Dynamic Contrast-Enhanced MRI in Abdominal Aortic Aneurysms as a Potential Marker for Disease Progression

Abdominal aortic aneurysms (AAAs) may rupture before reaching maximum diameter (D_max ) thresholds for repair. Aortic wall microvasculature has been associated with elastin content and rupture sites in specimens, but its relation to progression is unknown.

To investigate whether dynamic contrast-enhanced (DCE) MRI of AAA is associated with D_max or growth.

Prospective.

A total of 27 male patients with infrarenal AAA (mean age ± standard deviation = 75 ± 5 years) under surveillance with DCE MRI and 2 years of prior follow-up intervals with computed tomography (CT) or MRI.

A 3-T, dynamic three-dimensional (3D) fast gradient-echo stack-of-stars volumetric interpolated breath-hold examination (Star-VIBE).

Wall voxels were manually segmented in two consecutive slices at the level of D_max . We measured slope to 1-minute and area under the curve (AUC) to 1 minute and 4 minutes of the signal intensity change postcontrast relative to that precontrast arrival, and, K^trans , a measure of microvascular permeability, using the Patlak model. These were averaged over all wall voxels for association to D_max and growth rate, and, over left/right and anterior/posterior quadrants for testing circumferential homogeneity. D_max was measured orthogonal to the aortic centerline and growth rate was calculated by linear fit of D_max measurements.

Pearson correlation and linear mixed effects models. A P value <0.05 was considered statistically significant.

In 44 DCE MRIs, mean D_max was 45 ± 7 mm and growth rate in 1.5 ± 0.4 years of prior follow-up was 1.7 ± 1.2 mm per year. DCE measurements correlated with each other (Pearson r = 0.39-0.99) and significantly differed between anterior/posterior versus left/right quadrants. DCE measurements were not significantly associated with D_max (P = 0.084, 0.289, 0.054 and 0.255 for slope, AUC at 1 minute and 4 minutes, and K^trans , respectively). Slope and 4 minutes AUC significantly associated with growth rate after controlling for D_max .

Contrast uptake may be increased in lateral aspects of the AAA. Contrast enhancement 1-minute slope and 4-minutes AUC may be associated with a period of recent AAA growth that is independent of D_max .

3.

Stage 2.