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Using 3D Ultrasound To Improve Monitoring Of Dangerous Aneurysms

During her doctoral research, Esther Maas investigated the use of new ultrasound techniques to image dangerous aortic aneurysms for patient-specific care.

An aneurysm is a dangerous vascular condition in which a weak spot in a vessel wall can bulge like a balloon. In the aorta, the largest artery in the abdomen, such an aneurysm is life-threatening, especially when it bursts.

During her doctoral research, Esther Maas worked on a reliable way to monitor aneurysms using ultrasound. She conducted her research at the TU/e PULS/e group (Photoacoustics & Ultrasound Laboratory Eindhoven) and the Catharina Hospital in Eindhoven. She defended her thesis at the Department of Biomedical Engineering on April 9.

For such a dangerous vascular condition, an aneurysm is often discovered late or even too late. In fact, an aneurysm itself almost never causes any symptoms. It is only when the bulge bursts and bleeding occurs that an aneurysm is usually discovered afterward. When this happens in our body's most vital artery, the aorta, it is life-threatening.

Sometimes aneurysms are discovered earlier anyway, usually by chance. For example, during a scan of the abdominal cavity because of other symptoms. In that case, the vascular surgeon can continue to monitor the bulge and intervene when the risk of the aneurysm bursting becomes too great.

"The probability of an aneurysm rupturing is related to its size. Yet we also see differences in patients," Maas explains. "Sometimes relatively small aneurysms also rupture, while in other patients a relatively large aneurysm remains stable."

"The current criteria for operating to eliminate the aneurysm are mainly related to diameter, which means that sometimes surgery is performed too soon and sometimes too late. We wanted to improve that by improving our understanding of when an aneurysm is at risk of rupturing. To do this, we looked at the three-dimensional shape of the aneurysm and its mechanical properties."

Currently, standard two-dimensional ultrasound is employed to monitor an aneurysm. The disadvantage of this technique is that a picture can only be taken at one location at a time ("a slice"). While MRI and CT allow the entire three-dimensional shape of the aneurysm to be viewed, these techniques are expensive and time-consuming.

So Maas took up the challenge of using ultrasound to develop a reliable method of monitoring aneurysms. So that patients can be monitored safely, health care costs saved and doctors spared the task of operating unnecessarily.

3D ultrasound, especially as moving images (temporal 3D or 3D+t-echography), is an excellent method for imaging an aneurysm. It is fast, less stressful for the patient, does not emit radiation, and is also more affordable than the alternatives. Maas says, "It allows us to see the shape and movement of the aneurysm simultaneously."

The image quality could still be improved to allow the doctor to assess an aneurysm. "Processing these ultrasound images is challenging, however, because the images contain a speckled pattern. And, in addition, the gray shades are not directly traceable to a tissue," Maas says.

"Therefore, at the beginning of my research, we mainly worked on a method to automatically and accurately determine the shape of an aneurysm from 3D+t ultrasound images."

The actual patient images were taken at the Catharina Hospital in Eindhoven. As many as five hundred patients were monitored in this study. Maas states, "When they came for a conventional two-dimensional ultrasound for diameter control, we also made a 3D+t-echo."

"We developed a computer algorithm that looked for the vessel wall in the 3D+t-echo images. We compared the resulting shape to CT (computed tomography) images, the current gold standard for imaging aneurysms. This showed that the shape from 3D+t-echo images corresponds well with the shape from CT."

By automatically determining the aneurysm shape on all images of the 3D+t ultrasound time series, it was also possible to estimate the expansion of the vessel wall during the cardiac cycle. Combined with blood pressure, this gives an estimate of how elastic the vessel wall is.

"Using this technique, we found out that a combination of three-dimensional shape and elasticity has a better predictive value for aneurysm growth than measuring diameter alone," Maas continues.

"In the next step, we further improved the shape determination using deep learning. We used over 1,300 available 3D+t ultrasound images to train a model that could even more robustly determine the shape of the aneurysm."

But the researchers wanted to improve imaging even more. By combining multiple ultrasound images, they wanted to solve some of the shortcomings of ultrasound, one of which is that only a small area can be viewed at a time.

"This meant that the ultrasound image did not capture large aneurysms in their entirety," Maas explains. "To solve this, we took multiple ultrasound images side by side, first synchronizing these in time and then spatially superimposing and fusing them. This allowed us to image even larger aneurysms with ultrasound."

A second disadvantage of ultrasound is directional—the direction in which you look is very decisive. In one direction the image quality is much better than in the other direction.

Maas says, "To solve this, we combined ultrasound images of the aorta from different angles, which led to an improvement in contrast in the images and a better determination of expansion during the cardiac cycle."

"Our research showed how aneurysms can be monitored using 3D+t-echo images," Maas concludes. "First, by automatically determining different characteristics that are important for the growth of aneurysms in the abdominal cavity. In addition, by demonstrating the added value of combining multiple ultrasound images."

This marks a major step towards being able to use 3D+t ultrasound images to monitor aneurysms in the clinic, ultimately providing more patient-specific care.

More information: Characterization of abdominal aortic aneurysms using time-resolved 3D ultrasound. Research.Tue.Nl/en/publication … s-using-time-resolve

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Influencer Jackie Miller James Shares Aphasia Diagnosis 10 Months After Aneurysm Rupture

Jackie Miller James is starting a new chapter. 

The influencer shared that she's heading home to California after spending 10 months in hospitals across the U.S. while recovering from an aneurysm rupture in her brain, which left her in a medically induced coma last year.

In her first social media video since the episode, Jackie shared she is "ready to start living again."

