1
|
Ristow I, Riedel C, Lenz A, Well L, Adam G, Panuccio G, Kölbel T, Bannas P. Current Imaging Strategies in Patients with Abdominal Aortic Aneurysms. ROFO-FORTSCHR RONTG 2024; 196:52-61. [PMID: 37699431 DOI: 10.1055/a-2119-6448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND An abdominal aortic aneurysm (AAA) is defined as a localized dilatation of the abdominal aorta of ≥ 3 cm. With a prevalence of 4-8 %, AAA is one of the most common vascular diseases in Western society. Radiological imaging is an elementary component in the diagnosis, monitoring, and treatment planning of AAA patients. METHOD This is a narrative review article on preoperative imaging strategies of AAA, incorporating expert opinions based on the current literature and standard-of-care practices from our own center. Examples are provided to illustrate clinical cases from our institution. RESULTS AND CONCLUSION Radiological imaging plays a pivotal role in the initial diagnosis and monitoring of patients with AAA. Ultrasound is the mainstay imaging modality for AAA screening and surveillance. Contrast-enhanced CT angiography is currently considered the gold standard for preoperative imaging and image-based treatment planning in AAA repair. New non-contrast MR angiography techniques are robustly applicable and allow precise determination of aortic diameters, which is of critical importance, particularly with regard to current diameter-based surgical treatment guidelines. 3D imaging with multiplanar reformation and automatic centerline positioning enables more accurate assessment of the maximum aortic diameter. Modern imaging techniques such as 4D flow MRI have the potential to further improve individualized risk stratification in patients with AAA. KEY POINTS · Ultrasound is the mainstay imaging modality for AAA screening and monitoring. · Contrast-enhanced CT angiography is the gold standard for preoperative imaging in AAA repair. · Non-contrast MR angiography allows for accurate monitoring of aortic diameters in AAA patients. · Measurement of aortic diameters is more accurate with 3D-CT/MRI compared to ultrasound. · Research seeks new quantitative imaging biomarkers for AAA risk stratification, e. g., using 4D flow MRI.
Collapse
Affiliation(s)
- Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Riedel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Parenti VG, Vijay K, Maroules CD, Majdalany BS, Koweek LM, Khaja MS, Ghoshhajra BB, Agarwal PP, Contrella BN, Keefe NA, Lo BM, Malik SB, Surasi DS, Waite K, Williamson EE, Abbara S, Dill KE. ACR Appropriateness Criteria® Workup of Noncerebral Systemic Arterial Embolic Source. J Am Coll Radiol 2023; 20:S285-S300. [PMID: 37236749 DOI: 10.1016/j.jacr.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Noncerebral systemic arterial embolism, which can originate from cardiac and noncardiac sources, is an important cause of patient morbidity and mortality. When an embolic source dislodges, the resulting embolus can occlude a variety of peripheral and visceral arteries causing ischemia. Characteristic locations for noncerebral arterial occlusion include the upper extremities, abdominal viscera, and lower extremities. Ischemia in these regions can progress to tissue infarction resulting in limb amputation, bowel resection, or nephrectomy. Determining the source of arterial embolism is essential in order to direct treatment decisions. This document reviews the appropriateness category of various imaging procedures available to determine the source of the arterial embolism. The variants included in this document are known arterial occlusion in the upper extremity, lower extremity, mesentery, kidneys, and multiorgan distribution that are suspected to be of embolic etiology. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Vincent G Parenti
- Research Author, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | - Lynne M Koweek
- Panel Chair, Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | - Nicole A Keefe
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Sachin B Malik
- VA Palo Alto Health Care System, Palo Alto, California and Stanford University, Stanford, California
| | - Devaki Shilpa Surasi
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Kathleen Waite
- Duke University Medical Center, Durham, North Carolina, Primary care physician
| | - Eric E Williamson
- Mayo Clinic, Rochester, Minnesota; Society of Cardiovascular Computed Tomography
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
| |
Collapse
|
3
|
Correlation Between Proteolytic Activity and Abdominal Aortic Aneurysm Wall Morphology with Intraluminal Thrombus Volume. Ann Vasc Surg 2022; 87:487-494. [PMID: 35779804 DOI: 10.1016/j.avsg.2022.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to examine the influence of intraluminal thrombus (ILT) volume on the level of proteolytic activity and the content of abdominal aortic aneurysm (AAA) wall. METHODS The research was designed as a cross-sectional study at the Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia in the period from April 2017 to February 2018. During this period, a total of 155 patients with asymptomatic AAA underwent open surgical treatment and 50 were included in the study based on inclusion and exclusion criteria. Before surgery, patients included in the study were examined by MRI. During the operation, samples of ILT and AAA wall were taken for biochemical analysis. RESULTS A statistically significant correlation was found between the volume of the ILT and largest AAA diameter (ρ = 0.56; P < 0.001). The correlation of the ILT volume on the anterior wall and the concentration of MMP-9, MMP-2 and NE/ELA in the wall did not find statistical significance. Also, no statistically significant association was found between the volume of ILT and the concentration of ECM proteins (collagen type 3, elastin, proteoglycan) in the corresponding part of the wall. The association of ILT volume with MDA was also of no statistical significance. There was a positive statistical significance found in correlation of volume of ILT and catalase activity in the wall of AAA (ρ = 0.28, P = 0.049). CONCLUSIONS The volume of ILT in the aneurysmal sac seemed not to affect the level of proteolytic activity and the content of the aneurysm wall. However, a positive correlation was found between the ILT and the catalase activity. The effect of ILT on the aneurysm wall and its role in the progression of aneurysmal disease should be examined in future studies.
Collapse
|
4
|
Sivakumaran L, Alturkistani H, Lerouge S, Bertrand-Grenier A, Zehtabi F, Thérasse É, Roy-Cardinal MH, Bhatnagar S, Cloutier G, Soulez G. Strain Ultrasound Elastography of Aneurysm Sac Content after Randomized Endoleak Embolization with Sclerosing and Non-sclerosing Chitosan-based Hydrogels in a Canine Model. J Vasc Interv Radiol 2022; 33:495-504.e3. [PMID: 35150836 DOI: 10.1016/j.jvir.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare the mechanical properties of aneurysm content after endoleak embolization with a chitosan hydrogel (CH) versus a chitosan hydrogel with sodium tetradecyl sulphate (CH-STS) using strain ultrasound elastography (SUE). MATERIALS AND METHODS Bilateral common iliac artery type Ia endoleaks were created in nine dogs. Per animal, one endoleak was randomized to blinded embolization with CH, and the other, with CH-STS. Brightness mode ultrasound, Doppler ultrasound, SUE radiofrequency ultrasound, and computed tomography were performed for up to six months until sacrifice. Radiological and histopathological studies were co-registered to identify three regions of interest: embolic agent, intraluminal thrombus (ILT), and aneurysm sac. SUE segmentations were performed by two blinded, independent observers. Maximum axial strain (MAS) was the primary outcome. Statistical analysis was performed using Fisher's exact test, multivariable linear mixed-effects models, and intraclass correlation coefficients (ICCs). RESULTS Residual endoleaks were identified in 7/9 (78%) and 4/9 (44%) aneurysms embolized with CH and CH-STS, respectively (p=0.3348). CH-STS had 66% lower MAS (p<0.001) than CH. The ILT had 37% lower MAS (p=0.01) than CH and 77% greater MAS (p=0.079) than CH-STS. There was no significant difference in ILT between treatments. Aneurysm sacs embolized with CH-STS had 29% lower MAS (p<0.001) than those embolized with CH. Residual endoleak was associated with 53% greater aneurysm sac MAS (p<0.001). The ICC for MAS was 0.807 (95% confidence interval: 0.754-0.849) between segmentations. CONCLUSION CH-STS confers stiffer intraluminal properties to embolized aneurysms. Persistent endoleaks are associated with increased sac strain, an observation which may help guide management.
