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

Background: 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.Purpose: To investigate whether dynamic contrast-enhanced (DCE) MRI of AAA is associated with D-max or growth.Study Type: Prospective.Population: 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.Field Strength/Sequence: A 3-T, dynamic three-dimensional (3D) fast gradient-echo stack-of-stars volumetric interpolated breath-hold examination (Star-VIBE).Assessment: 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. Statistical Tests: Pearson correlation and linear mixed effects models. A P value < 0.05 was considered statistically significant.Results: 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.Conclusion: 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.

Automated summary

Contrast uptake in lateral aspects of AAA may be increased. Contrast enhancement measurements such as 1-minute slope and 4-minute AUC may be associated with recent AAA growth independent of D-max.