{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:39:40Z","timestamp":1772602780923,"version":"3.50.1"},"reference-count":40,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T00:00:00Z","timestamp":1672790400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"EU funds PO FEDER-FSE Bourgogne 2012\u20132020"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Ascending aortic aneurysm is a pathology that is important to be supervised and treated. During the years the aorta dilates, it becomes stiff, and its elastic properties decrease. In some cases, the aortic wall can rupture leading to aortic dissection with a high mortality rate. The main reference standard to measure when the patient needs to undertake surgery is the aortic diameter. However, the aortic diameter was shown not to be sufficient to predict aortic dissection, implying other characteristics should be considered. Therefore, the main objective of this work is to assess in-vivo the elastic properties of four different quadrants of the ascending aorta and compare the results with equivalent properties obtained ex-vivo. The database consists of 73 cine-MRI sequences of thoracic aorta acquired in axial orientation at the level of the pulmonary trunk. All the patients have dilated aorta and surgery is required. The exams were acquired just prior to surgery, each consisting of 30 slices on average across the cardiac cycle. Multiple deep learning architectures have been explored with different hyperparameters and settings to automatically segment the contour of the aorta on each image and then automatically calculate the aortic compliance. A semantic segmentation U-Net network outperforms the rest explored networks with a Dice score of 98.09% (\u00b10.96%) and a Hausdorff distance of 4.88 mm (\u00b11.70 mm). Local aortic compliance and local aortic wall strain were calculated from the segmented surfaces for each quadrant and then compared with elastic properties obtained ex-vivo. Good agreement was observed between Young\u2019s modulus and in-vivo strain. Our results suggest that the lateral and posterior quadrants are the stiffest. In contrast, the medial and anterior quadrants have the lowest aortic stiffness. The in-vivo stiffness tendency agrees with the values obtained ex-vivo. We can conclude that our automatic segmentation method is robust and compatible with clinical practice (thanks to a graphical user interface), while the in-vivo elastic properties are reliable and compatible with the ex-vivo ones.<\/jats:p>","DOI":"10.3390\/jcm12020402","type":"journal-article","created":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T03:27:44Z","timestamp":1672802864000},"page":"402","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Comparison of In-Vivo and Ex-Vivo Ascending Aorta Elastic Properties through Automatic Deep Learning Segmentation of Cine-MRI and Biomechanical Testing"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4395-6588","authenticated-orcid":false,"given":"Emmanouil","family":"Markodimitrakis","sequence":"first","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siyu","family":"Lin","sequence":"additional","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2342-7934","authenticated-orcid":false,"given":"Emmanouil","family":"Koutoulakis","sequence":"additional","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana Marcela","family":"Mar\u00edn-Castrill\u00f3n","sequence":"additional","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco Aar\u00f3n","family":"Tovar S\u00e1ez","sequence":"additional","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Leclerc","sequence":"additional","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7695-9416","authenticated-orcid":false,"given":"Chlo\u00e9","family":"Bernard","sequence":"additional","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"},{"name":"Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, 21079 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9959-6056","authenticated-orcid":false,"given":"Arnaud","family":"Boucher","sequence":"additional","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benoit","family":"Presles","sequence":"additional","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivier","family":"Bouchot","sequence":"additional","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"},{"name":"Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, 21079 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6794-5306","authenticated-orcid":false,"given":"Thomas","family":"Decourselle","sequence":"additional","affiliation":[{"name":"CASIS\u2014CArdiac Simulation & Imaging Software SAS, 21800 Quetigny, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-Catherine","family":"Morgant","sequence":"additional","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"},{"name":"Department of Cardio-Vascular and Thoracic Surgery, University Hospital of Dijon, 21079 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7970-366X","authenticated-orcid":false,"given":"Alain","family":"Lalande","sequence":"additional","affiliation":[{"name":"ImViA Laboratory, EA 7535, University of Burgundy and Franche-Comte, 21000 Dijon, France"},{"name":"Department of Medical Imaging, University Hospital of Dijon, 21079 