Objectives:
We previously reported excellent findings of X-ray phase-contrast tomography (PCX) for visualization of the formalin-fixed human aortic wall samples, and PCX enabled to demonstrate changes of tunica media in acute type A aortic dissection (AADA) . This study evaluates quantitative and dynamic measurements of fresh aortic wall samples of AADA with this modality.
Methods:
Fresh human aortic samples of the ascending aorta (n=7) were obtained during emergent aortic repair for AADA. Formalin-fixed human aortic walls of AADA (n=15) and normal aorta (n=15) were also investigated. PCX is approximately 1000 times more sensitive than absorption-contrast X-ray imaging and effective resolution of PCX is 11.7 μm. Quantitative and dynamic measurement has been developed to visualize changes in imaging of fresh aortic wall under various tensile force to simulate physiological condition, in which aortic wall is stretched according to blood pressure.
Results:
In normal aorta, quantitative measurement of density of the media was 1.095±0.003(g/cm3), and no different between intimal side (1.083±0.002) and adventitial side (1.085±0.003). On contrast, in formalin-fixed aorta of AADA, the medial density was 1.063±0.027, significantly lower than normal aorta (Figure-1), and different between intimal side and adventitial side (1.061±0.008 vs 1.081±0.011, respectively; p<0.005). In fresh sample of AADA, distribution of the medial density was equal to that of formalin-fixed aorta and differences of the medial density were clearly observed with elevation of tensile force of the aortic wall (Figure-1). These differences in density within tunica media were well correlated with distribution of elastic fibers and existence of cystic medial necrosis in pathological analysis.
Conclusions:
X-ray phase-contrast tomography was a strong modality to understand aortic structures and pathogenesis of acute type A aortic dissection.