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Evolution Prediction of the Aortic Diameter Based on the Thrombus Signal from MR Images on Small Abdominal Aortic Aneurysms

Evolution Prediction of the Aortic Diameter Based on the Thrombus Signal from MR Images on Small Abdominal Aortic Aneurysms

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Published by ijcsis
The paper is about studying the T1 and T2 from Magnetic Resonance (MR) Images examination for the existence of thrombus in patient with Small Abdominal Aortic Aneurysms (SAAA) in order to know whether thrombus signal has correlation with the evolution of aortic diameter enlargement, which then can be used to predict the risk of rupture of aortic wall. Data were derived from 16 patients with SAAA, whereas MR images obtained from 3T imager (Trio TIM, Siemens Medical Solution, Germany), which came from: the study of anatomy, cine-MR images, pictures T1/T2, blood flow images, and images after injection of contrast agents. The surface area of the aorta and luminal are determined by tracing manually, which can be used to determine the surface area of thrombus. The maximum diameter of the aorta are automatically obtained from manual tracing on T1 images. The parameters to study the thrombus signal are the mean, median, standard deviation, skewness and kurtosis. Each parameter is calculated on the area of thrombus, while for normalization we implement the signal in the muscles. All parameters are compared to evolution of aortic diameter. We found 13 out of 16 patients with SAAA have thrombus. But there is no correlation between thrombus signals and maximum diameter (mean (r = 0.318), median (r = 0.318), skewness (r = 0.304)), or even with maksimum evolution diameter (mean (r=0.512)). As the conclusion is the comparation between mathematical and visual calculation of thrombus categories reached 81% similar, but thrombus signal itself cannot be used to predict the evolution of aortic diameter.
The paper is about studying the T1 and T2 from Magnetic Resonance (MR) Images examination for the existence of thrombus in patient with Small Abdominal Aortic Aneurysms (SAAA) in order to know whether thrombus signal has correlation with the evolution of aortic diameter enlargement, which then can be used to predict the risk of rupture of aortic wall. Data were derived from 16 patients with SAAA, whereas MR images obtained from 3T imager (Trio TIM, Siemens Medical Solution, Germany), which came from: the study of anatomy, cine-MR images, pictures T1/T2, blood flow images, and images after injection of contrast agents. The surface area of the aorta and luminal are determined by tracing manually, which can be used to determine the surface area of thrombus. The maximum diameter of the aorta are automatically obtained from manual tracing on T1 images. The parameters to study the thrombus signal are the mean, median, standard deviation, skewness and kurtosis. Each parameter is calculated on the area of thrombus, while for normalization we implement the signal in the muscles. All parameters are compared to evolution of aortic diameter. We found 13 out of 16 patients with SAAA have thrombus. But there is no correlation between thrombus signals and maximum diameter (mean (r = 0.318), median (r = 0.318), skewness (r = 0.304)), or even with maksimum evolution diameter (mean (r=0.512)). As the conclusion is the comparation between mathematical and visual calculation of thrombus categories reached 81% similar, but thrombus signal itself cannot be used to predict the evolution of aortic diameter.

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(IJCSIS) International Journal of Computer Science and Information Security,Vol. 9, No.
3
, March 2011
Evolution Prediction of the Aortic Diameter Based onthe Thrombus Signal from MR Images on SmallAbdominal Aortic Aneurysms
A. Suhendra
1
, C.M. Karyati
2
, A.Muslim
3
, A.B. Mutiara
4
 
Faculty of Computer Science and Information Technology, Gunadarma UniversityJl. Margonda Raya No.100, Depok 16424, Indonesia
 
1,2,3,4
{adang,csyarah,amuslim,amutiara}@staff.gunadarma.ac.id
Abstract
—The paper is about studying the T1 and T2 fromMagnetic Resonance (MR) Images examination for the existenceof thrombus in patient with Small Abdominal Aortic Aneurysms(SAAA) in order to know whether thrombus signal hascorrelation with the evolution of aortic diameter enlargement,which then can be used to predict the risk of rupture of aorticwall. Data were derived from 16 patients with SAAA, whereasMR images obtained from 3T imager (Trio TIM, SiemensMedical Solution, Germany), which came from: the study of anatomy, cine-MR images, pictures T1/T2, blood flow images,and images after injection of contrast agents. The surface area of the aorta and luminal are determined by tracing manually, whichcan be used to determine the surface area of thrombus. Themaximum diameter of the aorta are automatically obtained frommanual tracing on T1 images. The parameters to study thethrombus signal are the mean, median, standard deviation,skewness and kurtosis. Each parameter is calculated on the areaof thrombus, while for normalization we implement the signal inthe muscles. All parameters are compared to evolution of aorticdiameter. We found 13 out of 16 patients with SAAA havethrombus. But there is no correlation between thrombus signalsand maximum diameter (mean (r = 0.318), median (r = 0.318),skewness (r = 0.304)), or even with maksimum evolution diameter(mean (r=0.512)). As the conclusion is the comparation betweenmathematical and visual calculation of thrombus categoriesreached 81% similar, but thrombus signal itself cannot be used topredict the evolution of aortic diameter.
Keywords-component; Thrombus signal; evolution of aorticdiameter; T1 and T2 weighted images; Small Abdominal AorticAneurysms.
I.
 
