TY - JOUR
T1 - Ultrasound Based Wall Stress Analysis of Abdominal Aortic Aneurysms using Multiperspective Imaging
AU - van Disseldorp, Emiel M J
AU - van Dronkelaar, Julia J
AU - Pluim, Josien P W
AU - van de Vosse, Frans N
AU - van Sambeek, Marc R H M
AU - Lopata, Richard G P
N1 - Funding Information:
This work was supported with an unrestricted educational grant from the Dutch “ Lijf en Leven ” Foundation.
Publisher Copyright:
© 2019 European Society for Vascular Surgery
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/1
Y1 - 2020/1
N2 - BACKGROUND: Current clinical guidelines for surgical repair of abdominal aortic aneurysms (AAAs) are primarily based on maximum diameter assessment. From a biomechanical point of view, not only the diameter but also peak wall stresses will play an important role in rupture risk assessment. These methods require patient specific geometry which typically uses computed tomography (CT) or magnetic resonance imaging. Recently, wall stress analysis based on 3D ultrasound (US) has been proposed, and shows promising results. However, the major limitations in these studies were the use of manual segmentation and the limiting field of view of US. Therefore in this study, the AAA is imaged with multiperspective 3D ultrasound, merged to obtain a large field of view, and afterwards automatically segmented. Geometry and wall stress results were validated using CT imaging.METHODS: Three dimensional US and CT data were available for 40 AAA patients (maximum diameter 34-61 mm). The full US based AAA geometry was determined using automatic segmentation, and when the aneurysm exceeded a single 3D volume, automatic fusion of multiple 3D US volumes was used. Wall stress analysis was performed for all AAA patients and percentile wall stresses were derived. The accuracy of the US based geometry and wall stress prediction was measured by comparison with CT data.RESULTS: Estimated geometries derived from 3D US and CT data showed good similarity, with an overall median similarity index (SI) of 0.89 and interquartile range of 0.87-0.92, whereas the median Hausdorff distances (HD), a measure for the maximum local mismatch, was 4.6 (4.0-5.9) mm for all AAA geometries. Thereby, the wall stress results based on merged multiperspective 3D US data revealed a greater similarity to CT than single 3D US data.CONCLUSION: This study showed that large volume geometry assessment of AAAs using multiperspective 3D ultrasound, segmentation and fusion, and wall stress analysis is feasible in a robust and labour efficient manner.
AB - BACKGROUND: Current clinical guidelines for surgical repair of abdominal aortic aneurysms (AAAs) are primarily based on maximum diameter assessment. From a biomechanical point of view, not only the diameter but also peak wall stresses will play an important role in rupture risk assessment. These methods require patient specific geometry which typically uses computed tomography (CT) or magnetic resonance imaging. Recently, wall stress analysis based on 3D ultrasound (US) has been proposed, and shows promising results. However, the major limitations in these studies were the use of manual segmentation and the limiting field of view of US. Therefore in this study, the AAA is imaged with multiperspective 3D ultrasound, merged to obtain a large field of view, and afterwards automatically segmented. Geometry and wall stress results were validated using CT imaging.METHODS: Three dimensional US and CT data were available for 40 AAA patients (maximum diameter 34-61 mm). The full US based AAA geometry was determined using automatic segmentation, and when the aneurysm exceeded a single 3D volume, automatic fusion of multiple 3D US volumes was used. Wall stress analysis was performed for all AAA patients and percentile wall stresses were derived. The accuracy of the US based geometry and wall stress prediction was measured by comparison with CT data.RESULTS: Estimated geometries derived from 3D US and CT data showed good similarity, with an overall median similarity index (SI) of 0.89 and interquartile range of 0.87-0.92, whereas the median Hausdorff distances (HD), a measure for the maximum local mismatch, was 4.6 (4.0-5.9) mm for all AAA geometries. Thereby, the wall stress results based on merged multiperspective 3D US data revealed a greater similarity to CT than single 3D US data.CONCLUSION: This study showed that large volume geometry assessment of AAAs using multiperspective 3D ultrasound, segmentation and fusion, and wall stress analysis is feasible in a robust and labour efficient manner.
KW - Aged
KW - Aged, 80 and over
KW - Aorta, Abdominal/diagnostic imaging
KW - Aortic Aneurysm, Abdominal/complications
KW - Aortic Rupture/etiology
KW - Clinical Decision-Making/methods
KW - Computed Tomography Angiography
KW - Feasibility Studies
KW - Female
KW - Finite Element Analysis
KW - Humans
KW - Imaging, Three-Dimensional/methods
KW - Male
KW - Middle Aged
KW - Practice Guidelines as Topic
KW - Risk Assessment
KW - Stress, Mechanical
KW - Ultrasonography/methods
KW - Validation
KW - Segmentation
KW - Abdominal aortic aneurysms
KW - 3D Ultrasound
KW - Multiperspective imaging
KW - Registration
UR - http://www.scopus.com/inward/record.url?scp=85075358513&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2019.01.026
DO - 10.1016/j.ejvs.2019.01.026
M3 - Article
C2 - 31727437
SN - 1078-5884
VL - 59
SP - 81
EP - 91
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 1
ER -