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Advances in Multimodality Aortic Imaging
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Advances in Multimodality Aortic Imaging

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nuclear Medicine & Radiology".

Deadline for manuscript submissions: closed (25 February 2024) | Viewed by 10067

Special Issue Editor

Dr. Nadjia Kachenoura

E-Mail Website
Guest Editor
Laboratoire d’Imagerie Biomédicale, Sorbonne University, Inserm, CNRS, 75006 Paris, France
Interests: CMR; phase contrast; imaging; medical technology; segmentation

Special Issue Information

Dear Colleagues,

The aorta, as the largest and the most elastic artery in the body, plays a major role in cushioning the pulsatile flow originating from the heart to protect the left ventricle from deleterious remodeling but also the highly vascularized target organs such as brain and kidneys from microvascular damage. Beyond natural stiffening with aging, which can be aggravated by various cardiovascular risk factors such as highly prevalent hypertension, diabetes or obesity, the thoracic aorta is subjected to several inherited or acquired pathological conditions.

Cardiovascular imaging is widely used in diagnosis and follow-up of aortic diseases. However, such clinical management mainly relies on morphological assessment alone, despite advances in cardiovascular imaging towards the 3D characterization of aortic geometry, stiffness and circulating blood flow. Such cutting-edge image acquisition tools (CT, MRI and ultrasound) combined with advanced image processing, including artificial intelligence, offer a new arsenal of biomarkers for aortic deformation and inner hemodynamic forces that can be of utmost usefulness to progress towards personalized risk assessment and patient management in various aortic diseases.

Dr. Nadjia Kachenoura
Guest Editor

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Keywords

  • aorta
  • cardiovascular imaging
  • stiffness
  • hemodynamics
  • vascular disease
  • image processing
  • artificial intelligence

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Published Papers (5 papers)

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Research

10 pages, 3082 KiB  
Article
Evaluating Image Quality and Radiation Dose in Low-Dose Thoraco-Abdominal CT Angiography with a Tin Filter for Patients with Aortic Disease
by Chang Hoon Oh, Soo Buem Cho and Hyeyoung Kwon
J. Clin. Med. 2024, 13(4), 996; https://doi.org/10.3390/jcm13040996 - 8 Feb 2024
Viewed by 982
Abstract
Background: We aimed to compared radiation exposure and image quality between tin-filter-based and standard dose thoraco-abdominal computed tomography angiography (TACTA) protocols, aiming to address a gap in the existing literature. Methods: In this retrospective study, ninety consecutive patients undergoing TACTA were included. Of [...] Read more.
Background: We aimed to compared radiation exposure and image quality between tin-filter-based and standard dose thoraco-abdominal computed tomography angiography (TACTA) protocols, aiming to address a gap in the existing literature. Methods: In this retrospective study, ninety consecutive patients undergoing TACTA were included. Of these, 45 followed a routine standard-dose protocol (ST100kV), and 45 underwent a low-dose protocol with a tin filter (TF100kV). Radiation metrics were compared. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM) were calculated for the thoracic and abdominal aorta and right common iliac artery. Two independent readers assessed the image noise, image contrast, sharpness, and subjective image quality. Results: The mean dose for the TF100kV group was significantly lower (DLP 128.25 ± 18.18 mGy*cm vs. 662.75 ± 181.29, p < 0.001; CTDIvol 1.83 ± 0.25 mGy vs. 9.28 ± 2.17, p = 0.001), with an effective dose close to 2.3 mSv (2.31 ± 0.33 mSv; p < 0.001). The TF100kV group demonstrated greater dose efficiency (FOM, thoracic aorta: 36.70 ± 22.77 vs. 13.96 ± 13.18 mSv−1, p < 0.001) compared to the ST100kV group. Conclusions: Dedicated low-dose TACTA using a tin filter can significantly reduce the radiation dose while maintaining sufficient diagnostic image quality. Full article
(This article belongs to the Special Issue Advances in Multimodality Aortic Imaging)
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10 pages, 5925 KiB  
Article
Preoperative Spinal Arterial Supply Mapping Using Non-Selective Cone Beam Computed Tomography before Complex Aortic Repair
by Baptiste Bonnet, Hicham Kobeiter, Lorenzo Pescatori, Youssef Zaarour, Wafa Boughanmi, Mario Ghosn, Frédéric Cochennec, Nicolas Mongardon, Pascal Desgranges, Vania Tacher and Haytham Derbel
J. Clin. Med. 2024, 13(3), 796; https://doi.org/10.3390/jcm13030796 - 30 Jan 2024
Viewed by 1629
Abstract
Pre-op spinal arterial mapping is crucial for complex aortic repair. This study explores the utility of non-selective cone beam computed tomography (CBCT) for pre-operative spinal arterial mapping to identify the Adamkiewicz artery (AKA) in patients undergoing open or endovascular repair of the descending [...] Read more.
Pre-op spinal arterial mapping is crucial for complex aortic repair. This study explores the utility of non-selective cone beam computed tomography (CBCT) for pre-operative spinal arterial mapping to identify the Adamkiewicz artery (AKA) in patients undergoing open or endovascular repair of the descending thoracic or thoracoabdominal aorta at risk of spinal cord ischemia. Pre-operative non-selective dual-phase CBCT after intra-aortic contrast injection was performed in the aortic segment to be treated. The origin of detected AKA was assessed based on image fusion between CBCT and pre-interventional computed tomography angiography. Then, the CBCT findings were compared with the incidence of postoperative spinal cord ischemia (SCI). Among 21 included patients (median age: 68 years, 20 men), AKA was detected in 67% within the explored field of view, predominantly from T7 to L1 intercostal and lumbar arteries. SCI occurred in 14%, but none when AKA was not detected (p < 0.01). Non-selective CBCT for AKA mapping is deemed safe and feasible, with potential predictive value for post-surgical spinal cord ischemia risk. The study concludes that non-selective aortic CBCT is a safe and feasible method for spinal arterial mapping, providing promising insights into predicting post-surgical SCI risk. Full article
(This article belongs to the Special Issue Advances in Multimodality Aortic Imaging)
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11 pages, 1019 KiB  
Article
Association between Biomarkers of Inflammation and 10-Year Changes in Aortic Stiffness: The Multi-Ethnic Study of Atherosclerosis
by Rithvik Swamynathan, Vinithra Varadarajan, Hieu Nguyen, Colin O. Wu, Kiang Liu, David A. Bluemke, Nadjia Kachenoura, Alban Redheuil, João A. C. Lima and Bharath Ambale-Venkatesh
J. Clin. Med. 2023, 12(15), 5062; https://doi.org/10.3390/jcm12155062 - 1 Aug 2023
Cited by 1 | Viewed by 1378
Abstract
Background. Chronic inflammation is associated with incident cardiovascular events. We study the association between biomarkers of inflammation and subclinical vascular dysfunction measured as proximal aortic stiffness. Methods. MRI imaging was performed in the Multi-Ethnic Study of Atherosclerosis (MESA) at baseline (2000) and [...] Read more.
