Contrast inhomogeneity in CT angiography of the abdominal aortic aneurysm

Elizabeth George, Andreas A. Giannopoulos, Ayaz Aghayev, Saurabh Rohatgi, Amir Imanzadeh, Antonios P. Antoniadis, Kanako K. Kumamaru, Yiannis S. Chatzizisis, Ruth Dunne, Michael Steigner, Michael Hanley, Edwin C. Gravereaux, Frank J. Rybicki, Dimitrios Mitsouras

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: If undetected, infrarenal Abdominal Aortic Aneurysm (AAA) growth can lead to rupture, a high-mortality complication. Some AAA patients exhibit inhomogeneous luminal contrast attenuation at first-pass CT angiography (CTA). This study assesses the association between this observation and aneurysm growth. Methods: Sixty-seven consecutive pre-repair AAA CTAs were included in this retrospective study. The "Gravitational Gradient" (GG), defined as the ratio of the mean attenuation in a region-of-interest placed posteriorly to that in a region-of-interest placed anteriorly within the lumen of the aortic aneurysm on a single axial slice, and the maximum aneurysm diameter were measured from each CT data set. "AAA Contrast Inhomogeneity" was defined as the absolute value of the difference between the GG and 1.0. Univariate and multivariate logistic regression was used to assess the association of aneurysm growth >0.4 and >1.0 cm/year to AAA Contrast Inhomogeneity, aneurysm diameter, patient characteristics and cardiovascular co-morbidities. Results: AAA Contrast Inhomogeneity was not correlated to aneurysm diameter (p = 0.325). In multivariable analysis that included initial aneurysm diameter and AAA Contrast Inhomogeneity, both factors were significantly associated with rapid aneurysm growth (initial diameter: p = 0.029 and 0.011, and, AAA Contrast Inhomogeneity: p = 0.045 and 0.048 for growth >0.4 cm/year and >1 cm/year respectively). Conclusions: AAA Contrast Inhomogeneity is a common observation in first-pass CTA. It is associated with rapid aneurysm growth, independent of aneurysm diameter.

Original languageEnglish (US)
Pages (from-to)179-183
Number of pages5
JournalJournal of Cardiovascular Computed Tomography
Issue number2
StatePublished - Mar 1 2016


  • Abdominal aortic aneurysm
  • Aneurysm growth
  • CT angiography
  • Contrast inhomogeneity
  • Risk stratification

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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