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de Azevedo FS, Almeida GDC, Alvares de Azevedo B, Ibanez Aguilar IF, Azevedo BN, Teixeira PS, Camargo GC, Correia MG, Nieckele AO, Oliveira GMM. Stress Load and Ascending Aortic Aneurysms: An Observational, Longitudinal, Single-Center Study Using Computational Fluid Dynamics. Bioengineering (Basel) 2024; 11:204. [PMID: 38534478 DOI: 10.3390/bioengineering11030204] [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: 12/27/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 03/28/2024] Open
Abstract
Ascending aortic aneurysm (AAoA) is a silent disease with high mortality; however, the factors associated with a worse prognosis are not completely understood. The objective of this observational, longitudinal, single-center study was to identify the hemodynamic patterns and their influence on AAoA growth using computational fluid dynamics (CFD), focusing on the effects of geometrical variations on aortic hemodynamics. Personalized anatomic models were obtained from angiotomography scans of 30 patients in two different years (with intervals of one to three years between them), of which 16 (53%) showed aneurysm growth (defined as an increase in the ascending aorta volume by 5% or more). Numerically determined velocity and pressure fields were compared with the outcome of aneurysm growth. Through a statistical analysis, hemodynamic characteristics were found to be associated with aneurysm growth: average and maximum high pressure (superior to 100 Pa); average and maximum high wall shear stress (superior to 7 Pa) combined with high pressure (>100 Pa); and stress load over time (maximum pressure multiplied by the time interval between the exams). This study provides insights into a worse prognosis of this serious disease and may collaborate for the expansion of knowledge about mechanobiology in the progression of AAoA.
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Affiliation(s)
- Fabiula Schwartz de Azevedo
- Department of Cardiology, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, RJ, Brazil
- Research and Teaching Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, RJ, Brazil
| | - Gabriela de Castro Almeida
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | - Bruno Alvares de Azevedo
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | - Ivan Fernney Ibanez Aguilar
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | - Bruno Nieckele Azevedo
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
| | | | - Gabriel Cordeiro Camargo
- Research and Teaching Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, RJ, Brazil
| | - Marcelo Goulart Correia
- Research and Teaching Department, Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, RJ, Brazil
| | - Angela Ourivio Nieckele
- Department of Mechanical Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, RJ, Brazil
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Zhang S, Gu H, Chang N, Li S, Xu T, Liu M, Wang X. Assessing Abdominal Aortic Aneurysm Progression by Using Perivascular Adipose Tissue Attenuation on Computed Tomography Angiography. Korean J Radiol 2023; 24:974-982. [PMID: 37724591 PMCID: PMC10550735 DOI: 10.3348/kjr.2023.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/06/2023] [Accepted: 07/11/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE Recent studies have highlighted the active and potential role of perivascular adipose tissue (PVAT) in atherosclerosis and aneurysm progression, respectively. This study explored the link between PVAT attenuation and abdominal aortic aneurysm (AAA) progression using computed tomography angiography (CTA). MATERIALS AND METHODS This multicenter retrospective study analyzed patients with AAA who underwent CTA at baseline and follow-up between March 2015 and July 2022. The following parameters were obtained: maximum diameter and total volume of the AAA, presence or absence of intraluminal thrombus (ILT), maximum diameter and volume of the ILT, and PVAT attenuation of the aortic aneurysm at baseline CTA. PVAT attenuation was divided into high (> -73.4 Hounsfield units [HU]) and low (≤ -73.4 HU). Patients who had or did not have AAA progression during the follow-up, defined as an increase in the aneurysm volume > 10 mL from baseline, were identified. Kaplan-Meier and multivariable Cox regression analyses were used to investigate the association between PVAT attenuation and AAA progression. RESULTS Our study included 167 participants (148 males; median age: 70.0 years; interquartile range: 63.0-76.0 years), of which 145 (86.8%) were diagnosed with AAA accompanied by ILT. Over a median period of 11.3 months (range: 6.0-85.0 months), AAA progression was observed in 67 patients (40.1%). Multivariable Cox regression analysis indicated that high baseline PVAT attenuation (adjusted hazard ratio [aHR] = 2.23; 95% confidence interval [CI], 1.16-4.32; P = 0.017) was independently associated with AAA progression. This association was demonstrated within the patients of AAA with ILT subcohort, where a high baseline PVAT attenuation (aHR = 2.23; 95% CI, 1.08-4.60; P = 0.030) was consistently independently associated with AAA progression. CONCLUSION Elevated PVAT attenuation is independently associated with AAA progression, including patients of AAA with ILT, suggesting the potential of PVAT attenuation as a predictive imaging marker for AAA expansion.
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Affiliation(s)
- Shuai Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, China
| | - Hui Gu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, China
| | - Na Chang
- Department of Medical Technology, Jinan Nursing Vocational College, Jinan, Shandong, China
| | - Sha Li
- Department of Clinical Medicine, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Tianqi Xu
- Department of Clinical Medicine, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Menghan Liu
- Depertment of Health Management, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China.
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong University, Jinan, Shandong, China.
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Lyu Z, King K, Rezaeitaleshmahalleh M, Pienta D, Mu N, Zhao C, Zhou W, Jiang J. Deep-learning-based image segmentation for image-based computational hemodynamic analysis of abdominal aortic aneurysms: a comparison study. Biomed Phys Eng Express 2023; 9:067001. [PMID: 37625388 DOI: 10.1088/2057-1976/acf3ed] [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: 06/01/2023] [Accepted: 08/25/2023] [Indexed: 08/27/2023]
Abstract
Computational hemodynamics is increasingly being used to quantify hemodynamic characteristics in and around abdominal aortic aneurysms (AAA) in a patient-specific fashion. However, the time-consuming manual annotation hinders the clinical translation of computational hemodynamic analysis. Thus, we investigate the feasibility of using deep-learning-based image segmentation methods to reduce the time required for manual segmentation. Two of the latest deep-learning-based image segmentation methods, ARU-Net and CACU-Net, were used to test the feasibility of automated computer model creation for computational hemodynamic analysis. Morphological features and hemodynamic metrics of 30 computed tomography angiography (CTA) scans were compared between pre-dictions and manual models. The DICE score for both networks was 0.916, and the correlation value was above 0.95, indicating their ability to generate models comparable to human segmentation. The Bland-Altman analysis shows a good agreement between deep learning and manual segmentation results. Compared with manual (computational hemodynamics) model recreation, the time for automated computer model generation was significantly reduced (from ∼2 h to ∼10 min). Automated image segmentation can significantly reduce time expenses on the recreation of patient-specific AAA models. Moreover, our study showed that both CACU-Net and ARU-Net could accomplish AAA segmentation, and CACU-Net outperformed ARU-Net in terms of accuracy and time-saving.