Collapse
Affiliation(s)
- Lojan Sivakumaran
- Laboratoire clinique du traitement de l'image. Centre de recherche du Centre hospitalier de l'Université de Montréal. Montréal, Québec, Canada; Université de Montréal. Montréal, Québec, Canada; Department of Diagnostic Radiology. McGill University. Montréal, Québec, Canada
| | - Husain Alturkistani
- Laboratoire clinique du traitement de l'image. Centre de recherche du Centre hospitalier de l'Université de Montréal. Montréal, Québec, Canada; King Khalid University Hospital. Radiology and Medical Imaging Department. Riyadh, Riyadh, Saudi Arabia
| | - Sophie Lerouge
- Département de génie mécanique. École de technologie supérieure. Department of Mechanical Engineering. Montréal, Québec, Canada; Laboratoire de biomatériaux endovasculaires. Centre de recherche du Centre Hospitalier de l'Université de Montréal. Montréal, Québec, Canada
| | - Antony Bertrand-Grenier
- Laboratoire clinique du traitement de l'image. Centre de recherche du Centre hospitalier de l'Université de Montréal. Montréal, Québec, Canada; Université de Montréal. Montréal, Québec, Canada; Laboratoire de biorhéologie et d'ultrasonographie médicale. Centre de recherche du Centre hospitalier de l'Université de Montréal. Montréal, Québec, Canada; Département de chimie, biochimie et physique. Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Fatemeh Zehtabi
- Laboratoire de biomatériaux endovasculaires. Centre de recherche du Centre Hospitalier de l'Université de Montréal. Montréal, Québec, Canada
| | - Éric Thérasse
- Department of Radiology. Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Marie-Hélène Roy-Cardinal
- Laboratoire de biorhéologie et d'ultrasonographie médicale. Centre de recherche du Centre hospitalier de l'Université de Montréal. Montréal, Québec, Canada
| | | | - Guy Cloutier
- Laboratoire de biorhéologie et d'ultrasonographie médicale. Centre de recherche du Centre hospitalier de l'Université de Montréal. Montréal, Québec, Canada
| | - Gilles Soulez
- Laboratoire clinique du traitement de l'image. Centre de recherche du Centre hospitalier de l'Université de Montréal. Montréal, Québec, Canada; Department of Radiology. Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
| |
Collapse
|
5
|
Kessler V, Klopf J, Eilenberg W, Neumayer C, Brostjan C. AAA Revisited: A Comprehensive Review of Risk Factors, Management, and Hallmarks of Pathogenesis. Biomedicines 2022; 10:94. [PMID: 35052774 PMCID: PMC8773452 DOI: 10.3390/biomedicines10010094] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/30/2021] [Indexed: 01/27/2023] Open
Abstract
Despite declining incidence and mortality rates in many countries, the abdominal aortic aneurysm (AAA) continues to represent a life-threatening cardiovascular condition with an overall prevalence of about 2-3% in the industrialized world. While the risk of AAA development is considerably higher for men of advanced age with a history of smoking, screening programs serve to detect the often asymptomatic condition and prevent aortic rupture with an associated death rate of up to 80%. This review summarizes the current knowledge on identified risk factors, the multifactorial process of pathogenesis, as well as the latest advances in medical treatment and surgical repair to provide a perspective for AAA management.
Collapse
Affiliation(s)
| | | | | | | | - Christine Brostjan
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria; (V.K.); (J.K.); (W.E.); (C.N.)
| |
Collapse
|
6
|
Effect of Doxycycline on Survival in Abdominal Aortic Aneurysms in a Mouse Model. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:9999847. [PMID: 34007253 PMCID: PMC8099506 DOI: 10.1155/2021/9999847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
Background Currently, there is no reliable nonsurgical treatment for abdominal aortic aneurysm (AAA). This study, therefore, investigates if doxycycline reduces AAA growth and the number of rupture-related deaths in a murine ApoE-/- model of AAA and whether gadofosveset trisodium-based MRI differs between animals with and without doxycycline treatment. Methods Nine ApoE-/- mice were implanted with osmotic minipumps continuously releasing angiotensin II and treated with doxycycline (30 mg/kg/d) in parallel. After four weeks, MRI was performed at 3T with a clinical dose of the albumin-binding probe gadofosveset (0.03 mmol/kg). Results were compared with previously published wild-type control animals and with previously studied ApoE-/- animals without doxycycline treatment. Differences in mortality were also investigated between these groups. Results In a previous study, we found that approximately 25% of angiotensin II-infused ApoE-/- mice died, whereas in the present study, only one out of 9 angiotensin II-infused and doxycycline-treated ApoE-/- mice (11.1%) died within 4 weeks. Furthermore, doxycycline-treated ApoE-/- mice showed significantly lower contrast-to-noise (CNR) values (p=0.017) in MRI compared to ApoE-/- mice without doxycycline treatment. In vivo measurements of relative signal enhancement (CNR) correlated significantly with ex vivo measurements of albumin staining (R 2 = 0.58). In addition, a strong visual colocalization of albumin-positive areas in the fluorescence albumin staining with gadolinium distribution in LA-ICP-MS was shown. However, no significant difference in aneurysm size was observed after doxycycline treatment. Conclusion The present experimental in vivo study suggests that doxycycline treatment may reduce rupture-related deaths in AAA by slowing endothelial damage without reversing aneurysm growth.
Collapse
|
7
|
Leach JR, Zhu C, Mitsouras D, Saloner D, Hope MD. Abdominal aortic aneurysm measurement at CT/MRI: potential clinical ramifications of non-standardized measurement technique and importance of multiplanar reformation. Quant Imaging Med Surg 2021; 11:823-830. [PMID: 33532280 DOI: 10.21037/qims-20-888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Accurate and reproducible measurement of abdominal aortic aneurysm (AAA) size is an essential component of patient management, and most reliably performed at CT using a multiplanar reformat (MPR) strategy. This approach is not universal, however. This study aims to characterize the measurement error present in routine clinical assessment of AAAs and the potential clinical ramifications. Patients were included if they had AAA assessed by CT and/or MRI at two time points at least 6 months apart. Clinical maximal AAA diameter, assessed by non-standardized methods, was abstracted from the radiology report at each time point and compared to the reference aneurysm diameter measured using a MPR strategy. Discrepancies between clinical and reference diameters, and associated aneurysm enlargement rates were analyzed. Two hundred thirty patients were included, with average follow-up 3.3±2.5 years. When compared to MPR-derived diameters, clinical aneurysm measurement inaccuracy was, on average, 3.3 mm. Broad limits of agreement were found for both clinical diameters [-6.7 to +6.5 mm] and aneurysm enlargement rates [-4.6 to +4.2 mm/year] when compared to MPR-based measures. Of 78 AAAs measuring 5-6 cm by the MPR method, 21 (26.9%) were misclassified by the clinical measurement with respect to a common repair threshold (5.5 cm), of which 5 were misclassified as below, and 16 were misclassified as above the threshold. The clinical use of non-standardized AAA measurement strategies can lead to incorrect classification of AAAs as larger or smaller than the commonly accepted repair threshold of 5.5 cm and can induce large errors in quantification of aneurysm enlargement rate.
Collapse
Affiliation(s)
- Joseph R Leach
- University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Chengcheng Zhu
- University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Dimitrios Mitsouras
- University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - David Saloner
- University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Michael D Hope
- University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| |
Collapse
|
8
|
Computer-aided quantification of non-contrast 3D black blood MRI as an efficient alternative to reference standard manual CT angiography measurements of abdominal aortic aneurysms. Eur J Radiol 2020; 134:109396. [PMID: 33217686 DOI: 10.1016/j.ejrad.2020.109396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/12/2020] [Accepted: 11/02/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Non-contrast 3D black blood MRI is a promising tool for abdominal aortic aneurysm (AAA) surveillance, permitting accurate aneurysm diameter measurements needed for patient management. PURPOSE To evaluate whether automated AAA volume and diameter measurements obtained from computer-aided segmentation of non-contrast 3D black blood MRI are accurate, and whether they can supplant reference standard manual measurements from contrast-enhanced CT angiography (CTA). MATERIALS AND METHODS Thirty AAA patients (mean age, 71.9 ± 7.9 years) were recruited between 2014 and 2017. Participants underwent both non-contrast black blood MRI and CTA within 3 months of each other. Semi-automatic (computer-aided) MRI and CTA segmentations utilizing deformable registration methods were compared against manual segmentations of the same modality using the Dice similarity coefficient (DSC). AAA lumen and total aneurysm volumes and AAA maximum diameter, quantified automatically from these segmentations, were compared against manual measurements using Pearson correlation and Bland-Altman analyses. Finally, automated measurements from non-contrast 3D black blood MRI were evaluated against manual CTA measurements using the Wilcoxon test, Pearson correlation and Bland-Altman analyses. RESULTS Semi-automatic segmentations had excellent agreement with manual segmentations (lumen DSC: 0.91 ± 0.03 and 0.94 ± 0.03; total aneurysm DSC: 0.92 ± 0.02 and 0.94 ± 0.03, for black blood MRI and CTA, respectively). Automated volume and maximum diameter measurements also had excellent correlation to their manual counterparts for both black blood MRI (volume: r = 0.99, P < 0.001; diameter: r = 0.97, P < 0.001) and CTA (volume: r = 0.99, P < 0.001; diameter: r = 0.97, P < 0.001). Compared to manual CTA measurements, bias and limits of agreement (LOA) for automated MRI measurements (lumen volume: 1.49, [-4.19 7.17] cm3; outer wall volume: -2.46, [-14.05 9.13] cm3; maximal diameter: 0.08, [-6.51 6.67] mm) were largely equivalent to those of manual MRI measurements, particularly for maximum AAA diameter (lumen volume: 0.73, [-6.47 7.93] cm3; outer wall volume: 0.98, [-10.54 12.5] cm3; maximal diameter: 0.08, [-3.67 3.83] mm). CONCLUSION Semi-automatic segmentation of non-contrast 3D black blood MRI efficiently provides reproducible morphologic AAA assessment yielding accurate AAA diameters and volumes with no clinically relevant differences compared to either automatic or manual measurements based on CTA.
