Note: This copy is for your personal non-commercial use only.

To order presentation-ready
copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights.

Original Research  n  Pediatric

Determining the Normal Aorta
Size in Children1

Imaging
Shilpa V. Hegde, MBBS
Purpose: To establish effective aorta diameter standards at multiple
Shelly Y. Lensing, MS
levels of the thoracic aorta, abdominal aorta, and com-
S. Bruce Greenberg, MD
mon iliac arteries by using computed tomographic (CT)
data in healthy children (infants, children, adolescents)
through young adults (hereafter referred to collectively as
“children”) of a wide range of sizes so that z scores may
be calculated.

Materials and This retrospective study was approved by the institutional

Methods: review board. The effective diameter, the average of aortic
anteroposterior and lateral diameters, was independently
measured at multiple levels of the aorta and common il-
iac arteries by two radiologists using 1-mm–collimation
double-oblique reconstructions. Ordinary least squares
regression methods were used to investigate models with
various functional forms that related effective diameters
at each level to patient body surface area (BSA) and sex.
The best model was selected by using R2, and formulas for
deriving the expected diameter and estimates of the mean
squared error (MSE) were generated.

Results: Results from 88 thoracic and 110 abdominal contrast mate-

rial–enhanced CT examinations were analyzed in children
without known cardiovascular disease who ranged in age
from 0 to 20 years (mean, 9.9 years; standard deviation,
5.7), with BSA ranging from 0.19 to 2.52 m2. Excellent
interrater reliability was present (correlation coefficients
ranged from 0.95 to 0.98). The best model was a polyno-
mial regression model of the natural log transformation
of the effective diameter that included linear, quadratic,
and cubic BSA terms and a sex main effect as indepen-
dent variables. The z scores were calculated by using the
observed and expected effective diameters and the MSE.

Conclusion: The range of normal effective diameters of the aorta at

multiple levels and the common iliac arteries was deter-
mined for children of different sizes and both sexes. Mea-
surements outside of the normal ranges are consistent
with aneurysm or hypoplasia.
1
 From the Department of Radiology, Section of Pediatric
Radiology (S.V.H., S.B.G.), and Department of Biostatistics  RSNA, 2014
q

(S.Y.L.), Arkansas Children’s Hospital, University of Arkan-

sas for Medical Sciences, 1 Children’s Way, Little Rock, AR Online supplemental material is available for this article.
72202. Received February 27, 2014; revision requested
March 31; final revision received July 2; accepted August
12; final version accepted August 20. Address correspon-
dence to S.B.G. (e-mail: Greenbergsbruce@uams.edu).

