Determining the normal aorta size in infants and children

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Presentation transcript:

Determining the normal aorta size in infants and children S Bruce Greenberg, Shilpa V Hegde, Shelly Lensing University of Arkansas for Medical Sciences Little Rock , AR.

Normal aorta size in Children Echocardiography: limited to planar measurements of thoracic aorta CT and MRA: Limited standards for thoracic aorta Technique Patient age No standards for abdominal aorta .

Purpose: Determine the normal range of effective diameters for the aorta at multiple locations and common iliac arteries in children of all sizes

Patients and methods: Inclusion criteria Exclusion Criteria All torso computed tomography examinations performed with IV contrast from 7/9/2012 to 12/27/2012 Exclusion Criteria Cardiovascular disease Unknown patient height Total CT examinations 137 Thorax 89 Abdomen 111

CT indications: Total 137 Indications for CT Oncology 57 Pain 22 Trauma 14 Infection 12 Miscellaneous 32

Patient age and size Age Mean : 9.9 years (Standard Deviation 5.7 years) Range : 2 weeks to 20 years Body Surface Area Mean: 1.24 m 2 (Standard Deviation 0.57 m 2) Range: 0.19 m 2 to 2.5 m 2

Measurement locations Double oblique MPR using 1 mm reconstructions Effective diameter measured by 2 readers

Measurement method: double oblique Effective diameter of abdominal Aorta just above the celiac axis = 16 mm

Statistical Methods Intraclass correlation for inter-rater reliability of 2 readers Multiple linear regression models relating Body surface area Effective diameter Outliers with standardized residuals < 3 or >3 were deleted

Intraclass Correlation: excellent Thorax Abdomen Aortic Annulus 0.95 Aortic Sinus 0.98 Sino Tubular Junction 0.98 Ascending Aorta 0.98 Arch 0.98 Isthmus 0.98 Prox. Descend. Aorta 0.97 Aorta at the diaphragm 0.97 Superior to celiac axis 0.96 Renal artery level 0.96 Superior to bifurcation 0.97 Right common iliac artery 0.95 Left common iliac artery 0.96

Results: AORTA ROOT Formula root MSE R2 Loge (Aorta Annulus) = 2.091 + 1.378*BSA - 0.634*BSA2 + 0.117*BSA3 0.088 0.902 Loge (Sinus of Valsalva) = 2.196 + 1.437*BSA - 0.661*BSA2 + 0.122*BSA3 0.097 0.892 Loge (Sino Tubular Junction) = 1.697 + 2.124*BSA – 1.106*BSA2 + 0.211*BSA3 0.109 0.894

Results: thoracic aorta Formula root MSE R2 loge(Mid Ascending Aorta)=1.790 + 1.998*BSA – 1.014*BSA2 + 0.189*BSA3 0.118 0.872 loge(Arch)=1.575 + 1.996*BSA – 0.984*BSA2 + 0.184*BSA3 0.107 0.906 loge(Isthmus)=1.426 + 2.197*BSA – 1.136*BSA2 + 0.216*BSA3 0.103 0.913 loge(Proximal Descending Aorta)=1.547 + 1.830*BSA – 0.930*BSA2 + 0.182*BSA3 0.113 0.881 loge(Aorta at Diaphragm)=1.587 + 1.485*BSA – 0.667*BSA2 + 0.119*BSA3 0.104 0.886

Results: Abdominal aorta and iliac arteries Formula root MSE R2 loge (Superior to Celiac Axis) = 1.579 + 1.350*BSA - 0.601*BSA2 + 0.112*BSA3 0.104 0.856 loge (Level Renal Arteries) = 1.256 + 1.598*BSA – 0.725*BSA2 + 0.135*BSA3 0.123 0.848 loge (Aorta above Bifurcation) = 1.014 + 2.003*BSA – 0.957*BSA2 + 0.172*BSA3 0.114 0.883 loge(Right Common Iliac)=0.352 + 2.753*BSA – 1.489*BSA2 + 0.283*BSA3 0.149 0.829 loge(Left Common Iliac)=0.409 + 2.704*BSA – 1.506*BSA2 + 0.296*BSA3 0.115 0.875

Z-score (Standard deviation) calculation

Z score calculation: 14 week old child with William’s Syndrome with a body surface area of 0.3m2. Effective diameter of the aorta at the level of isthmus was 4.7mm.

Z-score (STANDARD DEVIATION) calculation Observed value : natural log of observed measurement loge 4.7 = 1.54 Predicted value : loge(Isthmus) =1.426 + 2.197*BSA – 1.136*BSA2 + 0.216*BSA3 = 1.426 + 2.197*0.3 – 1.136*(0.3)2 + 0.216*(0.3)3 = 1.988 Z score = [calculation 1 – calculation 2] ÷ √ MSE = [1.54-1.98] ÷ 0.103 = - 4.2

Z-scores in Williams patient Enter BSA (units) Enter observed diameter (mm) Calculated predicted diameter (mm) Z-Scores Aorta Annulus #NUM! Sinus of Valsalva Sino Tubular Junction Mid Ascending Aorta Arch Isthmus Proximal Descending Aorta Aorta at Diaphragm Superior to Celiac Axis Level Renal Arteries Aorta above Bifurcation Right Common Iliac Left Common Iliac Enter BSA (units) Enter observed diameter (mm) Calculated predicted diameter (mm) Z-Scores 0.3 Aorta Annulus 9 11.2 -2.76 Sinus of Valsalva 10 13.2 -2.82 Sino Tubular Junction 4.5 9.6 -7.14 Mid Ascending Aorta 5.2 -5.29 Arch 5.3 7.9 -3.68 Isthmus 4.7 7.0 -4.02 Proximal Descending Aorta 4.8 7.4 -4.01 Aorta at Diaphragm -4.07 Superior to Celiac Axis 4.3 6.6 -4.19 Level Renal Arteries 3.4 5.1 -3.41 Aorta above Bifurcation 3.2 -2.93 Right Common Iliac 2.5 2.8 -0.68 Left Common Iliac 2.9 -1.22

Diffuse aorta hypoplasia Enter BSA (units) Enter observed diameter (mm) Calculated predicted diameter (mm) Z-Scores 0.3 Aorta Annulus 9 11.2 -2.76 Sinus of Valsalva 10 13.2 -2.82 Sino Tubular Junction 4.5 9.6 -7.14 Mid Ascending Aorta 5.2 -5.29 Arch 5.3 7.9 -3.68 Isthmus 4.7 7.0 -4.02 Proximal Descending Aorta 4.8 7.4 -4.01 Aorta at Diaphragm -4.07 Superior to Celiac Axis 4.3 6.6 -4.19 Level Renal Arteries 3.4 5.1 -3.41 Aorta above Bifurcation 3.2 -2.93 Right Common Iliac 2.5 2.8 -0.68 Left Common Iliac 2.9 -1.22

OR USE THE GRAPH : *

Objective evaluation of hypoplasia or aneurysm Conclusion Normal values for the effective diameter of the aorta can now be determined in children of all sizes using the derived formulas Objective evaluation of hypoplasia or aneurysm