Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair.

The MA3RS Study Investigators , David Newby, Rachael Forsythe, Olivia McBride, Jennifer Robson, Alex Vesey, Roderick Chalmers, Paul Burns, O James Garden, Scott Semple, Marc Dweck, Calum Gray, Tom MacGillivray, Chengjia Wang, Yolanda Georgia Koutraki, Neil Mitchard, Annette Cooper, Edwin van Beek, Graham McKillop, Weiyang HoLiz Fraser, Hayley Cuthbert, Peter Hoskins, Barry Doyle, Noel Conlisk, Wesley Stuart, Colin Berry, Giles Roditi, Laura Murdoch, Richard Holdsworth, Emma Scott, Lyndsey Milne, Fiona Strachan, Fiona Wee, Katerine Oatey, Catriona Graham, Gordon Murray, Garry Milne, Marise Bucukoglu, Kirsteen Goodman, Jakub Kaczynski, Anoop S V Shah, Andrew Tambyraja, Julie Brittenden, Robert Lambie, John Norrie

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

BACKGROUND: Ultrasmall superparamagnetic particles of iron oxide (USPIO) detect cellular inflammation on magnetic resonance imaging (MRI). In patients with abdominal aortic aneurysm, we assessed whether USPIO-enhanced MRI can predict aneurysm growth rates and clinical outcomes.
METHODS: In a prospective multicenter open-label cohort study, 342 patients with abdominal aortic aneurysm (diameter ≥40 mm) were classified by the presence of USPIO enhancement and were monitored with serial ultrasound and clinical follow-up for ≥2 years. The primary end point was the composite of aneurysm rupture or repair.
RESULTS: Participants (85% male, 73.1±7.2 years) had a baseline aneurysm diameter of 49.6±7.7 mm, and USPIO enhancement was identified in 146 (42.7%) participants, absent in 191 (55.8%), and indeterminant in 5 (1.5%). During follow-up (1005±280 days), 17 (5.0%) abdominal aortic aneurysm ruptures, 126 (36.8%) abdominal aortic aneurysm repairs, and 48 (14.0%) deaths occurred. Compared with those without uptake, patients with USPIO enhancement have increased rates of aneurysm expansion (3.1±2.5 versus 2.5±2.4 mm/year, P=0.0424), although this was not independent of current smoking habit (P=0.1993). Patients with USPIO enhancement had higher rates of aneurysm rupture or repair (47.3% versus 35.6%; 95% confidence intervals,1.1–22.2; P=0.0308). This finding was similar for each component of rupture (6.8% versus 3.7%, P=0.1857) or repair (41.8% versus 32.5%, P=0.0782). USPIO enhancement was associated with reduced event-free survival for aneurysm rupture or repair (P=0.0275), all-cause mortality (P=0.0635), and aneurysm-related mortality (P=0.0590). Baseline abdominal aortic aneurysm diameter (P<0.0001) and current smoking habit (P=0.0446) also predicted the primary outcome, and the addition of USPIO enhancement to the multivariate model did not improve event prediction (c-statistic, 0.7935–0.7936).
CONCLUSIONS: USPIO-enhanced MRI is a novel approach to the identification of aortic wall cellular inflammation in patients with abdominal aortic aneurysms and predicts the rate of aneurysm growth and clinical outcome. However, it does not provide independent prediction of aneurysm expansion or clinical outcomes in a model incorporating known clinical risk factors.
Original languageEnglish
Pages (from-to)787–797
Number of pages11
Issue number9
Early online date18 Jul 2017
Publication statusPublished - 29 Aug 2017

Keywords / Materials (for Non-textual outputs)

  • Aged
  • Aorta
  • Aortic Aneurysm, Abdominal
  • Aortic Rupture
  • Blood Pressure
  • Contrast Media
  • Dextrans
  • Disease-Free Survival
  • Female
  • Humans
  • Inflammation
  • Magnetic Resonance Imaging
  • Magnetite Nanoparticles
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Sex Factors
  • Smoking
  • Survival Rate
  • Journal Article


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