Anna Margaretha Sailer MD, MBA, Presenter: Nothing to Disclose

Bart A.J.M. Wagemans MD, Abstract Co-Author: Nothing to Disclose

Marco Das MD, Abstract Co-Author: Research Consultant, Bayer AG Research Grant, Siemens AG Speakers Bureau, Siemens AG

Michiel W. De Haan MD, PhD, Abstract Co-Author: Nothing to Disclose

Joachim Ernst Wildberger MD, PhD, Abstract Co-Author: Nothing to Disclose

Geert Willem H. Schurink MD, PhD, Abstract Co-Author: Nothing to Disclose

Aim of this study was to quantitatively assess the magnitude and direction of respiratory movement of the aorta and side branches.

This prospective study was approved by the institutional review board; informed consent was obtained from all patients. We performed a quantitative three-dimensional subtraction analysis of computed tomography during inspiration and expiration to establish the respiratory geometric movements of the aorta and side branches. 60 patients (42 men, 18 women, mean age 70 ± 9 years) with aortic disease were included. During breath-hold expiration and inspiration respectively, one millimeter (mm) slice thickness non-contrast enhanced and contrast-enhanced computed tomography of the aorta were performed respectively. By means of dedicated multiplanar reformation image subtraction software using the spine as reference point, position of relevant anatomic sections from both datasets were analyzed. These included the diaphragm domes, anterior thorax wall, ascending thoracic aorta (AAo), the origin of the left subclavian artery (LSO), descending thoracic aorta at level of tenth thoracic vertebra (DAo) as well as the origin of the renal arteries (RAO).  

With inspiration, the regions of interest of the aorta and side branches moved in anterior, medial and caudal direction compared to the expiration state. Threshold for vessel displacement was at least five mm anterior-posterior thoracic excursion or ten mm diaphragm dome movement. Mean 3-dimensional movement (± standard deviation) was 8.9 ± 3.6 mm (AAo), 11.1 ± 3.9 mm (LSO), 4.9 ± 2.5 mm (DAo) and 1.4 ± 1.1 mm (RAO). There was significantly less movement in the DAo compared to LSO (p < 0.001). Correlation coefficient between extent of LSO displacement and thorax excursion was 0.78.

The aorta and side branches undergo considerable respiratory movement. This finding may be important for thoracic and complex thoraco-abdominal endograft designs as well as fusion image guidance during endovascular aortic repair.

Respiratory movement is an important contribution to understanding the aortic dynamics; it has implications especially for planning and implantation of endovascular thoraco-abdominal aortic repair.

Sailer, A, Wagemans, B, Das, M, De Haan, M, Wildberger, J, Schurink, G, Quantitative Determination of Respiratory Movement of the Aorta and Side Branches.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004537.html