Comparison of two techniques (in vivo and ex-vivo) for evaluating the elastic properties of the ascending aorta: Prospective cohort study

Abstract

Introduction Aneurysms of the ascending aorta (AA) correspond to a dilatation of the ascending aorta that progressively evolves over several years. The main complication of aneurysms of the ascending aorta is type A aortic dissection, which is associated with very high rates of morbidity and mortality. Prophylactic ascending aorta replacement guidelines are currently based on maximal AA diameter. However, this criterion is imperfect. Stretching tests on the aorta carried out ex-vivo make it possible to determine the elastic properties of healthy and aneurysmal aortic fragments (tension test, resistance before rupture). For several years now, cardiac magnetic resonance imaging (MRI) has provided another means of evaluating the elastic properties of the aorta. This imaging technique has the advantage of being non-invasive and of establishing aortic compliance (local measurement of stiffness) without using contrast material by measuring the variation of the aortic surface area during the cardiac cycle, and pulse wave velocity (overall stiffness of the aorta). Materials and methods Prospective single-center study including 100 patients with ascending aortic aneurysm requiring surgery. We will perform preoperative cine-MRI and biomechanical laboratory stretching tests on aortic samples collected during the cardiac procedure. Images will be acquired with a 3T MRI with only four other acquisitions in addition to the conventional protocol. These additional sequences are a Fast Low Angle Shot (FLASH)-type sequence performed during a short breath-hold in the transverse plane at the level of the bifurcation of the pulmonary artery, and phase-contrast sequences that encodes velocity at the same localization, and also in planes perpendicular to the aorta at the levels of the sino-tubular junction and the diaphragm for the descending aorta. For ex-vivo tests, the experiments will be carried out by a biaxial tensile test machine (ElectroForce®). Each specimen will be stretched with 10 times of 10% preconditioning and at a rate of 10 mm/min until rupture. During the experiment, the tissue is treated under a 37°C saline bath. The maximum elastic modulus from each sample will be calculated. Results The aim of this study is to obtain local patient-specific elastic modulus distribution of the ascending aorta from biaxial tensile tests and to assess elastic properties of the aorta using MRI, then to evaluate the correlation between biaxial tests and MRI measurements. Discussion Our research hypothesis is that there is a correlation between the evaluation of the elastic properties of the aorta from cardiac MRI and from stretching tests performed ex-vivo on aorta samples collected during ascending aorta replacement.

Comparison of In-Vivo and Ex-Vivo Ascending Aorta Elastic Properties through Automatic Deep Learning Segmentation of Cine-MRI and Biomechanical Testing

“…The aortic wall was partitioned into four quadrants and rotated 60 degrees to achieve orientation relative to medial, posterior, lateral, and anterior quadrants [ 9 , 12 ]. The different areas as well as the curve for the calculation of local compliance are displayed in Figure 8 .…”

“…Morgant et al [ 12 ] compared global ex-vivo elastic properties of the aorta with in-vivo ones. Their results imply that a high correlation exists between the aortic stiffness measured by the maximum Young’s modulus and the aortic compliance measured from magnetic resonance imaging (MRI).…”

“…This study concentrates on the second approach, assessing aortic compliance, defined as the cross-sectional area variation during a cardiac cycle divided by the pulse pressure variation. While studies like the one of Morgant et al [ 12 ] assessed the global elastic properties of the aorta, our study contribution is based on the in-vivo assessment of local biomechanical properties. The reason we study the local properties is that the aortic wall certainly involves differences in the behavior of stiffness depending on the localization [ 9 ].…”

“…Considering this ex-vivo study, the lateral quadrant was the stiffest, while the medial quadrant had the lowest aortic stiffness across the walls. Local distensibility measurements from ex-vivo experiments [ 9 , 12 ] named maximum Young’s modulus and physiological Young’s modulus are compared with local in-vivo compliance of each quadrant to analyze the possible correlation between them. Aortic samples retrieved during surgery are stretched to investigate their ex-vivo elastic properties.…”

“…The first one is the evaluation between aorta segmentation predicted results of the DL model and ground truth provided by a medical expert, using metrics like Dice coefficient, Intersection over Union (IoU), and Hausdorff distance, precision, and recall. The second part is based on the aortic wall’s elastic properties and a comparison between in-vivo and ex-vivo results [ 9 , 12 ]. Then our work focused on the evaluation of the global and local elastic properties of the aorta (compliance and strain) and compared them with ex-vivo biomechanical properties.…”