Collapse
|
9
|
Henningsson M, Malik S, Botnar R, Castellanos D, Hussain T, Leiner T. Black-Blood Contrast in Cardiovascular MRI. J Magn Reson Imaging 2020; 55:61-80. [PMID: 33078512 PMCID: PMC9292502 DOI: 10.1002/jmri.27399] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022] Open
Abstract
MRI is a versatile technique that offers many different options for tissue contrast, including suppressing the blood signal, so‐called black‐blood contrast. This contrast mechanism is extremely useful to visualize the vessel wall with high conspicuity or for characterization of tissue adjacent to the blood pool. In this review we cover the physics of black‐blood contrast and different techniques to achieve blood suppression, from methods intrinsic to the imaging readout to magnetization preparation pulses that can be combined with arbitrary readouts, including flow‐dependent and flow‐independent techniques. We emphasize the technical challenges of black‐blood contrast that can depend on flow and motion conditions, additional contrast weighting mechanisms (T1, T2, etc.), magnetic properties of the tissue, and spatial coverage. Finally, we describe specific implementations of black‐blood contrast for different vascular beds.
Collapse
Affiliation(s)
- Markus Henningsson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Shaihan Malik
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Rene Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Daniel Castellanos
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tarique Hussain
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tim Leiner
- Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| |
Collapse
|
10
|
Sladojevic M, Zlatanovic P, Stanojevic Z, Koncar I, Vidicevic S, Tasic J, Isakovic A, Tomic I, Mutavdzic P, Stevanovic K, Trailovic R, Davidovic L. Influence of preoperative statins and aspirin administration on biological and magnetic resonance imaging properties in patients with abdominal aortic aneurysm. VASA 2020; 50:116-124. [PMID: 32669062 DOI: 10.1024/0301-1526/a000895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Main objective of this study was to evaluate the influence of statins and/or acetylsalicylic acid on biochemical characteristics of abdominal aortic aneurysm (AAA) wall and intraluminal thrombus (ILT). Patients and methods: Fifty patients with asymptomatic infrarenal AAA were analyzed using magnetic resonance imaging on T1w sequence. Relative ILT signal intensity (SI) was determined as a ratio between ILT and psoas muscle SI. Samples containing the full ILT thickness and aneurysm wall were harvested from the anterior surface at the level of the maximal diameter. The concentration of enzymes such as matrix metalloproteinase (MMP) 9, MMP2 and neutrophil elastase (NE/ELA) were analyzed in ILT and AAA wall; while collagen type III, elastin and proteoglycan 4 were analyzed in harvested AAA wall. Oxidative stress in the AAA wall was assessed by catalase and malondialdehyde activity in tissue samples. Results: Relative ILT signal intensity (1.09 ± 0.41 vs 0.89 ± 0.21, p = 0.013) were higher in non-statin than in statin group. Patients who were taking aspirin had lower relative ILT area (0.89 ± 0.19 vs 1.13. ± 0.44, p = 0.016), and lower relative ILT signal intensity (0.85 [0.73-1.07] vs 1.01 [0.84-1.19], p = 0.021) compared to non-aspirin group. There were higher concentrations of elastin in AAA wall among patients taking both of aspirin and statins (1.21 [0.77-3.02] vs 0.78 (0.49-1.05) ng/ml, p = 0.044) than in patients who did not take both of these drugs. Conclusions: Relative ILT SI was lower in patients taking statin and aspirin. Combination of antiplatelet therapy and statins was associated with higher elastin concentrations in AAA wall.
Collapse
Affiliation(s)
- Milos Sladojevic
- School of Medicine, University of Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Petar Zlatanovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Zeljka Stanojevic
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Serbia
| | - Igor Koncar
- School of Medicine, University of Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Sasenka Vidicevic
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Serbia
| | - Jelena Tasic
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Serbia
| | - Aleksandra Isakovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.,Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Serbia
| | - Ivan Tomic
- School of Medicine, University of Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Perica Mutavdzic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Ksenija Stevanovic
- School of Medicine, University of Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Ranko Trailovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Lazar Davidovic
- School of Medicine, University of Belgrade, Serbia.,Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| |
Collapse
|
11
|
Noninvasive imaging of vascular permeability to predict the risk of rupture in abdominal aortic aneurysms using an albumin-binding probe. Sci Rep 2020; 10:3231. [PMID: 32094414 PMCID: PMC7039902 DOI: 10.1038/s41598-020-59842-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/27/2020] [Indexed: 11/09/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) remains a fatal disease. Its development encompasses a complex interplay between hemodynamic stimuli on and changes in the arterial wall. Currently available biomarkers fail to predict the risk of AAA rupture independent of aneurysm size. Therefore, novel biomarkers for AAA characterization are needed. In this study, we used a mouse model of AAA to investigate the potential of magnetic resonance imaging (MRI) with an albumin-binding probe to assess changes in vascular permeability at different stages of aneurysm growth. Two imaging studies were performed: a longitudinal study with follow-up and death as endpoint to predict rupture risk and a week-by-week study to characterize AAA development. AAAs, which eventually ruptured, demonstrated a significantly higher in vivo MR signal enhancement from the albumin-binding probe (p = 0.047) and a smaller nonenhancing thrombus area compared to intact AAAs (p = 0.001). The ratio of albumin-binding-probe enhancement of the aneurysm wall to size of nonenhancing-thrombus-area predicted AAA rupture with high sensitivity/specificity (100%/86%). More advanced aneurysms with higher vascular permeability demonstrated an increased uptake of the albumin-binding-probe. These results indicate that MRI with an albumin-binding probe may enable noninvasive assessment of vascular permeability in murine AAAs and prediction of rupture risk.
Collapse
|
12
|
Magnetic resonance imaging assessment of proteolytic enzyme concentrations and biologic properties of intraluminal thrombus in abdominal aortic aneurysms. J Vasc Surg 2020; 72:1025-1034. [PMID: 32067878 DOI: 10.1016/j.jvs.2019.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/04/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether magnetic resonance imaging (MRI) can be used in assessment of biologic activity of intraluminal thrombus (ILT) and proteolytic processes of the abdominal aortic aneurysm wall. METHODS Using MRI, 50 patients with asymptomatic infrarenal abdominal aortic aneurysm were analyzed at the maximum aneurysm diameter on T1-weighted images in the arterial phase after administration of contrast material. Relative ILT signal intensity (SI) was determined as the ratio between ILT SI and psoas muscle SI. During surgery, the full thickness of the ILT and the adjacent part of the aneurysm wall were harvested at the maximal diameter for biochemical analysis. The concentrations of matrix metalloproteinase 9 and neutrophil elastase (NE/ELA) were analyzed in harvested thrombi, and the concentrations of collagen type III, elastin, and proteoglycans were analyzed in harvested aneurysm walls. RESULTS A significant positive correlation was found between the NE/ELA concentration of the ILT and the relative SI (ρ = 0.309; P = .029). Furthermore, a negative correlation was observed between the elastin content of the aneurysm wall and the relative SI (ρ = -0.300; P = .034). No correlations were found between relative SI and concentration of matrix metalloproteinase 9, NE/ELA, collagen type III, or proteoglycan 4 in the aneurysm wall. CONCLUSIONS These findings indicate a potential novel use of MRI in prediction of thrombus proteolytic enzyme concentrations and the extracellular matrix content of the aneurysm wall, thus providing additional information for the risk of potential aneurysm rupture.
