Towards personalised assessment of abdominal aortic aneurysm structural integrity

TL;DR

This study introduces a non-invasive, patient-specific method to assess AAA wall integrity by combining strain and tension analysis from 4D-CTA images, providing a novel index called RSII for rupture risk evaluation.

Contribution

It presents a new biomechanical assessment technique that estimates wall stiffness without needing wall strength data, using only imaging and blood pressure measurements.

Findings

RSII values are consistent across patients.

AAA walls show higher stiffness than healthy aortas.

Localized low-stiffness zones are found in dilated regions.

Abstract

Abdominal aortic aneurysm (AAA) is a life-threatening condition characterized by the progressive dilation of the aorta, which can lead to rupture if undetected or untreated. Stress-based rupture risk estimation using computational biomechanics has been widely studied; however, it requires wall strength data that cannot be measured in humans in vivo. To overcome this limitation, the goal of this study is to present a new method for biomechanical assessment of AAA via simultaneous consideration of tension and strain in AAA wall. We present a patient-specific, non-invasive method for assessing the structural integrity of the AAA wall using only time-resolved 3D computed tomography angiography (4D-CTA) images and blood pressure data. The proposed approach integrates wall strain (throughout the cardiac cycle) and wall tension analysis to compute a novel index, the Relative Structural Integrity Index (RSII), which quantifies local wall stiffness independently of wall thickness, wall material properties, and blood pressure measurement conditions. We applied our method to twenty patients from three different hospitals to extract visual RSII maps over the AAA wall of each individual patient and to compare the RSII values between aneurysmal and non-aneurysmal aortas in one patient. Our results primarily show similar RSII values across all patients, indicating the consistency of the method. Additionally, we observed patterns consistent with experimental findings reported in the literature: AAA walls exhibited higher stiffness than healthy aortic walls, while localized low-stiffness zones in the AAA wall were predominantly found in the most dilated regions.