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Alexander KC, Ikonomidis JS, Akerman AW. New Directions in Diagnostics for Aortic Aneurysms: Biomarkers and Machine Learning. J Clin Med 2024; 13:818. [PMID: 38337512 PMCID: PMC10856211 DOI: 10.3390/jcm13030818] [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: 12/22/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
This review article presents an appraisal of pioneering technologies poised to revolutionize the diagnosis and management of aortic aneurysm disease, with a primary focus on the thoracic aorta while encompassing insights into abdominal manifestations. Our comprehensive analysis is rooted in an exhaustive survey of contemporary and historical research, delving into the realms of machine learning (ML) and computer-assisted diagnostics. This overview draws heavily upon relevant studies, including Siemens' published field report and many peer-reviewed publications. At the core of our survey lies an in-depth examination of ML-driven diagnostic advancements, dissecting an array of algorithmic suites to unveil the foundational concepts anchoring computer-assisted diagnostics and medical image processing. Our review extends to a discussion of circulating biomarkers, synthesizing insights gleaned from our prior research endeavors alongside contemporary studies gathered from the PubMed Central database. We elucidate the prevalent challenges and envisage the potential fusion of AI-guided aortic measurements and sophisticated ML frameworks with the computational analyses of pertinent biomarkers. By framing current scientific insights, we contemplate the transformative prospect of translating fundamental research into practical diagnostic tools. This narrative not only illuminates present strides, but also forecasts promising trajectories in the clinical evaluation and therapeutic management of aortic aneurysm disease.
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Affiliation(s)
| | | | - Adam W. Akerman
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.C.A.); (J.S.I.)
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Pepe A, Egger J, Codari M, Willemink MJ, Gsaxner C, Li J, Roth PM, Schmalstieg D, Mistelbauer G, Fleischmann D. Automated cross-sectional view selection in CT angiography of aortic dissections with uncertainty awareness and retrospective clinical annotations. Comput Biol Med 2023; 165:107365. [PMID: 37647783 DOI: 10.1016/j.compbiomed.2023.107365] [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: 05/09/2023] [Revised: 07/20/2023] [Accepted: 08/12/2023] [Indexed: 09/01/2023]
Abstract
Surveillance imaging of patients with chronic aortic diseases, such as aneurysms and dissections, relies on obtaining and comparing cross-sectional diameter measurements along the aorta at predefined aortic landmarks, over time. The orientation of the cross-sectional measuring planes at each landmark is currently defined manually by highly trained operators. Centerline-based approaches are unreliable in patients with chronic aortic dissection, because of the asymmetric flow channels, differences in contrast opacification, and presence of mural thrombus, making centerline computations or measurements difficult to generate and reproduce. In this work, we present three alternative approaches - INS, MCDS, MCDbS - based on convolutional neural networks and uncertainty quantification methods to predict the orientation (ϕ,θ) of such cross-sectional planes. For the monitoring of chronic aortic dissections, we show how a dataset of 162 CTA volumes with overall 3273 imperfect manual annotations routinely collected in a clinic can be efficiently used to accomplish this task, despite the presence of non-negligible interoperator variabilities in terms of mean absolute error (MAE) and 95% limits of agreement (LOA). We show how, despite the large limits of agreement in the training data, the trained model provides faster and more reproducible results than either an expert user or a centerline method. The remaining disagreement lies within the variability produced by three independent expert annotators and matches the current state of the art, providing a similar error, but in a fraction of the time.
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Affiliation(s)
- Antonio Pepe
- Graz University of Technology, Institute of Computer Graphics and Vision, Inffeldgasse 16/II, 8010 Graz, Austria; Stanford University, School of Medicine, 3D and Quantitative Imaging Lab, 300 Pasteur Drive Stanford, CA 94305, USA; Computer Algorithms for Médicine (Café) Laboratory, Graz, Austria.
| | - Jan Egger
- Computer Algorithms for Médicine (Café) Laboratory, Graz, Austria; University Medicine Essen, Institute for AI in Medicine (IKIM), Girardetstraße 2, 45131 Essen, Germany.
| | - Marina Codari
- Stanford University, School of Medicine, 3D and Quantitative Imaging Lab, 300 Pasteur Drive Stanford, CA 94305, USA.
| | - Martin J Willemink
- Stanford University, School of Medicine, 3D and Quantitative Imaging Lab, 300 Pasteur Drive Stanford, CA 94305, USA.
| | - Christina Gsaxner
- Graz University of Technology, Institute of Computer Graphics and Vision, Inffeldgasse 16/II, 8010 Graz, Austria; Computer Algorithms for Médicine (Café) Laboratory, Graz, Austria.
| | - Jianning Li
- Computer Algorithms for Médicine (Café) Laboratory, Graz, Austria; University Medicine Essen, Institute for AI in Medicine (IKIM), Girardetstraße 2, 45131 Essen, Germany.
| | - Peter M Roth
- Graz University of Technology, Institute of Computer Graphics and Vision, Inffeldgasse 16/II, 8010 Graz, Austria.
| | - Dieter Schmalstieg
- Graz University of Technology, Institute of Computer Graphics and Vision, Inffeldgasse 16/II, 8010 Graz, Austria.
| | - Gabriel Mistelbauer
- Stanford University, School of Medicine, 3D and Quantitative Imaging Lab, 300 Pasteur Drive Stanford, CA 94305, USA.
| | - Dominik Fleischmann
- Stanford University, School of Medicine, 3D and Quantitative Imaging Lab, 300 Pasteur Drive Stanford, CA 94305, USA.