I
NTRODUCTION
 Aorta is the larger artery that delivers blood from the heartof human beings throughout the body. In this way, the humanblood flow will go through some branch, for example, that ledto the arm (subclavian arteries), heading toward of the head(carotid arteries), and headed toward of the chest (thoracicaorta), then toward of the diaphragm to the stomach(abdominal aorta). In the region around the stomach will bemuch more branching, including to the liver, intestines andkidneys. And last, the branching will be forwarded to thedirection of human legs (iliac arteries).Human blood will be pumped by the heart into the aorta,which then flows through the artery and its ramifications to allparts of the human body. The human blood pressure will refer to how much pressure in the arteries that brings blood to allcells of the human body through the delicate vessels(capillaries) which then will return to the heart through bloodvessels and takes oxygen through the lungs. There are a littledescription of the aorta which will be discussed further in thisstudy. It could be imagined if there are any damage to thehuman aorta would result in abnormalities in blood flow in thehuman body. In the following image, we can see the anatomyof the aorta and the arteries (figure 1) :
Figure 1. Anatomy of the aorta [1]
The Studies of human aorta have been conducted andsuccessfully detected abnormalities in the aortic wall, both atthe thoracic or abdominal aortas [1,2]. In general, the swellingof the aortic wall is very elastic, therefore if the swelling isoccur then aortic wall will not be able to shrink back and it willbe broken without being able to predict when the rupture risk of the aortic wall. It could be in the risk of patient death.An Abdominal Aortic Aneurysm, also called AAA, is abulging area in the wall of the aorta which is causing of anabnormal widening or ballooning until greater than 50 percentof the normal diameter. The the swelling of the aortic wallcould be caused by age (more than 60), male (four to five timesgreater than females), family history (first degree relatives suchas father or brother), genetic factors, hyperlipidemia (elevatedfats in the blood), hypertension (high blood pressure), smokingand diabetes.
14 http://sites.google.com/site/ijcsis/ISSN 1947-5500
 
(IJCSIS) International Journal of Computer Science and Information Security,Vol. 9, No.
3
, March 2011
Asymptomatic aneurysms may not require surgicalintervention until they reach a certain size or are noted to beincreasing in size over a certain period of time. The parametersfor surgical decisions, but are not limited to, are as follows[1,2]:
 
aneurysm size greater than 5 centimeters (about twoinches)
 
aneurysm growth rate is arround 0.5 centimeters(slightly less than one-fourth inch) over a period of sixmonths to one year 
 
patient’s ability to tolerate the procedureII.
 
T
ROMBUS
S
IGNAL
 Thrombosis term will refer to the formation of a blood clot(thrombus) in the blood vessels or human heart cavities.Abdominal Aortic Aneurysms are often associated with thethrombus (clots). This field have been studied anddemonstrated by the pathological, surgical, and clinicalexamination based on the results of computed tomography(CT), ultrasound imaging, angiography, traditional spin-echo(SE) or cine-MRI. There are many methods have been createdor modified to prove the existence of intact thrombus signal inthe aorta. But until now, with a disorder that occurs in theaorta, it is difficult to detect or properly evaluate the existenceof thrombus signal [2, 3].
Figure 2. Aneurysms with a formation of Thrombus [4]
The selection of images for thrombus formation analyzingis very important. Images are selected from the result of examination during relaxation took place (as shown in Figure 3of T1 and T2 images)[5].This work analysed the T1 and T2 of thrombus of SAAApatient examination to determine whether the thrombus signalhas correlation with the aortic diameter enlargement, and topredict the rupture risk of the aorta wall.III.
 
M
ATERIALS AND
M
ETHODS
 
A.
 
