aneurisms affect about 8% of men aged 65 years and above, but the occurrence of this 

condition is increasing in women too (5,6). Data available from the Centre for Disease 

Control and Prevention (CDC) in USA indicate that aortic aneurisms constitute the fifteenth 

leading cause of death in American men and women aged 60-84 years old (7).      

As aortic aneurisms remain one of the major causes of morbidity and mortality especially 

among older men, its prevalence is expected to increase gradually in parallel with population 

aging in most countries of the world. Aortic aneurisms are usually asymptomatic and are 

often detected upon radiological examinations performed for other reasons. Based on the 

radiological evidence, surgical or endovascular interventions are performed. Especially under 

emergency conditions, radiography and ultrasound examinations are very important in order 

to identify aortic aneurisms and aortic dissections (8). In principle, however, the diagnosis of 

aortic aneurisms is made through the following techniques: ultrasound, CT scan without 

contrast and/or with intravenous contrast (CTA), radiography, angiography (aortography) and 

magnetic resonance imaging (MRI) (8). The risk for rupture of aneurisms is related to the 

level of dilation. Several studies have convincingly argued that ultrasound may be a suitable 

method for the diagnosis of aortic aneurisms given the fact that it is a non-invasive technique, 

without radiation and relatively cheap (8). The sensitivity and specificity of ultrasound 

examination for detection of aortic aneurisms have been estimated at 87.4%-98.9% and 

99.9%, respectively (9). Nevertheless, the accuracy of ultrasound examination may be far 

lower in obese individuals and in those with intestinal meteorism (9). As a matter of fact, it is 

possible to assess only the ascendant thoracic aorta through trans-thoracic ultrasound 

examination, whereas assessment of the descendent thoracic aorta is possible only through 

trans-oesophageal ultrasound (10). 

In post-communist Albania, there has been an increase in cardiovascular diseases in the past 

two decades (11). In particular, the death rate from ischemic heart disease in Albania is the 

highest in South Eastern Europe (11), in line with the rapid changes in dietary patterns 

characterized by an increase in processed foods and an increase in the prevalence of smoking 

(12). In addition, Albania is the only country in South Eastern Europe which has experienced 

an increase in the mortality rate from ischemic heart disease and cerebrovascular diseases in 

the past two decades (11,12). However, specific information about the frequency and 

distribution of aortic aneurisms in the Albanian population is scant.  

In this framework, the aim of this study was to assess the concurrent validity of radiography 

and ultrasound examination among patients diagnosed with aortic aneurisms in Albania, a 

transitional country in South Eastern Europe which, among other reforms, is also undergoing 

a deep reform in the health care sector.    

 

Methods  

This study included 75 consecutive patients diagnosed with aortic aneurisms (thoracic and/or 

abdominal) admitted at the University Hospital Centre “Mother Teresa” in Tirana (the only 

tertiary care facility in Albania) for the period from January 2012 to December 2014 (56 men 

and 19 women).  

https://en.wikipedia.org/wiki/Aorta


Laci I, Spahiu A. Concurrent validity of radiography and ultrasound examination for the diagnosis of aortic 

aneurisms in Albanian patients (Original research). SEEJPH 2016, posted: 25 March 2016. DOI 

10.4119/UNIBI/SEEJPH-2016-98 

 

4 
 

For each patient, computerized tomography (CT) scan with contrast was used to confirm the 

diagnosis of aortic aneurisms.  

In addition to the CT scan (which is considered as the “gold standard” for the diagnosis of 

aneurisms), radiography was performed in 56 (74.7%) patients, whereas ultrasound 

examination was conducted in 45 (60.0%) patients (Table 1).  

 

Table 1. Examinations performed in a sample of Albanian patients diagnosed with 

aortic aneurisms during 2012-2014 (N=75) 
 

Radiography  Ultrasound  CT scan with contrast  

Number  Percent  Number  Percent  Number  Percent  

56 74.7% 45 60.0% 75  100.0% 

 

On the other hand, in 37 patients, radiography and ultrasound examination were 

simultaneously performed in order to assess the validity of these techniques. In principle, 

radiography and ultrasound examination were performed in patients admitted at the 

emergency unit who were residents in Tirana. Ultrasound in emergency conditions consisted 

of trans-thoracic or trans-abdominal examination, but not trans-oesophageal examination, 

because such a procedure involves a careful preparation and is not recommended under 

emergency conditions. On the other hand, patients from other districts of Albania for whom 

there was prior suspicion for aneurisms underwent directly CT scan examination.   

Furthermore, other relevant clinical information and demographic data were collected for 

each study participant. 

Mann-Whitney U-test was used to compare mean age and mean duration of hospitalization 

between male and female participants. On the other hand, Fisher’s exact test was used to 

compare the proportions of place of residence, smoking, hypertension and other chronic 

diseases between men and women. Conversely, Cramer’s V test (a measure of association 

between two nominal variables) was used to compare the concurrent validity of radiography 

and ultrasound examination. In all cases, a p-value of ≤0.05 was considered as statistically 

significant. Statistical Package for Social Sciences (SPSS, version 19.0) was used for the data 

analysis.     