q
 RSNA, 2014

Radiology: Volume 274: Number 3—March 2015  n  radiology.rsna.org 859

PEDIATRIC IMAGING: Normal Aorta Size in Children Hegde et al
N
ormal standards for both the
thoracic and abdominal aortic
diameter at multiple levels have
been established for adults and can
be used to determine stenosis or an-
eurysm formation (1). Standards for
infants (1 month to 1 year old), chil-
dren (birth to 12 years old or 1–12
years old), adolescents (13–17 years
old), and young adults (18–24 years
old) (hereafter, individuals in these
age groups will be referred to collec-
tively as “children”) are not as well
established. Echocardiography stan-
dards for the thoracic aorta rely on
planar measurements rather than on
transverse measurements. The planar
image is created along the long axis of
the aorta. As such, only one diameter
can be measured at a given level of
the aorta. An assumption is made that
the plane precisely bisects the aorta
and that the aorta is perfectly round.
Cross-sectional imaging standards us-
ing computed tomography (CT) and
magnetic resonance (MR) imaging of
the thoracic aorta are limited in chil-
dren, and no standards exist for the
abdominal aorta (2–4). Determining
diffuse aortic hypoplasia in conditions
such as Williams syndrome or aneu-
rysmal dilatation in children with Mar-
fan disease is hampered by the lack of
Advances in Knowledge
nn The normal ranges of effective
aortic diameters in children
(infants, children, adolescents)
through young adults (collectively
referred to as “children”) at mul-
tiple levels of the thoracic aorta,
abdominal aorta, and common
iliac arteries obtained with CT
were established by measuring
the effective diameter on double-
oblique reconstructions in chil-
dren of varying sizes and ana-
lyzing the measurements by using
the least squares regression
method to determine the range
of normal effective diameter.
nn Aortic effective diameter mea-
surements that are outside of the
normal range can be considered
aneurysmal or hypoplastic.
860 radiology.rsna.org  n Radiology: Volume 274: Number 3—March 2015
reliable standards (1). Our purpose
was to establish a set of standards for
the effective aortic diameter, the mean
of anteroposterior and transverse di-
ameter measurements of the aorta at
multiple levels of the thoracic aorta,
abdominal aorta, and common iliac
arteries in children of a wide range of
sizes by using CT.
Materials and Methods
The study was approved by the insti-
tutional review board (University of
Arkansas for Medical Sciences, Little
Rock, Ark). Informed consent was
waived by the institutional review
board. A retrospective study was per-
formed to determine the normal effec-
tive diameter of the aorta at different
levels in children of varying sizes. The
inclusion criteria for children evalu-
ated during a 6-month period between
July and December 2012 included the
following: (a) torso CT performed of
the whole torso or chest or abdomen
and pelvis with intravenous contrast
material during a 6-month period be-
tween July and December 2012 at a
tertiary care pediatric hospital (Arkan-
sas Children’s Hospital, Little Rock,
Ark), (b) patient height determined
by length measurement using a paper
tape measure in infants and toddlers
and a stadiometer for older children,
and (c) CT images archived using 0.5-
mm collimation.
Exclusion criteria included the
following: (a) history of cardiovascu-
lar disease; (b) patients without height
determined by using a tape measure
or stadiometer, which is necessary to
calculate body surface area (BSA) (pa-
tient weight is always available because
Implication for Patient Care
nn The range of normal effective
diameters of the aorta at mul-
tiple levels and the common iliac
arteries was determined for chil-
dren of different sizes and both
sexes; attention to these normal
ranges may allow the radiologist
to determine a diagnosis of
aortic hypoplasia or aneurysm.
contrast material dose is based on pa-
tient weight); and (c) CT images ar-
chived using collimation of greater than
0.5 mm.
Only the first CT scan was included
in the study if multiple examinations were
performed during the 6-month period.
One hundred thirty-seven of 740
screened torso CT examinations met
the study inclusion criteria. Of the
137 included CT studies, 88 included
the chest and 110 included the abdo-
men and pelvis. Among the 603 ex-
cluded examinations, the criteria for
exclusion included an examination for
which the archived-collimation images
were obtained with greater than 0.5-
mm collimation (n = 361), an examina-
tion with an absence of administration
of intravenous contrast material (n =
101), the examination was a repeat
examination during the study period
(n = 52), an examination performed
because the patient was suspected of
having a vascular abnormality (n = 51),
an examination that was a cardiac CT
examination (n = 22), an examination
that included only the pelvis at CT (n
= 8), and an examination that included
only the abdomen at CT (n = 8). The
BSA for each patient was calculated by
using the method of Haycock et al (5).
This method was selected because a
convenient BSA calculator is available
for free on the Internet (http://www.
