Non-invasive volumetric assessment of aortic atheroma: a core laboratory validation using computed tomography angiography

Abstract

Aortic atherosclerosis has been linked with worse peri- and post-procedural outcomes following a range of aortic procedures. Yet, there are currently no standardized methods for non-invasive volumetric pan-aortic plaque assessment. We propose a novel means of more accurately assessing plaque volume across whole aortic segments using computed tomography angiography (CTA) imaging. Sixty patients who underwent CTA prior to trans-catheter aortic valve implantation were included in this analysis. Specialized software analysis (3mensio Vascular™, Pie Medical, Maastricht, Netherlands) was used to reconstruct images using a centerline approach, thus creating true cross-sectional aortic images, akin to those images produced with intravascular ultrasonography. Following aortic segmentation (from the aortic valve to the renal artery origin), atheroma areas were measured across multiple contiguous evenly spaced (10 mm) cross-sections. Percent atheroma volume (PAV), total atheroma volume (TAV) and calcium score were calculated. In our populations (age 79.9 ± 8.5 years, male 52 %, diabetes 27 %, CAD 84 %, PVD 20 %), mean ± SD number of cross sections measured for each patient was 35.1 ± 3.5 sections. Mean aortic PAV and TAV were 33.2 ± 2.51 % and 83,509 ± 17,078 mm(3), respectively. Median (IQR) calcium score was 1.5 (0.7-2.5). Mean (SD) inter-observer coefficient of variation and agreement for plaque area among 4 different analysts was 14.1 (5.4), and the mean (95 % CI) Lin's concordance correlation coefficient was 0.79 (0.62-0.89), effectively simulating a Core Laboratory scenario. We provide an initial validation of cross-sectional volumetric aortic atheroma assessment using CTA. This proposed methodology highlights the potential for utilizing non-invasive aortic plaque imaging for risk prediction across a range of clinical scenarios.

Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease

“…[23] AAPs were measured across multiple contiguous, evenly spaced cross-sections with regular 5 mm intervals between perpendicular (axial) slices, and the vessel wall was divided into four quadrants on each perpendicular slice. [24] AAP was defined as the presence of calcium deposit, clearly visualized hypodensity, or focal aortic wall ≥2 mm in thickness. [25,26] AAPs were evaluated from the aspects of thickness, extent, and complexity.…”

“…The AAP thickness was defined as the distance from the highest point of the maximal plaque perpendicular to the wall of the outer membrane of the aorta. [24] The AAP extent was assessed as absent, mild (occupying single perpendicular slice or single quadrant on the perpendicular slice), and severe (occupying multiple perpendicular slices and multiple quadrants on at least one perpendicular slice). An AAP thickness of ≥4 mm or associated ulcerations or mural thrombus was defined as complex AAP.…”