Mariano E. Casciaro

Three-dimensional evaluation of thoracic aorta enlargement and unfolding in hypertensive men using non-contrast computed tomography.

Aging produces a simultaneous thoracic aorta (TA) enlargement and unfolding. We sought to analyze the impact of hypertension on these geometric changes. Non-contrast computed tomography images were obtained from coronary artery calcium scans, including the entire aortic arch, in 200 normotensive and 200 hypertensive asymptomatic men. An automated algorithm reconstructed the vessel in three-dimensions, estimating orthogonal aortic sections along the whole TA pathway, and calculated several geometric descriptors to assess TA morphology. Hypertensive patients were older with respect to normotensive (P<0.001). Diameter and volume of TA ascending, arch and descending segments were higher in hypertensive patients with respect to normotensive (P<0.001) and differences persisted after adjustment for age. Hypertension produced an accelerated unfolding effect on TA shape. We found increments in aortic arch width (P<0.001), radius of curvature (P<0.001) and area under the arch curve (P<0.01) with a concomitant tortuosity decrease (P<0.05) and no significant change in aortic arch height. Overall, hypertension produced an equivalent effect of 2−7-years of aging. In multivariate analysis adjusted for age and hypertension treatment, diastolic pressure was more associated to TA size and shape changes than systolic pressure. These data suggest that hypertension accelerates TA enlargement and unfolding deformation with respect to the aging effect.

Calcifications of the thoracic aorta on extended non-contrast-enhanced cardiac CT.

Background The presence of calcified atherosclerosis in different vascular beds has been associated with a higher risk of mortality. Thoracic aorta calcium (TAC) can be assessed from computed tomography (CT) scans, originally aimed at coronary artery calcium (CAC) assessment. CAC screening improves cardiovascular risk prediction, beyond standard risk assessment, whereas TAC performance remains controversial. However, the curvilinear portion of the thoracic aorta (TA), that includes the aortic arch, is systematically excluded from TAC analysis. We investigated the prevalence and spatial distribution of TAC all along the TA, to see how those segments that remain invisible in standard TA evaluation were affected. Methods and Results A total of 970 patients (77% men) underwent extended non-contrast cardiac CT scans including the aortic arch. An automated algorithm was designed to extract the vessel centerline and to estimate the vessel diameter in perpendicular planes. Then, calcifications were quantified using the Agatston score and associated with the corresponding thoracic aorta segment. The aortic arch and the proximal descending aorta, “invisible” in routine CAC screening, appeared as two vulnerable sites concentrating 60% of almost 11000 calcifications. The aortic arch was the most affected segment per cm length. Using the extended measurement method, TAC prevalence doubled from 31% to 64%, meaning that 52% of patients would escape detection with a standard scan. In a stratified analysis for CAC and/or TAC assessment, 111 subjects (46% women) were exclusively identified with the enlarged scan. Conclusions Calcium screening in the TA revealed that the aortic arch and the proximal descending aorta, hidden in standard TA evaluations, concentrated most of the calcifications. Middle-aged women were more prone to have calcifications in those hidden portions and became candidates for reclassification.

Identifying the principal modes of variation in human thoracic aorta morphology.

Purpose: Diagnosis and management of thoracic aorta (TA) disease demand the assessment of accurate quantitative information of the aortic anatomy. We investigated the principal modes of variation in aortic 3-dimensional geometry paying particular attention to the curvilinear portion. Materials and Methods: Images were obtained from extended noncontrast multislice computed tomography scans, originally intended for coronary calcium assessment. The ascending, arch, and descending aortas of 500 asymptomatic patients (57±9 y, 81% male) were segmented using a semiautomated algorithm that sequentially inscribed circles inside the vessel cross-section. Axial planes were used for the descending aorta, whereas oblique reconstructions through a toroid path were required for the arch. Vessel centerline coordinates and the corresponding diameter values were obtained. Twelve size and shape geometric parameters were calculated to perform a principal component analysis. Results: Statistics revealed that the geometric variability of the TA was successfully explained using 3 factors that account for ∼80% of total variability. Averaged aortas were reconstructed varying each factor in 5 intervals. Analyzing the parameter loadings for each principal component, the dominant contributors were interpreted as vessel size (46%), arch unfolding (22%), and arch symmetry (12%). Variables such as age, body size, and risk factors did not substantially modify the correlation coefficients, although some particular differences were observed with sex. Conclusions: We conclude that vessel size, arch unfolding, and symmetry form the basis for characterizing the variability of TA morphology. The numerical data provided in this study as supplementary material can be exploited to accurately reconstruct the curvilinear shape of normal TAs.

