Automated analysis of four-dimensional magnetic resonance images of the human aorta

  • Ryan K. Johnson
  • Senthil Premraj
  • Sonali S. Patel
  • Nicholas Walker
  • Andreas Wahle
  • Milan Sonka
  • Thomas D. Scholz
Original Paper


The purpose of the study was to demonstrate the accuracy and clinical utility of an automated method of image analysis of 4D (3D + time) magnetic resonance (MR) imaging of the human aorta. Serial MR images of the entire thoracic aorta were acquired on 32 healthy individuals. Graph theory based segmentation was applied to the images and cross sectional area (CSA) was determined for the entire length of thoracic aorta. Mean CSA was compared between the 3 years. CSA values at the level of sinuses of Valsalva and sino-tubular junction were used to calculate average diameters for comparison to Roman-Devereux norms. A robust automated segmentation method was developed that accurately reproduced CSA measurements for the entire length of thoracic aorta in serially acquired scans with a 1% error compared to expert tracing. Calculated aortic root diameters based on CSA correlated with Roman-Devereux norms. Mean CSA for the aortic root agreed well with previously published manually derived values. Automated analysis of 4D MR images of the thoracic aorta provides accurate and reproducible results for CSA in healthy human subjects. The ability to simultaneously analyze the entire length of thoracic aorta throughout the cardiac cycle opens the door to the calculation of novel indices of aortic biophysical properties. These novel indices may lead to earlier detection of patients at risk for adverse events.


Magnetic resonance imaging Aorta Connective tissue disease Cross sectional area Eccentricity Automated image analysis 