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Durrand J, Reicher J, Ayyash R. Vascular imaging for anaesthetists and intensivists, part 2: clinical applications. BJA Educ 2022; 22:376-386. [PMID: 36132881 PMCID: PMC9482869 DOI: 10.1016/j.bjae.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 10/15/2022] Open
Affiliation(s)
- J. Durrand
- James Cook University Hospital, Middlesbrough, UK
| | - J. Reicher
- Freeman Hospital, Newcastle Upon Tyne, UK
| | - R. Ayyash
- James Cook University Hospital, Middlesbrough, UK
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BELCARO G, CESARONE MR, DUGALL M, CORSI M, HOSOI M, BAVERA PM, COTELLESE R, FERAGALLI B, IPPOLITO E. Effects of the collagen modulator Centellicum® and spinal elongation exercises on subclinical abdominal aneurysmal dilatation. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.22.01537-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Verzini F, Desai N, Arko FR, Panneton JM, Thaveau F, Dagenais F, Guo J, Azizzadeh A. Clinical trial outcomes and thoracic aortic morphometry after one year with the Valiant Navion stent graft system. J Vasc Surg 2021; 74:569-578.e3. [PMID: 33592295 DOI: 10.1016/j.jvs.2021.01.047] [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: 07/01/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
AUTHORS' NOTE On February 17, 2021, Medtronic Incorporated issued a global voluntary recall of the Valiant Navion Thoracic Stent Graft System (the device under study in the Valiant Evo Global Clinical Program that is the subject of this publication), and instructed physicians to immediately cease use of the Valiant Navion system and return any unused product. Medtronic initiated the recall in response to three clinical trial subjects recently observed with stent fractures, two of whom have confirmed type IIIb endoleaks. The data collection, analysis, and manuscript submission occurred before the notice of this recall, and, specifically, the 100 procedures reviewed for this series were free of events at 1 year related to the reason for this device recall. The authors of this article and the manufacturer were unaware of the recently detected adverse events at the time of the preparation of the manuscript, and the 1-year trial results, and imaging-based analyses described are unchanged. Management of thoracic aortic aneurysms continues to be a challenging problem and outcomes are dependent on patient anatomy. The present publication focuses on the importance of achieving proximal and distal seals and the consideration of the temporal changes of the aortic morphology as a part of the TEVAR planning process. The authors believe there is still scientific merit in disclosing this information, despite the current nonavailability of the Valiant Navion system. OBJECTIVE The Valiant Navion stent graft system (Medtronic Inc, Santa Rosa, Calif) is a third-generation device with improved conformability. We have reported the 1-year clinical trial outcomes, with a focus on an imaging-based analysis of the aortic morphology. We assessed the effects of graft implantation on the native anatomy and the effects of the 1-year changes in thoracic aorta morphology on the original seal zones of the stent graft. METHODS A total of 100 subjects were enrolled in a prospective single-arm clinical trial investigating the Valiant Navion stent graft system. An independent core laboratory (Syntactx, New York, NY) assessed the anatomic characteristics and performance outcomes. RESULTS Through 1 year of follow-up, the freedom from all-cause mortality, aneurysm-related mortality, and secondary procedures was 89.8%, 97.0%, and 94.8% respectively. Of the 100 patients, 5 had undergone a total of six secondary procedures, and 9 patients had developed an endoleak (type Ia and Ib in 1, type Ia in 1, type Ib in 3, and type II in 4 patients) within the first year. After 1 year, 2 of 76 patients (2.6%) had had an increase in their maximum aneurysm diameter of ≥5 mm, 62 (81.6%) had had stable sacs, and 12 (15.8%) had experienced sac shrinkage. Although no deployment failures had occurred, 36 of the 100 proximal (36%) and 31 of the 100 distal (31%) attachment zones were considered short according to our definitions. The stent graft had conformed to the native anatomy at implantation, because the preprocedural thoracic aorta tortuosity (1.45 ± 0.02) had not significantly changed at 1 month after implantation (1.46 ± 0.02). Despite a natural increase in thoracic tortuosity after 1 year (1.49 ± 0.02), wall apposition had been maintained over time, as evidenced by the low endoleak rates. Aortic elongation and dilation had occurred at the proximal end of the graft by an average of 1.2 mm and 1.6 mm, respectively. Aortic remodeling was more pronounced at the distal end, with an average increase of 4.2 mm in length and 2.8 mm in diameter. CONCLUSIONS The included patients had had positive 1-year outcomes with high freedom from mortality, endoleak development, and secondary procedures. Aortic elongation and dilation were more prevalent at the distal end, emphasizing the importance of distal attachment zone consideration as part of preoperative planning. Because aortic remodeling can be expected to continue over time, additional follow-up and imaging analysis in the trial will be necessary to assess the aortic morphology and its effects on stent graft performance.
