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 ) 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 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 . 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 , a measure of microvascular permeability, using the Patlak model. These were averaged over all wall voxels for association to D and growth rate, and, over left/right and anterior/posterior quadrants for testing circumferential homogeneity. D was measured orthogonal to the aortic centerline and growth rate was calculated by linear fit of D 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 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 (P = 0.084, 0.289, 0.054 and 0.255 for slope, AUC at 1 minute and 4 minutes, and K , respectively). Slope and 4 minutes AUC significantly associated with growth rate after controlling for D .

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 .

Evidence Level: 3.

Technical Efficacy: Stage 2.