Ultrasound Probe Pressure Affects Aortic Wall Stiffness: A Patient-Specific Computational Study in Abdominal Aortic Aneurysms

Abstract

Abstract Purpose: Ultrasound imaging is key in the management of patients with an abdominal aortic aneurysm (AAA). It was recently shown that the cyclic diameter variations between diastole and systole, which can be quantified with US imaging, increase significantly with the strength of the applied probe pressure on the patient’s abdomen. The goal of this study is to investigate this effect more thoroughly. Methods: With finite-element modeling, pulsatile blood pressure and probe pressure are simulated in three patient-specific geometries. Two distinct models for the aortic wall were simulated: a nonlinear hyperelastic and a linear elastic model. In addition, varying stiffness was considered for the surrounding tissues. The effect of light, moderate, and firm probe pressure was quantified on the stresses and strains in the aortic wall, and on two in vivo stiffness measures. In addition, the Elasticity Loss Index was proposed to quantify the change in stiffness due to probe pressure. Results: Firm probe pressure decreased the measured aortic stiffness, and material stiffness was affected only when the wall was modeled as nonlinear, suggesting a shift in the stress–strain curve. In addition, stiffer surrounding tissues and a more elongated aneurysm sac decreased the responsiveness to the probe pressure. Conclusion: The effect of probe pressure on the AAA wall stiffness was clarified. In particular, the AAA wall nonlinear behavior was found to be of primary importance in determining the probe pressure response. Thus, further work will intend to make use of this novel finding in a clinical context.