Ultrasound Based Wall Stress Analysis of Abdominal Aortic Aneurysms using Multiperspective Imaging

Emiel M J van Disseldorp; Julia J van Dronkelaar; Josien P W Pluim; Frans N van de Vosse; Marc R H M van Sambeek; Richard G P Lopata

doi:10.1016/j.ejvs.2019.01.026

Ultrasound Based Wall Stress Analysis of Abdominal Aortic Aneurysms using Multiperspective Imaging

Eur J Vasc Endovasc Surg. 2020 Jan;59(1):81-91. doi: 10.1016/j.ejvs.2019.01.026. Epub 2019 Nov 11.

Authors

Emiel M J van Disseldorp¹, Julia J van Dronkelaar², Josien P W Pluim³, Frans N van de Vosse², Marc R H M van Sambeek¹, Richard G P Lopata⁴

Affiliations

¹ Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands.
² Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
³ Medical Imaging Analysis Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
⁴ Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. Electronic address: r.lopata@tue.nl.

PMID: 31727437
DOI: 10.1016/j.ejvs.2019.01.026

Abstract

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.

Keywords: 3D Ultrasound; Abdominal aortic aneurysms; Multiperspective imaging; Registration; Segmentation; Validation.

Publication types

Comparative Study

MeSH terms

Aged
Aged, 80 and over
Aorta, Abdominal / diagnostic imaging*
Aorta, Abdominal / pathology
Aortic Aneurysm, Abdominal / complications
Aortic Aneurysm, Abdominal / diagnostic imaging*
Aortic Aneurysm, Abdominal / surgery
Aortic Rupture / etiology
Aortic Rupture / prevention & control
Clinical Decision-Making / methods
Computed Tomography Angiography
Feasibility Studies
Female
Finite Element Analysis
Humans
Imaging, Three-Dimensional / methods*
Imaging, Three-Dimensional / standards
Male
Middle Aged
Practice Guidelines as Topic
Risk Assessment
Stress, Mechanical*
Ultrasonography / methods
Ultrasonography / standards