Collapse
|
13
|
Singh TP, Wong SA, Moxon JV, Gasser TC, Golledge J. Systematic review and meta-analysis of the association between intraluminal thrombus volume and abdominal aortic aneurysm rupture. J Vasc Surg 2019; 70:2065-2073.e10. [DOI: 10.1016/j.jvs.2019.03.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/19/2019] [Indexed: 01/08/2023]
|
14
|
Syed MBJ, Fletcher AJ, Forsythe RO, Kaczynski J, Newby DE, Dweck MR, van Beek EJR. Emerging techniques in atherosclerosis imaging. Br J Radiol 2019; 92:20180309. [PMID: 31502858 PMCID: PMC6849665 DOI: 10.1259/bjr.20180309] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis is a chronic immunomodulated disease that affects multiple vascular beds and results in a significant worldwide disease burden. Conventional imaging modalities focus on the morphological features of atherosclerotic disease such as the degree of stenosis caused by a lesion. Modern CT, MR and positron emission tomography scanners have seen significant improvements in the rapidity of image acquisition and spatial resolution. This has increased the scope for the clinical application of these modalities. Multimodality imaging can improve cardiovascular risk prediction by informing on the constituency and metabolic processes within the vessel wall. Specific disease processes can be targeted using novel biological tracers and "smart" contrast agents. These approaches have the potential to inform clinicians of the metabolic state of atherosclerotic plaque. This review will provide an overview of current imaging techniques for the imaging of atherosclerosis and how various modalities can provide information that enhances the depiction of basic morphology.
Collapse
Affiliation(s)
- Maaz BJ Syed
- British Heart Foundation Centre of Cardiovascular Science
| | | | | | | | | | - Marc R Dweck
- British Heart Foundation Centre of Cardiovascular Science
| | | |
Collapse
|
15
|
Leach JR, Kao E, Zhu C, Saloner D, Hope MD. On the Relative Impact of Intraluminal Thrombus Heterogeneity on Abdominal Aortic Aneurysm Mechanics. J Biomech Eng 2019; 141:111010. [PMID: 31253989 PMCID: PMC6808003 DOI: 10.1115/1.4044143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/14/2019] [Indexed: 01/31/2023]
Abstract
Intraluminal thrombus (ILT) is present in the majority of abdominal aortic aneurysms (AAA) of a size warranting consideration for surgical or endovascular intervention. The rupture risk of AAAs is thought to be related to the balance of vessel wall strength and the mechanical stress caused by systemic blood pressure. Previous finite element analyses of AAAs have shown that ILT can reduce and homogenize aneurysm wall stress. These works have largely considered ILT to be homogeneous in mechanical character or have idealized a stiffness distribution through the thrombus thickness. In this work, we use magnetic resonance imaging (MRI) to delineate the heterogeneous composition of ILT in 7 AAAs and perform patient-specific finite element analysis under multiple conditions of ILT layer stiffness disparity. We find that explicit incorporation of ILT heterogeneity in the finite element analysis is unlikely to substantially alter major stress analysis predictions regarding aneurysm rupture risk in comparison to models assuming a homogenous thrombus, provided that the maximal ILT stiffness is the same between models. Our results also show that under a homogeneous ILT assumption, the choice of ILT stiffness from values common in the literature can result in significantly larger variations in stress predictions compared to the effects of thrombus heterogeneity.
Collapse
Affiliation(s)
- Joseph R Leach
- Department of Radiology andBiomedical Imaging,University of California, San Francisco,513 Parnassus Avenue Suite S-261,Box 0628,San Francisco, CA 94143e-mail:
| | - Evan Kao
- Department of Radiology andBiomedical Imaging,University of California, San Francisco,San Francisco, CA 94143e-mail:
| | - Chengcheng Zhu
- Department of Radiology andBiomedical Imaging,University of California, San Francisco,San Francisco, CA 94143e-mail:
| | - David Saloner
- Department of Radiology andBiomedical Imaging,University of California, San Francisco,San Francisco, CA 94143e-mail:
| | - Michael D Hope
- Department of Radiology andBiomedical Imaging,University of California, San Francisco,San Francisco, CA 94143e-mail:
| |
Collapse
|
16
|
Zhu C, Cao L, Wen Z, Ahn S, Raithel E, Forman C, Hope M, Saloner D. Surveillance of abdominal aortic aneurysm using accelerated 3D non-contrast black-blood cardiovascular magnetic resonance with compressed sensing (CS-DANTE-SPACE). J Cardiovasc Magn Reson 2019; 21:66. [PMID: 31660983 PMCID: PMC6816154 DOI: 10.1186/s12968-019-0571-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 3D non-contrast high-resolution black-blood cardiovascular magnetic resonance (CMR) (DANTE-SPACE) has been used for surveillance of abdominal aortic aneurysm (AAA) and validated against computed tomography (CT) angiography. However, it requires a long scan time of more than 7 min. We sought to develop an accelerated sequence applying compressed sensing (CS-DANTE-SPACE) and validate it in AAA patients undergoing surveillance. METHODS Thirty-eight AAA patients (all males, 73 ± 6 years) under clinical surveillance were recruited for this study. All patients were scanned with DANTE-SPACE (scan time 7:10 min) and CS-DANTE-SPACE (scan time 4:12 min, a reduction of 41.4%). Nine 9 patients were scanned more than 2 times. In total, 50 pairs of images were available for comparison. Two radiologists independently evaluated the image quality on a 1-4 scale, and measured the maximal diameter of AAA, the intra-luminal thrombus (ILT) and lumen area, ILT-to-muscle signal intensity ratio, and the ILT-to-lumen contrast ratio. The sharpness of the aneurysm inner/outer boundaries was quantified. RESULTS CS-DANTE-SPACE achieved comparable image quality compared with DANTE-SPACE (3.15 ± 0.67 vs. 3.03 ± 0.64, p = 0.06). There was excellent agreement between results from the two sequences for diameter/area and ILT ratio measurements (ICCs> 0.85), and for quantifying growth rate (3.3 ± 3.1 vs. 3.3 ± 3.4 mm/year, ICC = 0.95.) CS-DANTE-SPACE showed a higher ILT-to-lumen contrast ratio (p = 0.01) and higher sharpness than DANTE-SPACE (p = 0.002). Both sequences had excellent inter-reader reproducibility for quantitative measurements (ICC > 0.88). CONCLUSION CS-DANTE-SPACE can reduce scan time while maintaining image quality for AAA imaging. It is a promising tool for the surveillance of patients with AAA disease in the clinical setting.
Collapse
Affiliation(s)
- Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, UCSF, 4150 Clement Street, San Francisco, CA 94121 USA
| | - Lizhen Cao
- Department of Radiology and Biomedical Imaging, UCSF, 4150 Clement Street, San Francisco, CA 94121 USA
- Department of Radiology, Xuanwu Hospital, Beijing, China
| | - Zhaoying Wen
- Department of Radiology and Biomedical Imaging, UCSF, 4150 Clement Street, San Francisco, CA 94121 USA
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, 100029 China
| | | | | | | | - Michael Hope
- Department of Radiology and Biomedical Imaging, UCSF, 4150 Clement Street, San Francisco, CA 94121 USA
| | - David Saloner
- Department of Radiology and Biomedical Imaging, UCSF, 4150 Clement Street, San Francisco, CA 94121 USA
| |
Collapse
|
17
|
Zhu C, Leach JR, Tian B, Cao L, Wen Z, Wang Y, Liu X, Liu Q, Lu J, Saloner D, Hope MD. Evaluation of the distribution and progression of intraluminal thrombus in abdominal aortic aneurysms using high-resolution MRI. J Magn Reson Imaging 2019; 50:994-1001. [PMID: 30694008 DOI: 10.1002/jmri.26676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Intraluminal thrombus (ILT) signal intensity on MRI has been studied as a potential marker of abdominal aortic aneurysm (AAA) progression. PURPOSE 1) To characterize the relationship between ILT signal intensity and AAA diameter; 2) to evaluate ILT change over time; and 3) to assess the relationship between ILT features and AAA growth. STUDY TYPE Prospective. SUBJECTS Eighty AAA patients were imaged, and a subset (n = 41) were followed with repeated MRI for 16 ± 9 months. FIELD STRENGTH/SEQUENCE 3D black-blood fast-spin-echo sequence at 3 T. ASSESSMENT ILT was designated as "bright" if the signal was greater than 1.2 times that of adjacent psoas muscle. AAAs were divided into three groups based on ILT: Type 1: bright ILT; Type 2: isointense ILT; Type 3: no ILT. During follow-up, an active ILT change was defined as new ILT formation or an increase in ILT signal intensity to bright; stable ILT was defined as no change in ILT type or ILT became isointense from bright previously. STATISTICAL TESTS Shapiro-Wilk test; Mann-Whitney U-test; Fisher's exact test; Kruskal-Wallis test; Spearman's r; intraclass correlation coefficient (ICC), Cohen's kappa. RESULTS AAAs with Type 1 ILT were larger than those with Types 2 and 3 ILT (5.1 ± 1.1 cm, 4.4 ± 0.9 cm, 4.2 ± 0.8 cm, P = 0.008). The growth rate of AAAs with Type 1 ILT was significantly greater than that of AAAs with Types 2 and 3 ILT (2.6 ± 2.5, 0.6 ± 1.3, 1.5 ± 0.6 mm/year, P = 0.01). During follow-up, AAAs with active ILT changes had a 3-fold increased growth rate compared with AAAs with stable ILT (3.6 ± 3.0 mm/year vs. 1.2 ± 1.5 mm/year, P = 0.008). DATA CONCLUSION AAAs with bright ILT are larger in diameter and grow faster. Active ILT change is associated with faster AAA growth. Black-blood MRI can characterize ILT features and monitor their change over time, which may provide new insights into AAA risk assessment. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019;50:994-1001.
