Measurement of Abdominal Aortic Aneurysm Strain Using MR Deformable Image Registration Accuracy and Relationship to Recent Aneurysm Progression

BackgroundManagement of asymptomatic abdominal aortic aneurysm (AAA) based on maximum aneurysm diameter and growth rate fails to preempt many ruptures. Assessment of aortic wall biomechanical properties may improve assessment of progression and rupture risk. This study aimed to assess the accuracy of AAA wall strain measured by cine magnetic resonance imaging (MRI) deformable image registration (MR strain) and investigate its relationship with recent AAA progression. Methods The MR strain accuracy was evaluated in silico against ground truth strain in 54 synthetic MRIs generated from a finite element model simulation of an AAA patient's abdomen for different aortic pulse pressures, tissue motions, signal intensity variations, and image noise. Evaluation included bias with 95% confidence interval (CI) and correlation analysis. Association of MR strain with AAA growth rate was assessed in 25 consecutive patients with >6 months of prior surveillance, for whom cine balanced steady-state free-precession imaging was acquired at the level of the AAA as well as the proximal, normal-caliber aorta. Univariate and multivariate regressions were used to associate growth rate with clinical variables, maximum AAA diameter (Dmax), and peak circumferential MR strain through the cardiac cycle. The MR strain interoperator variability was assessed using bias with 95% CI, intraclass correlation coefficient, and coefficient of variation. Results In silico experiments revealed an MR strain bias of 0.48% +/- 0.42% and a slope of correlation to ground truth strain of 0.963. In vivo, AAA MR strain (1.2% +/- 0.6%) was highly reproducible (bias +/- 95% CI, 0.03% +/- 0.31%; intraclass correlation coefficient, 97.8%; coefficient of variation, 7.14%) and was lower than in the nonaneurysmal aorta (2.4% +/- 1.7%). Dmax (beta = 0.087) and MR strain (beta= -1.563) were both associated with AAA growth rate. The MR strain remained an independent factor associated with growth rate (beta= -0.904) after controlling for Dmax. Conclusions Deformable image registration analysis can accurately measure the circumferential strain of the AAA wall from standard cine MRI and may offer patient-specific insight regarding AAA progression.