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Affiliation(s)
- Zonghan Lyu
- Biomedical Engineering, Michigan Technological University, Houghton, Michigan, MI, United States of America
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Michigan, MI, United States of America
| | - Kristin King
- Biomedical Engineering, Michigan Technological University, Houghton, Michigan, MI, United States of America
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Michigan, MI, United States of America
| | - Mostafa Rezaeitaleshmahalleh
- Biomedical Engineering, Michigan Technological University, Houghton, Michigan, MI, United States of America
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Michigan, MI, United States of America
| | - Drew Pienta
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Michigan, MI, United States of America
- Applied Computing, Michigan Technological University, Houghton, Michigan, MI, United States of America
| | - Nan Mu
- Biomedical Engineering, Michigan Technological University, Houghton, Michigan, MI, United States of America
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Michigan, MI, United States of America
| | - Chen Zhao
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Michigan, MI, United States of America
- Applied Computing, Michigan Technological University, Houghton, Michigan, MI, United States of America
| | - Weihua Zhou
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Michigan, MI, United States of America
- Applied Computing, Michigan Technological University, Houghton, Michigan, MI, United States of America
| | - Jingfeng Jiang
- Biomedical Engineering, Michigan Technological University, Houghton, Michigan, MI, United States of America
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Michigan, MI, United States of America
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, MN, United States of America
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Rezaeitaleshmahalleh M, Lyu Z, Mu N, Zhang X, Rasmussen TE, McBane RD, Jiang J. Characterization of small abdominal aortic aneurysms' growth status using spatial pattern analysis of aneurismal hemodynamics. Sci Rep 2023; 13:13832. [PMID: 37620387 PMCID: PMC10449842 DOI: 10.1038/s41598-023-40139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/05/2023] [Indexed: 08/26/2023] Open
Abstract
Aneurysm hemodynamics is known for its crucial role in the natural history of abdominal aortic aneurysms (AAA). However, there is a lack of well-developed quantitative assessments for disturbed aneurysmal flow. Therefore, we aimed to develop innovative metrics for quantifying disturbed aneurysm hemodynamics and evaluate their effectiveness in predicting the growth status of AAAs, specifically distinguishing between fast-growing and slowly-growing aneurysms. The growth status of aneurysms was classified as fast (≥ 5 mm/year) or slow (< 5 mm/year) based on serial imaging over time. We conducted computational fluid dynamics (CFD) simulations on 70 patients with computed tomography (CT) angiography findings. By converting hemodynamics data (wall shear stress and velocity) located on unstructured meshes into image-like data, we enabled spatial pattern analysis using Radiomics methods, referred to as "Hemodynamics-informatics" (i.e., using informatics techniques to analyze hemodynamic data). Our best model achieved an AUROC of 0.93 and an accuracy of 87.83%, correctly identifying 82.00% of fast-growing and 90.75% of slowly-growing AAAs. Compared with six classification methods, the models incorporating hemodynamics-informatics exhibited an average improvement of 8.40% in AUROC and 7.95% in total accuracy. These preliminary results indicate that hemodynamics-informatics correlates with AAAs' growth status and aids in assessing their progression.
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Affiliation(s)
- Mostafa Rezaeitaleshmahalleh
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
- Joint Center for Biocomputing and Digital Health, Health Research Institute, and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
| | - Zonghan Lyu
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
- Joint Center for Biocomputing and Digital Health, Health Research Institute, and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
| | - Nan Mu
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
- Joint Center for Biocomputing and Digital Health, Health Research Institute, and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
| | - Xiaoming Zhang
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Todd E Rasmussen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert D McBane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA.
- Joint Center for Biocomputing and Digital Health, Health Research Institute, and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA.
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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Rezaeitaleshmahalleh M, Sunderland KW, Lyu Z, Johnson T, King K, Liedl DA, Hofer JM, Wang M, Zhang X, Kuczmik W, Rasmussen TE, McBane RD, Jiang J. Computerized Differentiation of Growth Status for Abdominal Aortic Aneurysms: A Feasibility Study. J Cardiovasc Transl Res 2023; 16:874-885. [PMID: 36602668 DOI: 10.1007/s12265-022-10352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023]
Abstract
Fast-growing abdominal aortic aneurysms (AAA) have a high rupture risk and poor outcomes if not promptly identified and treated. Our primary objective is to improve the differentiation of small AAAs' growth status (fast versus slow-growing) through a combination of patient health information, computational hemodynamics, geometric analysis, and artificial intelligence. 3D computed tomography angiography (CTA) data available for 70 patients diagnosed with AAAs with known growth status were used to conduct geometric and hemodynamic analyses. Differences among ten metrics (out of ninety metrics) were statistically significant discriminators between fast and slow-growing groups. Using a support vector machine (SVM) classifier, the area under receiving operating curve (AUROC) and total accuracy of our best predictive model for differentiation of AAAs' growth status were 0.86 and 77.50%, respectively. In summary, the proposed analytics has the potential to differentiate fast from slow-growing AAAs, helping guide resource allocation for the management of patients with AAAs.
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Affiliation(s)
- Mostafa Rezaeitaleshmahalleh
- Department of Biomedical Engineering, Michigan Technological University, MI, Houghton, USA
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
| | - Kevin W Sunderland
- Department of Biomedical Engineering, Michigan Technological University, MI, Houghton, USA
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
| | - Zonghan Lyu
- Department of Biomedical Engineering, Michigan Technological University, MI, Houghton, USA
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
| | - Tonie Johnson
- Department of Biomedical Engineering, Michigan Technological University, MI, Houghton, USA
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
| | - Kristin King
- Department of Biomedical Engineering, Michigan Technological University, MI, Houghton, USA
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
| | - David A Liedl
- Department of Cardiovascular Medicine, Mayo Clinic, MN, Rochester, USA
| | - Janet M Hofer
- Department of Cardiovascular Medicine, Mayo Clinic, MN, Rochester, USA
| | - Min Wang
- Department of Management Science and Statistics, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Xiaoming Zhang
- Department of Radiology, Mayo Clinic, MN, Rochester, USA
| | - Wiktoria Kuczmik
- Department of Cardiovascular Medicine, Mayo Clinic, MN, Rochester, USA
| | - Todd E Rasmussen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert D McBane
- Department of Cardiovascular Medicine, Mayo Clinic, MN, Rochester, USA
| | - Jingfeng Jiang
- Department of Biomedical Engineering, Michigan Technological University, MI, Houghton, USA.
- Joint Center for Biocomputing and Digital Health, Health Research Institute and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA.
- Department of Radiology, Mayo Clinic, MN, Rochester, USA.
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Wang X, Carpenter HJ, Ghayesh MH, Kotousov A, Zander AC, Amabili M, Psaltis PJ. A review on the biomechanical behaviour of the aorta. J Mech Behav Biomed Mater 2023; 144:105922. [PMID: 37320894 DOI: 10.1016/j.jmbbm.2023.105922] [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: 03/06/2023] [Revised: 05/14/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023]
Abstract
Large aortic aneurysm and acute and chronic aortic dissection are pathologies of the aorta requiring surgery. Recent advances in medical intervention have improved patient outcomes; however, a clear understanding of the mechanisms leading to aortic failure and, hence, a better understanding of failure risk, is still missing. Biomechanical analysis of the aorta could provide insights into the development and progression of aortic abnormalities, giving clinicians a powerful tool in risk stratification. The complexity of the aortic system presents significant challenges for a biomechanical study and requires various approaches to analyse the aorta. To address this, here we present a holistic review of the biomechanical studies of the aorta by categorising articles into four broad approaches, namely theoretical, in vivo, experimental and combined investigations. Experimental studies that focus on identifying mechanical properties of the aortic tissue are also included. By reviewing the literature and discussing drawbacks, limitations and future challenges in each area, we hope to present a more complete picture of the state-of-the-art of aortic biomechanics to stimulate research on critical topics. Combining experimental modalities and computational approaches could lead to more comprehensive results in risk prediction for the aortic system.
