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Aortic Geometric Atlas: Centile-Based Reference Charts and Pathological Signatures Across the Adult Lifespan

Cameron A Beeche1,2,3, Hamed Tavolinejad2,4, Zhirui Li5

  • 1Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Medrxiv : the Preprint Server for Health Sciences
|July 17, 2026
PubMed

Insights

We developed an automated pipeline to analyze aortic geometry from CT scans, creating a reference atlas. This atlas identifies new cardiovascular disease markers beyond simple diameter measurements.

Area of Science:

  • Cardiovascular Imaging and Radiology
  • Medical Informatics and Computational Biology

Background:

  • The aorta is a critical site for cardiovascular disease, but current CT assessments rely on limited manual diameter measurements.
  • There is a need for more comprehensive and automated methods to assess thoracic aortic geometry for improved clinical insights.

Purpose of the Study:

  • To develop an automated pipeline, the Aortic Geometry Toolkit (AGT), for comprehensive characterization of thoracic aortic geometry.
  • To create the Aortic Geometric Atlas, a population-scale reference for sex-specific, age-stratified aortic geometric phenotypes (AGPs).
  • To investigate the prognostic value of AGPs, including non-caliber features, for incident cardiovascular disease.

Main Methods:

  • Development of the Aortic Geometry Toolkit (AGT) to extract 38 AGPs from CT scans.
  • Application of AGT to a large cohort (140,319 CT studies from 62,366 participants).
  • Construction of sex-specific, centile-based reference ranges using data from participants without aortic disease.
  • Phenome-wide time-to-event analysis to identify associations between AGPs and incident diseases.

Main Results:

  • The Aortic Geometric Atlas provides comprehensive, sex-specific, and age-stratified reference ranges for 38 AGPs.
  • Non-caliber geometric features of the aorta demonstrated predictive value for cardiovascular disease beyond traditional diameter measurements.
  • Identified 861 prognostic associations between AGPs and 155 phecodes, highlighting the clinical relevance of detailed aortic geometry.

Conclusions:

  • The Aortic Geometric Atlas offers a population-scale reference for individualized aortic assessment using automated analysis.
  • Aortic geometric phenotypes (AGPs) serve as early, subclinical markers for predicting incident cardiovascular disease.
  • AGT and the Aortic Geometric Atlas represent a significant advancement in leveraging CT imaging for cardiovascular risk stratification.

Keywords:
Aging ChartsAortaComputed TomographyGeometric PhenotypingRisk-stratification

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