Quantification of abdominal aortic aneurysm stiffness using magnetic resonance elastography and its comparison to aneurysm diameter Arunark Kolipaka,

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Quantification of abdominal aortic aneurysm stiffness using magnetic resonance elastography and its comparison to aneurysm diameter Arunark Kolipaka, PhD, Venkata Sita Priyanka Illapani, MS, William Kenyhercz, MPH, Joshua D. Dowell, MD, PhD, Michael R. Go, MD, Jean E. Starr, MD, Patrick S. Vaccaro, MD, Richard D. White, MD Journal of Vascular Surgery Volume 64, Issue 4, Pages 966-974 (October 2016) DOI: 10.1016/j.jvs.2016.03.426 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Schematic of magnetic resonance elastography (MRE) driver setup. The passive driver is placed on the abdomen. Sound waves are noninvasively transmitted to the passive driver from the active driver, through a plastic tube, and into the subject's abdomen. Journal of Vascular Surgery 2016 64, 966-974DOI: (10.1016/j.jvs.2016.03.426) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Sagittal magnitude image of one of the participants with contour (red) outlining the aorta. B-E, Snapshot of wave propagation at four points in time. F, Weighted stiffness map from x, y, and z encoding directions with a mean stiffness value of 21.1 ± 4.2 kPa at the area of the aneurysm (dashed white circle). G-L, Sagittal magnitude images and their corresponding stiffness maps for three participants with abdominal aortic aneurysm (AAA) diameters of 5 cm, 4.5 cm, and 3 cm and mean stiffness values of 10.3 kPa, 28.1 kPa, and 12.2 kPa, respectively. It can be observed that in participants with same AAA diameters, the stiffness values are different. Journal of Vascular Surgery 2016 64, 966-974DOI: (10.1016/j.jvs.2016.03.426) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Two-dimensional (2D) abdominal aortic aneurysm (AAA) stiffness measurements are significantly (P < .0001) higher than three-dimensional (3D) AAA stiffness measurements. LFE, Local-frequency estimation. B, Plot shows 3D AAA stiffness vs 2D AAA stiffness with a Spearman correlation coefficient of 0.48, which was significant (P = .02). Journal of Vascular Surgery 2016 64, 966-974DOI: (10.1016/j.jvs.2016.03.426) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 4 A, Plot of two-dimensional (2D) and three-dimensional (3D) abdominal aortic aneurysm (AAA) stiffness, as a function of AAA diameter, showing the Spearman correlation coefficient of 0.16 (2D) and −0.18 (3D) was not significant (P > .4). B, Plot of ratio of stiffness as a function of ratio of diameter in AAA region to that of remote normal-caliber aorta within the same patient shows the Spearman correlation coefficient of 0.1 (2D) and 0.03 (3D) was not significant (P > .6). Journal of Vascular Surgery 2016 64, 966-974DOI: (10.1016/j.jvs.2016.03.426) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 5 A, Box plot shows the significant difference among three stiffness groups (two-dimensional [2D]): abdominal aortic aneurysm (AAA), AAA remote normal, and healthy normal aortas. The horizontal line in the middle of each box indicates the median; the top and bottom borders of the box mark the 75th and 25th percentiles, respectively, and the whiskers mark the 90th and 10th percentiles. B, The three-dimensional (3D) stiffness measurements differ significantly between AAA region and remote normal aorta in AAA patients (P < .0001). Journal of Vascular Surgery 2016 64, 966-974DOI: (10.1016/j.jvs.2016.03.426) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 6 A, Plot of abdominal aortic aneurysm (AAA) stiffness as a function of the percentage of thrombus area shows no significant correlation at −0.01 for two-dimensional (2D) and −0.39 for three-dimensional (3D) stiffness measurements (P > .07). B, Plot of AAA stiffness as a function of percentage of thrombus diameter shows no significant correlation, at −0.007 for 2D and −0.42 for 3D measurements (P > .05). Journal of Vascular Surgery 2016 64, 966-974DOI: (10.1016/j.jvs.2016.03.426) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 7 A, Plot of abdominal aortic aneurysm (AAA) stiffness as a function of calcium score in the AAA region showing no significant correlation −0.26 for two-dimensional (2D) and 0.25 for three-dimensional (3D) stiffness measurements (P > .43). B, Plot of remote normal-caliber aorta stiffness in AAA patients as a function of calcium score in the remote region shows no significant correlation, at −0.22 for 2D and −0.45 for 3D stiffness measurements (P > .2). Journal of Vascular Surgery 2016 64, 966-974DOI: (10.1016/j.jvs.2016.03.426) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 8 Plot of abdominal aortic aneurysm (AAA) stiffness (two-dimensional [2D] and three-dimensional [3D]) as a function of mean arterial pressure (MAP) shows no significant Spearman correlation coefficient of −0.26 for 2D and −0.21 for 3D measurements (P > .2). Journal of Vascular Surgery 2016 64, 966-974DOI: (10.1016/j.jvs.2016.03.426) Copyright © 2016 Society for Vascular Surgery Terms and Conditions