Nonrigid registration of dynamic medical imaging data using nD + t B-splines and a groupwise optimization approach.

The presented study details the virtual deployment of a bifurcated stent graft (Medtronic Talent) in an Abdominal Aortic Aneurysm model, using the finite element method. The entire deployment procedure is modeled, with the stent graft being crimped and bent according to the vessel geometry, and subsequently released. The finite element results are validated in vitro with placement of the device in a silicone mock aneurysm, using high resolution CT scans to evaluate the result. The presented work confirms the capability of finite element computer simulations to predict the deformed configuration after endovascular aneurysm repair (EVAR). These simulations can be used to quantify mechanical parameters, such as neck dilations, radial forces and stresses in the device, that are difficult or impossible to obtain from medical imaging.

Virtual evaluation of stent graft deployment: A validated modeling and simulation study☆

Dynamics of the aorta before and after endovascular aneurysm repair: a systematic review.

The aim of this study was to provide an insight into normative values of the ascending aorta in regards to novel endovascular procedures using ECG-gated multi-detector CT angiography. Seventy-seven adult patients without ascending aortic abnormalities were evaluated. Measurements at relevant levels of the aortic root and ascending aorta were obtained. Diameter variations of the ascending aorta during cardiac cycle were also considered. Mean diameters (mm) were as follows: LV outflow tract 20.3 ± 3.4, coronary sinus 34.2 ± 4.1, sino-tubular junction 29.7 ± 3.4 and mid ascending aorta 32.7 ± 3.8 with coefficients of variation (CV) ranging from 12 to 17%. Mean distances (mm) were: from the plane passing through the proximal insertions of the aortic valve cusps to the right brachio-cephalic artery (BCA) 92.6 ± 11.8, from the plane passing through the proximal insertions of the aortic valve cusps to the proximal coronary ostium 12.1 ± 3.7, and between both coronary ostia 7.2 ± 3.1, minimal arc of the ascending aorta from left coronary ostium to right BCA 52.9 ± 9.5, and the fibrous continuity between the aortic valve and the anterior leaflet of the mitral valve 14.6 ± 3.3, CV 13–43%. Mean aortic valve area was 582.0 ± 131.9 mm2. The variation of the antero-posterior and transverse diameters of the ascending aorta during the cardiac cycle were 8.4% and 7.3%, respectively. Results showed large inter-individual variations in diameters and distances but with limited intra-individual variations during the cardiac cycle. A personalized approach for planning endovascular devices must be considered.

/pdf/ascending-aorta-measurements-as-assessed-by-ecg-gated-multi-41vohw9eov.pdf

Ascending aorta measurements as assessed by ECG-gated multi-detector computed tomography: a pilot study to establish normative values for transcatheter therapies

With advancements in technology and a better understanding of human cardiovascular physiology, research as well as clinical care can go beyond dimensional anatomy offered by traditional imaging and investigate aortic functional properties and the impact disease has on this function. Linking the knowledge of the histopathological changes with the alterations in aortic function observed on noninvasive imaging results in a better understanding of disease pathophysiology. Translating this to clinical medicine, these noninvasive imaging assessments of aortic function are proving to be able to diagnose disease, better predict risk, and assess response to therapies. This review is designed to summarize the various hemodynamic measures that can characterize the aorta, the various noninvasive techniques, and applications for various disease states.

Noninvasive Imaging of Flow and Vascular Function in Disease of the Aorta.

To detect distensibility changes that might be an indicator for an increased risk of rupture, cross-sectional area changes of abdominal aortic aneurysms (AAA) have been determined using ECG-gated CT Distensibility measurements of the aorta were performed in 67 patients with AAA Time-resolved images were acquired with a four detector-row CT system using a modified CT-angiography protocol Pulsatility-related cross-sectional area changes were calculated above and at AAA level by semiautomatic segmentation; distensibility values were obtained using additional systemic blood pressure measurements Values were compared for small O 5 cm (n = 23) aneurysms The aorta could be segmented successfully in all patients Upstream AAA distensibility D was significantly higher than at AAA level for both groups: means above AAA (at AAA) D
 above
 = (13±08)·10−5 Pa−1 (D
 AAA
 = (06±05)·10−5 Pa−1) t-test pD<00001 Differences of the distensibility between smaller and larger aneurysms were not found to be significant Distensibility can be measured non-invasively with ECG-gated CT The reduction of distensibility within aneurysms compared to normal proximal aorta is subtle; the lack of difference between both small and large aneurysms suggests that this reduction occurs early in the aneurysm's development Hence, reduced distensibility might be a predictive parameter in patients with high risk of aortic disease

Quantification of aortic distensibility in abdominal aortic aneurysm using ECG-gated multi-detector computed tomography

Quantification of aortic distensibility in abdominal aortic aneurysm using ECG-gated

Background: Clostridium septicum infections are rare but often fatal. They are known to be associated with a compromised immune system, e.g. with hematologic mali

Fatal Clostridium septicum infection in a patient with non-Hodgkin's lymphoma undergoing multimodal oncologic therapy.

Aortic distensibility is a parameter to grade vascular diseases and age-related effects because it is related to the elastic properties of the vessel wall. In this study vascular cross-sectional area changes have been determined using ECG-gated CT to analyse the age dependency of aortic distensibility. Distensibility measurements of the aorta were performed in 31 subjects (28 to 85 years). Time-resolved images were acquired either with a 4- or 16-detector row CT system using a modified CT angiography protocol. Cross-sectional area changes of the aorta were calculated by semiautomatic segmentation, and distensibility values were obtained using additional systemic blood pressure measurements. The aorta could be segmented successfully in all subjects. A decrease of aortic distensibility with age was found (r=0.50). Below (above) the renal arteries, the annual decrease was Δ D
 infrarenal
 =(−2.1±0.7)·10−7 Pa−1a−1, (D
 suprarenal
 Δ=(−3.5±1.1)·10−7 Pa−1a−1). Differences between the ages, the youngest third and oldest third studied, were found to be significant (P
 suprarenal
 =0.003; P
 infrarenal
 =0.025). An age-dependent decrease of aortic wall elasticity can be determined in a modified routine CT angiography study.

Age related changes of human aortic distensibility: evaluation with ECG-gated CT

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Quantification of aortic distensibility in abdominal aortic aneurysm using ECG-gated multi-detector computed tomography

Quantification of aortic distensibility in abdominal aortic aneurysm using ECG-gated

Fatal Clostridium septicum infection in a patient with non-Hodgkin's lymphoma undergoing multimodal oncologic therapy.

Age related changes of human aortic distensibility: evaluation with ECG-gated CT