Predicting rupture locations of ascending aortic aneurysms using CT-based finite element models

Accurate rupture risk assessment of ascending aortic aneurysms is important for reducing aneurysm-related mortality. More recently, computational models have been shown to better predict rupture risk than diameter-based measurements. However, it remains unclear whether finite element (FE) models of the ascending aorta can predict rupture location, and over what timeframe those predictions are reliable. The aim of this study was to evaluate FE models of the ascending aorta generated from computed tomography (CT) scans in predicting rupture location. Pre- and post-rupture CT scans were obtained of 12 patients who underwent emergency surgical repair for ascending aorta rupture with varying time intervals between scans (20 days - 6 years). A rigid iterative closest point (ICP) registration was used to overlay post-rupture aortic geometries with pre-rupture FE models and directly compare predicted regions of high equivalent strain with actual rupture. The FE model predicted the rupture location in the 5 patients with the shortest time intervals between the pre- and post-rupture scans (20 days - 2 years, 3 months). However, rupture location was not predicted in the 4/5 patients with greater than 3 years between scans. Achieving a physiological equivalent strain distribution in the FE model was highly dependent on the resolution of the pre-rupture scan and whether contrast agent was present. The results suggest there may be a time interval beyond which FE predictions of rupture location may not be reliable. The results in this study may help clinical validation of FE models of ascending aortic aneurysms predicting rupture risk.