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Evaluation of Ductal Tissue in Coarctation of the Aorta Using X-Ray Phase-Contrast Tomography
Ryuma Iwaki1, Hironori Matsuhisa2, Susumu Minamisawa3
1Department of Cardiovascular Surgery, Kobe Children's Hospital, 1-6-7, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan. rryuma.0619@gmail.com.
Insights
X-ray phase-contrast tomography (XPCT) accurately maps 3D ductal tissue in coarctation of the aorta (CoA). Complete resection of ductal tissue, including intimal thickness, is crucial to prevent re-coarctation after surgery.
Area of Science:
- Cardiovascular Imaging
- Medical Physics
- Histopathology
Background:
- Coarctation of the aorta (CoA) is a congenital heart defect requiring surgical intervention.
- Understanding the three-dimensional (3D) distribution of ductal tissue is critical for successful surgical repair and preventing re-coarctation.
- Accurate imaging techniques are needed to delineate ductal tissue within aortic specimens.
Purpose of the Study:
- To assess the histological accuracy of X-ray phase-contrast tomography (XPCT) for visualizing 3D ductal tissue distribution in coarctation of the aorta (CoA) specimens.
- To investigate the precise anatomical extent of ductal tissue, including media and intima, within CoA samples.
- To correlate XPCT findings with established histological markers.
Main Methods:
- Nine coarctation of the aorta (CoA) specimens, including the aortic isthmus and ductus arteriosus (DA), were analyzed using XPCT.
- Post-scanning, samples underwent histological evaluation with elastica van Gieson (EVG) staining and TFAP2B immunostaining.
- 3D imaging data from XPCT were quantitatively analyzed for ductal tissue dimensions and spatial distribution.
Main Results:
- XPCT clearly depicted ductal tissue as low-density areas, correlating positively with elastic fiber formation (R=0.69, P<0.001).
- TFAP2B expression aligned with low-density regions and intimal thickness observed in XPCT images.
- 3D analysis revealed specific dimensions of ductal media and intima, with intimal spread being more extensive than medial spread.
Conclusions:
- XPCT provides high-contrast resolution comparable to histological assessment for evaluating ductal tissue in CoA.
- Complete resection of intimal thickness, extending to the opposite side of the DA insertion, is necessary to eliminate residual ductal tissue.
- This comprehensive resection strategy is vital for preventing postoperative re-coarctation in CoA patients.
Abstract:
We assessed the histological accuracy of X-ray phase-contrast tomography (XPCT) and investigated three-dimensional (3D) ductal tissue distribution in coarctation of the aorta (CoA) specimens. We used nine CoA samples, including the aortic isthmus, ductus arteriosus (DA), and their confluences. 3D images were obtained using XPCT. After scanning, the samples were histologically evaluated using elastica van Gieson (EVG) staining and transcription factor AP-2 beta (TFAP2B) immunostaining. XPCT sectional images clearly depicted ductal tissue distribution as low-density areas. In comparison with EVG staining, the mass density of the aortic wall positively correlated with elastic fiber formation (R = 0.69, P < 0.001). TFAP2B expression was consistent with low-density area including intimal thickness on XPCT images. On 3D imaging, the distances from the DA insertion to the distal terminal of the ductal media and to the intima on the ductal side were 1.63 ± 0.22 mm and 2.70 ± 0.55 mm, respectively. In the short-axis view, the posterior extension of the ductal tissue into the aortic lumen was 79 ± 18% of the diameter of the descending aorta. In three specimens, the aortic wall was entirely occupied by ductal tissue. The ductal intima spread more distally and laterally than the ductal media. The contrast resolution of XPCT images was comparable to that of histological assessment. Based on the 3D images, we conclude that complete resection of intimal thickness, including the opposite side of the DA insertion, is required to eliminate residual ductal tissue and to prevent postoperative re-coarctation.
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