title: Computed Tomography Imaging Features in Acute Uncomplicated Stanford Type-B Aortic Dissection Predict Late Adverse Events.
abstract: BACKGROUND
  Medical treatment of initially uncomplicated acute Stanford type-B aortic dissection is associated with a high rate of late adverse events. Identification of individuals who potentially benefit from preventive endografting is highly desirable.
  
  
  RESULTS
  The association of computed tomography imaging features with late adverse events was retrospectively assessed in 83 patients with acute uncomplicated Stanford type-B aortic dissection, followed over a median of 850 (interquartile range 247-1824) days. Adverse events were defined as fatal or nonfatal aortic rupture, rapid aortic growth (>10 mm/y), aneurysm formation (≥6 cm), organ or limb ischemia, or new uncontrollable hypertension or pain. Five significant predictors were identified using multivariable Cox regression analysis: connective tissue disease (hazard ratio [HR] 2.94, 95% confidence interval [CI]: 1.29-6.72;P=0.01), circumferential extent of false lumen in angular degrees (HR 1.03 per degree, 95% CI: 1.01-1.04,P=0.003), maximum aortic diameter (HR 1.10 per mm, 95% CI: 1.02-1.18,P=0.015), false lumen outflow (HR 0.999 per mL/min, 95% CI: 0.998-1.000;P=0.055), and number of intercostal arteries (HR 0.89 per n, 95% CI: 0.80-0.98;P=0.024). A prediction model was constructed to calculate patient specific risk at 1, 2, and 5 years and to stratify patients into high-, intermediate-, and low-risk groups. The model was internally validated by bootstrapping and showed good discriminatory ability with an optimism-corrected C statistic of 70.1%.
  
  
  CONCLUSIONS
  Computed tomography imaging-based morphological features combined into a prediction model may be able to identify patients at high risk for late adverse events after an initially uncomplicated type-B aortic dissection.
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sailer
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Sander M J
authors.initials: SM
authors.lastname: van Kuijk
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Nelemans
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Anne S
authors.initials: AS
authors.lastname: Chin
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Aya
authors.initials: A
authors.lastname: Kino
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Mark
authors.initials: M
authors.lastname: Huininga
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Johanna
authors.initials: J
authors.lastname: Schmidt
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Gabriel
authors.initials: G
authors.lastname: Mistelbauer
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Kathrin
authors.initials: K
authors.lastname: Bäumler
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Peter
authors.initials: P
authors.lastname: Chiu
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Michael P
authors.initials: MP
authors.lastname: Fischbein
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Michael D
authors.initials: MD
authors.lastname: Dake
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: D Craig
authors.initials: DC
authors.lastname: Miller
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
authors.forename: Geert Willem H
authors.initials: GW
authors.lastname: Schurink
authors.affiliation: From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.). d.fleischmann@stanford.edu.
authors.forename: Dominik
authors.initials: D
authors.lastname: Fleischmann
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D001019:Aortic Rupture / Q000209:etiology; D001027:Aortography / Q000379:methods*; D000072226:Computed Tomography Angiography; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007511:Ischemia / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: aneurysm; angiography; aorta; aortic rupture; computed; hypertension; regression analysis; tomography