Angle estimation of human femora in a three-dimensional virtual environment

The estimation of human femur morphology and angulation provide useful information for assisted surgery, follow-up evaluation and prosthesis design, cerebral palsy management, congenital dislocation of the hip and fractures of the femur. Conventional methods that estimate femoral neck anteversion employ planar projections because accurate 3D estimations require complex reconstruction routines. In a recent work, we proposed a cylinder fitting method to estimate bifurcation angles in coronary arteries and we thought to test it in the estimation of femoral neck anteversion, valgus and shaft-neck angles. Femora from 10 patients were scanned using multisliced computed tomography. Virtual cylinders were fitted to 3 regions of the bone painted by the user to automatically estimate the femoral angles. Comparisons were made with a conventional manual method. Inter- and intra-reading measurements were evaluated for each method. We found femoral angles from both methods strongly correlated. Average anteversion, neck-shaft and valgus angles were 17.5°, 139.5°, 99.1°, respectively. The repeatability and reproducibility of the automated method showed a 5-fold reduction in inter- and intra-reading variability. Accordingly, the coefficients of variation for the manual method were below 25% whereas for the automated method were below 6%. The valgus angle assessment was globally the most accurate with differences below 1°. Maximum distances from true surface bone points and fitting cylinders attained 6 mm. The employment of virtual cylinders fitted to different regions of human femora consistently helped to assess true 3D angulations.

Construction of a 3D coronary map to assess geometrical information in-vivo from coronary patients

Traditional risk factors are involved in the development of coronary artery disease (CAD), but geometrical risk factors have also proved to be determinant. In this work we present a new method to construct a 3D map of the left coronary artery tree using CT image processing and skeletonization techniques. We computed cumulative length-volume functions through the coronary tree bifurcations and also the relationships between total tree volumes, total length, number of segments and bifurcations with respect to the presence and severity of atherosclerotic plaques. A total of 65 patients, 40 with and 20 without CAD were recruited. We found more vascular segments and bifurcations per patient in the CAD group. Accordingly, total cumulative length was longer in CAD patients (p<0.01) whereas total cumulative volume was similar between groups. Cumulative length-volume (L-V) relationships conformed to an allometric function L = KV.V?. The allometric slope ??0.75 did not change with disease, whereas the allometric constant KV was lower in the healthy group (p<0.05) consistent with the literature. These results suggest that CAD patients follow a compensatory mechanism, dilating the vessels to maintain a normal coronary flow. The 3D coronary map offers useful quantitative information of the coronary morphometry.

Association of thoracic aorta calcium and non cardiac vascular events in cardiac disease-free individuals

OBJECTIVE Thoracic aorta calcium (TAC) is measurable on the same computed tomography (CT) scan as coronary artery calcium (CAC) but has still unclear clinical value. We assessed TAC and CAC relations with non-cardiac vascular events history in a cohort of subjects at risk for cardiovascular disease. METHODS We analyzed retrospectively 1000 consecutive subjects having undergone CAC detection by non-contrast multi-slice CT with measurement field longer than usual in order to measure total TAC including aortic arch calcium. We also determined partial TAC restricted to ascending and descending thoracic aorta sites by removing arch calcium from total TAC. Calcium deposits were measured with a custom made software using Agatston score. RESULTS Compared with the rest of the cohort, the 30 subjects with non-cardiac vascular event history had higher median values [95% CI] of total TAC (282 [28-1809] vs 39 [0-333], p < 0.01) and partial TAC (4 [0-284] vs 0 [0-5], p < 0.01) but no different value of CAC (73 [0-284] vs 16 [0-148]). Odds ratio [95% CI] of having non-cardiac vascular event per 1-SD increase in log-transformed calcium value was significant for total TAC but not for CAC, if total TAC and CAC were entered separately (1.56 [1.12-2.24], p < 0.01 and 1.13 [0.86-1.50], respectively) or together (1.57 [1.10-2.32], p < 0.01 and 0.98 [0.73-1.32], respectively) in the logistic adjusted model. CONCLUSION TAC assessment simultaneous with CAC detection provides complementary information on the extra coronary component of cardiovascular risk beyond CACs coronary risk prediction. Further studies are required to prospectively confirm this result.

Towards automatic measurement of anteversion and neck-shaft angles in human femurs using CT images.

