Assessment of aortic arch involvement in ascending thoracic aortic aneurysm by three-dimensional growth mapping using CT-angiography.
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| Title: | Assessment of aortic arch involvement in ascending thoracic aortic aneurysm by three-dimensional growth mapping using CT-angiography. |
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| Authors: | Tjahjadi, Nicasius S.1 (AUTHOR), Campello Jorge, Carlos Alberto2 (AUTHOR), Marway, Prabhvir Singh2 (AUTHOR), Knauer, Heather A.2 (AUTHOR), Hazenberg, Constantijn3 (AUTHOR), van Herwaarden, Joost3 (AUTHOR), Figueroa, C. Alberto4 (AUTHOR), Patel, Himanshu J.1 (AUTHOR), Burris, Nicholas S.2 (AUTHOR) nburris@med.umich.edu |
| Source: | European Radiology. Jun2025, Vol. 35 Issue 6, p3508-3518. 11p. |
| Subjects: | Ascending aorta aneurysms, Thoracic aorta, Disease progression, Angiography |
| Abstract: | Purpose: We investigated pre-surgical arch growth by vascular deformation mapping (VDM) and examined how well proximal arch diameter indicates arch involvement by the primary ascending aneurysm. Methods and materials: A total of 123 patients who underwent elective repair of ascending thoracic aortic aneurysm (aTAA) with or without concomitant arch repair and had 2 or more pre-operative computed tomography angiography (CTA) studies with a minimum interval of > 22 months were included. We compared growth at the proximal arch measured by three-dimensional VDM analysis with standard diameter measurements in overall, dilated (≥ 40 mm), and non-dilated (< 40 mm) arch subgroups. Results: Concurrent (hemi)arch replacement was performed in 30% of patients. In 59% of patients, VDM growth and arch diameter assessments were concordant VDM growth rate was higher in the dilated arch group (0.46 mm/year vs 0.26 mm/year, p = 0.007), however, pre-operative proximal arch diameter was similar in growth and non-growing arches among patients without arch dilation (36.2 mm vs 35.9 mm). Among non-dilated arches, 26% demonstrated significant growth by VDM but not by standard diameter measurements. Arch growth assessments by VDM and standard diameter measurements agreed with 73%; discrepancies up to 6 mm were observed. Within the post-operative subgroup, 12 (55%) patients demonstrated growth (> 0.3 mm/year) of the native aortic arch, with most (7/12, 59%) having non-dilated arches on pre-operative CT. Conclusion: Reliable assessment of arch involvement in aTAA by diameter thresholds is limited. VDM analysis allows for a more comprehensive analysis of arch growth and involvement by the ascending aneurysm, which may be useful to advance patient-specific surgical planning. Key Points: QuestionCan VDM measured proximal aortic arch diameter indicate proximal arch involvement by a primary ascending aneurysm? FindingsDiscrepancies between arch dilation status by conventional diameter thresholds and VDM exist; over half of patients with dilated proximal arches demonstrated no growth by VDM pre-operatively. Clinical relevanceArch involvement is common in ascending aortic aneurysms, though the degree of growth is not accurately assessed pre-operatively by standard measurements. VDM is an emerging technique that provides a three-dimensional assessment of arch growth and may inform patient-specific repair strategies. [ABSTRACT FROM AUTHOR] |
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| Database: | Engineering Source |
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