Published online before print
10.1148/radiol.14140500  Content codes:
Radiology 2015; 274:859–865
Abbreviations:
BSA = body surface area
MSE = mean squared error
SD = standard deviation
Author contributions:
Guarantors of integrity of entire study, S.V.H., S.B.G.;
study concepts/study design or data acquisition or data
analysis/interpretation, all authors; manuscript drafting
or manuscript revision for important intellectual content,
all authors; approval of final version of submitted
manuscript, all authors; agrees to ensure any questions
related to the work are appropriately resolved, all authors;
literature research, S.V.H., S.B.G.; clinical studies, S.V.H.,
S.B.G.; statistical analysis, S.Y.L.; and manuscript editing,
all authors
Conflicts of interest are listed at the end of this article.
PEDIATRIC IMAGING: Normal Aorta Size in Children Hegde et al
Figure 1
Figure 1:  A, Sagittal oblique, B, coronal oblique multiplanar reconstructions obtained perpendicular to the aorta were created to determine cross section of the
aorta at the level superior to the celiac axis. Arrows = planes used to create the true cross-sectional image, C. C, Effective diameter of abdominal aorta obtained
superior to the celiac axis is 11.2 mm.
ultradrive.com/BSAc.htm) and has
been used in our department for many
years to determine BSA.
All study examinations were per-
formed with either of two CT scan-
ners (Aquilion 64 or Aquilion One;
Toshiba, Otawara-shi, Japan). The
intravenous contrast material used
for children who weighed less than 10
kg was iohexol (Omnipaque 240; GE
Healthcare, Little Chalfont, Bucking-
hamshire, England), 240 mg of iodine
per milliliter, at a dose of 3 mL per
kilogram of body weight. For chil-
dren who weighed more than 10 kg,
iohexol (Omnipaque 300; GE Health-
care), 300 mg of iodine per milliliter,
at a dose of 2 mL per kilogram, with
a maximum dose of 100 mL, was used.
Images were reconstructed by using
axial 0.5-mm collimation. Multiplanar
reformations were created by using a
workstation (Vitrea FX; Vital Images,
Minneapolis, Minn). All multiplanar
reformations were double-oblique re-
constructions obtained perpendicular
to the aorta (Fig 1). The effective di-
ameter at each level was determined
by averaging the anteroposterior and
lateral diameter measurements. The
aortic levels at which measurements
were obtained were as follows: aortic
annulus, aorta at the sinuses, ascend-
ing aorta at the level of the right pul-
monary artery, aortic arch, isthmus,
proximal descending aorta (distal to
the aortic arch where the descending
Radiology: Volume 274: Number 3—March 2015  n  radiology.rsna.org 861
aorta obtains a cranial-caudal orien-
tation), aorta at the diaphragm, aorta
superior to the celiac axis, aorta at
the level of the renal arteries, and
superior to the descending aortic bi-
furcation. Right and left iliac artery
effective diameters were measured
midway between the aortic bifurca-
tion and the common iliac artery bi-
furcation. Images from all studies were
independently read by two pediatric
radiologists (S.B.G., with 25 years of
experience, and S.V.H., with 2 years
of experience). Each radiologist inde-
pendently created 1-mm-thick double-
oblique multiplanar reconstructions
from the original axial data sets and
used electronic calipers to measure
anteroposterior and lateral diameters
that were used to determine the effec-
tive diameter.
Statistical Methods
Intraclass correlation coefficients were
computed for evaluating the interrater
reliability of diameter measurements
from two readers (6). These two mea-
surements were then averaged for fur-
ther analysis. Ordinary least squares re-
gression models were fit to describe the
relationship between aortic diameter at
a particular level (dependent variable)
and independent variables defined by
BSA. Following the approach and using
models described in two studies that
modeled aortic diameter measured with
an echocardiogram (3,4), three sets of
models were initially evaluated by using
R2 to determine the functional form with
the best fit, as shown in the examples for
the aortic annulus (AA) that follow:
AA = b0 + b1· BSA + b2 · BSA2+ b3
· BSA3,(1)
loge (AA) = b0 + b1· BSA + b2 ·
BSA2+ b3 · BSA3, (2)
and
loge (AA) = b0 + b1 · loge (BSA), (3)
where b0 is the intercept and b1–b3 are
the slopes estimated by the model for
linear, quadratic, and cubic terms; BSA
is used to predict loge of the aortic annu-
lus (ie, natural log of the aortic annulus).
After the best model was identified,
the effect of sex was investigated by add-
ing a sex main effect and interactions
with the BSA terms in the model. Age
was not included in the model because
the effect of age is confounded by BSA,
as the two are highly correlated (Spear-
man correlation, 0.93). Finally, outliers
were identified as being observations
with studentized residuals greater than
three or less than negative three. The
models were then refitted without out-
liers, consistent with studies performed
in patients in whom echocardiograms
were obtained (7,8). From these
models’ slope estimates, formulas were
specified for the predicted diameters,
PEDIATRIC IMAGING: Normal Aorta Size in Children Hegde et al
Table 1
Age According to Sex
No. of Male No. of Female
Age (y) Patients Patients
0–2 11 (15) 9 (15)
3–5 12 (16) 12 (19)
6–11 14 (19) 12 (19)
12–16 20 (27) 22 (35)
17–20 18 (24) 7 (11)
Total 75 62
Note.—Numbers in parentheses are percentages.
and estimates of the mean squared er-
ror (MSE) were obtained, so that the
z scores could be calculated. Analyses
were performed by using software (SAS
9.3; SAS Institute, Cary, NC).
Results
Patient Characteristics
The age and sex distributions are sum-
marized in Table 1. For 137 children,
the median age was 10 years 11 months,
and age ranged from 2 months to 20
years 11 months (mean, 9.9 years; stan-
dard deviation [SD], 5.7 years). The
mean BSA was 1.23 m2 ± 0.62 (SD) for
the thorax and 1.22 m2 ± 0.57 for the
abdomen; BSA for both ranged from
0.19 to 2.52 m2. The most common
clinical indication for a CT scan was
oncology follow-up (n = 57, 42%). No
tumor compression or other mass com-
pression of the aorta occurred in our
study. Other common indications were
pain (n = 22, 16%), trauma (n = 14,
10%), and infection (n = 12, 9%).
Interrater Reliability
There was excellent interrater reliabil-
ity between the two readers, indicating
that the method to determine the effec-
tive diameter was reproducible (Table
2). Intraclass correlation coefficients
ranged from 0.95 to 0.98 (Table 2).
Regression Models
The best model was the polynomial
regression model of natural log of the
effective diameter that included linear,
862 radiology.rsna.org  n Radiology: Volume 274: Number 3—March 2015
Table 2 and that all polynomial terms remained
significant. The equations, MSEs, and
Intraclass Correlation at Different R2 for the final models may be found in
Aortic Levels as Measured by Two Table 3. These equations can be used to
Radiologists calculate the predicted diameter of the
All
Intraclass aorta at various levels. To calculate a z
20 (15) score, we first obtained the predicted
Correlation
24 (18)
Aortic Level Coefficient natural log of the diameter of the aorta
26 (19)
at various levels by using the patient’s
42 (31) Annulus 0.95
BSA and sex in the formulas. Then, we
25 (18) Sinus of Valsalva 0.98
calculated the natural log of the ob-
137 Sinotubular junction 0.98
served diameters. The z score, z, at a
Mid ascending aorta 0.98
Arch 0.98
particular level could then be calculated
Isthmus 0.98 thus:
Proximal descending aorta 0.97
log e( D obs) —log e( D pred)
At the diaphragm 0.97 z= ,(4)
Superior to the celiac axis 0.96 MSE
Level of renal arteries 0.96
Above the bifurcation 0.97 where Dobs is observed diameter and
Right common iliac artery 0.95 Dpred is predicted diameter. Note that
Left common iliac artery 0.96 the formulas in Table 3 already give
the predicted values on the natural
log scale, so once the formulas are ap-
plied, there is no need to natural log
quadratic, and cubic terms as indepen- transform the calculated value. The z
dent variables (Eq [2]). The R2 was the scores are approximately normally dis-
highest for this model for all levels; the tributed, with a mean of 0 and SD of 1.
R2 for this model versus Equation (1) The z scores represent how many SDs
and Equation (3) was higher by a me- above or below the predicted regression
dian of 0.023 (range, 0.014–0.036) and line (or mean) an observation is. For
0.005 (range, 0.002–0.034), respec- example, a measurement with a z score
tively. For all levels, the intercept and of 2 means that the value for the sub-
linear, quadratic, and cubic terms were ject is 2 SDs above what would be esti-
significant (all P , .05). mated for the mean; whereas a z score
The effect of sex was investigated of 22 would indicate that the value for
and was found to be significant as a the subject is 2 SDs below what would
main effect for Valsalva sinus, isth- be expected. Also, given the theoreti-
mus, proximal descending aorta, aorta cal normal distribution, it is expected
at the diaphragm, and right common that values for 68.3% of the population
iliac artery (all P , .05). This factor are within the mean 6 1 SD, those for
indicated that the curves were shifted 95.4% of the population are within the
higher (ie, had a larger intercept) for mean 6 2 SDs, and those for 99.7% of
male children as compared with female the population are within the mean 6 3
children. For consistency, a sex main SDs. The same information can be dis-
effect was included in all models. In- played in the form of a graph that does
teractions between sex and linear, qua- not require calculations. An example
dratic, and cubic BSA terms all were for the aortic annulus level is included
not significant. (Fig 2). Graphs of all aortic levels and
Outliers were deleted for five levels: the common iliac arteries are included
Three levels had one outlier, and two in Appendix E1 (online).
had two outliers; the remaining levels
had no outliers. For the models with
outliers removed, it was verified that Discussion
the cubic model for the log of the di- A prerequisite for identifying abnormal
ameter remained the best model, as is to first determine normal. The nor-
compared with the other two models mal range of aortic effective diameters
PEDIATRIC IMAGING: Normal Aorta Size in Children Hegde et al