Collapse
Affiliation(s)
- Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Joseph R Leach
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Bing Tian
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Lizhen Cao
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Zhaoying Wen
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA.,Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yan Wang
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Xinke Liu
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA.,Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi Liu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - David Saloner
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| |
Collapse
|
18
|
|
19
|
Ghulam QM, Bredahl K, Sandholt B, Taudorf M, Lönn L, Rouet L, Sillesen H, Eiberg JP. Contrast Enhanced Three Dimensional Ultrasound for Intraluminal Thrombus Assessment in Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2018; 56:673-680. [PMID: 30166213 DOI: 10.1016/j.ejvs.2018.07.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 07/21/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The impact of intraluminal thrombus (ILT) on abdominal aortic aneurysm (AAA) progression can be investigated non-invasively by three dimensional contrast enhanced ultrasound (3D-CEUS). The aim was to validate 3D-CEUS ILT volume and thickness measurements against computed tomography angiography (CTA), and to determine inter- and intra-operator reproducibility. METHODS The design was for a planned comparison of 3D-CEUS and CTA and of repeated 3D-CEUS measurements in a blinded set up. Consecutive patients with asymptomatic AAA (n = 137, maximum diameter 30-55 mm) from a single centre were consecutively assessed by CTA and 3D-CEUS in a blinded setup. After exclusion of failed CTA (n = 2) and inconclusive 3D-CEUS (n = 8), 127 3D-CEUS/CTA pairs were analysed by Bland-Altman plots. 3D-CEUS inter- and intra-operator reproducibility were determined in a subgroup (n = 30) measured twice by two blinded investigators. RESULTS In 24 of 127 (19%) patients, no ILT was found on 3D-CEUS. Intraluminal thrombus absence was confirmed by 3D-CTA analysis in all but two cases. Mean ILT volume difference between 3D-CEUS and CTA was 2.2 mL (5% of mean volume) and range of variability (ROV) amounted to ± 10.2 mL. Mean ILT thickness difference was 0.6 mm with a ROV of ± 4.6 mm 3D-CEUS inter-operator variations of ILT volume and thickness measurements were low (ROV ± 8.8 mL and ±2.9 mm, respectively). The corresponding intra-operator ROVs were ±7.5 mL and ±3.3 mm, respectively. CONCLUSIONS 3D-CEUS demonstrated good reproducibility and a good agreement with CTA when estimating ILT volume and maximum thickness in AAA patients. It is a promising research tool to investigate potential interactions between ILT, AAA growth, and rupture.
Collapse
Affiliation(s)
- Qasam M Ghulam
- Department of Vascular Surgery, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Kim Bredahl
- Department of Vascular Surgery, Rigshospitalet, Denmark
| | - Benjamin Sandholt
- Department of Vascular Surgery, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Lars Lönn
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Radiology, Rigshospitalet, Denmark
| | | | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jonas P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy of Medical Education and Simulation (CAMES), Capital Region of Denmark, Copenhagen, Denmark
| |
Collapse
|
20
|
Groeneveld ME, Meekel JP, Rubinstein SM, Merkestein LR, Tangelder GJ, Wisselink W, Truijers M, Yeung KK. Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture. J Am Heart Assoc 2018; 7:JAHA.117.007791. [PMID: 29960996 PMCID: PMC6064909 DOI: 10.1161/jaha.117.007791] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The natural course of abdominal aortic aneurysms (AAA) is growth and rupture if left untreated. Numerous markers have been investigated; however, none are broadly acknowledged. Our aim was to identify potential prognostic markers for AAA growth and rupture. METHODS AND RESULTS Potential circulating, biomechanical, and genetic markers were studied. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library in February 2017, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study selection, data extraction, and methodological quality assessment were conducted by 2 independent researchers. Plausibility of markers was based on the amount of publications regarding the marker (more than 3), pooled sample size (more than 100), bias risk and statistical significance of the studies. Eighty-two studies were included, which examined circulating (n=40), biomechanical (n=27), and genetic markers (n=7) and combinations of markers (n=8). Factors with an increased expansion risk included: AAA diameter (9 studies; n=1938; low bias risk), chlamydophila pneumonia (4 studies; n=311; medium bias risk), S-elastin peptides (3 studies; n=205; medium bias risk), fluorodeoxyglucose uptake (3 studies; n=104; medium bias risk), and intraluminal thrombus size (5 studies; n=758; medium bias risk). Factors with an increased rupture risk rupture included: peak wall stress (9 studies; n=579; medium bias risk) and AAA diameter (8 studies; n=354; medium bias risk). No meta-analysis was conducted because of clinical and methodological heterogeneity. CONCLUSIONS We identified 5 potential markers with a prognostic value for AAA growth and 2 for rupture. While interpreting these data, one must realize that conclusions are based on small sample sizes and clinical and methodological heterogeneity. Prospective and methodological consonant studies are strongly urged to further study these potential markers.
Collapse
Affiliation(s)
- Menno E Groeneveld
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands.,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Jorn P Meekel
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands.,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Sidney M Rubinstein
- Department of Health Sciences and Amsterdam Public Health research institute, VU University, Amsterdam, The Netherlands
| | - Lisanne R Merkestein
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Geert Jan Tangelder
- Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Willem Wisselink
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Maarten Truijers
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Kak Khee Yeung
- Department of Vascular Surgery, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands .,Department of Physiology, Amsterdam Cardiovascular Sciences (ACS), VU University Medical Center (VUmc), Amsterdam, The Netherlands
| |
Collapse
|
21
|
Francois CJ, Skulborstad EP, Majdalany BS, Chandra A, Collins JD, Farsad K, Gerhard-Herman MD, Gornik HL, Kendi AT, Khaja MS, Lee MH, Sutphin PD, Kapoor BS, Kalva SP. ACR Appropriateness Criteria ® Abdominal Aortic Aneurysm: Interventional Planning and Follow-Up. J Am Coll Radiol 2018; 15:S2-S12. [DOI: 10.1016/j.jacr.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/17/2022]
|
22
|
Domagała Z, Stępak H, Drapikowski P, Kociemba A, Pyda M, Karmelita-Katulska K, Dzieciuchowicz Ł, Oszkinis G. Geometric verification of the validity of Finite Element Method analysis of Abdominal Aortic Aneurysms based on Magnetic Resonance Imaging. Biocybern Biomed Eng 2018. [DOI: 10.1016/j.bbe.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
23
|
Paraskevas KI, Torella F, Swaelens C, England A, Chan TY, Shaikh U, McWilliams RG, Fisher RK. Temporal Changes in Intraluminal Thrombus Volume Within Abdominal Aortic Aneurysms: Implications for Planning Endovascular Aneurysm Sealing. J Endovasc Ther 2017; 25:47-51. [PMID: 29251206 DOI: 10.1177/1526602817748585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore whether or not there are temporal changes in the abdominal aortic aneurysm (AAA) and intraluminal thrombus (ILT) volumes between planning and implantation of the endovascular aneurysm sealing (EVAS) device and how these changes influence lumen volume. METHODS A retrospective review was conducted of 51 AAA patients (mean age 76±7.1 years; 36 men) in whom 2 serial preoperative computed tomography angiograms (CTAs) had been performed within 1 to 18 months before fenestrated endovascular repair. The 2 preoperative CTAs were analyzed to identify changes in total sac, ILT, and lumen volumes. RESULTS Over a median 7.0 months (interquartile range 4, 10), 46 (90%) of 51 AAAs increased in volume between the 2 CTAs. ILT volume increased in 44 aneurysms. In contrast, lumen volume increased in 31 and decreased in 20 AAAs. There was a strong correlation between changes in AAA volume and ILT volume (rs=0.859, p<0.001), which remained significant after adjustment for initial volumes (rs=0.815; p<0.001). There was no correlation between the time interval separating the 2 CTAs and changes in AAA volume (rs=0.115; p=0.421), changes in ILT volume (rs=0.084; p=0.599), or changes in lumen volume (rs=0.060; p=0.676). The AAA growth rate (defined as the change in AAA size/days between CTAs) showed a weak correlation with ILT volume (rs=0.272, p=0.054), which disappeared after adjustment for initial AAA size (rs=-0.002, p=0.991). Between the 2 CTAs, 12 aneurysms crossed the new <1.4 Nellix maximum aorta/lumen diameter ratio. CONCLUSION As AAAs grow, the increase in aortic volume is largely occupied by additional ILT formation, with minimal change in lumen volume. These changes may alter the suitability of the aneurysm for the Nellix device and could have implications for EVAS planning and device deployment.