Automatic assessment of human femur morphology may provide useful clinical information with regard to hip and knee surgery, prosthesis design and management of hip instability. To this end, neck–shaft and anteversion angles are usually used. We propose a full automatic method to estimate these angles in human femurs. Multislice CT images from 18 dried bones were analysed. The algorithm fits 3D cylinders to different regions of the bone to estimate the angles. A manual segmentation and a conventional angle assessment were used for validation. We found anteversion angle as 20 ± 7° and neck–shaft angle as 130 ± 9°. Mean distances from femur surface to cylinders were 5.5 ± 0.6, 3.5 ± 0.6 and 2.4 ± 0.4 mm for condyles, diaphysis and neck regions, respectively. Automatic and conventional angles were positively correlated (r2>0.85). Manual and automatic segmentations did not differ. The method was fast and 100% reproducible. A robust in vivo segmentation algorithm should be integrated to advance towards a clinically compliant methodology.

Estimation of coronary length-volume allometric relations Of human arteries invivo using CT

Assessing the individual geometry of the coronary arteries in a patient can help to explain diffuse artery disease. Some allometric functions, relating arterial length and volume, were verified in porcine arteries and human autopsies but not in vivo. In this work we use skeletonization methods on MSCT images to render the whole coronary tree in healthy and cardiovascular patients. Twenty patients with and without coronary artery disease were recruited. The coronary was segmented with minimum user intervention. Vessels were separated and measured. A 3D coronary map was individually calculated. The allometric length-volume function L=kvVβ was evaluated in each patient and plotted in a Log-Log scale. The coefficient kv ranged 1.00±0.35. Slopes ranged β = 0.69−0.88 and seemed to overlap in the scatter Log plot. The analysis of covariance verified this perception and concluded that lines were parallel. In other words, the allometric function stood for all patients. Values were not different from other studies in humans and pigs. The combination of multislice CT with morphological extraction algorithms was effective to extract allometric functions from coronary arteries in patients and can be easily applied in the clinic.

Estudio regional de la elasticidad aórtica porcina utilizando un modelo en derivadas de orden fraccional

Understanding and modelling the mechanical behaviour of the aorta is a problem being treated since several decades ago. Usually, it is assumed that the viscoelastic properties of the aorta gradually change from the heart towards periphery, going from mainly elastic to more viscous vessels. This behaviour might be associated with the gradual diminution of the elastin/collagen ratio and the increase of smooth muscle presence. Nevertheless, some reports show that the mechanical properties of the aorta do not vary uniformly. In this work we performed uniaxial tensile and relaxation tests of four specimens from different regions of a porcine aorta. A test machine conceived and built in our laboratory was adapted to measure stress and strain in a controlled temperature environment. Two models were fit to the relaxation curves: one based on a traditional spring/dashpot arrangement and another one with a fractional-order-derivative element. The latter was more accurate in terms of the root mean square error (−33%) with respect to the traditional model. Moreover, it has 4 instead of 5 parameters to adapt. In this test, we did not find a gradual change in the aortic stiffness: it increased from the ascending to the distal descending segment, whereas a raise was observed in the proximal descending region.

Automated Assessment of Thoracic Aorta Morphology and Calcium Distribution

Calcifications are heterogeneously distributed within different vascular beds. The presence and extent of cal-cium can be measured from non-contrast CT images and has been associated with higher cardiovascular risks. Using heart scans, thoracic aorta calcium (TAC) can be simultaneously as-sessed, although the aortic arch is systematically excluded. In this work we developed an automated technique that estimated the thoracic aorta (TA) morphology in 3D and the associated calcifications. One hundred non-diabetic patients (male gender 50%, aging 55-to-60 y.o.) at intermediate risk were randomly selected. Extended non-contrast CT scans, that included the aortic arch, were conducted. A custom software segmented the thoracic aorta using an adaptive circle fitting method that esti-mated the aortic centerline and diameter in ≈l140 points per pa-tient. Traditional risk factors were similar between men and women (p=NS). As expected, the Framingham risk score was higher in men (p<0.001). All TA size measurement were larger in men, including mean diameter, length and volume (p<0.001). In shape variables, aortic arch width was wider in men (p<0.001), although the arch height and tortuosity were similar with respect to women (p=NS). We did not find differences in TAC distribution for the ascending, arch and descending seg-ments. Calcifications were mostly concentrated in the aortic arch and the proximal descending portions. We conclude that, in spite of having larger and wider TAs, men and women had similar calcification distribution. Calcium appeared along the TA curvilinear portion that remains invisible in traditional cor-onary calcium examinations. Further analyses are required to evaluate if this extended TAC inspection could be used to revise its prognostic value in prospective studies.