Preliminary findings in quantification of changes in septal motion during follow-up of type B aortic dissections Christof Karmonik, PhD, Cassidy Duran,

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Preliminary findings in quantification of changes in septal motion during follow-up of type B aortic dissections Christof Karmonik, PhD, Cassidy Duran, MD, Dipan J. Shah, MD, Javier E. Anaya-Ayala, MD, Mark G. Davies, MD, Alan B. Lumsden, MD, Jean Bismuth, MD Journal of Vascular Surgery Volume 55, Issue 5, Pages 1419-1426.e1 (May 2012) DOI: 10.1016/j.jvs.2011.10.127 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 Top, On left, selected sagittal images of a three-dimensional (3D) contrast-enhanced magnetic resonance imaging (MRI) scan showing aortic lumen hyperintense relative to surrounding tissue (patient 1). True lumen, false lumen, as well as intra-arterial septum (IS) can be readily appreciated. Aortic dissections (AD) originated immediately posterior to the origin of the left vertebral artery. On right, Tortuosity of the aorta and the IS can be appreciated in a 3D surface reconstruction of the aorta created from the 3D contrast-enhanced acquisition shown on the left. Location of two-dimensional (2D) pcMRI images is marked by red square. Bottom, 2D pcMRI images at selected time points in the cardiac cycle. Second image from left was acquired at the time of systole. Upper row shows magnitude images and lower row shows phase difference images. Hypointense true lumen and false lumen marking high velocity flow during systole can be appreciated, which diminishes at later times points (image intensity isointense with surrounding ie, stationary tissue). Journal of Vascular Surgery 2012 55, 1419-1426.e1DOI: (10.1016/j.jvs.2011.10.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 Top, true lumen (TL) boundary outlines for subject 8 at six selected time points during the cardiac cycle for initial presentation (upper row) and for follow-up (lower row). Outlines are color-coded using the same color scheme as for the TL aortic waveform, where systolic flow is shown in red color tones and diastolic flow in black color tones (see below). On far right, segmented TL lumen (white) with segmented TL boundary (red). Straight lines in red are the main axes of the angular coordinate system used to define extension of IS septum (here ranging from −119 degrees to 37 degrees as indicated by the straight black lines). The same coordinate system was used to plot the IS motion parameters (see below). Bottom, TL aortic waveform (TL flow), IS boundary displacement during the cardiac cycle (IS disp), IS extension (IS ext), IS contraction (IS cont), and IS average displacement (IS avg). The former three parameters are plotted vs time (cardiac cycle in seconds), whereas the latter three parameters are plotted vs angular location (using the angular coordinate system defined above as indicated by the broken arrow lines). TL flow is in mL/s and IS motion parameters are in mm. Correlation between TL flow and IS disp was used to define correlation of TL flow with average aortic displacement (IS corr). Journal of Vascular Surgery 2012 55, 1419-1426.e1DOI: (10.1016/j.jvs.2011.10.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 Plots with individual values for intra-arterial septum (IS) extension (IS ext) (A), IS contraction (IS cont) (B), IS correlation (IS corr) (C) and the fraction of IS moving in phase with aortic flow (IS in-phase, D). High variability for all parameters can be appreciated at initial presentation, which is reduced for the values obtained at long-term follow-up. Straight lines indicate results of linear regression. Moderate R values were obtained for IS corr and IS in-phase; R values for IS ext and IS cont were lower than 0.3. Journal of Vascular Surgery 2012 55, 1419-1426.e1DOI: (10.1016/j.jvs.2011.10.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 4 Intra-arterial septum (IS) motion (ISM) relative to baseline for short-term (blue) and midterm follow-up groups (red). While a large variability existed during short-term follow-up (which is reflected by the large spread of the blue symbols in the figure), only one subject showed a moderately elevated increase in ISM (arrow) while ISM for the remaining three was decreased. Journal of Vascular Surgery 2012 55, 1419-1426.e1DOI: (10.1016/j.jvs.2011.10.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions