Radiomics-Based Risk Assessment Correlates With Outcomes in Patients With Acute Type B Aortic Dissection Undergoing Thoracic Endovascular Repair

Abstract

Objectives:

Our study aimed to investigate the correlations between radiomics-based assessment and outcomes, including positive aortic remodeling (PAR), reintervention for dissection at 1 year, and overall survival, in patients with Type B aortic dissection (TBAD) who underwent thoracic endovascular aortic repair (TEVAR).

Methods:

This was a single-center, retrospective, cohort study. The cohort comprised 104 patients who had undergone TEVAR of TBAD in our institution between January 2010 and October 2022. We segmented preoperative computed tomography (CT) images of the patients’ descending aorta regions, then extracted a comprehensive set of radiomic features, including first-order features, shape features (2D and 3D), gray-level co-occurrence matrix (GLCM), gray-level size zone matrix, gray-level run length matrix, gray-level dependence matrix, neighborhood gray-tone difference matrix, from the regions of interest. Next, we selected radiomics features associated with total descending aorta positive aortic remodeling (TDA-PAR) and reintervention by least absolute shrinkage and selection operator (LASSO) regression and features associated with survival by LASSO-Cox regression. This enabled us to calculate radiomics-based risk scores for each patient. We then allocated the patients to high and low radiomics-based risk groups, the cutoff being the median score. We used 3 different models to validate the radiomics-based risk scores.

Results:

The patients’ baseline characteristics did not differ between those who achieved TDA-PAR and those who did not. The radiomics-based risk scores were significantly and independently associated with all 3 outcomes. As to the impact of specific radiomics features, we found that GLSZM_SmallAreaLowGrayLevelEmphasis and shape_Maximum2DDiameterColumn had positive impacts on both reintervention and survival outcomes, whereas GLCM_Idmn positively affected survival but negatively affected reintervention. We found that radiomics-based risk for TDA-PAR correlated most significantly with zone 6 PAR.

Conclusions:

Radiomics-based risk scores were significantly associated with the outcomes of TDA-PAR, reintervention, and overall survival. Radiomics has the potential to make significant contributions to prediction of outcomes in patients with TBAD undergoing TEVAR.

Clinical Impact

In this study of 104 patients with Type B aortic dissection, we demonstrated associations between radiomics-based risk and postoperative outcomes, including total descending aorta positive aortic remodeling, reintervention and survival. These findings highlight radiomics’ potential as a tool for risk stratification and prognostication in acute Type B aortic dissection management.

Keywords

Type B aortic dissection radiomics thoracic endovascular aortic repair total descending aorta positive aortic remodeling reintervention

Get full access to this article

View all access options for this article.

References

Goldfinger

Halperin

Marin

, et al Thoracic aortic aneurysm and dissection. J Am Coll Cardiol. 2014;64(16):1725–1739.

McClure

Brogly

Lajkosz

, et al Epidemiology and management of thoracic aortic dissections and thoracic aortic aneurysms in Ontario, Canada: a population-based study. J Thorac Cardiovasc Surg. 2018;155(6):2254–2264.

Erbel

Aboyans

Boileau

, et al 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873–2926.

Lombardi

Hughes

Appoo

, et al Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg. 2020;71(3):723–747.

Roselli

EE.

Thoracic endovascular aortic repair versus open surgery for type-B chronic dissection. J Thorac Cardiovasc Surg. 2015;149(2 suppl):S163–S167.

MacGillivray

Gleason

Patel

, et al The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. J Thorac Cardiovasc Surg. 2022;163(4):1231–1249.

Conway

Qato

Mondry

, et al Outcomes of thoracic endovascular aortic repair for chronic aortic dissections. J Vasc Surg. 2018;67(5):1345–1352.

VIRTUE Registry Investigators. Mid-term outcomes and aortic remodelling after thoracic endovascular repair for acute, subacute, and chronic aortic dissection: the VIRTUE Registry. Eur J Vasc Endovasc Surg. 2014;48(4):363–371.

Fanelli

Cannavale

O’Sullivan

, et al Endovascular repair of acute and chronic aortic type B dissections: main factors affecting aortic remodeling and clinical outcome. JACC Cardiovasc Interv. 2016;9(2):183–191.

10.

Lambin

Rios-Velazquez

Leijenaar

, et al Radiomics: extracting more information from medical images using advanced feature analysis. Eur J Cancer. 2012;48(4):441–446.

11.

Zhou

Luo

Wang

, et al Deep learning prediction for distal aortic remodeling after thoracic endovascular aortic repair in Stanford type B aortic dissection. J Endovasc Ther. 2023:15266028231160101.

12.

Dong

Yang

, et al Preoperative predictors of late aortic expansion in acute type B aortic dissection treated with TEVAR. J Clin Med. 2023;12(8):2826.

13.

, et al The number of preoperative abdominal false lumen-perfused small branches is related to abdominal aortic remodeling after thoracic endovascular aortic repair for type B aortic dissection. Ann Vasc Surg. 2021;71:56–64.

14.

Zhu

Huang

Zhao

, et al Influence of distal entry tears in acute type B aortic dissection after thoracic endovascular aortic repair. J Vasc Surg. 2017;66(2):375–385.

15.

Vargo

Maigrot

Roselli

EE.

Chronic thoracoabdominal aortic dissection: endovascular options to obliterate the false lumen. Ann Cardiothorac Surg. 2021;10(6):778–783.

16.

Gillies

Kinahan

Hricak

Radiomics: images are more than pictures, they are data. Radiology. 2016;278(2):563–577.

17.

Ding

Zhang

, et al A radiomics model based on aortic computed tomography angiography: the impact on predicting the prognosis of patients with aortic intramural hematoma (IMH). Quant Imaging Med Surg. 2023;13(2):598–609.

18.

Guo

Chen

Lin

, et al Non-contrast CT-based radiomic signature for screening thoracic aortic dissections: a multicenter study. Eur Radiol. 2021;31(9):7067–7076.

19.

von Elm

Altman

Egger

, et al The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296.

20.

Zwanenburg

Vallières

Abdalah

, et al The image biomarker standardization initiative: standardized quantitative radiomics for high-throughput image-based phenotyping. Radiology. 2020;295(2):328–338.

21.

van Griethuysen

JJM

Fedorov

Parmar

, et al Computational radiomics system to decode the radiographic phenotype. Cancer Res. 2017;77(21):e104–e107.

22.

Oishi

Yamashita

Kimura

, et al Preoperative distal aortic diameter is a significant predictor of late aorta-related events after endovascular repair for chronic type B aortic dissection. Gen Thorac Cardiovasc Surg. 2020;68(10):1086–1093.

23.

Blakeslee-Carter

Potter

Banks

, et al Aortic visceral segment instability is evident following thoracic endovascular aortic repair for acute and subacute type B aortic dissection. J Vasc Surg. 2022;76(2):389–399.

24.

Qiu

Zha

Zhang

, et al A meta-analysis of combined proximal stent grafting with or without adjunctive distal bare stent for the management of aortic dissection. J Vasc Surg. 2020;72(3):1109–1120.

25.

Liu

Yan

, et al Extended stent coverage decreases distal aortic segmental enlargement after the endovascular repair of acute complicated type b aortic dissection: a multi-center retrospective study of 814 patients. J Endovasc Ther. 2022;29(1):96–108.