False lumen enhancement characteristics on computed tomography angiography predict risk of aneurysm formation in acute type B aortic dissection

Molly E. Roseland; Yunus Ahmed; Joost A. Van Herwaarden; Frans L. Moll; Bo Yang; Himanshu J. Patel; Nicholas S. Burris

doi:10.1093/icvts/ivab095

False lumen enhancement characteristics on computed tomography angiography predict risk of aneurysm formation in acute type B aortic dissection

Molly E. Roseland
, Yunus Ahmed
, Joost A. Van Herwaarden
, Frans L. Moll
, Bo Yang
, Himanshu J. Patel
, Nicholas S. Burris^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: Differential luminal enhancement [between true lumen (TL) and false lumen (FL)] results from differential flow patterns, most likely due to outflow restriction in the FL. We aimed to assess the impact of differential luminal enhancement at baseline computed tomography angiography on the risk of adverse events in patients with acute type B aortic dissection (TBAD).

METHODS: Baseline computed tomography angiographies of patients with acute TBAD between 2007 and 2016 (n = 48) were analysed using three-dimensional software at multiple sites along the descending thoraco-abdominal aorta. At each location, we measured contrast density in TL and FL [Houndsfield unit (HU)], maximal diameter (cm) and circumferential FL extent (°). Outcome data were collected via retrospective chart review. Multivariable logistic regression models were employed to determine the independent risk of TL-FL differential luminal enhancement on aneurysm formation (maximal diameter ≥55 mm) and medical treatment failure.

RESULTS: Patients were predominately male (75%) and 52.8±12.9 years at diagnosis. The mean follow-up was 5.9±2.6 years, and 42% (n = 20/48) patients were diagnosed with thoraco-abdominal aortic aneurysm. The baseline absolute difference between FL and TL contrast density measured at 2 cm distal to primary entry tear (TL-FLabs-Tear) was significantly higher among patients who developed aneurysm (26 HU, IQR: 15-53 vs 13 HU, IQR: 4-24, P = 0.001). Aneurysm development during follow-up was predicted by TL-FLabs-Tear (odds ratio 1.07, P = 0.012) and baseline maximal aortic diameter (odds ratio 1.90, P < 0.001). High (≥18 HU) differential luminal enhancement was associated with lower rates of aneurysm-free survival and higher rates of medical treatment failure.

CONCLUSIONS: Differential luminal enhancement may be a novel predictor of aneurysm formation among patients with acute TBAD.

Original language	English
Pages (from-to)	434-441
Number of pages	8
Journal	Interactive cardiovascular and thoracic surgery
Volume	33
Issue number	3
DOIs	https://doi.org/10.1093/icvts/ivab095
Publication status	Published - Sept 2021

Keywords

Aneurysm, Dissecting/diagnostic imaging
Aortic Aneurysm, Thoracic/diagnostic imaging
Aortography
Blood Vessel Prosthesis Implantation
Computed Tomography Angiography
Endovascular Procedures
Humans
Male
Retrospective Studies
Treatment Outcome

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10.1093/icvts/ivab095

ivab095Final published version, 745 KBLicence: Taverne

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@article{1f9379fa73f44dac916423197344dd15,

title = "False lumen enhancement characteristics on computed tomography angiography predict risk of aneurysm formation in acute type B aortic dissection",

abstract = "OBJECTIVES: Differential luminal enhancement [between true lumen (TL) and false lumen (FL)] results from differential flow patterns, most likely due to outflow restriction in the FL. We aimed to assess the impact of differential luminal enhancement at baseline computed tomography angiography on the risk of adverse events in patients with acute type B aortic dissection (TBAD).METHODS: Baseline computed tomography angiographies of patients with acute TBAD between 2007 and 2016 (n = 48) were analysed using three-dimensional software at multiple sites along the descending thoraco-abdominal aorta. At each location, we measured contrast density in TL and FL [Houndsfield unit (HU)], maximal diameter (cm) and circumferential FL extent (°). Outcome data were collected via retrospective chart review. Multivariable logistic regression models were employed to determine the independent risk of TL-FL differential luminal enhancement on aneurysm formation (maximal diameter ≥55 mm) and medical treatment failure.RESULTS: Patients were predominately male (75\%) and 52.8±12.9 years at diagnosis. The mean follow-up was 5.9±2.6 years, and 42\% (n = 20/48) patients were diagnosed with thoraco-abdominal aortic aneurysm. The baseline absolute difference between FL and TL contrast density measured at 2 cm distal to primary entry tear (TL-FLabs-Tear) was significantly higher among patients who developed aneurysm (26 HU, IQR: 15-53 vs 13 HU, IQR: 4-24, P = 0.001). Aneurysm development during follow-up was predicted by TL-FLabs-Tear (odds ratio 1.07, P = 0.012) and baseline maximal aortic diameter (odds ratio 1.90, P < 0.001). High (≥18 HU) differential luminal enhancement was associated with lower rates of aneurysm-free survival and higher rates of medical treatment failure.CONCLUSIONS: Differential luminal enhancement may be a novel predictor of aneurysm formation among patients with acute TBAD.",

keywords = "Aneurysm, Dissecting/diagnostic imaging, Aortic Aneurysm, Thoracic/diagnostic imaging, Aortography, Blood Vessel Prosthesis Implantation, Computed Tomography Angiography, Endovascular Procedures, Humans, Male, Retrospective Studies, Treatment Outcome",

author = "Roseland, \{Molly E.\} and Yunus Ahmed and \{Van Herwaarden\}, \{Joost A.\} and Moll, \{Frans L.\} and Bo Yang and Patel, \{Himanshu J.\} and Burris, \{Nicholas S.\}",

year = "2021",

month = sep,

doi = "10.1093/icvts/ivab095",

language = "English",

volume = "33",

pages = "434--441",

journal = "Interactive cardiovascular and thoracic surgery",

issn = "1569-9293",

publisher = "Oxford University Press",

number = "3",

}

False lumen enhancement characteristics on computed tomography angiography predict risk of aneurysm formation in acute type B aortic dissection. / Roseland, Molly E.; Ahmed, Yunus; Van Herwaarden, Joost A. et al.
In: Interactive cardiovascular and thoracic surgery, Vol. 33, No. 3, 09.2021, p. 434-441.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - False lumen enhancement characteristics on computed tomography angiography predict risk of aneurysm formation in acute type B aortic dissection

AU - Roseland, Molly E.