Collapse
Affiliation(s)
- Kosmas I Paraskevas
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | - Francesco Torella
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | - Charles Swaelens
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Tze Y Chan
- 3 Department of Radiology, Royal Liverpool University Hospital, Liverpool, UK
| | - Usman Shaikh
- 3 Department of Radiology, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Robert K Fisher
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| |
Collapse
|
24
|
Behr-Andersen C, Gammelgaard L, Fründ ET, Dahl M, Lindholt JS. Magnetic resonance imaging of the intraluminal thrombus in abdominal aortic aneurysms: a quantitative and qualitative evaluation and correlation with growth rate. THE JOURNAL OF CARDIOVASCULAR SURGERY 2017; 60:221-229. [PMID: 28847145 DOI: 10.23736/s0021-9509.17.09921-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The role of the intraluminal thrombus (ILT) in abdominal aortic aneurysm (AAA) growth remains incompletely understood. MRI is superior to other methods in depicting the morphology of the ILT. This study brings preliminary, but novel information on the presence and morphological characteristics of the ILT and AAA growth rates in a screening cohort. METHODS Cohort study with 46 patients from the Viborg Vascular Trial. All underwent one non-contrast-enhanced magnetic resonance imaging (MRI) at the end of follow-up. ILT presence was noted and, if present, it was allocated to one of four morphological categories based on visual appearance and signal intensity on T2 weighted images. RESULTS The mean growth rate was 1.95 mm/year ±0.87 (SD). The observation time was 5.59±0.63 (SD) years. ILT was present in AAA size groups as follows: 30-34.9 mm 20.00%, 35-39.9 mm 88.89%, 40-44.9 mm 81.25%, 45-49.9 mm 100% and 50-54.9 mm 100%. Out of 46, 8 had no ILT at the time of MRI. The presence of any sort of ILT yielded a significantly increased unadjusted and an adjusted growth rate of 1.09 mm/year (95% CI: 0.48; 1.70) and 1.24 mm/year (95% CI: 0.64; 1.83), respectively. All four thrombus types were retrospectively associated with an increased recorded growth rate compared with "no thrombus". Presence of a thin circumferential thrombus was retrospectively associated with the highest increase in growth rate, viz. 2.09 mm/year (95% CI: 1.23; 2.95). CONCLUSIONS We observed faster growth rate in those AAA that had developed an ILT. Even faster growth was observed amongst those AAA containing a thin ILT located along the inner circumference.
Collapse
Affiliation(s)
- Carsten Behr-Andersen
- Cardiovascular Research Center, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark -
| | - Lise Gammelgaard
- Department of Radiology, Viborg Regional Hospital, Viborg, Denmark
| | - Ernst T Fründ
- Elitary Research Center of Individualized Treatment of Arterial Diseases (CIMA), Cardiovascular Center of Excellence (CAVAC), Department of Heart, Lung and Vascular Surgery, University Hospital of Odense, Denmark
| | - Marie Dahl
- Cardiovascular Research Center, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Jes S Lindholt
- Cardiovascular Research Center, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark.,Elitary Research Center of Individualized Treatment of Arterial Diseases (CIMA), Cardiovascular Center of Excellence (CAVAC), Department of Heart, Lung and Vascular Surgery, University Hospital of Odense, Denmark
| |
Collapse
|
25
|
Wang Y, Seguro F, Kao E, Zhang Y, Faraji F, Zhu C, Haraldsson H, Hope M, Saloner D, Liu J. Segmentation of lumen and outer wall of abdominal aortic aneurysms from 3D black-blood MRI with a registration based geodesic active contour model. Med Image Anal 2017; 40:1-10. [PMID: 28549310 DOI: 10.1016/j.media.2017.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 05/05/2017] [Accepted: 05/12/2017] [Indexed: 11/24/2022]
Abstract
Segmentation of the geometric morphology of abdominal aortic aneurysm is important for interventional planning. However, the segmentation of both the lumen and the outer wall of aneurysm in magnetic resonance (MR) image remains challenging. This study proposes a registration based segmentation methodology for efficiently segmenting MR images of abdominal aortic aneurysms. The proposed methodology first registers the contrast enhanced MR angiography (CE-MRA) and black-blood MR images, and then uses the Hough transform and geometric active contours to extract the vessel lumen by delineating the inner vessel wall directly from the CE-MRA. The proposed registration based geometric active contour is applied to black-blood MR images to generate the outer wall contour. The inner and outer vessel wall are then fused presenting the complete vessel lumen and wall segmentation. The results obtained from 19 cases showed that the proposed registration based geometric active contour model was efficient and comparable to manual segmentation and provided a high segmentation accuracy with an average Dice value reaching 89.79%.
Collapse
Affiliation(s)
- Yan Wang
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States.
| | - Florent Seguro
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
| | - Evan Kao
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States; University of California, Berkeley; San Francisco, United States
| | - Yue Zhang
- Veterans Affairs Medical Center, San Francisco, United States
| | - Farshid Faraji
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
| | - Chengcheng Zhu
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
| | - Henrik Haraldsson
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
| | - Michael Hope
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
| | - David Saloner
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States; Veterans Affairs Medical Center, San Francisco, United States
| | - Jing Liu
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
| |
Collapse
|
26
|
Zhu C, Tian B, Leach JR, Liu Q, Lu J, Chen L, Saloner D, Hope MD. Non-contrast 3D black blood MRI for abdominal aortic aneurysm surveillance: comparison with CT angiography. Eur Radiol 2017; 27:1787-1794. [PMID: 27553926 PMCID: PMC5323367 DOI: 10.1007/s00330-016-4559-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/04/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Management of abdominal aortic aneurysms (AAAs) is based on diameter. CT angiography (CTA) is commonly used, but requires radiation and iodinated contrast. Non-contrast MRI is an appealing alternative that may allow better characterization of intraluminal thrombus (ILT). This study aims to 1) validate non-contrast MRI for measuring AAA diameter, and 2) to assess ILT with CTA and MRI. METHOD 28 patients with AAAs (diameter 50.7 ± 12.3 mm) underwent CTA and non-contrast MRI. MRI was acquired at 3 T using 1) a conventional 3D gradient echo (GRE) sequence and 2) a 3D T1-weighted black blood fast-spin-echo sequence. Two radiologists independently measured the AAA diameter. The ratio of signal of ILT and adjacent psoas muscle (ILTr = signalILT/signalMuscle) was quantified. RESULTS Strong agreement between CTA and non-contrast MRI was shown for AAA diameter (intra-class coefficient > 0.99). Both approaches had excellent inter-observer reproducibility (ICC > 0.99). ILT appeared homogenous on CTA, whereas MRI revealed compositional variations. Patients with AAAs ≥5.5 cm and <5.5 cm had a variety of distributions of old/fresh ILT types. CONCLUSIONS Non-contrast 3D black blood MRI provides accurate and reproducible AAA diameter measurements as validated by CTA. It also provides unique information about ILT composition, which may be linked with elevated risk for disease progression. KEY POINTS • Non-contrast MRI is an appealing alternative to CTA for AAA management. • Non-contrast MRI can accurately measure AAA diameters compared to CTA. • MRI affords unique characterization of intraluminal thrombus composition.