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Affiliation(s)
- Xiaochen Wang
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Harry J Carpenter
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Mergen H Ghayesh
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - Andrei Kotousov
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Anthony C Zander
- School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Marco Amabili
- Department of Mechanical Engineering, McGill University, Montreal H3A 0C3, Canada
| | - Peter J Psaltis
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5005, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia 5000, Australia; Vascular Research Centre, Heart Health Theme, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia
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Geronzi L, Martinez A, Rochette M, Yan K, Bel-Brunon A, Haigron P, Escrig P, Tomasi J, Daniel M, Lalande A, Lin S, Marin-Castrillon DM, Bouchot O, Porterie J, Valentini PP, Biancolini ME. Computer-aided shape features extraction and regression models for predicting the ascending aortic aneurysm growth rate. Comput Biol Med 2023; 162:107052. [PMID: 37263151 DOI: 10.1016/j.compbiomed.2023.107052] [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: 03/30/2023] [Revised: 04/27/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE ascending aortic aneurysm growth prediction is still challenging in clinics. In this study, we evaluate and compare the ability of local and global shape features to predict the ascending aortic aneurysm growth. MATERIAL AND METHODS 70 patients with aneurysm, for which two 3D acquisitions were available, are included. Following segmentation, three local shape features are computed: (1) the ratio between maximum diameter and length of the ascending aorta centerline, (2) the ratio between the length of external and internal lines on the ascending aorta and (3) the tortuosity of the ascending tract. By exploiting longitudinal data, the aneurysm growth rate is derived. Using radial basis function mesh morphing, iso-topological surface meshes are created. Statistical shape analysis is performed through unsupervised principal component analysis (PCA) and supervised partial least squares (PLS). Two types of global shape features are identified: three PCA-derived and three PLS-based shape modes. Three regression models are set for growth prediction: two based on gaussian support vector machine using local and PCA-derived global shape features; the third is a PLS linear regression model based on the related global shape features. The prediction results are assessed and the aortic shapes most prone to growth are identified. RESULTS the prediction root mean square error from leave-one-out cross-validation is: 0.112 mm/month, 0.083 mm/month and 0.066 mm/month for local, PCA-based and PLS-derived shape features, respectively. Aneurysms close to the root with a large initial diameter report faster growth. CONCLUSION global shape features might provide an important contribution for predicting the aneurysm growth.
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Affiliation(s)
- Leonardo Geronzi
- University of Rome Tor Vergata, Department of Enterprise Engineering "Mario Lucertini", Rome, Italy; Ansys France, Villeurbanne, France.
| | - Antonio Martinez
- University of Rome Tor Vergata, Department of Enterprise Engineering "Mario Lucertini", Rome, Italy; Ansys France, Villeurbanne, France
| | | | - Kexin Yan
- Ansys France, Villeurbanne, France; University of Lyon, INSA Lyon, CNRS, LaMCoS, UMR5259, 69621 Villeurbanne, France
| | - Aline Bel-Brunon
- University of Lyon, INSA Lyon, CNRS, LaMCoS, UMR5259, 69621 Villeurbanne, France
| | - Pascal Haigron
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Pierre Escrig
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Jacques Tomasi
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Morgan Daniel
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000, Rennes, France
| | - Alain Lalande
- ICMUB Laboratory, CNRS 6302, University of Burgundy, 21078 Dijon, France; Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Siyu Lin
- ICMUB Laboratory, CNRS 6302, University of Burgundy, 21078 Dijon, France; Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Diana Marcela Marin-Castrillon
- ICMUB Laboratory, CNRS 6302, University of Burgundy, 21078 Dijon, France; Medical Imaging Department, University Hospital of Dijon, Dijon, France
| | - Olivier Bouchot
- Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, Dijon, France
| | - Jean Porterie
- Cardiac Surgery Department, Rangueil University Hospital, Toulouse, France
| | - Pier Paolo Valentini
- University of Rome Tor Vergata, Department of Enterprise Engineering "Mario Lucertini", Rome, Italy
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Mu N, Lyu Z, Rezaeitaleshmahalleh M, Zhang X, Rasmussen T, McBane R, Jiang J. Automatic segmentation of abdominal aortic aneurysms from CT angiography using a context-aware cascaded U-Net. Comput Biol Med 2023; 158:106569. [PMID: 36989747 PMCID: PMC10625464 DOI: 10.1016/j.compbiomed.2023.106569] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/22/2022] [Accepted: 01/22/2023] [Indexed: 01/24/2023]
Abstract
We delineate abdominal aortic aneurysms, including lumen and intraluminal thrombosis (ILT), from contrast-enhanced computed tomography angiography (CTA) data in 70 patients with complete automation. A novel context-aware cascaded U-Net configuration enables automated image segmentation. Notably, auto-context structure, in conjunction with dilated convolutions, anisotropic context module, hierarchical supervision, and a multi-class loss function, are proposed to improve the delineation of ILT in an unbalanced, low-contrast multi-class labeling problem. A quantitative analysis shows that the automated image segmentation produces comparable results with trained human users (e.g., DICE scores of 0.945 and 0.804 for lumen and ILT, respectively). Resultant morphological metrics (e.g., volume, surface area, etc.) are highly correlated to those parameters generated by trained human users. In conclusion, the proposed automated multi-class image segmentation tool has the potential to be further developed as a translational software tool that can be used to improve the clinical management of AAAs.
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Affiliation(s)
- Nan Mu
- Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931, USA
| | - Zonghan Lyu
- Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931, USA
| | | | | | | | | | - Jingfeng Jiang
- Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931, USA; Center for Biocomputing and Digital Health, Health Research Institute, Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, 49931, USA.
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9
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Sénémaud J, Gaudry M, Jouve E, Blanchard A, Milleron O, Dulac Y, Olivier-Faivre L, Stephan D, Odent S, Lanéelle D, Dupuis-Girod S, Jondeau G, Bal-Theoleyre L. Primary Non-Aortic Lesions Are Not Rare in Marfan Syndrome and Are Associated with Aortic Dissection Independently of Age. J Clin Med 2023; 12:jcm12082902. [PMID: 37109238 PMCID: PMC10141376 DOI: 10.3390/jcm12082902] [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: 03/08/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE The study sought to estimate the prevalence of primary non-aortic lesions (PNAL) unrelated to extension of aortic dissection (AD) in a cohort of patients with Marfan syndrome (MFS). METHODS Adult patients presenting with pathogenic FBN1 mutations and an available pan-aortic contrast-enhanced CTA in eight French MFS clinics from April to October 2018 were included. Clinical and radiological data, particularly the presence of aortic lesions and PNAL (including aneurysm and ectasia), were retrospectively analyzed. RESULTS Out of 138 patients, 28 (20.3%) had PNAL. In total, 27 aneurysms in 13 patients and 41 ectasias in 19 patients were reported mainly in the subclavian, iliac, and vertebral segments. Four patients (31%) with aneurysms and none with ectasia required prophylactic intervention during follow-up (median: 46 months). In multivariate analysis, factors associated with PNAL were history of AD (OR = 3.9, 95%CI: 1.3-12.1, p = 0.018), history of previous descending aortic surgery (OR = 10.3, 95%CI: 2.2-48.3, p = 0.003) and age (per 10 years OR = 1.6, 95%CI: 1.1-2.4, p = 0.008). CONCLUSION PNAL is not rare in MFS patients with evolutive aortic disease. Natural history may differ between aneurysms and ectasia, emphasizing the need for standardized definitions and systematic screening for PNAL.
