ObjectiveTo study the differences in computed tomography angiography (CTA) imaging of gothic arches, crenel arches, and romanesque arches in children with Aortic Coarctation (CoA), and to apply computational fluid dynamics (CFD) to study hemodynamic changes in CoA children with gothic arch aorta.MethodsThe case data and CTA data of children diagnosed with CoA (95 cases) in our hospital were retrospectively collected, and the morphology of the aortic arch in the children was defined as gothic arch (n = 27), crenel arch (n = 25) and romanesque arch (n = 43). The three groups were compared with D1/AOA, D2/AOA, D3/AOA, D4/AOA, D5/AOA, and AAO-DAO angle, TAO-DAO angle, and aortic arch height to width ratio (A/T). Computational fluid dynamics was applied to assess hemodynamic changes in children with gothic arches.ResultsThere were no significant differences between D1/AOA and D2/AOA among gothic arch, crenel arch, and romanesque arch (P > 0.05). The differences in D3/AOA, D4/AOA, and D5/AOA among the three groups were statistically significant (P < 0.05), D4/AOA, D5/AOA of the gothic arch group were smaller than the crenel arch group, and the D3/AOA and D5/AOA of the gothic arch group were smaller than the romanesque arch group (P < 0.05). The difference in AAO-DAO angle among the three groups was statistically significant (P < 0.05), and the AAO-DAO angle of gothic arch was smaller than that of romanesque arch and crenel arch group (P < 0.05). There was no significant difference in the TAO-DAO angle between the three groups (P > 0.05). The difference in A/T values among the three groups was statistically significant (P < 0.05), and the A/T values: gothic arch > romanesque arch > crenel arch (P < 0.05). The CFD calculation of children with gothic arch showed that the pressure drop between the distal stenosis and the descending aorta was 58 mmHg, and the flow rate at the isthmus and descending aorta was high and turbulent.ConclusionGothic aortic arch is common in CoA, it may put adverse effects on the development of the aortic isthmus and descending aorta, and its A/T value and AAO-DAO angle are high. CFD could assess hemodynamic changes in CoA.
ObjectiveTo explore the application of the proposed intelligent image processing method in the diagnosis of aortic coarctation computed tomography angiography (CTA) and to clarify its value in the diagnosis of aortic coarctation based on the diagnosis results.MethodsFifty-three children with coarctation of the aorta (CoA) and forty children without CoA were selected to constitute the study population. CTA was performed on all subjects. The minimum diameters of the ascending aorta, proximal arch, distal arch, isthmus, and descending aorta were measured using manual and intelligent methods, respectively. The Wilcoxon signed-rank test was used to analyze the differences between the two measurements. The surgical diagnosis results were used as the gold standard, and the diagnostic results obtained by the two measurement methods were compared with the gold standard to quantitatively evaluate the diagnostic results of CoA by the two measurement methods. The Kappa test was used to analyze the consistency of intelligence diagnosis results with the gold standard.ResultsWhether people have CoA or not, there was a significant difference (p < 0.05) in the measurements of the minimum diameter at most sites using the two methods. However, close final diagnoses were made using the intelligent method and the manual. Meanwhile, the intelligent measurement method obtained higher accuracy, specificity, and AUC (area under the curve) compared to manual measurement in diagnosing CoA based on Karl's classification (accuracy = 0.95, specificity = 0.9, and AUC = 0.94). Furthermore, the diagnostic results of the intelligence method applied to the three criteria agreed well with the gold standard (all kappa ≥ 0.8). The results of the comparative analysis showed that Karl's classification had the best diagnostic effect on CoA.ConclusionThe proposed intelligent method based on image processing can be successfully applied to assist in the diagnosis of CoA.
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