 

Results  

This study involved 75 patients with a confirmed diagnosis of aortic aneurism according to 

CT scan with contrast (“gold standard”).  

Demographic characteristics and clinical data of the patients included in this study are 

presented in Table 2.  

Overall, 56 (74.7%) patients were men and 19 (25.3%) were women (male-to-female ratio 

about 3/1). Mean age in women was higher than in men, a difference which nevertheless was 

not statistically significant (62.5±13.8 vs. 58.0±15.7 years, respectively, P=0.41). On the 

whole, 31 patients were residents in Tirana compared with 44 patients who were residents in 

other districts of Albania. Mean duration of hospitalization was 7.4±8.9 days, with no 

statistically significant sex-difference (P=0.261), notwithstanding a longer duration in men 

(10.3±9.5) compared to women (6.4±8.6). The overall prevalence of smoking was 

32/75=43%; it was considerably higher in men than in women (52% vs. 16%, respectively, 

P=0.007). The overall prevalence of hypertension was 55/75=73%, with no significant 

difference between men and women (P=0.249). Overall, 60% (45 out 75) of the patients had 

other pre-existing chronic conditions, which were evenly distributed between men and 

women (Table 2). 

https://en.wikipedia.org/wiki/Association_%28statistics%29
https://en.wikipedia.org/wiki/Nominal_data#Nominal_scale


Laci I, Spahiu A. Concurrent validity of radiography and ultrasound examination for the diagnosis of aortic 

aneurisms in Albanian patients (Original research). SEEJPH 2016, posted: 25 March 2016. DOI 

10.4119/UNIBI/SEEJPH-2016-98 

 

5 
 

Table 2. Demographic data and clinical characteristics of the patients diagnosed with 

aortic aneurisms 
 

CHARACTERISTIC WOMEN (N=19)  MEN (N=56)  TOTAL (N=75)  

Age (years) 58.0±15.7
*
  62.5±13.8 59.1±15.3 

Place of residence: 

Tirana 

Other districts   

Total  

 

8 (25.8)
† 

11 (25.0) 

19 (25.3) 

 

23 (74.2) 

33 (75.0) 

56 (74.7) 

 

31 (100.0) 

44 (100.0) 

75 (100.0) 

Length of hospitalization (days)  6.4±8.6 10.3±9.5 7.4±8.9 

Smoking: 

Yes  

No   

 

3 (9.4)
 

16 (37.2) 

 

29 (90.6) 

27 (62.8) 

 

32 (100.0) 

43 (100.0) 

Hypertension: 

Yes 

No  

 

16 (29.1)
 

3 (15.0) 

 

39 (70.9) 

17 (85.0) 

 

55 (100.0) 

20 (100.0) 

Other chronic diseases: 

Yes 

No  

 

11 (24.4)
 

8 (26.7) 

 

34 (75.6) 

22 (73.3) 

 

45 (100.0) 

30 (100.0) 
 

* 
Mean ± standard deviation.  

†
 Number and row percentages (in parenthesis)   

 
Radiography was able to detect 20 patients with a confirmed diagnosis of aortic aneurism. 

Hence, 35.7% of suspected cases (20 out of 56 patients who underwent this procedure) were 

detected through radiography. It should be noted that radiography played a major role in 

thoracic aortic aneurisms, but less so for abdominal aortic aneurisms, except for old 

abdominal aneurisms with wall calcifications which enabled a prompt diagnosis upon 

radiography.  

Conversely, trans-thoracic and trans-abdominal ultrasound examination was able to detect 36 

patients with a confirmed diagnosis of aortic aneurism. Thus, 80.0% of suspected cases (36 

out of 45 patients who underwent this procedure) were detected through ultrasound 

examination (data not shown in the tables).   

It should be emphasized that complications such as ruptures, dissections, hematomas, or clots 

could not be detected either through radiography or by ultrasound examination.           

Table 3 presents findings from radiography and ultrasound examination performed 

simultaneously in a sub-sample of 37 patients. In this sub-sample of patients diagnosed with 

aortic aneurisms (N=37), overall, 9 subjects (or, 24.3% of them) were detected through 

ultrasound examination but not radiography (Cramer’s V=0.609, P<0.001). 

