On the effect of computed tomography resolution to distinguish between abdominal aortic aneurysm wall tissue and calcification: A proof of concept

Purpose The purpose of this study is to determine the optimal target CT spatial resolution for accurately imaging abdominal aortic aneurysm (AAA) wall characteristics, distinguishing between tissue and calcification components, for an accurate assessment of rupture risk. Materials and methods Ruptured and non-ruptured AAA-wall samples were acquired from eight patients undergoing open surgical aneurysm repair upon institutional review board approval and informed consent was obtained from all patients. Physical measurements of AAA-wall cross-section were made using scanning electron microscopy. Samples were scanned using high resolution micro-CT scanning. A resolution range of 15.5–155 μm was used to quantify the influence of decreasing resolution on wall area measurements, in terms of tissue and calcification. A statistical comparison between the reference resolution (15.5 μm) and multi-detector CT resolution (744 μm) was also made. Results Electron microscopy examination of ruptured AAAs revealed extremely thin outer tissue structure <200 μm in radial distribution which is supporting the aneurysm wall along with large areas of adjacent medial calcifications far greater in area than the tissue layer. The spatial resolution of 155 μm is a significant predictor of the reference AAA-wall tissue and calcification area measurements (r = 0.850; p < 0.001; r = 0.999; p < 0.001 respectively). The tissue and calcification area at 155 μm is correct within 8.8% ± 1.86 and 26.13% ± 9.40 respectively with sensitivity of 87.17% when compared to the reference. Conclusion The inclusion of AAA-wall measurements, through the use of high resolution-CT will elucidate the variations in AAA-wall tissue and calcification distributions across the wall which may help to leverage an improved assessment of AAA rupture risk.