Collapse
Affiliation(s)
- Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, Room BA34, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Bing Tian
- Department of Radiology, Changhai Hospital, 168 Changhai Road, Shanghai, China 200433
| | - Joseph R. Leach
- Department of Radiology and Biomedical Imaging, University of California San Francisco, Room BA34, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Qi Liu
- Department of Radiology, Changhai Hospital, 168 Changhai Road, Shanghai, China 200433
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, 168 Changhai Road, Shanghai, China 200433
| | - Luguang Chen
- Department of Radiology, Changhai Hospital, 168 Changhai Road, Shanghai, China 200433
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, Room BA34, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
- Radiology Service, VA Medical Center, San Francisco, CA, USA
| | - Michael D. Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, Room BA34, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
| |
Collapse
|
27
|
Wanhainen A, Mani K, Golledge J. Surrogate Markers of Abdominal Aortic Aneurysm Progression. Arterioscler Thromb Vasc Biol 2016; 36:236-44. [DOI: 10.1161/atvbaha.115.306538] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/14/2015] [Indexed: 12/25/2022]
Abstract
The natural course of many abdominal aortic aneurysms (AAA) is to gradually expand and eventually rupture and monitoring the disease progression is essential to their management. In this publication, we review surrogate markers of AAA progression. AAA diameter remains the most widely used and important marker of AAA growth. Standardized reporting of reproducible methods of measuring AAA diameter is essential. Newer imaging assessments, such as volume measurements, biomechanical analyses, and functional and molecular imaging, as well as circulating biomarkers, have potential to add important information about AAA progression. Currently, however, there is insufficient evidence to recommend their routine use in clinical practice.
Collapse
Affiliation(s)
- Anders Wanhainen
- From the Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (A.W., K.M.); The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia (J.G.)
| | - Kevin Mani
- From the Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (A.W., K.M.); The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia (J.G.)
| | - Jonathan Golledge
- From the Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (A.W., K.M.); The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia (J.G.)
| |
Collapse
|
28
|
Salloum E, Bertrand-Grenier A, Lerouge S, Kauffman C, Héon H, Therasse E, Salazkin I, Roy Cardinal MH, Cloutier G, Soulez G. Endovascular Repair of Abdominal Aortic Aneurysm: Follow-up with Noninvasive Vascular Elastography in a Canine Model. Radiology 2015; 279:410-9. [PMID: 26690905 DOI: 10.1148/radiol.2015142098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the ability of noninvasive vascular elastography (NIVE) to help characterize endoleaks and thrombus organization in a canine model of abdominal aortic aneurysm after endovascular aneurysm repair with stent-grafts, in comparison with computed tomography (CT) and pathologic examination findings. MATERIALS AND METHODS All protocols were approved by the Animal Care Committee in accordance with the guidelines of the Canadian Council of Animal Care. Stent-grafts were implanted in a group of 18 dogs with aneurysms created in the abdominal aorta. Type I endoleak was created in four aneurysms; type II endoleak, in 13 aneurysms; and no endoleak, in one aneurysm. Doppler ultrasonography and NIVE examinations were performed at baseline and at 1-week, 1-month, 3-month, and 6-month follow-up. Angiography, CT, and macroscopic tissue examination were performed at sacrifice. Strain values were computed by using the Lagrangian speckle model estimator. Areas of endoleak, solid organized thrombus, and fresh thrombus were identified and segmented by comparing the results of CT and macroscopic tissue examination. Strain values were compared by using the Wilcoxon rank-sum and Kruskal-Wallis tests. RESULTS All stent-grafts were successfully deployed, and endoleaks were clearly depicted in the last follow-up elastography examinations. Maximal axial strains over consecutive heart cycles in endoleak, organized thrombus, and fresh thrombus areas were 0.78% ± 0.22, 0.23% ± 0.02, 0.10% ± 0.04, respectively. Strain values were significantly different between endoleak and organized or fresh thrombus areas (P < .000) and between organized and fresh thrombus areas (P < .0002). No correlation was found between strain values and type of endoleak, sac pressure, endoleak size, and aneurysm size. CONCLUSION NIVE may be able to help characterize endoleak and thrombus organization, regardless of the size, pressure, and type of endoleak.
Collapse
Affiliation(s)
- Eli Salloum
- From the Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (E.S., A.B., C.K., E.T., G.C., G.S.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (E.T., G.S.); Centre de Recherche de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, Canada H2X 0A9 (E.S., A.B., S.L., C.K., H.H., E.T., I.S., M.H.R.C., G.C., G.S.); Laboratory of Biorheology and Medical Ultrasonics (E.S., A.B., M.H.R.C., G.C.) and Clinical Image Processing Laboratory (E.S., A.B., C.K., G.S.), Centre de Recherche de l'Université de Montréal, Montreal, Quebec, Canada; and Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada (S.L.)
| | - Antony Bertrand-Grenier
- From the Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (E.S., A.B., C.K., E.T., G.C., G.S.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (E.T., G.S.); Centre de Recherche de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, Canada H2X 0A9 (E.S., A.B., S.L., C.K., H.H., E.T., I.S., M.H.R.C., G.C., G.S.); Laboratory of Biorheology and Medical Ultrasonics (E.S., A.B., M.H.R.C., G.C.) and Clinical Image Processing Laboratory (E.S., A.B., C.K., G.S.), Centre de Recherche de l'Université de Montréal, Montreal, Quebec, Canada; and Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada (S.L.)
| | - Sophie Lerouge
- From the Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (E.S., A.B., C.K., E.T., G.C., G.S.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (E.T., G.S.); Centre de Recherche de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, Canada H2X 0A9 (E.S., A.B., S.L., C.K., H.H., E.T., I.S., M.H.R.C., G.C., G.S.); Laboratory of Biorheology and Medical Ultrasonics (E.S., A.B., M.H.R.C., G.C.) and Clinical Image Processing Laboratory (E.S., A.B., C.K., G.S.), Centre de Recherche de l'Université de Montréal, Montreal, Quebec, Canada; and Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada (S.L.)
| | - Claude Kauffman
- From the Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (E.S., A.B., C.K., E.T., G.C., G.S.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (E.T., G.S.); Centre de Recherche de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, Canada H2X 0A9 (E.S., A.B., S.L., C.K., H.H., E.T., I.S., M.H.R.C., G.C., G.S.); Laboratory of Biorheology and Medical Ultrasonics (E.S., A.B., M.H.R.C., G.C.) and Clinical Image Processing Laboratory (E.S., A.B., C.K., G.S.), Centre de Recherche de l'Université de Montréal, Montreal, Quebec, Canada; and Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada (S.L.)
| | - Hélène Héon
- From the Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (E.S., A.B., C.K., E.T., G.C., G.S.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (E.T., G.S.); Centre de Recherche de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, Canada H2X 0A9 (E.S., A.B., S.L., C.K., H.H., E.T., I.S., M.H.R.C., G.C., G.S.); Laboratory of Biorheology and Medical Ultrasonics (E.S., A.B., M.H.R.C., G.C.) and Clinical Image Processing Laboratory (E.S., A.B., C.K., G.S.), Centre de Recherche de l'Université de Montréal, Montreal, Quebec, Canada; and Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada (S.L.)
| | - Eric Therasse
- From the Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (E.S., A.B., C.K., E.T., G.C., G.S.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (E.T., G.S.); Centre de Recherche de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, Canada H2X 0A9 (E.S., A.B., S.L., C.K., H.H., E.T., I.S., M.H.R.C., G.C., G.S.); Laboratory of Biorheology and Medical Ultrasonics (E.S., A.B., M.H.R.C., G.C.) and Clinical Image Processing Laboratory (E.S., A.B., C.K., G.S.), Centre de Recherche de l'Université de Montréal, Montreal, Quebec, Canada; and Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada (S.L.)
| | - Igor Salazkin
- From the Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (E.S., A.B., C.K., E.T., G.C., G.S.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (E.T., G.S.); Centre de Recherche de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, Canada H2X 0A9 (E.S., A.B., S.L., C.K., H.H., E.T., I.S., M.H.R.C., G.C., G.S.); Laboratory of Biorheology and Medical Ultrasonics (E.S., A.B., M.H.R.C., G.C.) and Clinical Image Processing Laboratory (E.S., A.B., C.K., G.S.), Centre de Recherche de l'Université de Montréal, Montreal, Quebec, Canada; and Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada (S.L.)