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Affiliation(s)
- Jean Sénémaud
- Service de Chirurgie Vasculaire, Thoracique et de Transplantation Pulmonaire, AP-HP, CHU Bichat, 75018 Paris, France
| | - Marine Gaudry
- Service de Chirurgie Vasculaire, AP-HM, CHU La Timone, 13385 Marseille, France
| | - Elisabeth Jouve
- Service d'Evaluation Médicale, AP-HM, CHU La Conception, 13005 Marseille, France
| | - Arnaud Blanchard
- Centre de Référence Constitutif Pour le Syndrome de Marfan et Apparentés, Centre Aorte Timone, AP-HM, CHU La Timone Adultes, 13014 Marseille, France
| | - Olivier Milleron
- Centre National de Référence Pour le Syndrome de Marfan et Apparentés, VASCERN HTAD European Reference Centre, Service de Cardiologie, AP-HP, CHU Bichat, INSERM U 1148 LVTS, Université de Paris, 75014 Paris, France
| | - Yves Dulac
- Centre de Référence Constitutif Pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU de Toulouse, 31300 Toulouse, France
| | - Laurence Olivier-Faivre
- Centre de Compétence Pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU de Dijon, 21000 Dijon, France
| | - Dominique Stephan
- Centre de Compétence Pour le Syndrome de Marfan et Apparentés, CHU Nouvel Hôpital Civil, 67000 Strasbourg, France
| | - Sylvie Odent
- Centre de Compétence Pour le Syndrome de Marfan et Apparentés, Hôpital Sud, CHU de Rennes, 35200 Rennes, France
| | - Damien Lanéelle
- Centre de Compétence Pour le Syndrome de Marfan et Apparentés, CHU de la Côte de Nacre, 14033 Caen, France
| | - Sophie Dupuis-Girod
- Centre de Compétence Pour le Syndrome de Marfan et Apparentés, CHU Hôpital Louis Pradel, 69500 Lyon, France
| | - Guillaume Jondeau
- Centre National de Référence Pour le Syndrome de Marfan et Apparentés, VASCERN HTAD European Reference Centre, Service de Cardiologie, AP-HP, CHU Bichat, INSERM U 1148 LVTS, Université de Paris, 75014 Paris, France
| | - Laurence Bal-Theoleyre
- Centre de Référence Constitutif Pour le Syndrome de Marfan et Apparentés, Centre Aorte Timone, AP-HM, CHU La Timone Adultes, 13014 Marseille, France
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10
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Li GJ, Yang QH, Yang GK, Yang G, Hou Y, Hou LJ, Li ZX, Du LJ. MiR-125b and SATB1-AS1 might be shear stress-mediated therapeutic targets. Gene 2023; 857:147181. [PMID: 36623676 DOI: 10.1016/j.gene.2023.147181] [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: 08/18/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
The aim of the study was to explore the potential molecular mechanism associated with shear stress on abdominal aortic aneurysm (AAA) progression. This study performed RNA sequencing on AAA patients (SQ), AAA patients after endovascular aneurysm repair (EVAR, SH), and normal controls (NC). Furthermore, we identified the differentially expressed microRNAs (miRNAs), long noncoding RNAs (lncRNAs), and circular RNA (cirRNAs) and constructed competing endogenous RNA (ceRNA) networks. Finally, 164 differentially expressed miRNAs, 179 co-differentially expressed lncRNAs, and 440 co-differentially expressed circRNAs among the three groups were obtained. The differentially expressed miRNAs mainly enriched in 325 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Target genes associated with co-differentially expressed genes among the group of SH, SQ, and NC mainly enriched in 66 KEGG pathways. LncRNA-miRNA-mRNA interactions, including 15 lncRNAs, 63 miRNAs and 57 mRNAs, was constructed. CircRNA-miRNA-mRNA ceRNA network included 79 circRNAs, 21 miRNAs, and 49 mRNAs. Among them, KLRC2 and CSTF1, targeted by miR-125b, participated in cell-mediated immunity regulation. MiR-320-related circRNAs and SATB1-AS1 serving as the sponge of miRNAs, such as has-circ-0129245, has-circ-0138746, and has-circ-0139786, were hub genes in ceRNA network. In conclusion, AAA patients might be benefit from EVAR based on various pathways and some molecules, such as miR-125b and SATB1-AS1, related with shear stress.
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Affiliation(s)
- Guo-Jian Li
- Department of Vascular Surgery, Affiliated Hospital of Yunnan University, Kunming 650021, Yunnan, China
| | - Qiong-Hui Yang
- Department of Pharmaceutical, The Third People's Hospital of Yunnan Province, Kunming 650011, Yunnan, China
| | - Guo-Kai Yang
- Department of Vascular Surgery, Affiliated Hospital of Yunnan University, Kunming 650021, Yunnan, China
| | - Guang Yang
- Department of Radiology, the First People's Hospital of Anning, China
| | - Yi Hou
- Department of Vascular Surgery, Affiliated Hospital of Yunnan University, Kunming 650021, Yunnan, China
| | - Li-Juan Hou
- Department of Vascular Surgery, Affiliated Hospital of Yunnan University, Kunming 650021, Yunnan, China
| | - Zhao-Xiang Li
- Department of Vascular Surgery, Affiliated Hospital of Yunnan University, Kunming 650021, Yunnan, China
| | - Ling-Juan Du
- Department of Vascular Surgery, Affiliated Hospital of Yunnan University, Kunming 650021, Yunnan, China.
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11
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Vaitėnas G, Mosenko V, Račytė A, Medelis K, Skrebūnas A, Baltrūnas T. Abdominal Aortic Aneurysm Diameter versus Volume: A Systematic Review. Biomedicines 2023; 11:biomedicines11030941. [PMID: 36979920 PMCID: PMC10046268 DOI: 10.3390/biomedicines11030941] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/05/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Recently, AAA volume measurement has been proposed as a potentially valuable surveillance method in situations when diameter measurement might fail. OBJECTIVE The aim of this systematic review was to analyze the results of previous studies comparing AAA diameter and volume measurements. METHODS A systematic search in PubMed, Cochrane, and EMBASE databases was performed to identify studies investigating the use of diameter and volume measurements in AAA diagnosis and prognosis in English, German, and Russian, published until December 2022. The manuscripts were reviewed by three researchers and scored on the quality of the research using MINORS criteria. RESULTS After screening 752 manuscripts, 19 studies (n = 1690) were included. The majority (n = 17) of the manuscripts appeared to favor volume. It is, however, important to highlight the heterogeneity of methodologies and lack of standardized protocol for measuring both volume and diameter in the included studies, which hindered the interpretation of the results. CONCLUSIONS The clinical relevance of abdominal aortic aneurysm volume measurement is still unclear, although studies show favorable and promising results for volumetric changes in AAA, especially in follow-up after EVAR.