  1. 1.
    Roman MJ, Devereux RB, Kramer-Fox R, O’Loughlin J (1989) Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol 64:507–512CrossRefPubMedGoogle Scholar
  2. 2.
    Sluysmans T, Colan SD (2005) Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol 99:445–457CrossRefPubMedGoogle Scholar
  3. 3.
    Draney MT, Arko FR, Alley MT, Markl M, Herfkens RJ, Pelc NJ, Zarins CK, Taylor CA (2004) Quantification of vessel wall motion and cyclic strain using cine phase contrast MRI: in vivo validation in the porcine aorta. Magn Reson Med 52:286–295CrossRefPubMedGoogle Scholar
  4. 4.
    Meijboom LJ, Groenink M, van der Wall EE, Romkes H, Stoker J, Mulder BJ (2000) Aortic root asymmetry in marfan patients evaluation by magnetic resonance imaging and comparison with standard echocardiography. Int J Card Imaging 16:161–168CrossRefPubMedGoogle Scholar
  5. 5.
    Zhao F, Zhang H, Wahle A, Thomas MT, Stolpen AH, Scholz TD, Sonka M (2009) Congenital aortic disease: 4D magnetic resonance segmentation and quantatative analysis. Med Image Anal 13:483–493CrossRefPubMedGoogle Scholar
  6. 6.
    Palágyi K, Tschirren J, Hoffman EA, Sonka M (2006) Quantitative analysis of pulmonary airway tree structures. Comput Biol Med 36:974–996CrossRefPubMedGoogle Scholar
  7. 7.
    Mosteller RD (1987) Simplified calculation of body-surface area. N Engl J Med 317:1098PubMedGoogle Scholar
  8. 8.
    Summers RM, Andrasko-Bourgeois J, Feuerstein IM, Hill SC, Jones EC, Busse MK, Wise B, Bove KE, Rishforth BA, Tucker E, Spray TL, Hoeg JM (1998) Evaluation of the aortic root by MRI: insights from patients with homozygous familial hypercholesterolemia. Circulation 98:509–518PubMedGoogle Scholar
  9. 9.
    Mohiaddin RH, Schoser K, Amanuma M, Burman ED, Longmore DB (1990) MR imaging of age-related dimensional changes of thoracic aorta. J Comput Assist Tomogr 14:748–752CrossRefPubMedGoogle Scholar
  10. 10.
    Roman MJ, Rosen SE, Kramer-Fox R, Devereux RB (1993) Prognostic significance of the pattern of aortic root dilation in the Marfan syndrome. J Am Coll Cardiol 22:1470–1476PubMedCrossRefGoogle Scholar
  11. 11.
    Rozendaal L, Groenink M, Naeff MS, Hennekam RC, Hart AA, van der Wall EE, Mulder BJ (1998) Marfan syndrome in children and adolescents: an adjusted nomogram for screening aortic root dilatation. Heart 79:69–72PubMedGoogle Scholar
  12. 12.
    Engelfriet PM, Boersma E, Tijssen JGP, Bouma BJ, Mulder BJM (2006) Beyond the root: dilatation of the distal aorta in Marfan’s syndrome. Heart 92:1238–1243CrossRefPubMedGoogle Scholar
  13. 13.
    Finkbohner R, Johnston D, Crawford ES, Coselli J, Milewicz DM (1995) Marfan syndrome. Long-term survival and complications after aortic aneurysm repair. Circulation 91:728–733PubMedGoogle Scholar
  14. 14.
    Nollen GJ, Groenink M, Tijssen JGP, Van Der Wall EE, Mulder BJM (2004) Aortic stiffness and diameter predict progressive aortic dilatation in patients with Marfan syndrome. Eur Heart J 25:1146–1152CrossRefPubMedGoogle Scholar
  15. 15.
    Albornoz G, Coady MA, Roberts M, Davies RR, Tranquilli M, Rizzo JA, Elefteriades JA (2006) Familial thoracic aortic aneurysms and dissections–incidence, modes of inheritance, and phenotypic patterns. Ann Thorac Surg 82:1400–1405CrossRefPubMedGoogle Scholar
  16. 16.
    Oderich GS, Panneton JM, Bower TC, Lindor NM, Cherry KJ, Noel AA, Kalra M, Sullivan T, Gloviczki P (2005) The spectrum, management and clinical outcome of Ehlers-Danlos syndrome type IV: a 30-year experience. J Vasc Surg 42:98–106CrossRefPubMedGoogle Scholar
  17. 17.
    Nollen GJ, Mulder BJM (2004) What is new in the Marfan syndrome? Int J Cardiol 97(Suppl 1):103–108CrossRefPubMedGoogle Scholar
  18. 18.
    Kawamoto S, Bluemke DA, Traill TA, Zerhouni EA (1997) Thoracoabdominal aorta in Marfan syndrome: MR imaging findings of progression of vasculopathy after surgical repair. Radiology 203:727–732PubMedGoogle Scholar
  19. 19.
    Adams JN, Brooks M, Redpath TW, Smith FW, Dean J, Gray J, Walton S, Trent RJ (1995) Aortic distensibility and stiffness index measured by magnetic resonance imaging in patients with Marfan’s syndrome. Br Heart J 73:265–269CrossRefPubMedGoogle Scholar
  20. 20.
    Forbat SM, Mohiaddin RH, Yang GZ, Firmin DN, Underwood SR (1995) Measurement of regional aortic compliance by MR imaging: a study of reproducibility. J Magn Reson Imaging 5:635–639CrossRefPubMedGoogle Scholar
  21. 21.
    Groenink M, de Roos A, Mulder BJ, Verbeeten B, Timmermans J, Zwinderman AH, Spaan JA, van der Wall EE (2001) Biophysical properties of the normal-sized aorta in patients with Marfan syndrome: evaluation with MR flow mapping. Radiology 219:535–540PubMedGoogle Scholar
  22. 22.
    Jeremy RW, Huang H, Hwa J, McCarron H, Hughes CF, Richards JG (1994) Relation between age, arterial distensibility, and aortic dilation in the marfan syndrome. Am J Cardiol 74:369–373CrossRefPubMedGoogle Scholar
  23. 23.
    Laffon E, Marthan R, Montaudon M, Latrabe V, Laurent F, Ducassou D (2005) Feasibility of aortic pulse pressure and pressure wave velocity MRI measurement in young adults. J Magn Reson Imaging 21:53–58CrossRefPubMedGoogle Scholar
  24. 24.
    Savolainen A, Keto P, Hekali P, Nisula L, Kaitila I, Viitasalo M, Poutanen VP, Standertskjöld-Nordenstam CG, Kupari M (1992) Aortic distensibility in children with the Marfan syndrome. Am J Cardiol 70:691–693CrossRefPubMedGoogle Scholar
  25. 25.
    Grotenhuis HB, Ottenkamp J, Westenberg JJM, Bax JJ, Kroft LJM, de Roos A (2007) Reduced aortic elasticity and dilatation are associated with aortic regurgitation and left ventricular hypertrophy in nonstenotic bicuspid aortic valve patients. J Am Coll Cardiol 49:1660–1665CrossRefPubMedGoogle Scholar
  26. 26.
    Groenink M, de Roos A, Mulder BJ, Spaan JA, van der Wall EE (1998) Changes in aortic distensibility and pulse wave velocity assessed with magnetic resonance imaging following beta-blocker therapy in the Marfan syndrome. Am J Cardiol 82:203–208CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2010

Authors and Affiliations

  • Ryan K. Johnson
    • 1
  • Senthil Premraj
    • 2
  • Sonali S. Patel
    • 1
  • Nicholas Walker
    • 1
  • Andreas Wahle
    • 2
  • Milan Sonka
    • 2
  • Thomas D. Scholz
    • 1
    • 3
  1. 1.Department of Pediatrics, Carver College of MedicineUniversity of IowaIowa CityUSA
  2. 2.Department of Electrical and Computer EngineeringUniversity of IowaIowa CityUSA
  3. 3.Department of Pediatrics, Division of Pediatric CardiologyUniversity of Iowa Children’s HospitalIowa CityUSA

Personalised recommendations