Table 3
Formulae to Calculate the Predicted Diameter on a Natural Log Scale
Aortic Level Formula Sample Size* MSE R2

Annulus loge(ED) = 2.049 + 0.022 · M + 1.359 · BSA 2 0.614 · BSA2 + 0.112 · BSA3 88 0.084 0.912
Sinus of Valsalva loge(ED) = 2.145 + 0.061· M + 1.519 · BSA 2 0.724 · BSA2 + 0.134 · BSA3 88 0.095 0.896
Sinotubular junction loge(ED) = 1.761 + 0.0081· M + 1.930 · BSA 2 0.977 · BSA2 + 0.189 · BSA3 87 0.106 0.898
Mid ascending aorta loge(ED) = 1.747 2 0.016 · M + 2.053 · BSA 2 1.044 · BSA2 + 0.195 · BSA3 88 0.116 0.875
Arch loge(ED) = 1.519 + 0.038 · M + 2.047 · BSA 2 1.006 · BSA2 + 0.187 · BSA3 88 0.109 0.908
Isthmus loge(ED) = 1.295 + 0.058 · M + 2.396 · BSA 2 1.276 · BSA2 + 0.245 · BSA3 88 0.095 0.928
Proximal descending aorta loge(ED) = 1.467 + 0.080 · M + 1.880 · BSA 2 0.937 · BSA2 + 0.176 · BSA3 88 0.103 0.904
At the diaphragm loge(ED) = 1.492 + 0.058 · M + 1.593 · BSA 2 0.739 · BSA2 + 0.132 · BSA3 88 0.095 0.905
Superior to the celiac axis loge(ED) = 1.499 + 0.023 · M + 1.454 · BSA 2 0.663 · BSA2 + 0.123 · BSA3 110 0.102 0.872
Level of renal arteries loge(ED) = 1.205 + 0.043 · M + 1.555 · BSA 2 0.658 · BSA2 + 0.115 · BSA3 109 0.118 0.870
Above the bifurcation loge(ED) = 1.021 + 0.042 · M + 1.826 · BSA 2 0.812 · BSA2 + 0.138 · BSA3 109 0.109 0.874
Right common iliac artery loge(ED) = 0.388 + 0.079 · M + 2.475 · BSA 2 1.272 · BSA2 + 0.233 · BSA3 108 0.130 0.860
Left common iliac artery loge(ED) = 0.417 + 0.062 · M + 2.486 · BSA 2 1.323 · BSA2 + 0.252 · BSA3 108 0.120 0.872

Note.—ED = effective diameter, loge = natural log, M = male, MSE = square root of the MSE; male = 1 when patient is male and male = 0 when patient is female.
* Sample size for final model after removing 0–2 outliers.