 

Table 3. Findings from radiography and ultrasound examination performed 

simultaneously in a sub-sample of 37 patients 
 

RADIOGRAPHY  
ULTRASOUND 

TOTAL 
Yes No 

Yes  14 (100.0%) 0 (0%) 14 (100.0%) 

No 9 (39.1%) 14 (60.9%) 23 (100.0%) 

Total 23 (62.2%) 14 (37.8%) 37 (100.0%) 

 



Laci I, Spahiu A. Concurrent validity of radiography and ultrasound examination for the diagnosis of aortic 

aneurisms in Albanian patients (Original research). SEEJPH 2016, posted: 25 March 2016. DOI 

10.4119/UNIBI/SEEJPH-2016-98 

 

6 
 

Overall, 23 (or, 62.2%) of the cases in this sub-sample (N=37) were detected by one of the 

two examination methods (radiography or ultrasound). Conversely, 14 (37.8%) of the cases 

in this-sample were not detected either by radiography or ultrasound examination (Table 2).      

In 18 patients with thoracic aneurisms pertinent to ascendant aorta where radiography and 

ultrasound were simultaneously performed, ultrasound was able to diagnose 5 (27.8%) cases 

which were not detected through radiography (P=0.038) (not shown in the tables). 

Conversely, in 16 patients with abdominal aneurisms where radiography and ultrasound were 

simultaneously performed, ultrasound was able to diagnose 4 (25.0%) cases which were not 

detected through radiography (P=0.034). The remaining three patients diagnosed with 

thoracic-abdominal aneurisms were not detected either by ultrasound examination or 

radiography.        

 

Discussion  

This may be the first report from Albania informing about clinical characteristics of a 

consecutive sample of patients diagnosed with aortic aneurisms according to CT scan with 

contrast examination which is regarded as the gold standard for the confirmation of the 

diagnosis of this condition. Main findings of this study include a higher sensitivity of 

ultrasound examination compared to radiography. Hence, of the 37 patients who underwent 

both of these procedures, 9 (24.3%) subjects were detected through ultrasound examination 

but not radiography (P<0.001). 

Radiography in emergency conditions is feasible and is considered as a straightforward 

procedure (8). In our study, radiography was able to detect about 36% (20/56) of the cases 

with aortic aneurisms. In particular, radiography played a major role for detection of thoracic 

aortic aneurisms, whereas in cases of abdominal aortic aneurisms it was less effective (valid).      

Similarly, trans-thoracic and trans-abdominal ultrasound examination is also feasible in 

emergency conditions (8,9). In our study, ultrasound examination was able to detect 80% 

(36/45) of the cases with aortic aneurisms. The remaining 9 (or, 20%) of the cases were not 

detected through ultrasound probably due to the inability of the examiners (lack of proper 

training) involved in this procedure.      

Notwithstanding the higher detection rate of ultrasound examination compared to 

radiography, it was not possible in our study to assess the complications of aneurisms such as 

dissections, ruptures, fistulisation with other organs, involvement of blood vessels stemming 

from the respective aneurisms, or calcifications. On the other hand, in our study, hematomas 

were partly assessed through ultrasound examination.    

Our findings related to radiography are generally in line with previous reports from the 

international literature (13). Hence, according to a previous study, aortic aneurisms were 

confirmed in about 50% of the cases (13). In any case, it is argued that chest radiography has 

a limited value for the diagnosis of aortic aneurisms (8,13). Radiography plays an important 

role only in cases of aortic aneurisms with wall calcifications. In all suspected cases of aortic 

aneurisms though, CT scan with intravenous contrast should be promptly conducted (8,13).         

This study may have several limitations. Our study included all consecutive patients 

diagnosed with aortic aneurisms over a three-year period at the University Hospital Centre 

“Mother Teresa”, which is the only tertiary care facility in Albania. Based on this recruitment 

approach, our study population involved an all-inclusive sample for the three-year period 

under investigation. Furthermore, the diagnosis of aortic aneurisms was based on the state-of-

the-art clinical protocols and up-to-date examination techniques employed in similar studies 

conducted in other countries. In any case, the self-reported information which was collected 

through semi-structured interviews may have been prone to different types of information 



Laci I, Spahiu A. Concurrent validity of radiography and ultrasound examination for the diagnosis of aortic 

aneurisms in Albanian patients (Original research). SEEJPH 2016, posted: 25 March 2016. DOI 

10.4119/UNIBI/SEEJPH-2016-98 

 

7 
 

bias. This may have been the case of self-reported smoking, hypertension and other pre-

existing conditions.  

In conclusion, this study provides useful evidence about the detection rate of radiography and 

ultrasound examination among patients diagnosed with aortic aneurisms in Albania, a 

transitional country in South Eastern Europe. Findings from this study provide valuable clues 

about the concurrent validity and predictive value of these two key examinations for the 

diagnosis of aortic aneurisms. 

 

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Laci I, Spahiu A. Concurrent validity of radiography and ultrasound examination for the diagnosis of aortic 

aneurisms in Albanian patients (Original research). SEEJPH 2016, posted: 25 March 2016. DOI 

10.4119/UNIBI/SEEJPH-2016-98 

 

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© 2016 Laci et al; This is an Open Access article distributed under the terms of the Creative Commons 

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, 

and reproduction in any medium, provided the original work is properly cited.     

 

 

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