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Akkoyun E, Kwon ST, Acar AC, Lee W, Baek S. Predicting abdominal aortic aneurysm growth using patient-oriented growth models with two-step Bayesian inference. Comput Biol Med 2020; 117:103620. [PMID: 32072970 PMCID: PMC7064358 DOI: 10.1016/j.compbiomed.2020.103620] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE For small abdominal aortic aneurysms (AAAs), a regular follow-up examination is recommended every 12 months for AAAs of 30-39 mm and every six months for AAAs of 40-55 mm. Follow-up diameters can determine if a patient follows the common growth model of the population. However, the rapid expansion of an AAA, often associated with higher rupture risk, may be overlooked even though it requires surgical intervention. Therefore, the prognosis of abdominal aortic aneurysm growth is clinically important for planning treatment. This study aims to build enhanced Bayesian inference methods to predict maximum aneurysm diameter. METHODS 106 CT scans from 25 Korean AAA patients were retrospectively obtained. A two-step approach based on Bayesian calibration was used, and an exponential abdominal aortic aneurysm growth model (population-based) was specified according to each individual patient's growth (patient-specific) and morphologic characteristics of the aneurysm sac (enhanced). The distribution estimates were obtained using a Markov Chain Monte Carlo (MCMC) sampler. RESULTS The follow-up diameters were predicted satisfactorily (i.e. the true follow-up diameter was in the 95% prediction interval) for 79% of the scans using the population-based growth model, and 83% of the scans using the patient-specific growth model. Among the evaluated geometric measurements, centerline tortuosity was a significant (p = 0.0002) predictor of growth for AAAs with accelerated and stable expansion rates. Using the enhanced prediction model, 86% of follow-up scans were predicted satisfactorily. The average prediction errors of population-based, patient-specific, and enhanced models were ±2.67, ±2.61 and ± 2.79 mm, respectively. CONCLUSION A computational framework using patient-oriented growth models provides useful tools for per-patient basis treatment and enables better prediction of AAA growth.
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Affiliation(s)
- Emrah Akkoyun
- Department of Health Informatics, Graduate School of Informatics, Middle East Technical University, Dumlupinar Bulvari #1, 06800, Cankaya, Ankara, Turkey
| | - Sebastian T Kwon
- Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, 757 Westwood Blvd., Los Angeles, CA, 90095, USA
| | - Aybar C Acar
- Department of Health Informatics, Graduate School of Informatics, Middle East Technical University, Dumlupinar Bulvari #1, 06800, Cankaya, Ankara, Turkey
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - Seungik Baek
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI, 48824, USA.
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Gharahi H, Zambrano BA, Lim C, Choi J, Lee W, Baek S. On growth measurements of abdominal aortic aneurysms using maximally inscribed spheres. Med Eng Phys 2015; 37:683-91. [PMID: 26004506 DOI: 10.1016/j.medengphy.2015.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 12/26/2014] [Accepted: 04/25/2015] [Indexed: 11/25/2022]
Abstract
The maximum diameter, total volume of the abdominal aorta, and its growth rate are usually regarded as key factors for making a decision on the therapeutic operation time for an abdominal aortic aneurysm (AAA) patient. There is, however, a debate on what is the best standard method to measure the diameter. Currently, two dominant methods for measuring the maximum diameter are used. One is measured on the planes perpendicular to the aneurism's central line (orthogonal diameter) and the other one is measured on the axial planes (axial diameter). In this paper, another method called 'inscribed-spherical diameter' is proposed to measure the diameter. The main idea is to find the diameter of the largest sphere that fits within the aorta. An algorithm is employed to establish a centerline for the AAA geometries obtained from a set of longitudinal scans obtained from South Korea. This centerline, besides being the base of the inscribed spherical method, is used for the determination of orthogonal and axial diameter. The growth rate parameters are calculated in different diameters and the total volume and the correlations between them are studied. Furthermore, an exponential growth pattern is sought for the maximum diameters over time to examine a nonlinear growth pattern of AAA expansion both globally and locally. The results present the similarities and discrepancies of these three methods. We report the shortcomings and the advantages of each method and its performance in the quantification of expansion rates. While the orthogonal diameter measurement has an ability of capturing a realistic diameter, it fluctuated. On the other hand, the inscribed sphere diameter method tends to underestimate the diameter measurement but the growth rate can be bounded in a narrow region for aiding prediction capability. Moreover, expansion rate parameters derived from this measurement exhibit good correlation with each other and with growth rate of volume. In conclusion, although the orthogonal method remains the main method of measuring the diameter of an abdominal aorta, employing the idea of maximally inscribed spheres provides both a tool for generation of the centerline, and an additional parameter for quantification of aneurysmal growth rates.
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Affiliation(s)
- H Gharahi
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA
| | - B A Zambrano
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA
| | - C Lim
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA
| | - J Choi
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA; Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - W Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Republic of Korea
| | - S Baek
- Department of Mechanical Engineering, Michigan State University, 2457 Engineering Building, East Lansing, MI 48824, USA.