"What a year it's been for me and my family," she wrote in the caption of her March 26 Instagram post. "Last May, I was given a 50/50 chance of making it through the night… and now I'm here writing you."

The 35-year-old explained that she struggles with aphasia—a language disorder that Bruce Willis was also diagnosed with—and noted that it impacts her speech and has limited her use of her right arm and leg.

"But, I'm more motivated than ever to keep putting in the work," she shared. "While recovery has had some incredibly tough moments, having my 10-month old daughter Knoxly by my side has been my source of motivation. And throughout it all, Austin has been my rock. Friends and family have also stepped up in truly amazing ways to support us." 

Dr. Dre Had Three Strokes After His Brain Aneurysm Burst. How Common Is That?

Dr. Dre, the record producer and rapper whose real name is Andre Romelle Young, recently revealed that the brain aneurysm that hospitalized him in 2021 led to three strokes within his two-week hospital stay.

"It's just something that you can't control that just happens," Dr. Dre said during a March 14 interview on the podcast "The Life of Mine With James Corden."

Dr. Dre said he asked his doctors how he could have prevented his aneurysm but none could give him any answers. They did, however, tell him that he had high blood pressure, which, if left untreated, is a risk factor for brain aneurysms and a leading cause of stroke.

"I had no idea that I had high blood pressure or anything like that. I'm lifting weights, I'm running, I'm doing everything I can to keep myself healthy," he said during the podcast. "High blood pressure in Black men, that's just what it is. They call it the silent killer. You just have no idea."

More on stroke risk among Black people: There's a big gap between Black and white stroke victims. It's a major health concern.

How common is stroke after a brain aneurysm rupture?

The type of stroke that occurs after a brain aneurysm ruptures is called a hemorrhagic stroke. It happens when a weak spot on an artery in the brain balloons with blood (the aneurysm) and bursts, damaging surrounding brain cells with pressure, according to the Centers for Disease Control and Prevention.

About 30,000 people in the U.S. Experience a brain aneurysm rupture each year, according to the Brain Aneurysm Foundation; it's estimated that one ruptures every 18 minutes.

Data show that ruptured brain aneurysms account for 3%-5% of all new strokes, the foundation says. It's also known that 1 in 4 stroke survivors go on to have another stroke, according to the American Stroke Association.

Meanwhile, an estimated 6.8 million people in the U.S., or 1 in 50 people, have a small, unruptured brain aneurysm that does not cause symptoms, the foundation says. They only become problematic when they grow large and burst.

The more common type of stroke is called an ischemic stroke. It occurs when blood supply to part of the brain is blocked or reduced, the CDC says, preventing oxygen from reaching brain tissue and causing brain cells to die.

How to spot a stroke

Familiarizing yourself with the symptoms of stroke can save lives because early treatment is critical to a person's survival and quality of life.

A helpful acronym to remind you of this is BE FAST, said Dr. Susana Bowling, medical director of the Neuroscience Institute at Summa Health and Summa's Comprehensive Stroke Center in Ohio.

"B" is for balance. Does the person have a sudden loss of gait or balance that's causing them to stumble or fall?

"E" is for eye. Have they lost vision in one or both eyes?

"F" is for face. Is there any drooping or weakness on one side of their face? Can they smile?

"A" is for arms. Do they have a sudden onset of weakness in one arm?

"S" is for speech. Are they having difficulty speaking or slurring their words? Are people having a hard time understanding them?

"T" is for time to call 911.

A common saying in the stroke community is "time is brain," Bowling said, because it takes only five minutes for neurons in the brain to start dying: "Every minute counts, so the longer you wait to seek any help, the more deficits you would be accumulating and the worse outcomes you will have."

The more time that passes after a person has a stroke, the fewer treatments are available to them, Bowling added. "Not only will the treatments potentially be less effective, but they also can be more dangerous. As you accumulate brain injury, the risk for complications of the treatments increase as well."

Perhaps the biggest sign to look for is the sudden onset of symptoms, Bowling said, like a person suddenly losing the ability to talk during a phone call.

"If you see any BE FAST symptoms, call 911," she said. "If you have any of these symptoms, this is the one chance that life has given you to take actions before you can no longer take an action."

How to lower your risk of stroke

Although the cause of a stroke cannot always be determined – a phenomenon known as a cryptogenic stroke – there are known risk factors you can avoid that may increase your chances of having one.

Here are seven ways to lower your risk of stroke:

◾ Manage blood pressure. High blood pressure damages and weakens arteries. Consistent exercise and a balanced diet can help lower it, but many people require medication.

◾ Control cholesterol.  When too much of these waxy substances build up in your blood, they contribute to plaque build-up in arteries, putting you at higher risk of stroke. Diet changes – such as cutting saturated fat – can help. Many people also need medication.

◾ Reduce blood sugar. High blood glucose can damage your heart. Diet and exercise often can work to get numbers under control in the pre-diabetes stage.

◾ Get active. Ideally, you should move for at least 150 minutes a week – the equivalent of five 30-minute brisk walks. But every little bit counts.

◾ Eat better. That means more whole grains, fruits and vegetables and less ultra-processed foods.

◾ Lose weight. Excess fat in your abdominal area increases the risk of heart disease.

◾ Stop smoking. While rates have declined, an estimated 11.5% (28.3 million) of U.S. Adults still smoked cigarettes in 2021, according to the CDC. Quitting is the single best thing smokers could do for their health, experts say.

Kim Painter and Betty Lin-Fisher contributed to this report.

This article originally appeared on USA TODAY: Dr. Dre: How common are strokes after brain aneurysm?

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