Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA.
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Eur J Cardiothorac Surg. 2021 Sep 11;60(3):651-659. doi: 10.1093/ejcts/ezab142.
Confident growth assessment during imaging follow-up is often limited by substantial variability of diameter measurements and the fact that growth does not always occur at standard measurement locations. There is a need for imaging-based techniques to more accurately assess growth. In this study, we investigated the feasibility of a three-dimensional aortic growth assessment technique to quantify aortic growth in patients following open aortic repair.
Three-dimensional aortic growth was measured using vascular deformation mapping (VDM), a technique which quantifies the localized rate of volumetric growth at the aortic wall, expressed in units of Jacobian (J) per year. We included 16 patients and analysed 6 aortic segments per patient (96 total segments). Growth was assessed by 3 metrics: clinically reported diameters, Jacobian determinant and targeted diameter re-measurements.
VDM was able to clearly depict the presence or absence of localized aortic growth and allows for an assessment of the distribution of growth and its relation to anatomic landmarks (e.g. anastomoses, branch arteries). Targeted diameter change showed a stronger and significant correlation with J (r = 0.20, P = 0.047) compared to clinical diameter change (r = 0.15, P = 0.141). Among 20/96 (21%) segments with growth identified by VDM, growth was confirmed by clinical measurements in 7 and targeted re-measurements in 11. Agreement of growth assessments between VDM and diameter measurements was slightly higher for targeted re-measurements (kappa = 0.38) compared to clinical measurements (kappa = 0.25).
Aortic growth is often uncertain and underappreciated when assessed via standard diameter measurements. Three-dimensional growth assessment with VDM offers a more comprehensive assessment of growth, allows for targeted diameter measurements and could be an additional tool to determine which post-surgical patients at high and low risk for future complications.
在影像学随访中，由于直径测量值存在较大差异，且生长并不总是发生在标准测量部位，因此对生长情况的评估往往缺乏信心。需要采用基于影像学的技术来更准确地评估生长情况。本研究旨在探讨血管变形测绘（VDM）这一三维主动脉生长评估技术，用于量化主动脉开放修复术后患者的主动脉生长情况。
采用 VDM 测量三维主动脉生长情况，该技术可量化主动脉壁局部容积生长率，以每年雅可比（J）的单位表示。共纳入 16 例患者，每例患者分析 6 个主动脉节段（共 96 个节段）。采用 3 种指标评估生长情况：临床报告的直径、雅可比行列式和靶向直径再测量。
VDM 能够清晰地显示局部主动脉生长的有无，并可评估生长的分布及其与解剖学标志（如吻合口、分支动脉）的关系。与临床直径变化（r=0.15，P=0.141）相比，靶向直径变化与 J 的相关性更强且具有统计学意义（r=0.20，P=0.047）。20/96（21%）个通过 VDM 确定有生长的节段中，有 7 个通过临床测量，11 个通过靶向再测量确认了生长。与直径测量相比，VDM 与靶向再测量评估生长的一致性更高（kappa=0.38），而与临床测量的一致性略低（kappa=0.25）。
通过标准直径测量评估主动脉生长时，生长情况往往不确定且被低估。VDM 的三维生长评估可更全面地评估生长情况，可进行靶向直径测量，并可能成为确定术后哪些高风险和低风险患者有发生未来并发症的附加工具。
