Comparison of diametric and volumetric changes in Stanford type B aortic dissection patients in assessing aortic remodeling post-stent graft treatment

Affiliations

¹ Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, 26600, Pekan, Pahang, Malaysia.
² Discipline of Medical Radiation Science, Curtin University, Perth 6845, Australia.
³ Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
⁴ Department of Mechanical, Materials and Manufacturing, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia.
⁵ Department of Vascular Surgery, Sir Charles Gairdner Hospital, Nedlands, Perth WA 6009, Australia.
⁶ Curtin Medical School, Curtin University, Perth 6845, Australia.
⁷ University of Western Australia, Crawley WA 6009, Australia.
⁸ Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China.
⁹ Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
¹⁰ Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
¹¹ Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.

PMID: 33936960
PMCID: PMC8047377
DOI: 10.21037/qims-20-814

Comparison of diametric and volumetric changes in Stanford type B aortic dissection patients in assessing aortic remodeling post-stent graft treatment

Wan Naimah Wan Ab Naim et al. Quant Imaging Med Surg. 2021 May.

. 2021 May;11(5):1723-1736.

doi: 10.21037/qims-20-814.

Authors

Affiliations

¹ Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, 26600, Pekan, Pahang, Malaysia.
² Discipline of Medical Radiation Science, Curtin University, Perth 6845, Australia.
³ Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
⁴ Department of Mechanical, Materials and Manufacturing, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia.
⁵ Department of Vascular Surgery, Sir Charles Gairdner Hospital, Nedlands, Perth WA 6009, Australia.
⁶ Curtin Medical School, Curtin University, Perth 6845, Australia.
⁷ University of Western Australia, Crawley WA 6009, Australia.
⁸ Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China.
⁹ Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia.
¹⁰ Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
¹¹ Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.

PMID: 33936960
PMCID: PMC8047377
DOI: 10.21037/qims-20-814

Abstract

Background: The study aims to analyze the correlation between the maximal diameter (both axial and orthogonal) and volume changes in the true (TL) and false lumens (FL) after stent-grafting for Stanford type B aortic dissection.

Method: Computed tomography angiography was performed on 13 type B aortic dissection patients before and after procedure, and at 6 and 12 months follow-up. The lumens were divided into three regions: the stented area (Region 1), distal to the stent graft to the celiac artery (Region 2), and between the celiac artery and the iliac bifurcation (Region 3). Changes in aortic morphology were quantified by the increase or decrease of diametric and volumetric percentages from baseline measurements.

Results: At Region 1, the TL diameter and volume increased (pre-treatment: volume =51.4±41.9 mL, maximal axial diameter =22.4±6.8 mm, maximal orthogonal diameter =21.6±7.2 mm; follow-up: volume =130.7±69.2 mL, maximal axial diameter =40.1±8.1 mm, maximal orthogonal diameter =31.9+2.6 mm, P<0.05 for all comparisons), while FL decreased (pre-treatment: volume =129.6±150.5 mL; maximal axial diameter =43.0±15.8 mm; maximal orthogonal diameter =28.3±12.6 mm; follow-up: volume =66.6±95.0 mL, maximal axial diameter =24.5±19.9 mm, maximal orthogonal diameter =16.9±13.7, P<0.05 for all comparisons). Due to the uniformity in size throughout the vessel, high concordance was observed between diametric and volumetric measurements in the stented region with 93% and 92% between maximal axial diameter and volume for the true/false lumens, and 90% and 92% between maximal orthogonal diameter and volume for the true/false lumens. Large discrepancies were observed between the different measurement methods at regions distal to the stent graft, with up to 46% differences between maximal orthogonal diameter and volume.

Conclusions: Volume measurement was shown to be a much more sensitive indicator in identifying lumen expansion/shrinkage at the distal stented region.

Keywords: Aortic dissection; aortic remodeling; computed tomography angiography; maximal diameter; volume.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-814). ZS serves as an unpaid associate editor of Quantitative Imaging in Medicine and Surgery. The other authors have no conflicts of interest to declare.

Figures

**Figure 1**
Visualisation workflow: (A) 3D reconstructed geometry of segmented AD aorta (TL and FL) during pre-treatment and post-treatment, (B) axial plane (X-Y Plane), (C) centroid points at both TL and FL, and (D) diameter of TL and FL. AD, aortic dissection; FL, false lumen; TL, true lumen.

**Figure 2**
The Bland-Altman plots for (A) maximal axial diameter; (B) maximal orthogonal diameter and (C) volume.

**Figure 3**
Boxplots showing the differences in TL volume (A), TL maximal axial diameter (B), TL maximal orthogonal diameter (C), FL volume (D), FL maximal axial diameter (E) and FL maximal orthogonal diameter (F) changes between pre-treatment, post-treatment and follow-up at Regions 1, 2 and 3. FL, false lumen; TL, true lumen.

**Figure 4**
Localized expansion (red rectangular box) of the stent graft edge (Region 2 TL) during post treatment for Patient 5, which increased at 6 and 12 months follow-up. TL, true lumen.

**Figure 5**
Selected axial slices from three different regions (proximal, mid and distal) along Region 1 of Patient 6 pre- and post-treatment. The solid contours represent the region of interest for FL, while D represents the calculated diameter. FL, false lumen.

See this image and copyright information in PMC

References

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Comparison of diametric and volumetric changes in Stanford type B aortic dissection patients in assessing aortic remodeling post-stent graft treatment

Affiliations

Comparison of diametric and volumetric changes in Stanford type B aortic dissection patients in assessing aortic remodeling post-stent graft treatment

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Other Literature Sources