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Affiliation(s)
| | - Valerija Mosenko
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
| | - Austėja Račytė
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
| | - Karolis Medelis
- Center of Vascular and Endovascular Surgery, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
| | | | - Tomas Baltrūnas
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania
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12
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Contrast-enhanced CT radiomics improves the prediction of abdominal aortic aneurysm progression. Eur Radiol 2023; 33:3444-3454. [PMID: 36920519 DOI: 10.1007/s00330-023-09490-7] [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: 07/25/2022] [Revised: 12/06/2022] [Accepted: 01/27/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To determine if three-dimensional (3D) radiomic features of contrast-enhanced CT (CECT) images improve prediction of rapid abdominal aortic aneurysm (AAA) growth. METHODS This longitudinal cohort study retrospectively analyzed 195 consecutive patients (mean age, 72.4 years ± 9.1) with a baseline CECT and a subsequent CT or MR at least 6 months later. 3D radiomic features were measured for 3 regions of the AAA, viz. the vessel lumen only; the intraluminal thrombus (ILT) and aortic wall only; and the entire AAA sac (lumen, ILT, and wall). Multiple machine learning (ML) models to predict rapid growth, defined as the upper tercile of observed growth (> 0.25 cm/year), were developed using data from 60% of the patients. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve (AUC) in the remaining 40% of patients. RESULTS The median AAA maximum diameter was 3.9 cm (interquartile range [IQR], 3.3-4.4 cm) at baseline and 4.4 cm (IQR, 3.7-5.4 cm) at the mean follow-up time of 3.2 ± 2.4 years (range, 0.5-9 years). A logistic regression model using 7 radiomic features of the ILT and wall had the highest AUC (0.83; 95% confidence interval [CI], 0.73-0.88) in the development cohort. In the independent test cohort, this model had a statistically significantly higher AUC than a model including maximum diameter, AAA volume, and relevant clinical factors (AUC = 0.78, 95% CI, 0.67-0.87 vs AUC = 0.69, 95% CI, 0.57-0.79; p = 0.04). CONCLUSION A radiomics-based method focused on the ILT and wall improved prediction of rapid AAA growth from CECT imaging. KEY POINTS • Radiomic analysis of 195 abdominal CECT revealed that an ML-based model that included textural features of intraluminal thrombus (if present) and aortic wall improved prediction of rapid AAA progression compared to maximum diameter. • Predictive accuracy was higher when radiomic features were obtained from the thrombus and wall as opposed to the entire AAA sac (including lumen), or the lumen alone. • Logistic regression of selected radiomic features yielded similar accuracy to predict rapid AAA progression as random forests or support vector machines.
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13
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Lowis C, Ramara Winaya A, Kumari P, Rivera CF, Vlahos J, Hermantara R, Pratama MY, Ramkhelawon B. Mechanosignals in abdominal aortic aneurysms. Front Cardiovasc Med 2023; 9:1021934. [PMID: 36698932 PMCID: PMC9868277 DOI: 10.3389/fcvm.2022.1021934] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/29/2022] [Indexed: 01/11/2023] Open
Abstract
Cumulative evidence has shown that mechanical and frictional forces exert distinct effects in the multi-cellular aortic layers and play a significant role in the development of abdominal aortic aneurysms (AAA). These mechanical cues collectively trigger signaling cascades relying on mechanosensory cellular hubs that regulate vascular remodeling programs leading to the exaggerated degradation of the extracellular matrix (ECM), culminating in lethal aortic rupture. In this review, we provide an update and summarize the current understanding of the mechanotransduction networks in different cell types during AAA development. We focus on different mechanosensors and stressors that accumulate in the AAA sac and the mechanotransduction cascades that contribute to inflammation, oxidative stress, remodeling, and ECM degradation. We provide perspectives on manipulating this mechano-machinery as a new direction for future research in AAA.
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Affiliation(s)
- Christiana Lowis
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Biomedicine, Indonesia International Institute for Life-Sciences, Jakarta, Indonesia
| | - Aurellia Ramara Winaya
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Biomedicine, Indonesia International Institute for Life-Sciences, Jakarta, Indonesia
| | - Puja Kumari
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Cell Biology, New York University Langone Medical Center, New York, NY, United States
| | - Cristobal F. Rivera
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Cell Biology, New York University Langone Medical Center, New York, NY, United States
| | - John Vlahos
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Cell Biology, New York University Langone Medical Center, New York, NY, United States
| | - Rio Hermantara
- Department of Biomedicine, Indonesia International Institute for Life-Sciences, Jakarta, Indonesia
| | - Muhammad Yogi Pratama
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Cell Biology, New York University Langone Medical Center, New York, NY, United States,Muhammad Yogi Pratama,
| | - Bhama Ramkhelawon
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Cell Biology, New York University Langone Medical Center, New York, NY, United States,*Correspondence: Bhama Ramkhelawon,
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14
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Zschäpitz D, Bohmann B, Lutz B, Eckstein HH, Reeps C, Maegdefessel L, Gasser CT, Busch A. Rupture risk parameters upon biomechanical analysis independently change from vessel geometry during abdominal aortic aneurysm growth. JVS Vasc Sci 2022; 4:100093. [PMID: 36756656 PMCID: PMC9900617 DOI: 10.1016/j.jvssci.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022] Open
Abstract
Objective The indication for abdominal aortic aneurysm (AAA) repair is based on a diameter threshold. However, mechanical properties, such as peak wall stress (PWS) and peak wall rupture index (PWRI), influence the individual rupture risk. This study aims to correlate biomechanical and geometrical AAA characteristics during aneurysm growth applying a new linear transformation-based comparison of sequential imaging. Methods Patients with AAA with two sequential computed tomography angiographies (CTA) were identified from a single-center aortic database. Patient characteristics included age, gender, and comorbidities. Semiautomated segmentation of CTAs was performed using Endosize (Therenva) for geometric variables (diameter, neck configuration, α/β angle, and vessel tortuosity) and for finite element method A4 Clinics Research Edition (Vascops) for additional variables (intraluminal thrombus [ILT]), vessel volume, PWS, PWRI). Maximum point coordinates from at least one CTA 6 to 24 months before their final were predicted for the final preoperative CTA using linear transformation along fix and validation points to estimate spatial motion. Pearson's correlation and the t test were used for comparison. Results Thirty-two eligible patients (median age, 70 years) were included. The annual AAA growth rate was 3.7 mm (interquartile range [IQR], 2.25-5.44; P < .001) between CTs. AAA (+17%; P < .001) and ILT (+43%; P < .001) volume, maximum ILT thickness (+35%; P < .001), β angle (+1.96°; P = .017) and iliac tortuosity (+0.009; P = .012) increased significantly. PWS (+12%; P = .0029) and PWRI (+16%; P < .001) differed significantly between both CTAs. Both mechanical parameters correlated most significantly with the AAA volume increase (r = 0.68 [P < .001] and r = 0.6 [P < .001]). Changes in PWS correlated best with the aneurysm neck configuration. The spatial motion of maximum ILT thickness was 14.4 mm (IQR, 7.3-37.2), for PWS 8.4 mm (IQR, 3.8-17.3), and 11.5 mm (IQR, 5.9-31.9) for PWRI. Here, no significant correlation with any of the aforementioned parameters, patient age, or time interval between CTs were observed. Conclusions PWS correlates highly significant with vessel volume and aneurysm neck configuration. Spatial motion of maximum ILT thickness, PWS, and PWRI is detectable and predictable and might expose different aneurysm wall segments to maximum stress throughout aneurysm growth. Linear transformation could thus add to patient-specific rupture risk analysis. Clinical Relevance Abdominal aortic aneurysm rupture risk assessment is a key feature in future individualized therapy approaches for patients, since more and more data are obtained concluding a heterogeneous disease entity that might not be addressed ideally looking only at diameter enlargement. The approach presented in this pilot study demonstrates the feasibility and importance of measuring peak wall stress and rupture risk indices based on predicted and actual position of maximum stress points including intraluminal thrombus.