| | - Marie-Hélène Roy Cardinal
- From the Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (E.S., A.B., C.K., E.T., G.C., G.S.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (E.T., G.S.); Centre de Recherche de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, Canada H2X 0A9 (E.S., A.B., S.L., C.K., H.H., E.T., I.S., M.H.R.C., G.C., G.S.); Laboratory of Biorheology and Medical Ultrasonics (E.S., A.B., M.H.R.C., G.C.) and Clinical Image Processing Laboratory (E.S., A.B., C.K., G.S.), Centre de Recherche de l'Université de Montréal, Montreal, Quebec, Canada; and Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada (S.L.)
| | - Guy Cloutier
- From the Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (E.S., A.B., C.K., E.T., G.C., G.S.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (E.T., G.S.); Centre de Recherche de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, Canada H2X 0A9 (E.S., A.B., S.L., C.K., H.H., E.T., I.S., M.H.R.C., G.C., G.S.); Laboratory of Biorheology and Medical Ultrasonics (E.S., A.B., M.H.R.C., G.C.) and Clinical Image Processing Laboratory (E.S., A.B., C.K., G.S.), Centre de Recherche de l'Université de Montréal, Montreal, Quebec, Canada; and Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada (S.L.)
| | - Gilles Soulez
- From the Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, Université de Montréal, Montreal, Quebec, Canada (E.S., A.B., C.K., E.T., G.C., G.S.); Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (E.T., G.S.); Centre de Recherche de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, Canada H2X 0A9 (E.S., A.B., S.L., C.K., H.H., E.T., I.S., M.H.R.C., G.C., G.S.); Laboratory of Biorheology and Medical Ultrasonics (E.S., A.B., M.H.R.C., G.C.) and Clinical Image Processing Laboratory (E.S., A.B., C.K., G.S.), Centre de Recherche de l'Université de Montréal, Montreal, Quebec, Canada; and Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Quebec, Canada (S.L.)
| |
Collapse
|
29
|
Isotropic 3D black blood MRI of abdominal aortic aneurysm wall and intraluminal thrombus. Magn Reson Imaging 2015; 34:18-25. [PMID: 26471514 DOI: 10.1016/j.mri.2015.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/07/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The aortic wall and intraluminal thrombus (ILT) have been increasingly studied as potential markers of progressive disease with abdominal aortic aneurysms (AAAs). Our goal was to develop a high resolution, 3D black blood MR technique for AAA wall and ILT imaging within a clinically acceptable scan time. METHODS Twenty two patients with AAAs (maximal diameter 4.3±1.0cm), along with five healthy volunteers, were imaged at 3T with a 3D T1-weighted fast-spin-echo sequence using variable flip angle trains (SPACE) with a preparation pulse (DANTE) for suppressing blood signal. Volunteers and ten patients were also scanned with SPACE alone for comparison purposes. The signal to noise ratio (SNR) and the aortic wall/ILT to lumen contrast to noise ratio (CNR) were measured. Qualitative image scores (1-4 scale) assessing the inner lumen and outer wall boundaries of AAA were performed by two blinded reviewers. In patients with ILT, the ratio of ILT signal intensity (ILTSI) over psoas muscle SI (MuscleSI) was calculated, and the signal heterogeneity of ILT was quantified as standard deviation (SD) over the mean. RESULTS All subjects were imaged successfully with an average scan time of 7.8±0.7minutes. The DANTE preparation pulse for blood suppression substantially reduced flow artifacts in SPACE with lower lumen SNR (8.8 vs. 21.4, p<0.001) and improved the wall/ILT to lumen CNR (9.9 vs. 6.3, p<0.001) in patients. Qualitative assessment showed improved visualization of lumen boundaries (73% higher scores on average, p=0.01) and comparable visualization of outer wall boundary (p>0.05). ILT was present in ten patients, with relatively high signal and a wide SD (average ILTSI/MuscleSI 1.42±0.48 (range 0.75-2.11)) and with SD/mean of 27.7%±6.6% (range 19.6%-39.4%). CONCLUSION High resolution, 3D black blood MRI of AAAs can be achieved in a clinical accepted scan time with reduction of flow artifacts using the DANTE preparation pulse. Signal characteristics of ILT can be quantified and may be used for improved patient-specific risk stratification.
Collapse
|
30
|
Multimodality imaging assessment of the deleterious role of the intraluminal thrombus on the growth of abdominal aortic aneurysm in a rat model. Eur Radiol 2015; 26:2378-86. [PMID: 26396112 DOI: 10.1007/s00330-015-4010-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate imaging changes occurring in a rat model of elastase-induced abdominal aortic aneurysm (AAA), with emphasis on the intraluminal thrombus (ILT) occurrence. METHODS The post-induction growth of the AAA diameter was characterized using ultrasound in 22 rats. ILT was reported on 13 rats that underwent 14 magnetic resonance imaging (MRI) 2-18 days post-surgery, and on 10 rats that underwent 18 fluoro-deoxyglucose (FDG) positron emission tomography (PET)/microcomputed tomography examinations 2-27 days post-surgery. Logistic regressions were used to establish the evolution with time of AAA length, diameter, ILT thickness, volume, stratification, MRI and FDG PET signalling properties, and histological assessment of inflammatory infiltrates. RESULTS All of the following significantly increased with time post-induction (p < 0.001): AAA length, AAA diameter, ILT maximal thickness, ILT volume, ILT iron content and related MRI signalling changes, quantitative uptake on FDG PET, and the magnitude of inflammatory infiltrates on histology. However, the aneurysm growth peak followed occurrence of ILT approximately 6 days after elastase infusion. CONCLUSION Our model emphasizes that occurrence of ILT precedes AAA peak growth. Aneurysm growth is associated with increasing levels of iron, signalling properties changes in both MRI and FDG PET, relating to its biological activities. KEY POINTS • ILT occurrence in AAA is associated with increasing FDG uptake and growth. • MRI signalling changes in ILT reflect activities such as haemorrhage and RBC trapping. • Monitoring ILT activities using MRI may require no exogenous contrast agent.
Collapse
|
31
|
Georg Y, Delay C, Schwein A, Lejay A, Thaveau F, Gaertner S, Stephan D, Heim F, Chakfe N. [Contribution of mathematical models and biomechanical properties in predicting the risk of abdominal aortic aneurysm rupture]. ACTA ACUST UNITED AC 2015; 41:63-8. [PMID: 26318549 DOI: 10.1016/j.jmv.2015.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 07/17/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Rupture is the worst outcome of abdominal aortic aneurysm (AAA). The decision to operate should include counterbalancing the risk of aneurysm rupture against the risk of aneurysm repair, within the context of a patient's overall life expectancy. Current surgical guidelines are based on population studies, and important variables are missed in predicting individual risk of rupture. METHODS In this literature review, we focused on the contribution of biomechanical and mathematical models in predicting risk of AAA rupture. RESULTS Anatomical features as diameter asymmetry and lack of tortuosity are shown to be anatomical risk factors of rupture. Wall stiffness (due to modifications of elastin and collagen composition) and increased inflammatory response are also factors that affect the structural integrity of the AAA wall. Biomechanical studies showed that wall strength is lower in ruptured than non-ruptured AAA. Intra-luminal thrombus also has a big role to play in the occurrence of rupture. Current mathematical models allow more variables to be included in predicting individual risk of rupture. CONCLUSION Moving away from using maximal transverse diameter of the AAA as a unique predictive factor and instead including biological, structural and biomechanical variables in predicting individual risk of rupture will be essential in the future and will help gain precision and accuracy in surgical indications.
Collapse
Affiliation(s)
- Y Georg
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - C Delay
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - A Schwein
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - A Lejay
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - F Thaveau
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - S Gaertner
- Service des maladies vasculaires, hypertension artérielle et pharmacologie clinique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - D Stephan
- Service des maladies vasculaires, hypertension artérielle et pharmacologie clinique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - F Heim
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Laboratoire de physique et mécanique textile, ENSISA, 11, rue Alfred-Werner, 68093 Mulhouse cedex, France
| | - N Chakfe
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France.
| |
Collapse
|
32
|
Commentary on "Abdominal aortic aneurysms with high thrombus signal intensity on magnetic resonance imaging are associated with high growth." The devil is in the detail. Eur J Vasc Endovasc Surg 2014; 48:685-6. [PMID: 25179769 DOI: 10.1016/j.ejvs.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/01/2014] [Indexed: 11/21/2022]
|