Dijon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bissacco, D., Settembrini, A.M., and Mazzari, A. (2022). Acute Aortic Syndromes and Thoracic Aortic Aneurysms: From Diagnosis to Treatment. Primary Management in General, Vascular and Thoracic Surgery: A Practical Approach, Springer International Publishing.","DOI":"10.1007\/978-3-031-12563-8"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/jama.283.7.897","article-title":"The International Registry of Acute Aortic Dissection (IRAD). New Insights Into an Old Disease","volume":"283","author":"Hagan","year":"2000","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3650","DOI":"10.18632\/aging.101702","article-title":"Abdominal aortic aneurysm in aged population","volume":"10","author":"Umebayashi","year":"2018","journal-title":"Aging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1161\/01.CIR.0000154569.08857.7A","article-title":"Thoracic and Abdominal Aortic Aneurysms","volume":"111","author":"Isselbacher","year":"2005","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/S0003-4975(10)65594-4","article-title":"Management of Acute Aortic Dissections","volume":"10","author":"Daily","year":"1970","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 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 The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology ESC","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1016\/j.jtcvs.2013.05.025","article-title":"Aortic diameter predicts acute type A aortic dissection in patients with Marfan syndrome but not in patients without Marfan syndrome","volume":"147","author":"Kim","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1161\/CIRCULATIONAHA.107.702720","article-title":"Aortic diameter \u2265 5.5 cm is not a good predictor of type A aortic dissection: Observations from the International Registry of Acute Aortic Dissection (IRAD)","volume":"116","author":"Pape","year":"2007","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.actbio.2022.06.019","article-title":"Aortic local biomechanical properties in ascending aortic aneurysms","volume":"149","author":"Lin","year":"2022","journal-title":"Acta Biomater."},{"key":"ref_10","first-page":"1137","article-title":"Determination of Young modulus by the hardness indentation diagram","volume":"41","author":"Bulychev","year":"1975","journal-title":"Zavod. Lab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/S0895-7061(01)02319-6","article-title":"Clinical applications of arterial stiffness; definitions and reference values","volume":"15","author":"Staessen","year":"2002","journal-title":"Am. J. Hypertens."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Morgant, M.C., Lin, S., Marin-Castrillon, D., Bernard, C., Laubriet, A., Cochet, A., Lalande, A., and Bouchot, O. (2021). Comparison of two techniques (in vivo and ex-vivo) for evaluating the elastic properties of the ascending aorta: Prospective cohort study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0256278"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.mcna.2015.02.011","article-title":"Cardiac MRI","volume":"99","author":"Pfeiffer","year":"2015","journal-title":"Med. Clin. N. Am."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/S0140-6736(99)00179-8","article-title":"Clinical value of aortic pulse-wave velocity measurement","volume":"354","author":"Lehmann","year":"1999","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/BF00877747","article-title":"Elastic properties and Windkessel function of the human aorta","volume":"9","author":"Belz","year":"1995","journal-title":"Cardiovasc. Drugs Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1097\/00004424-200212000-00008","article-title":"Automatic determination of aortic compliance with cine-magnetic resonance imaging: An application of fuzzy logic theory","volume":"37","author":"Lalande","year":"2002","journal-title":"Investig. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.mri.2009.07.001","article-title":"Influence of age and sex on aortic distensibility assessed by MRI in healthy subjects","volume":"28","author":"Rose","year":"2010","journal-title":"Magn. Reson. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Rose, J.L., Lalande, A., Bourennane, E.B., Walker, P.M., Bouchot, O., Steinmetz, E., Legrand, L., Voisin, Y., Wolf, Y., and Brunotte, F. (2005, January 25\u201328). Automatic detection of vessel wall contours from cine-MRI for aortic compliance determination. Proceedings of the Computers in Cardiology, Lyon, France.","DOI":"10.1109\/CIC.2005.1588124"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1088\/0031-9155\/48\/15\/310","article-title":"Determination of aortic compliance from magnetic resonance images using an automatic active contour model","volume":"48","author":"Krug","year":"2003","journal-title":"Phys. Med. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.bspc.2017.09.002","article-title":"Automatic determination of aortic compliance based on MRI and adapted curvilinear detector","volume":"40","author":"Bouchot","year":"2018","journal-title":"Biomed. Signal Process. Control"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/BF02584301","article-title":"What are the residual stresses doing in our blood vessels?","volume":"19","author":"Fung","year":"1991","journal-title":"Ann. Biomed. Eng."