Dynamic analysis of biomechanical properties of the infrarenal aorta

Background: The prediction of an infrarenal aortic aneurysm rupture is currently based on determination of the maximum aortic diameter, whereby some aneurysms rupture earlier despite a smaller diameter and others remain stable even with a larger caliber. Objectives: The prediction of an aneurysm can be improved by the use of biomechanical simulation based on stress and strain analyses. The real-time 3D speckle tracking ultrasound (4D) is increasingly used in clinical practice but the value in aortic diagnostics has not yet been analyzed. Material and methods: The article provides a literature review on the application of dynamic imaging in 2D and 4D sonography and describes the methodology of strain analysis. Results: The M‑mode and 2D speckle tracking ultrasound provide valuable information about the local distensibility of the aorta but currently without clinical implementation of the methodology in the prediction of aneurysm rupture. After validation of 4D ultrasound with the use of a silicon phantom, the biomechanical parameters were introduced into the strain analysis, which reliably describe the amplitude as well as the heterogeneity of wall deformation. In addition, the high spatial and temporal resolution of 4D ultrasound makes it possible to develop methods for determining the patient-specific properties of the aortic wall. Conclusion: The use of 4D ultrasound is a promising non-invasive examination of aortic aneurysms with detection of wall areas with a pathological movement pattern. Numerous validation studies are still required in clinical practice before the method can enable a reliable prediction of the rupture risk. © 2017, Springer Medizin Verlag GmbH.