in the aortic root, thoracic aorta, ab-
dominal aorta, and iliac arteries in
children were determined in a wide
range of child sizes in our study. The
regression equations derived from the
measurements allow for the calculation
of z scores. A z score calculator using
a spreadsheet (Excel; Microsoft, Red-
mond, Wash) is now used at our insti-
tution (Arkansas Children’s Hospital),
with only the patient BSA, sex, and
effective diameter at the level of inter-
est entered to determine the z score.
The range of normal effective diame-
ters of the aorta at multiple levels and
of the common iliac arteries was de-
termined for children of different sizes
and both sexes. Measurements outside
of the normal ranges are consistent
with aneurysm or hypoplasia. Echocar-
diography is the standard method for
determining the size of the thoracic
aorta in children. A recent review of
echocardiographic methods showed a
general lack of standardization in tech-
nique (9).
The current guideline is to obtain
measurements perpendicular to the
axis of blood flow at reproducible land-
marks. The aortic diameter is measured
in a single plane from a planar image.
The aorta is not always round, leading
to an error in effective diameter. The
limited available ultrasonography (US)
windows frequently fetter the ability to
accurately determine aortic effective
diameter. In our experience, echocar-
diographic standards are especially
poor in larger children.
Measurements of aortic diameter
should be taken at reproducible ana-
tomic landmarks perpendicular to the
axis of blood flow (10). CT and MR im-
aging three-dimensional data sets are
ideal for creating multiplanar recon-
structions perpendicular to the aorta
for accurate measurements of the aor-
tic diameter (11). Axial reconstructions
introduce error in measuring the true
aortic effective diameter because of the
normal oblique course of the aorta. If
the patient is suspected of having an
aneurysm or hypoplasia, a double-
oblique reconstruction should be cre-
ated. Few reports of the normal tho-
racic aorta size in children determined
by using CT or MR exist. Fitzgerald
et al (2) correlated axial CT measure-
ments of the thoracic aorta with pa-
tient age in children. The study was
limited by the use of 5–10-mm-thick
axial sections, which do not allow for
multiplanar reconstructions perpendic-
ular to the aorta. The authors failed to
relate aortic diameter to patient size.
Akay et al (3) correlated thoracic aor-
tic diameter to thoracic vertebral diam-
eter. The researchers in that study also
failed to relate aortic diameter with
patient size. Both studies were limited
to the thoracic aorta. Wolak et al (12)
used CT to relate the ascending and
descending thoracic aortic diameter to
patient age, sex, and BSA but only in-
cluded adults in their study.
Kaiser et al (4) used contrast mate-
rial–enhanced MR angiography studies
to measure aortic diameters in chil-
dren. The study utilized double-oblique
measurements perpendicular to the
aorta and related effective diameter
measurements to BSA. The youngest
child in the study was 2 years of age,
and the smallest BSA was greater than
one-half of a square meter. Hence, the
study had no information in regard to
infants. Our study included newborns
to 20-year-old patients who ranged in
size from 0.19 to 2.52 m2.
Our study identified sex differences
in aortic effective diameter. Gautier et
al (13), in an echocardiographic study
limited to the aortic root, also identi-
fied sex differences in the aortic root
diameter. The study of Gautier et al
focused on determining normal stan-
dards to help determine aneurysmal
dilatation in older children with Mar-
fan syndrome and was weighted toward
older children and teenagers.
No standards for the normal size
of the abdominal aorta in children,