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Affiliation(s)
- David Zschäpitz
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Bianca Bohmann
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Brigitta Lutz
- Division of Vascular and Endovascular Surgery, Department for Visceral-, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christian Reeps
- Division of Vascular and Endovascular Surgery, Department for Visceral-, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Lars Maegdefessel
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christian T. Gasser
- Department of Engineering Mechanics, Royal Institute of Technology, Stockholm, Sweden
| | - Albert Busch
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany,Division of Vascular and Endovascular Surgery, Department for Visceral-, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus and University Hospital, Technische Universität Dresden, Dresden, Germany,Correspondence: Albert Busch, MD, PhD, Department for Visceral, Thoracic and Vascular Surgery, Technical University Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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15
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Hemostatic Biomarkers and Volumetry Help to Identify High-Risk Abdominal Aortic Aneurysms. Life (Basel) 2022; 12:life12060823. [PMID: 35743854 PMCID: PMC9225361 DOI: 10.3390/life12060823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
Predicting the progression of small aneurysms is a main challenge in abdominal aortic aneurysm (AAA) management. The combination of circulating biomarkers and image techniques might provide an alternative for risk stratification. We evaluated the association of plasma TAT complexes (TAT) and D-dimer with AAA severity in 3 groups of patients: group 1, without AAA (n = 52), group 2, AAA 40−50 mm (n = 51) and group 3, AAA > 50 mm (n = 50). TAT (p < 0.001) and D-dimer (p < 0.001) were increased in patients with AAA (groups 2 and 3) vs. group 1. To assess the association between baseline TAT and D-dimer concentrations, and AAA growth, aortic diameter and volume (volumetry) were measured by computed tomography angiography (CTA) in group 2 at recruitment (baseline) and 1-year after inclusion. Baseline D-dimer and TAT levels were associated with AAA diameter and volume variations at 1-year independently of confounding factors (p ≤ 0.044). Additionally, surgery incidence, recorded during a 4-year follow-up in group 2, was associated with larger aneurysms, assessed by aortic diameter and volumetry (p ≤ 0.036), and with elevated TAT levels (sub-hazard ratio 1.3, p ≤ 0.029), while no association was found for D-dimer. The combination of hemostatic parameters and image techniques might provide valuable tools to evaluate AAA growth and worse evolution.
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16
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Chen M, Yang F, Chen L, Liu J, Luo S, Li J, Huang W, Liu Y, Fan R, Geng Q, Chen J, Luo J. OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6555500. [PMID: 35349692 DOI: 10.1093/ejcts/ezac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/16/2022] [Accepted: 03/10/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Min Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fan Yang
- Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lyufan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jitao Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Songyuan Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jie Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenhui Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuan Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruixin Fan
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qingshan Geng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianfang Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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17
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Peng Y, Zhang X, Li J, Zhang X, He H, Li X, Fang K, Zheng L, Shu C. Enlarged Lumen Volume of Proximal Aortic Segment and Acute Type B Aortic Dissection: A Computer Fluid Dynamics Study of Ideal Aortic Models. Int J Gen Med 2022; 15:535-543. [PMID: 35046712 PMCID: PMC8763263 DOI: 10.2147/ijgm.s343403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Recent study has revealed that enlarged diameters of the ascending aorta and proximal aortic arch enhance the probability of ATBAD. However, little is understood about the relation to ATBAD. Objective This study explored the differences in proximal aortic segment (PAS) morphology in patients with acute type B aortic dissection (ATBAD), and performed hemodynamic simulations to provide proof of principle. Materials and Methods The morphological characteristics of PAS in the ATBAD group (n = 163) and corresponding segment in the control group (n = 120) were retrospectively measured. The morphological parameters were analyzed using comprehensive statistical approaches. Ridge regression analysis was also performed to determine the association between independent variable and dependent variable. P < 0.01 was considered significant. Idealized aortic models were established based on variables of statistical significance, and hemodynamic simulations were performed to evaluate blood flow changes caused by morphology. Results Diameters at landmarks of PAS were significantly larger in the ATBAD group. The lumen volume (VPAS) of PAS in the ATBAD group was significantly enlarged than that of the control group (124,659.07 ± 34,089.27 mm3 vs 89,796.65 ± 30,334.40 mm3; P < 0.001). Furthermore, the VPAS was positively correlated to diameters. As the VPAS increased, the fluid kinetic energy in PAS enhanced linearly, and time-averaged wall shear stress and oscillatory shear index at the distal area of the left subclavian artery increased significantly. Conclusion In the ATBAD group, the enlarged VPAS and increased diameters of PAS are positively correlated. Meanwhile, the enlarged VPAS leads to more aggressive hemodynamic parameters at the distal area of the left subclavian artery, which may create a contributory condition for ATBAD.
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Affiliation(s)
- Yuan Peng
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, 410011, People’s Republic of China
| | - Xuelan Zhang
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, 100083, People’s Republic of China
| | - Jiehua Li
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, 410011, People’s Republic of China
| | - Xiaolong Zhang
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, 410011, People’s Republic of China
| | - Hao He
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, 410011, People’s Republic of China
| | - Xin Li
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, 410011, People’s Republic of China
| | - Kun Fang
- Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100037, People’s Republic of China
| | - Liancun Zheng
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, 100083, People’s Republic of China
| | - Chang Shu
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, 410011, People’s Republic of China
- Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100037, People’s Republic of China
- Correspondence: Chang Shu Tel +86-731-85295832 Email
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18
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Lindquist Liljeqvist M, Bogdanovic M, Siika A, Gasser TC, Hultgren R, Roy J. Geometric and biomechanical modeling aided by machine learning improves the prediction of growth and rupture of small abdominal aortic aneurysms. Sci Rep 2021; 11:18040. [PMID: 34508118 PMCID: PMC8433325 DOI: 10.1038/s41598-021-96512-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/02/2021] [Indexed: 12/17/2022] Open
Abstract
It remains difficult to predict when which patients with abdominal aortic aneurysm (AAA) will require surgery. The aim was to study the accuracy of geometric and biomechanical analysis of small AAAs to predict reaching the threshold for surgery, diameter growth rate and rupture or symptomatic aneurysm. 189 patients with AAAs of diameters 40–50 mm were included, 161 had undergone two CTAs. Geometric and biomechanical variables were used in prediction modelling. Classifications were evaluated with area under receiver operating characteristic curve (AUC) and regressions with correlation between observed and predicted growth rates. Compared with the baseline clinical diameter, geometric-biomechanical analysis improved prediction of reaching surgical threshold within four years (AUC 0.80 vs 0.85, p = 0.031) and prediction of diameter growth rate (r = 0.17 vs r = 0.38, p = 0.0031), mainly due to the addition of semiautomatic diameter measurements. There was a trend towards increased precision of volume growth rate prediction (r = 0.37 vs r = 0.45, p = 0.081). Lumen diameter and biomechanical indices were the only variables that could predict future rupture or symptomatic AAA (AUCs 0.65–0.67). Enhanced precision of diameter measurements improves the prediction of reaching the surgical threshold and diameter growth rate, while lumen diameter and biomechanical analysis predicts rupture or symptomatic AAA.