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/BF00406415","article-title":"Mechanical properties and Young\u2019s modulus of human skin in vivo","volume":"269","author":"Agache","year":"1980","journal-title":"Arch. Dermatol. Res."},{"key":"ref_23","first-page":"217","article-title":"Determination of young\u2019s modulus for the human cornea","volume":"49","author":"Sjontoft","year":"1987","journal-title":"Bull. Math. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/0003-9969(95)00109-3","article-title":"Hardness and young\u2019s modulus of human peritubular and intertubular dentine","volume":"41","author":"Kinney","year":"1996","journal-title":"Arch. Oral Biol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/BF02474798","article-title":"Stress-strain studies in cadaveric human tendon and an anomaly in the young\u2019s modulus thereof","volume":"4","author":"Harris","year":"1966","journal-title":"Med. Biolog. Eng."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.ejvs.2010.02.015","article-title":"In Vitro Characterisation of Physiological and Maximum Elastic Modulus of Ascending Thoracic Aortic Aneurysms Using Uniaxial Tensile Testing","volume":"39","author":"Duprey","year":"2010","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.medengphy.2008.03.002","article-title":"Regional and directional variations in the mechanical properties of ascending thoracic aortic aneurysms","volume":"31","author":"Iliopoulos","year":"2009","journal-title":"Med. Eng. Phys."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"104705","DOI":"10.1016\/j.jmbbm.2021.104705","article-title":"Regional biomechanical and failure properties of healthy human ascending aorta and root","volume":"123","author":"Xuan","year":"2021","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e016715","DOI":"10.1161\/JAHA.120.016715","article-title":"Biomechanics of Aortic Dissection: A Comparison of Aortas Associated With Bicuspid and Tricuspid Aortic Valves","volume":"9","author":"Chung","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Liu, L., and \u00d6zsu, M.T. (2016). Cross-Validation. Encyclopedia of Database Systems, Springer.","DOI":"10.1007\/978-1-4899-7993-3"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ronneberger, O., Fischer, P., and Brox, T. (2015). U-Net: Convolutional Networks for Biomedical Image Segmentation. International Conference on Medical Image Computing and Computer-Assisted Intervention, Springer.","DOI":"10.1007\/978-3-319-24574-4_28"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Buslaev, A., Iglovikov, V.I., Khvedchenya, E., Parinov, A., Druzhinin, M., and Kalinin, A.A. (2020). Albumentations: Fast and Flexible Image Augmentations. Information, 11.","DOI":"10.3390\/info11020125"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1109\/LGRS.2018.2802944","article-title":"Road Extraction by Deep Residual U-Net","volume":"15","author":"Zhang","year":"2018","journal-title":"IEEE Geosci. Remote Sens. Lett."},{"key":"ref_34","unstructured":"Oktay, O., Schlemper, J., Folgoc, L.L., Lee, M.C.H., Heinrich, M.P., Misawa, K., Mori, K., McDonagh, S.G., Hammerla, N.Y., and Kainz, B. (2018). Attention U-Net: Learning Where to Look for the Pancreas. arXiv."},{"key":"ref_35","unstructured":"Chen, X., Yao, L., and Zhang, Y. (2020). Residual Attention U-Net for Automated Multi-Class Segmentation of COVID-19 Chest CT Images. arXiv."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"He, K., Zhang, X., Ren, S., and Sun, J. (2016, January 27\u201330). Deep Residual Learning for Image Recognition. Proceedings of the IEEE Conference on Computer Vision and Pattern Recognition (CVPR), Las Vegas, NV, USA.","DOI":"10.1109\/CVPR.2016.90"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Alom, M.Z., Hasan, M., Yakopcic, C., Taha, T.M., and Asari, V.K. (2018). Recurrent Residual Convolutional Neural Network based on U-Net (R2U-Net) for Medical Image Segmentation. arXiv.","DOI":"10.1109\/NAECON.2018.8556686"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Zhou, Z., Siddiquee, M.M.R., Tajbakhsh, N., and Liang, J. (2018). UNet++: A Nested U-Net Architecture for Medical Image Segmentation. Deep Learning in Medical Image Analysis and Multimodal Learning for Clinical Decision Support, Springer.","DOI":"10.1007\/978-3-030-00889-5_1"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"141","DOI":"10.11613\/BM.2015.015","article-title":"Understanding Bland Altman analysis","volume":"25","author":"Giavarina","year":"2015","journal-title":"Biochem. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.jvs.2022.01.146","article-title":"Geometrical determinants of target vessel instability in fenestrated endovascular aortic repair","volume":"76","author":"Squizzato","year":"2022","journal-title":"J. Vasc. Sur."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/2\/402\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T17:58:15Z","timestamp":1760119095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/2\/402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,4]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["jcm12020402"],"URL":"https:\/\/doi.org\/10.3390\/jcm12020402","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,4]]}}}