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Sughimoto K, Takahara Y, Mogi K, Yamazaki K, Tsubota K, Liang F, Liu H. Blood flow dynamic improvement with aneurysm repair detected by a patient-specific model of multiple aortic aneurysms. Heart Vessels 2013; 29:404-12. [DOI: 10.1007/s00380-013-0381-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
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Georgakarakos E, Georgiadis GS, Xenakis A, Kapoulas KC, Lazarides MK, Tsangaris AS, Ioannou CV. Application of Bioengineering Modalities in Vascular Research: Evaluating the Clinical Gain. Vasc Endovascular Surg 2012; 46:101-8. [DOI: 10.1177/1538574412436699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Using knowledge gained from bioengineering studies, current vascular research focuses on the delineation of the natural history and risk assessment of clinical vascular entities with significant morbidity and mortality, making the development of new, more accurate predictive criteria a great challenge. Additionally, conclusions derived from computational simulation studies have enabled the improvement and modification of many biotechnology products that are used routinely in the treatment of vascular diseases. This review highlights the promising role of the bioengineering applications in the vascular field.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George S. Georgiadis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Antonios Xenakis
- Fluids Section, School of Mechanical Engineering, National Technical University of Athens, Athens, Greece
| | - Konstantinos C. Kapoulas
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Miltos K. Lazarides
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - Christos V. Ioannou
- Department of Vascular Surgery, University of Crete, University Hospital of Heraklion, Heraklion, Greece
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Hurks R, Pasterkamp G, Vink A, Hoefer IE, Bots ML, van de Pavoordt HD, de Vries JPP, Moll FL. Circumferential heterogeneity in the abdominal aortic aneurysm wall composition suggests lateral sides to be more rupture prone. J Vasc Surg 2012; 55:203-9. [DOI: 10.1016/j.jvs.2011.06.113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/22/2011] [Accepted: 06/24/2011] [Indexed: 12/27/2022]
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Zhao S, Li W, Gu L. Biomechanical prediction of abdominal aortic aneurysm rupture risk: Sensitivity analysis. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/jbise.2012.511083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Georgakarakos E, Ioannou CV, Papaharilaou Y, Kostas T, Katsamouris AN. Computational evaluation of aortic aneurysm rupture risk: what have we learned so far? J Endovasc Ther 2011; 18:214-25. [PMID: 21521062 DOI: 10.1583/10-3244.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In current clinical practice, aneurysm diameter is one of the primary criteria used to decide when to treat a patient with an abdominal aortic aneurysm (AAA). It has been shown that simple association of aneurysm diameter with the probability of rupture is not sufficient, and other parameters may also play a role in causing or predisposing to AAA rupture. Peak wall stress (PWS), intraluminal thrombus (ILT), and AAA wall mechanics are the factors most implicated with rupture risk and have been studied by computational risk evaluation techniques. The objective of this review is to examine these factors that have been found to influence AAA rupture. The prediction rate of rupture among computational models depends on the level of model complexity and the predictive value of the biomechanical parameters used to assess risk, such as PWS, distribution of ILT, wall strength, and the site of rupture. There is a need for simpler geometric analogues, including geometric parameters (e.g., lumen tortuosity and neck length and angulation) that correlate well with PWS, conjugated with clinical risk factors for constructing rupture risk predictive models. Such models should be supported by novel imaging techniques to provide the required patient-specific data and validated through large, prospective clinical trials.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, Demokritus University of Thrace, University Hospital of Alexandroupolis, Greece
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Georgakarakos E, Ioannou CV, Georgiadis GS, Kapoulas K, Schoretsanitis N, Lazarides M. Expanding Current EVAR Indications to Include Small Abdominal Aortic Aneurysms: A Glimpse of the Future. Angiology 2011; 62:500-3. [DOI: 10.1177/0003319711398651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The traditional criterion of maximum transverse diameter is not sufficient to differentiate the small abdominal aortic aneurysms (AAAs) that are either prone to rupture or prone to enlarge rapidly. Wall stress may be a more reliable indicator with respect to these tasks. We review the importance of geometric features in rupture- or growth-predictive models and stress the need for further evaluation and validation of geometric indices. This study may lead to identifying those small AAAs that could justify early endovascular intervention.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, “Demokritos” University of Thrace, University Hospital of Alexandroupolis, Greece,
| | - Christos V. Ioannou
- Department of Vascular Surgery, University of Crete, University Hospital of Heraklion, Greece
| | - George S. Georgiadis
- Department of Vascular Surgery, “Demokritos” University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Konstantinos Kapoulas
- Department of Vascular Surgery, “Demokritos” University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Nikolaos Schoretsanitis
- Department of Vascular Surgery, “Demokritos” University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Miltos Lazarides
- Department of Vascular Surgery, “Demokritos” University of Thrace, University Hospital of Alexandroupolis, Greece
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