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Affiliation(s)
- Moritz Lindquist Liljeqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. .,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Marko Bogdanovic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Antti Siika
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - T Christian Gasser
- Department of Engineering Mechanics, Royal Institute of Technology, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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19
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Beyond the AJR: "Prediction of Abdominal Aortic Aneurysm Growth Using Geometric Assessment of Computerised Tomography Images Acquired During the Aneurysm Surveillance Period". AJR Am J Roentgenol 2021; 217:768. [PMID: 33728975 DOI: 10.2214/ajr.21.25789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Qin S, Wu B, Liu J, Shiu WS, Yan Z, Chen R, Cai XC. Efficient parallel simulation of hemodynamics in patient-specific abdominal aorta with aneurysm. Comput Biol Med 2021; 136:104652. [PMID: 34329862 DOI: 10.1016/j.compbiomed.2021.104652] [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: 05/17/2021] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
Surgical planning for aortic aneurysm repair is a difficult task. In addition to the morphological features obtained from medical imaging, alternative features obtained with computational modeling may provide additional useful information. Though numerical studies are noninvasive, they are often time-consuming, especially when we need to study and compare multiple repair scenarios, because of the high computational complexity. In this paper, we present a highly parallel algorithm for the numerical simulation of unsteady blood flows in the patient-specific abdominal aorta before and after the aneurysmic repair. We model the blood flow with the unsteady incompressible Navier-Stokes equations with different outlet boundary conditions, and solve the discretized system with a highly scalable domain decomposition method. With this approach, a high resolution simulation of a full-size adult aorta can be obtained in less than an hour, instead of days with older methods and software. In addition, we show that the parallel efficiency of the proposed method is near 70% on a parallel computer with 2, 880 processor cores.
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Affiliation(s)
- Shanlin Qin
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bokai Wu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jia Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Wen-Shin Shiu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zhengzheng Yan
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Rongliang Chen
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Shenzhen Key Laboratory for Exascale Engineering and Scientific Computing, Shenzhen, China.
| | - Xiao-Chuan Cai
- Department of Mathematics, University of Macau, Macau, China.
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21
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Morphological and hemodynamic analysis of the patient-specific renal cell carcinoma models. J Biomech 2021; 126:110636. [PMID: 34298292 DOI: 10.1016/j.jbiomech.2021.110636] [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: 11/13/2020] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 11/24/2022]
Abstract
Although the morbidity of renal cell carcinoma (RCC) has been increasing as the seventh most common tumours, to our knowledge, there is few studies foucsing on the hemodynamics of the renal artery (RA) with RCC. The objective of this study is to perform morphological and hemodynamic analysis of the RA and abdominal aorta artery (AAA) in the control healthy and RCC patient groups. Three-dimensional (3D) geometries are reconstructed from 18 control healthy subjects and 15 RCC patients based on Computed Tomography Angiography (CTA) images. There is higer in the lumen diameter of the RA (6.21 ± 0.89 mm) and curvature of the RA (1.2 ± 0.07) in the RCC patient group compared with the control healthy group (4.29 ± 1.08 mm, 1.1 ± 0.1), respectively. In the hemodynamic analysis, the surface area ratio (%) of low time-averaged wall shear stress (SAR-TAWSS) at the RA (10.65 ± 11.65) and AAA (48.49 ± 12.79) in the RCC patient group is significantly higher than that in the control healthy group (0.23 ± 0.22, 21.57 ± 20.5), respectively. It is found that RCC altered the morphology of the RA in the RCC patient group, which could deteriorate the hemodynamic environment of the RA and AAA. The finding in this study could enhance us to understand the progression of vascular disease caused by RCC.
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22
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Heterogeneity of Ex Vivo and In Vivo Properties along the Length of the Abdominal Aortic Aneurysm. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current clinical guidelines for the management of aortic abdominal aneurysms (AAAs) overlook the structural and mechanical heterogeneity of the aortic tissue and its role in the regional weakening that drives disease progression. This study is a comprehensive investigation of the structural and biomechanical heterogeneity of AAA tissue along the length and circumference of the aorta, by means of regional ex vivo and in vivo properties. Biaxial testing and histological analysis were performed on ex vivo human aortic specimens systematically collected during open repair surgery. Wall-shear stress and three-dimensional principal strain analysis were performed to allow for in vivo regional characterization of individual aortas. A marked effect of position along the aortic length was observed in both ex vivo and in vivo properties, with the central regions corresponding to the aneurysmal sac being significantly different from the adjacent regions. The heterogeneity along the circumference of the aorta was reflected in the ex vivo biaxial response at low strains and histological properties. Present findings uniquely show the importance of regional characterization for aortic assessment and the need to correlate heterogeneity at the tissue level with non-invasive measurements aimed at improving clinical outcomes.
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23
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Nieto-Palomo F, Pérez-Rueda MÁ, Lipsa LM, Vaquero-Puerta C, Vilalta-Alonso JA, Vilalta-Alonso G, Soudah-Prieto E. Statistical techniques for predicting rupture risk in abdominal aortic aneurysms: A contribution based on bootstrap. Sci Prog 2021; 104:368504211003785. [PMID: 33827352 PMCID: PMC10454785 DOI: 10.1177/00368504211003785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The morphometry of abdominal aortic aneurysms (AAA) has been recognized as one of the main factors that may predispose them to rupture. The need to quantify the morphometry of AAA on a patient-specific basis constitutes a valuable tool for assisting in rupture risk prediction. Previous results of this research group have determined the correlations between hemodynamic stresses and aneurysm morphometry by means of the Pearson coefficient. The present work aims to find how the AAA morphology correlates with the hemodynamic stresses acting on the arterial wall. To do so, the potential of the bootstrap technique has been explored. Bootstrap works appropriately in applications where few data are available (13 patient-specific AAA models were simulated). The methodology developed can be considered a contribution to predicting the hemodynamic stresses from the size and shape indices. The present work explores the use of a specific statistical technique (the bootstrap technique) to predict, based on morphological correlations, the patient-specific aneurysm rupture risk, provide greater understanding of this complex phenomenon that can bring about improvements in the clinical management of aneurysmatic patients. The results obtained using the bootstrap technique have greater reliability and robustness than those obtained by regression analysis using the Pearson coefficient, thus allowing to obtain more reliable results from the characteristics of the samples used, such as their small size and high variability. Additionally, it could be an indicator that other indices, such as AAA length, deformation rate, saccular index, and asymmetry, are important.
