{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T17:20:12Z","timestamp":1774632012803,"version":"3.50.1"},"reference-count":25,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,2,2]],"date-time":"2021-02-02T00:00:00Z","timestamp":1612224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: To develop a tool for assessing normalcy of the thoracic aorta (TA) by echocardiography, based on either a linear regression model (Z-score), or a machine learning technique, namely one-class support vector machine (OC-SVM) (Q-score). Methods: TA diameters were measured in 1112 prospectively enrolled healthy subjects, aging 5 to 89 years. Considering sex, age and body surface area we developed two calculators based on the traditional Z-score and the novel Q-score. The calculators were compared in 198 adults with TA &gt; 40 mm, and in 466 patients affected by either Marfan syndrome or bicuspid aortic valve (BAV). Results: Q-score attained a better Area Under the Curve (0.989; 95% CI 0.984\u20130.993, sensitivity = 97.5%, specificity = 95.4%) than Z-score (0.955; 95% CI 0.942\u20130.967, sensitivity = 81.3%, specificity = 93.3%; p &lt; 0.0001) in patients with TA &gt; 40 mm. The prevalence of TA dilatation in Marfan and BAV patients was higher as Z-score &gt; 2 than as Q-score &lt; 4% (73.4% vs. 50.09%, p &lt; 0.00001). Conclusions: Q-score is a novel tool for assessing TA normalcy based on a model requiring less assumptions about the distribution of the relevant variables. Notably, diameters do not need to depend linearly on anthropometric measurements. Additionally, Q-score can capture the joint distribution of these variables with all four diameters simultaneously, thus accounting for the overall aortic shape. This approach results in a lower rate of predicted TA abnormalcy in patients at risk of TA aneurysm. Further prognostic studies will be necessary for assessing the relative effectiveness of Q-score versus Z-score.<\/jats:p>","DOI":"10.3390\/diagnostics11020220","type":"journal-article","created":{"date-parts":[[2021,2,2]],"date-time":"2021-02-02T13:01:12Z","timestamp":1612270872000},"page":"220","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Two-Dimensional Aortic Size Normalcy: A Novelty Detection Approach"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3117-9245","authenticated-orcid":false,"given":"Paolo","family":"Frasconi","sequence":"first","affiliation":[{"name":"Department of Information Engineering, University of Florence, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7364-1955","authenticated-orcid":false,"given":"Daniele","family":"Baracchi","sequence":"additional","affiliation":[{"name":"Department of Information Engineering, University of Florence, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betti","family":"Giusti","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy"},{"name":"Atherothrombotic Diseases Center, Careggi Hospital, 50139 Florence, Italy"},{"name":"Marfan Syndrome and Related Disorders Regional (Tuscany) Referral Center, Careggi Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ada","family":"Kura","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaia","family":"Spaziani","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Meyer Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Cherubini","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Azienda Sanitaria-Universitaria Integrata of Trieste, 34125 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Favilli","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Meyer Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Di Lenarda","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Azienda Sanitaria-Universitaria Integrata of Trieste, 34125 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guglielmina","family":"Pepe","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50139 Florence, Italy"},{"name":"Atherothrombotic Diseases Center, Careggi Hospital, 50139 Florence, Italy"},{"name":"Marfan Syndrome and Related Disorders Regional (Tuscany) Referral Center, Careggi Hospital, 50139 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Nistri","sequence":"additional","affiliation":[{"name":"Cardiology Service, CMSR Veneto Medica, 36077 Altavilla Vicentina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. 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