AU - Ahmed, Yunus

AU - Van Herwaarden, Joost A.

AU - Moll, Frans L.

AU - Yang, Bo

AU - Patel, Himanshu J.

AU - Burris, Nicholas S.

PY - 2021/9

Y1 - 2021/9

N2 - OBJECTIVES: Differential luminal enhancement [between true lumen (TL) and false lumen (FL)] results from differential flow patterns, most likely due to outflow restriction in the FL. We aimed to assess the impact of differential luminal enhancement at baseline computed tomography angiography on the risk of adverse events in patients with acute type B aortic dissection (TBAD).METHODS: Baseline computed tomography angiographies of patients with acute TBAD between 2007 and 2016 (n = 48) were analysed using three-dimensional software at multiple sites along the descending thoraco-abdominal aorta. At each location, we measured contrast density in TL and FL [Houndsfield unit (HU)], maximal diameter (cm) and circumferential FL extent (°). Outcome data were collected via retrospective chart review. Multivariable logistic regression models were employed to determine the independent risk of TL-FL differential luminal enhancement on aneurysm formation (maximal diameter ≥55 mm) and medical treatment failure.RESULTS: Patients were predominately male (75%) and 52.8±12.9 years at diagnosis. The mean follow-up was 5.9±2.6 years, and 42% (n = 20/48) patients were diagnosed with thoraco-abdominal aortic aneurysm. The baseline absolute difference between FL and TL contrast density measured at 2 cm distal to primary entry tear (TL-FLabs-Tear) was significantly higher among patients who developed aneurysm (26 HU, IQR: 15-53 vs 13 HU, IQR: 4-24, P = 0.001). Aneurysm development during follow-up was predicted by TL-FLabs-Tear (odds ratio 1.07, P = 0.012) and baseline maximal aortic diameter (odds ratio 1.90, P < 0.001). High (≥18 HU) differential luminal enhancement was associated with lower rates of aneurysm-free survival and higher rates of medical treatment failure.CONCLUSIONS: Differential luminal enhancement may be a novel predictor of aneurysm formation among patients with acute TBAD.

AB - OBJECTIVES: Differential luminal enhancement [between true lumen (TL) and false lumen (FL)] results from differential flow patterns, most likely due to outflow restriction in the FL. We aimed to assess the impact of differential luminal enhancement at baseline computed tomography angiography on the risk of adverse events in patients with acute type B aortic dissection (TBAD).METHODS: Baseline computed tomography angiographies of patients with acute TBAD between 2007 and 2016 (n = 48) were analysed using three-dimensional software at multiple sites along the descending thoraco-abdominal aorta. At each location, we measured contrast density in TL and FL [Houndsfield unit (HU)], maximal diameter (cm) and circumferential FL extent (°). Outcome data were collected via retrospective chart review. Multivariable logistic regression models were employed to determine the independent risk of TL-FL differential luminal enhancement on aneurysm formation (maximal diameter ≥55 mm) and medical treatment failure.RESULTS: Patients were predominately male (75%) and 52.8±12.9 years at diagnosis. The mean follow-up was 5.9±2.6 years, and 42% (n = 20/48) patients were diagnosed with thoraco-abdominal aortic aneurysm. The baseline absolute difference between FL and TL contrast density measured at 2 cm distal to primary entry tear (TL-FLabs-Tear) was significantly higher among patients who developed aneurysm (26 HU, IQR: 15-53 vs 13 HU, IQR: 4-24, P = 0.001). Aneurysm development during follow-up was predicted by TL-FLabs-Tear (odds ratio 1.07, P = 0.012) and baseline maximal aortic diameter (odds ratio 1.90, P < 0.001). High (≥18 HU) differential luminal enhancement was associated with lower rates of aneurysm-free survival and higher rates of medical treatment failure.CONCLUSIONS: Differential luminal enhancement may be a novel predictor of aneurysm formation among patients with acute TBAD.

KW - Aneurysm, Dissecting/diagnostic imaging

KW - Aortic Aneurysm, Thoracic/diagnostic imaging

KW - Aortography

KW - Blood Vessel Prosthesis Implantation

KW - Computed Tomography Angiography

KW - Endovascular Procedures

KW - Humans

KW - Male

KW - Retrospective Studies

KW - Treatment Outcome

UR - https://www.scopus.com/pages/publications/85114722656

U2 - 10.1093/icvts/ivab095

DO - 10.1093/icvts/ivab095

M3 - Article

C2 - 33963411

AN - SCOPUS:85114722656

SN - 1569-9293

VL - 33

SP - 434

EP - 441

JO - Interactive cardiovascular and thoracic surgery

JF - Interactive cardiovascular and thoracic surgery

IS - 3

ER -

False lumen enhancement characteristics on computed tomography angiography predict risk of aneurysm formation in acute type B aortic dissection

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