Nievergeld Arjet, Fonken Judith, Maas Esther, Muller Jan-Willem, Thirugnanasambandam Mirunalini, van Sambeek Marc, Lopata Richard
PULS/e Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
APL Bioeng. 2024 Oct 28;8(4):046105. doi: 10.1063/5.0200251. eCollection 2024 Dec.
Image-based patient-specific rupture risk analysis for abdominal aortic aneurysms (AAAs) has shown considerable promise. However, clinical translation has been hampered by the use of invasive and costly imaging modalities. Despite being a promising alternative, ultrasound (US) makes a full analysis, including intraluminal thrombus (ILT), not trivial. This study explored the feasibility of assessing AAA rupture risk parameters, e.g., peak wall stress (PWS) and peak wall rupture index (PWRI), using US-based models of the AAA wall, finally including ILT. Three-dimensional US data were segmented from a group of AAA patients whose CT data were available within 30 days. The segmented vessel wall and ILT boundaries were converted into a mesh including and excluding ILT to evaluate the effect of adding ILT on the model output. US-based rupture risk parameters (PWS and PWRI) were compared to CT-based results. The US-based PWS and PWRI, including ILT, showed good agreement with CT-based results, and the model excluding ILT showed no significant bias in wall stress or rupture index. When including ILT, a lower US-based wall stress and rupture index of 7.2% and 3.8% were found, respectively. The intraclass correlation coefficient (ICC) of PWS was 0.60. The highest ICC was found for the PWRI (ICC = 0.86), indicating good absolute agreement. This study showed that PWRI can be estimated with US when including the ILT, yielding comparable results to CT, and good absolute agreement. Future work should focus on improving the contrast of ILT in US, since this will be essential to performing large-scale studies in AAA cohorts.
基于图像的腹主动脉瘤（AAA）患者特异性破裂风险分析已显示出巨大潜力。然而，侵入性和昂贵的成像方式阻碍了其临床转化。尽管超声（US）是一种有前景的替代方法，但包括腔内血栓（ILT）在内的全面分析并非易事。本研究探讨了使用基于超声的AAA壁模型评估AAA破裂风险参数（如峰值壁应力（PWS）和峰值壁破裂指数（PWRI））的可行性，最终纳入了ILT。从一组在30天内有CT数据的AAA患者中分割出三维超声数据。将分割出的血管壁和ILT边界转换为包含和不包含ILT的网格，以评估添加ILT对模型输出的影响。将基于超声的破裂风险参数（PWS和PWRI）与基于CT的结果进行比较。包括ILT的基于超声的PWS和PWRI与基于CT的结果显示出良好的一致性，不包括ILT的模型在壁应力或破裂指数方面没有显著偏差。当纳入ILT时，基于超声的壁应力和破裂指数分别降低了7.2%和3.8%。PWS的组内相关系数（ICC）为0.60。PWRI的ICC最高（ICC = 0.86），表明绝对一致性良好。本研究表明，当纳入ILT时，PWRI可以用超声估计，结果与CT相当，且绝对一致性良好。未来的工作应集中在提高超声中ILT的对比度，因为这对于在AAA队列中进行大规模研究至关重要。