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Affiliation(s)
- Fabio Verzini
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy.
| | - Nimesh Desai
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Frank R Arko
- Department of Endovascular Surgery, Carolinas Medical Center, Charlotte, NC
| | - Jean M Panneton
- Department of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Va
| | - Fabien Thaveau
- Department of Vascular Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Francois Dagenais
- Division of Cardiac Surgery, University of Quebec, Quebec City, Quebec, Canada
| | - Jia Guo
- Department of Clinical Research, Medtronic Inc, Santa Rosa, Calif
| | - Ali Azizzadeh
- Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
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Yoon WJ, Mell MW. Outcome comparison of thoracic endovascular aortic repair performed outside versus inside proximal landing zone length recommendation. J Vasc Surg 2020; 72:1883-1890. [DOI: 10.1016/j.jvs.2020.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/10/2020] [Indexed: 11/25/2022]
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Kohlman-Trigoboff D, Rich K, Foley A, Fitzgerald K, Arizmendi D, Robinson C, Brown R, Treat-Jacobson D. Society for Vascular Nursing endovascular repair of abdominal aortic aneurysm updated nursing clinical practice guideline. JOURNAL OF VASCULAR NURSING 2020; 38:36-65. [PMID: 32534654 PMCID: PMC7707638 DOI: 10.1016/j.jvn.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Debra Kohlman-Trigoboff
- Duke University Medical Center, Division of Cardiology, Duke Heart and Vascular, Durham, North Carolina.
| | - Kathleen Rich
- Critical Care Administration, Franciscan Health-Michigan City, Michigan City, Indiana
| | - Anne Foley
- Department of Vascular Surgery, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Fitzgerald
- The Vascular Group, PLLC, Albany Medical Center Hospital, Albany, New York
| | - Dianne Arizmendi
- Corporal Michael Crescenz VA Hospital, Philadelphia, Pennsylvania
| | | | - Rebecca Brown
- National Institutes of Health's National Center for Advancing Translational Sciences, University of Minnesota School of Nursing, Minneapolis, Minnesota
| | - Diane Treat-Jacobson
- Nursing Research for Improved Care, University of Minnesota School of Nursing, Minneapolis, Minnesota
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Domanin M, Trimarchi S. Commentary: Another Issue for the Modern Vascular Specialist to Consider: Advanced Imaging Software. J Endovasc Ther 2019; 26:688-690. [PMID: 31364462 DOI: 10.1177/1526602819866437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Maurizio Domanin
- Department of Clinical and Community Sciences, University of Milan, Italy.,Unit of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Department of Clinical and Community Sciences, University of Milan, Italy.,Unit of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Hu DK, Pisimisis GT, Sheth RA. Repair of abdominal aortic aneurysms: preoperative imaging and evaluation. Cardiovasc Diagn Ther 2018; 8:S157-S167. [PMID: 29850427 DOI: 10.21037/cdt.2018.01.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Imaging is a critical component of the pre-procedure evaluation and planning of endovascular aneurysm repair (EVAR). Imaging is the mainstay for proper assessment of procedural candidacy, relevant vascular anatomy, device selection, and surgical approach. Computed tomography angiography (CTA) has long been considered the preferred modality for pre-operative imaging and evaluation prior to EVAR. Recently, advances in image quality and software technology have further enhanced the proceduralist's ability to plan and perform EVAR. In this review, we highlight the current state of the art to provide interventionalists a contemporary assessment of the available tools for pre-operative imaging and evaluation prior to EVAR.
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Affiliation(s)
- David K Hu
- Baylor College of Medicine, Houston, TX, USA.,Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - George T Pisimisis
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA.,Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
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Wang LJ, Prabhakar AM, Kwolek CJ. Current status of the treatment of infrarenal abdominal aortic aneurysms. Cardiovasc Diagn Ther 2018; 8:S191-S199. [PMID: 29850431 DOI: 10.21037/cdt.2017.10.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aortic aneurysms are the 13th leading cause of death in the United States. While aneurysms can occur along the entire length of the aorta, the infrarenal location is the most common. Targeted ultrasound screening has been found to be an effective and economical means of preventing aortic aneurysm rupture. The indication for repair includes either symptomatic aneurysms or aneurysms with a diameter greater than 5.4 cm. Treatment options for the repair of infrarenal aortic aneurysms are open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Currently, EVAR is the primary treatment method for the repair of infrarenal aortic aneurysms due to improved short-term morbidity and mortality outcomes. This article is intended to review the current status of the management of infrarenal abdominal aortic aneurysms (AAA).
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Affiliation(s)
- Linda J Wang
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand M Prabhakar
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher J Kwolek
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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