Radiology: Volume 274: Number 3—March 2015  n  radiology.rsna.org 863

PEDIATRIC IMAGING: Normal Aorta Size in Children Hegde et al
Figure 2
Figure 2:  Effective diameter of the aorta at aortic annulus versus BSA in, A, male and, B, female patients.
Dotted lines = z scores, which denote the number of SDs above and below the mean (solid line), ○ =
patients.
to our knowledge, exist. In a single
study (14), the researchers evaluated
the diameter of the abdominal aorta
in children by using B-mode US, but
the study was limited to the infrarenal
864 radiology.rsna.org  n Radiology: Volume 274: Number 3—March 2015
abdominal aorta and the iliac arteries.
The study was further limited by mea-
suring diameters in only the antero-
posterior dimension. The effective
diameter of the abdominal aorta was
measured at multiple levels in our
study. We are unaware of any exist-
ing study about CT or MR imaging
measurements of the effective diame-
ter of the abdominal aorta or the iliac
arteries in children.
A limitation of our study was that
electrocardiographic gating is not rou-
tinely performed for torso CT imaging.
As such, the measurement reflects
neither end-systolic nor end-diastolic
measurements. An intermediate ef-
fective diameter, rather than a true
maximum or minimum aortic diam-
eter, is measured. The range for the
measured diameters will include this
variation and may slightly increase the
SD at each level. However, this is also
true of the technique most likely to be
used when performing torso imaging.
Another limitation of the study was
the number of patients included in the
study. The study included 88 thoracic
and 110 abdominal studies.
Although the formulas apply to
most pediatric patients that a clinician
is likely to encounter, the formulas are
only valid for the range of data ana-
lyzed here. We limited the models that
we evaluated to three that had been
described in the literature (7,8) for
aortic diameter measured with an
echocardiogram; other better-fitting
models may exist that are better jus-
tified. It should be kept in mind that
the 13 levels for each patient are cor-
related, so it is not surprising that the
best model is the same in functional
form for all levels. Also, consistent with
others (7,8), we refitted the model af-
ter removing outliers; this procedure
can reduce the estimated variability
around the fitted line, resulting in the
estimated MSE being slightly under-
estimated. Also, a small percentage
(roughly 5%) of a healthy population
will have values outside of 2 SDs, so
although a reading is beyond 2 SDs,
it could still be a true normal finding,
but having objective data for a healthy
population gives important context for
further clinical evaluation.
Disclosures of Conflicts of Interest: S.V.H. dis-
closed no relevant relationships. S.Y.L. disclosed
no relevant relationships. S.B.G. disclosed no
relevant relationships.
PEDIATRIC IMAGING: Normal Aorta Size in Children Hegde et al
References
1. Rogers IS, Massaro JM, Truong QA, et al.
Distribution, determinants, and normal
reference values of thoracic and abdominal
aortic diameters by computed tomography
(from the Framingham Heart Study). Am J
Cardiol 2013;111(10):1510–1516.
2. Fitzgerald SW, Donaldson JS, Poznanski
AK. Pediatric thoracic aorta: normal mea-
surements determined with CT. Radiology
1987;165(3):667–669.
3. Akay HO, Ozmen CA, Bayrak AH, et al. Di-
ameters of normal thoracic vascular struc-
tures in pediatric patients. Surg Radiol Anat
2009;31(10):801–807.
4. Kaiser T, Kellenberger CJ, Albisetti M,
Bergsträsser E, Valsangiacomo Buechel
ER. Normal values for aortic diameters in
children and adolescents: assessment in
vivo by contrast-enhanced CMR-angiogra-
phy. J Cardiovasc Magn Reson 2008 (Dec
5);10:56.
5. Haycock GB, Schwartz GJ, Wisotsky DH.
Geometric method for measuring body sur-
face area: a height-weight formula validated
in infants, children, and adults. J Pediatr
1978;93(1):62–66.
Radiology: Volume 274: Number 3—March 2015  n  radiology.rsna.org 865
6. Shrout PE, Fleiss JL. Intraclass correlations:
uses in assessing rater reliability. Psychol
Bull 1979;86(2):420–428.
7. Olivieri L, Arling B, Friberg M, Sable C.
Coronary artery Z score regression equa-
tions and calculators derived from a large
heterogeneous population of children un-
dergoing echocardiography. J Am Soc Echo-
cardiogr 2009;22(2):159–164.
8. Pettersen MD, Du W, Skeens ME, Humes
11. Freeman LA, Young PM, Foley TA, Wil-
RA. Regression equations for calculation
of z scores of cardiac structures in a large
cohort of healthy infants, children, and ado-
lescents: an echocardiographic study. J Am
Soc Echocardiogr 2008;21(8):922–934.
9. Cantinotti M, Scalese M, Molinaro S, Murzi
B, Passino C. Limitations of current echo-
cardiographic nomograms for left ventric-
ular, valvular, and arterial dimensions in
children: a critical review. J Am Soc Echo-
cardiogr 2012;25(2):142–152.
10. Hiratzka LF, Bakris GL, Beckman JA, et al.
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/
SIR/STS/SVM guidelines for the diagnosis and
management of patients with thoracic aortic
disease: executive summary—a report of the
American College of Cardiology Foundation/
American Heart Association Task Force on
Practice Guidelines, American Association for
Thoracic Surgery, American College of Radi-
ology, American Stroke Association, Society
of Cardiovascular Anesthesiologists, Society
for Cardiovascular Angiography and Inter-
ventions, Society of Interventional Radiology,
Society of Thoracic Surgeons, and Society for
Vascular Medicine. Catheter Cardiovasc In-
terv 2010;76(2):E43–E86.
liamson EE, Bruce CJ, Greason KL. CT
and MRI assessment of the aortic root and
ascending aorta. AJR Am J Roentgenol
2013;200(6):W581–W592.
12. Wolak A, Gransar H, Thomson LEJ, et al.
Aortic size assessment by noncontrast car-
diac computed tomography: normal limits by
age, gender, and body surface area. JACC
Cardiovasc Imaging 2008;1(2):200–209.
13. Gautier M, Detaint D, Fermanian C, et al.
Nomograms for aortic root diameters in chil-
dren using two-dimensional echocardiogra-
phy. Am J Cardiol 2010;105(6):888–894.
14. Munk A, Darge K, Wiesel M, Troeger J. Di-
ameter of the infrarenal aorta and the iliac
arteries in children: ultrasound measure-
ments. Transplantation 2002;73(4):631–635.