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Affiliation(s)
- Félix Nieto-Palomo
- Mechanical Engineering Division, CARTIF Technological Center, Valladolid, Boecillo, Spain
- Institute for Advanced Production Technologies (ITAP), University of Valladolid, Valladolid, Spain
| | - María-Ángeles Pérez-Rueda
- Department of Mechanical Engineering, Faculty of Industrial Engineering of the University of Valladolid, Valladolid, Spain
- Institute for Advanced Production Technologies (ITAP), University of Valladolid, Valladolid, Spain
| | - Laurentiu-Mihai Lipsa
- Mechanical Engineering Division, CARTIF Technological Center, Valladolid, Boecillo, Spain
- Institute for Advanced Production Technologies (ITAP), University of Valladolid, Valladolid, Spain
| | - Carlos Vaquero-Puerta
- Angiology and Vascular Surgery Service, Clinic Hospital and University of Valladolid, Valladolid, Spain
- Institute for Advanced Production Technologies (ITAP), University of Valladolid, Valladolid, Spain
| | - José-Alberto Vilalta-Alonso
- Industrial Engineering Department, Universidad Tecnológica de La Habana José Antonio Echeverría (Cujae), Havana, Cuba
| | - Guillermo Vilalta-Alonso
- Thermal Sciences and Fluids Department, Federal University of São João del-Rei, São João del-Rei, Brazil
- Institute for Advanced Production Technologies (ITAP), University of Valladolid, Valladolid, Spain
| | - Eduardo Soudah-Prieto
- International Center for Numerical Methods in Engineering (CIMNE), Technical University of Catalonia, Barcelona, Catalunya, Spain
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24
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Puiseux T, Sewonu A, Moreno R, Mendez S, Nicoud F. Numerical simulation of time-resolved 3D phase-contrast magnetic resonance imaging. PLoS One 2021; 16:e0248816. [PMID: 33770130 PMCID: PMC7997039 DOI: 10.1371/journal.pone.0248816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/06/2021] [Indexed: 11/26/2022] Open
Abstract
A numerical approach is presented to efficiently simulate time-resolved 3D phase-contrast Magnetic resonance Imaging (or 4D Flow MRI) acquisitions under realistic flow conditions. The Navier-Stokes and Bloch equations are simultaneously solved with an Eulerian-Lagrangian formalism. A semi-analytic solution for the Bloch equations as well as a periodic particle seeding strategy are developed to reduce the computational cost. The velocity reconstruction pipeline is first validated by considering a Poiseuille flow configuration. The 4D Flow MRI simulation procedure is then applied to the flow within an in vitro flow phantom typical of the cardiovascular system. The simulated MR velocity images compare favorably to both the flow computed by solving the Navier-Stokes equations and experimental 4D Flow MRI measurements. A practical application is finally presented in which the MRI simulation framework is used to identify the origins of the MRI measurement errors.
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Affiliation(s)
- Thomas Puiseux
- IMAG, University Montpellier, CNRS, Montpellier, France
- Spin Up, Strasbourg, France
- I2MC, INSERM UMR 1297, Toulouse, France
- * E-mail:
| | | | - Ramiro Moreno
- Spin Up, Strasbourg, France
- I2MC, INSERM UMR 1297, Toulouse, France
- ALARA Expertise, Strasbourg, France
| | - Simon Mendez
- IMAG, University Montpellier, CNRS, Montpellier, France
| | - Franck Nicoud
- IMAG, University Montpellier, CNRS, Montpellier, France
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25
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Forneris A, Kennard J, Ismaguilova A, Shepherd RD, Studer D, Bromley A, Moore RD, Rinker KD, Di Martino ES. Linking Aortic Mechanical Properties, Gene Expression and Microstructure: A New Perspective on Regional Weakening in Abdominal Aortic Aneurysms. Front Cardiovasc Med 2021; 8:631790. [PMID: 33659281 PMCID: PMC7917077 DOI: 10.3389/fcvm.2021.631790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Current clinical practice for the assessment of abdominal aortic aneurysms (AAA) is based on vessel diameter and does not account for the multifactorial, heterogeneous remodeling that results in the regional weakening of the aortic wall leading to aortic growth and rupture. The present study was conducted to determine correlations between a novel non-invasive surrogate measure of regional aortic weakening and the results from invasive analyses performed on corresponding ex vivo aortic samples. Tissue samples were evaluated to classify local wall weakening and the likelihood of further degeneration based on non-invasive indices. Methods: A combined, image-based fluid dynamic and in-vivo strain analysis approach was used to estimate the Regional Aortic Weakness (RAW) index and assess individual aortas of AAA patients prior to elective surgery. Nine patients were treated with complete aortic resection allowing the systematic collection of tissue samples that were used to determine regional aortic mechanics, microstructure and gene expression by means of mechanical testing, microscopy and transcriptomic analyses. Results: The RAW index was significantly higher for samples exhibiting lower mechanical strength (p = 0.035) and samples classified as low elastin content (p = 0.020). Samples with higher RAW index had the greatest number of genes differentially expressed compared to any constitutive metric. High RAW samples showed a decrease in gene expression for elastin and a down-regulation of pathways responsible for cell movement, reorganization of cytoskeleton, and angiogenesis. Conclusions: This work describes the first AAA index free of assumptions for material properties and accounting for patient-specific mechanical behavior in relation to aneurysm strength. Use of the RAW index captured biomechanical changes linked to the weakening of the aorta and revealed changes in microstructure and gene expression. This approach has the potential to provide an improved tool to aid clinical decision-making in the management of aortic pathology.
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Affiliation(s)
- Arianna Forneris
- Biomedical Engineering, University of Calgary, Calgary, AB, Canada.,Department of Civil Engineering, University of Calgary, Calgary, AB, Canada
| | - Jacob Kennard
- Biomedical Engineering, University of Calgary, Calgary, AB, Canada
| | | | | | - Deborah Studer
- Biomedical Engineering, University of Calgary, Calgary, AB, Canada
| | - Amy Bromley
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Randy D Moore
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Kristina D Rinker
- Biomedical Engineering, University of Calgary, Calgary, AB, Canada.,Department of Chemical and Petroleum Engineering, University of Calgary, Calgary, AB, Canada.,Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada
| | - Elena S Di Martino
- Biomedical Engineering, University of Calgary, Calgary, AB, Canada.,Department of Civil Engineering, University of Calgary, Calgary, AB, Canada
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26
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Mitsouras D, Leach JR. Expanding the Radiologist's Arsenal against Abdominal Aortic Aneurysms, a Versatile Adversary. Radiology 2020; 295:730-732. [PMID: 32233921 PMCID: PMC7263282 DOI: 10.1148/radiol.2020200531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Dimitrios Mitsouras
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif; and Department of Radiology, Veterans Affairs Medical Center, 4150 Clement St, 114D, San Francisco, CA 94121
| | - Joseph R. Leach
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif; and Department of Radiology, Veterans Affairs Medical Center, 4150 Clement St, 114D, San Francisco, CA 94121
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