Background. Chronic inflammation is associated with incident cardiovascular events. We study the association between biomarkers of inflammation and subclinical vascular dysfunction measured as proximal aortic stiffness. Methods. MRI imaging was performed in the Multi-Ethnic Study of Atherosclerosis (MESA) at baseline (2000) and at the 10-year follow-up. Aortic arch pulse wave velocity (PWV) and ascending and descending aorta distensibility (AAD, DAD) were measured in 1223 asymptomatic individuals at both exams. Linear regression was used to study the association of baseline inflammation—C-reactive protein (CRP), interleukin-6 (IL6), and fibrinogen (Fib)—with baseline and 10-year changes in aortic stiffness (PWV, AAD, DAD). Results. The mean age of the participants was 59 ± 9 years, 47.8% of them were men, 32.6% were hypertensive at baseline, and 7.6% were diabetic. At baseline and follow-up, the mean AAD values were, respectively, 1.73 × 10−3 mmHg−1 and 1.57 × 10−3 mmHg−1, the mean DAD values were 2.19 × 10−3 mmHg−1 and 1.99 × 10−3 mmHg−1, and the mean PWV values were 8.10 m/s and 8.99 m/s. At baseline, the AAD (in 10−3 mmHg−1) and DAD (in 10−3 mmHg−1) were inversely associated with CRP (in mg/L) (AAD coeff: −0.047, p-value: 0.011, DAD coeff: −0.068, p-value: <0.001) and IL6 (in pg/mL) (AAD coeff: −0.098, p-value: 0.003, DAD coeff: −0.14, p-value: <0.001) in a univariable analysis but not after adjustment for demographic variables or cardiovascular risk factors. The baseline DAD was inversely associated with Fib (in mg/dL) (coeff: −0.334, p-value: 0.001). The baseline PWV (in m/s) was positively associated with IL6 (in pg/mL) in a univariable analysis (coeff: 0.054, p-value: 0.014). In a longitudinal analysis, the 10-year changes in DAD were inversely associated with CRP, even after adjustment for demographics and risk factors (DAD coeff: −0.08, p-value 0.044). Conclusions. Higher CRP levels at baseline were independently associated with a 10-year increase in aortic stiffness, measured as decreased aortic distensibility. Full article
(This article belongs to the Special Issue Advances in Multimodality Aortic Imaging)
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15 pages, 3540 KiB  
Article
Comparison of In-Vivo and Ex-Vivo Ascending Aorta Elastic Properties through Automatic Deep Learning Segmentation of Cine-MRI and Biomechanical Testing
by Emmanouil Markodimitrakis, Siyu Lin, Emmanouil Koutoulakis, Diana Marcela Marín-Castrillón, Francisco Aarón Tovar Sáez, Sarah Leclerc, Chloé Bernard, Arnaud Boucher, Benoit Presles, Olivier Bouchot, Thomas Decourselle, Marie-Catherine Morgant and Alain Lalande
J. Clin. Med. 2023, 12(2), 402; https://doi.org/10.3390/jcm12020402 - 4 Jan 2023
Cited by 5 | Viewed by 4185
Abstract
Ascending aortic aneurysm is a pathology that is important to be supervised and treated. During the years the aorta dilates, it becomes stiff, and its elastic properties decrease. In some cases, the aortic wall can rupture leading to aortic dissection with a high [...] Read more.
Ascending aortic aneurysm is a pathology that is important to be supervised and treated. During the years the aorta dilates, it becomes stiff, and its elastic properties decrease. In some cases, the aortic wall can rupture leading to aortic dissection with a high mortality rate. The main reference standard to measure when the patient needs to undertake surgery is the aortic diameter. However, the aortic diameter was shown not to be sufficient to predict aortic dissection, implying other characteristics should be considered. Therefore, the main objective of this work is to assess in-vivo the elastic properties of four different quadrants of the ascending aorta and compare the results with equivalent properties obtained ex-vivo. The database consists of 73 cine-MRI sequences of thoracic aorta acquired in axial orientation at the level of the pulmonary trunk. All the patients have dilated aorta and surgery is required. The exams were acquired just prior to surgery, each consisting of 30 slices on average across the cardiac cycle. Multiple deep learning architectures have been explored with different hyperparameters and settings to automatically segment the contour of the aorta on each image and then automatically calculate the aortic compliance. A semantic segmentation U-Net network outperforms the rest explored networks with a Dice score of 98.09% (±0.96%) and a Hausdorff distance of 4.88 mm (±1.70 mm). Local aortic compliance and local aortic wall strain were calculated from the segmented surfaces for each quadrant and then compared with elastic properties obtained ex-vivo. Good agreement was observed between Young’s modulus and in-vivo strain. Our results suggest that the lateral and posterior quadrants are the stiffest. In contrast, the medial and anterior quadrants have the lowest aortic stiffness. The in-vivo stiffness tendency agrees with the values obtained ex-vivo. We can conclude that our automatic segmentation method is robust and compatible with clinical practice (thanks to a graphical user interface), while the in-vivo elastic properties are reliable and compatible with the ex-vivo ones. Full article
(This article belongs to the Special Issue Advances in Multimodality Aortic Imaging)
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7 pages, 1785 KiB  
Article
What Are the Biomechanical Properties of an Aortic Aneurysm Associated with Quadricuspid Aortic Valve?
by Siyu Lin, Marie-Catherine Morgant, Diana M. Marín-Castrillón, Chloé Bernard, Arnaud Boucher, Benoît Presles, Alain Lalande and Olivier Bouchot
J. Clin. Med. 2022, 11(16), 4897; https://doi.org/10.3390/jcm11164897 - 20 Aug 2022
Viewed by 1310
Abstract
Association of quadricuspid aortic valve (QAV) with ascending aortic aneurysms (AsAA) is rare. A 63-year-old female with hypertension was found (on MRI) to have an ascending aortic aneurysm (52 mm in maximum diameter) and dilatation at the level of the sinotubular junction (38 [...] Read more.
Association of quadricuspid aortic valve (QAV) with ascending aortic aneurysms (AsAA) is rare. A 63-year-old female with hypertension was found (on MRI) to have an ascending aortic aneurysm (52 mm in maximum diameter) and dilatation at the level of the sinotubular junction (38 mm in diameter) associated with quadricuspid aortic valve. An ascending aortic wall replacement surgery was performed. In this study, we focus on the behavior of the aorta associated with QAV considering the in vitro biomechanical characteristics and histology. The properties of QAV are closer to bicuspid aortic valve than tricuspid aortic valve, but with higher wall thickness. Full article
(This article belongs to the Special Issue Advances in Multimodality Aortic Imaging)
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