Assessment of Coronary Artery Aneurysms Cased By Kawasaki Diesease Using Transluminal ...

32 Pages·2015·0.82 MB·English

UC San Diego
UC San Diego Electronic Theses and Dissertations
Title
Assessment of Coronary Artery Aneurysms Cased By Kawasaki Diesease Using Transluminal
Attenuation Gradient Analysis of CT Angiograms
Permalink
https://escholarship.org/uc/item/8tq7r7rb
Author
Gutierrez, Noelia Grande
Publication Date
2015

Peer reviewed|Thesis/dissertation
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UNIVERSITYOFCALIFORNIA,SANDIEGO
AssessmentofCoronaryArteryAneurysmsCausedByKawasakiDiseaseUsing
TransluminalAttenuationGradientAnalysisofCTAngiograms
AThesissubmittedinpartialsatisfactionofthe
requirementsforthedegreeMasterofScience
in
EngineeringSciences(AppliedMechanics)
by
NoeliaGrandeGutierrez
Committeeincharge:
ProfessorAlisonL.Marsden,Chair
ProfessorJuanCarlosdelAlamo
ProfessorAndrewKahn
2015
Copyright
NoeliaGrandeGutierrez,2015
Allrightsreserved.
TheThesisofNoeliaGrandeGutierrezisapproved,anditis
acceptable in quality and form for publication onmicrofilm
andelectronically:
Chair
UniversityofCalifornia,SanDiego
2015
iii
TABLEOFCONTENTS
SignaturePage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
TableofContents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
ListofFigures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
ListofTables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
AbstractoftheThesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.1 PatientPopulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.2 CTAngiographyacquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.3 Coronaryarterysegmentation. . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.4 TransluminalAttenuationGradient . . . . . . . . . . . . . . . . . . . . . . . . 4
2.5 SensitivitytoRegionofInterest . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.6 GeometricalParameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.7 StatisticalAnalysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3.1 PatientDemographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3.2 TransluminalAttenuationGradient . . . . . . . . . . . . . . . . . . . . . . . . 8
3.3 SensitivitytoRegionofInterest . . . . . . . . . . . . . . . . . . . . . . . . . 9
3.4 GeometricalParameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
4.1 Patternofcontrastvariation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
4.2 TAGsensitivitytoRegionofInterest . . . . . . . . . . . . . . . . . . . . . . . 14
4.3 EffectofCTACoverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
4.4 TAGvs. GeometricalParameters . . . . . . . . . . . . . . . . . . . . . . . . . 15
4.5 ClinicalImplications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4.6 Strengthsandlimitationsofthestudy . . . . . . . . . . . . . . . . . . . . . . . 17
5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
iv
LISTOFFIGURES
Figure2.1: RepresentativeexamplesofTAGincoronaryarteries . . . . . . . . . . . . 5
Figure3.1: Transluminalattenuationgradientanalysis . . . . . . . . . . . . . . . . . . 11
Figure3.2: SensitivitytoRegionofInterest . . . . . . . . . . . . . . . . . . . . . . . . 11
Figure3.3: Transluminal attenuation gradient (TAG) in aneurysmal coronary arteries
accordingtomaximumaneurysmdiameter . . . . . . . . . . . . . . . . . 12
Figure3.4: CorrelationanalysisbetweenTransluminalAttenuationGradient(TAG)and
geometricalparameters. . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
v
LISTOFTABLES
Table3.1: PatientDemographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Table3.2: TransluminalAttenuationGradientanalysispervesselaccordingtopresence
ofaneurysmalregion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
vi
ACKNOWLEDGEMENTS
Thisthesis,infulliscurrentlybeingpreparedforsubmissionforpublicationofthemate-
rial. NoeliaGrandeGutierrez,JaneC.Burns,AlisonL.Marsden,AndrewM.KahnAssessment
ofCoronaryArteryAneurysmsCausedByKawasakiDiseaseUsingTransluminalAttenuation
GradientAnalysisofCTAngiograms.. Thethesisauthorwastheprimaryinvestigatorandauthor
ofthismaterial.
vii
ABSTRACTOFTHETHESIS
AssessmentofCoronaryArteryAneurysmsCausedByKawasakiDiseaseUsing
TransluminalAttenuationGradientAnalysisofCTAngiograms
by
NoeliaGrandeGutierrez
MasterofScienceinEngineeringSciences(AppliedMechanics)
UniversityofCalifornia,SanDiego,2015
ProfessorAlisonL.Marsden,Chair
Patientswithcoronaryarteryaneurysms(CAA)resultingfromKawasakiDisease(KD)
areatriskforthrombosisandmyocardialinfarction. CurrentguidelinesrecommendusingCAA
diameter>8mmasthecriterionforinitiatingsystemicanticoagulation,butthereislittleoutcome
datatosupportthischoice. TransluminalAttenuationGradient(TAG)hasbeenproposedasa
non-invasive method for evaluating the functional significance of coronary stenoses using CT
Angiography(CTA).HoweverTAGhasnotpreviouslybeenusedtoassessCAA.Wehypothesized
thatabnormalflowdynamicsinCAAcausedbyKDcouldbequantifiedusingTAG.Wequantified
TAGinthemajorcoronaryarteriesbyperforminglinearregressionoftheaveragelumenintensity
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as a function of vessel length and compared TAG values for aneurysmal and normal arteries.
Aneurysm geometry was characterized using maximum aneurysm diameter, aneurysm shape
indexandsphericityindex. TAGofaneurysmalarterieswassignificantlylowerthaninnormal
arteries. Significant differences were also seen between aneurysmal vs. normal left anterior
descendingandrightcoronary. Geometricalparametersshowedminimaltonocorrelationwith
TAG.ThisstudyisthefirstapplicationofTAGanalysistoCAAcausedbyKD,anddemonstrates
significantly different TAG values in aneurysmal versus normal arteries. Lack of correlation
betweenTAGandCAAgeometrysuggeststhatTAGmayprovideinformationonhemodynamic
conditionsnotavailablefromanatomyalone. TheuseofTAGinKDpatientsrepresentsapossible
extensiontostandardCTAthatcouldaidinclinicaldecision-makingandhelptobetterevaluate
theriskofthrombusformation.
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