Data
Data were obtained from 16 patients with Small AbdominalAortic Aneurysms (SAAA) who have been examined sinceJuly 2006 until January 2010. Each patient has been examinedat least 1 to 4 times with examination period between 6 to 12months (depend on the patient). MR Images were acquired on a3T Imager (Trio TIM, Siemens Medical Solution, Germany).According to the result of clinical data, there are differencecharacteristics based on status of each patient (smoking/exsmoking, fat in blood (dyslipidemied), and hypertency) asshown in Table I.
(a)
 
(b)
 
Figure 3. (a) T1- image and (b) T2- image at the level of Abdominal AorticAneurysmsTABLE I. P
ATIENT
S
C
HARACTERISTICS
 
Name of Patient SexAge(year)Characteristics
Patient 1 Male 65 SmookingPatient 2 Female 68 DyslipidémiePatient 3 Male 62Smooking, Hypertensi,DyslipidémiePatient 4 Male 82 Ex SmookingPatient 5 Male 83 -Patient 6 Male 59 Ex SmookingPatient 7 Male 53 -Patient 8 Male 79Ex Smooking,Hypertensi,DyslipidémiePatient 9 Male 77Ex Smooking,Hypertensi,DyslipidémiePatient 10 Male 71 Smooking,
15 http://sites.google.com/site/ijcsis/ISSN 1947-5500
 
(IJCSIS) International Journal of Computer Science and Information Security,Vol. 9, No.
3
, March 2011
Name of Patient SexAge(year)Characteristics
DyslipidémiePatient 11 Female 74 Ex SmookingPatient 12 Male 69 -Patient 13 Male 55Ex Smooking,Hypertensi,DyslipidémiePatient 14 Male 51Ex Smooking,DyslipidémiePatient 15 Male 73Ex Smooking,Hypertensi,DyslipidémiePatient 16 Male 59 Smooking
B.
 
Protocol Small Abdominal Aortic Aneurysms
In this study protocol, images originating from: the study of anatomy, cine-MR images for 3D/4D modeling, images T1/T2,blood flow images, and images after injection of contrastagents have been used to study the aspects of inflammation.For each patient, the images are located in the same positionbetween one to another examination.
C.
 
Processing
We used MatLab software to precess the data. Preliminaryexamination has been conducted for predictive aspect, and finalexamination has been conducted as well for data which hasmore important thrombus, more areas, and more signals. Theborders have been manually traced to define the Aorta Surfaceand Luminal Surface, therefore Thrombus Surface = AortaSurface – Luminal Surface, (see figure 4).In aortic wall surface calculation, thrombus is found if thethrombus surface area is greater than 30% of aortic surfacearea. Diameter of aorta is achieved by tracing manually theaorta surface. There are three kinds of diameter positions:Anterior-Posterior Diameter, Transversal Diameter andMaximum diameter, as shown in the figure 5.The muscle signal are slightly differences among eachexaminations, therefore we normalized the data of muscle area.
(a) (b)
 
Figure 4. (a) Manual tracing in Aorta Surface, (b) Manual tracing in LuminalSurface (in green line)(a) (b)
 
(c)Figure 5. (a) Anterior-Posterior Diameter, (b) Transversal Diameter, (c)Maximum Diameter (a)
 
(b)
 
(c)
 
Figure 6. (a) T1-W image and (b) T2-W image after manual tracing, (c)Normalization area in the muscle
D.
 
Paramaters
Maximum aortic diameter was automatically obtained frommanual tracing on T1 image in all examinations. Then wecalculated the evolution of the aortic diameter (mm/year) =
 maximum diameter (mm) /
examination date (day) * 365days. Several parameters were used to study the thrombussignal, such as mean, median, standard deviation, skewness thatdescribes the degree of asymmetry of the signal histogram byusing the equation
n
i
(
x
i
-x
)
3
/Ns
3
, and the kurtosis thatdescribes how sharp the peak of the signal histogram which isdefined by using the equation
n
i
(
x
i
-x
)
4
/Ns
4
-3
, where
n
i
isnumber of pixel at aorta
x
i
,
x
is mean value of the aorta,
s
is theSD, and
is the total number of pixels. [5]Each parameter is calculated for the thrombus area, and thesignal in the muscle is used to normalize the mean of signal inthrombus, the median of signal in thrombus and the standarddeviation of signal in thrombus. These parameters arecompared to the evolution of the aortic diameter. By using
16 http://sites.google.com/site/ijcsis/ISSN 1947-5500

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