• OSF researchers developed an AI tool that creates a 3D model of the aorta and generates hundreds of precise measurements in seconds.
• More accurate and consistent measurements could help doctors detect aneurysm growth earlier and determine the safest time for surgery.
• The technology could eventually support automated diagnosis and improve care for patients with conditions such as Marfan syndrome and Turner syndrome.

A team at OSF HealthCare is developing an artificial intelligence-powered tool designed to improve how physicians measure and monitor the aorta, a breakthrough that could help doctors detect dangerous aneurysms earlier and make more informed decisions about when surgery is needed.

The project, led by pediatric cardiologist Mathew Bramlet, MD, at OSF HealthCare Children's Hospital of Illinois, combines expertise from OSF HealthCare, Jump Simulation and Education Center, the University of Illinois College of Medicine Peoria and University of Illinois engineering researchers. The technology creates a highly detailed three-dimensional "digital twin" of a patient's anatomy from MRI or CT scans, allowing software to automatically analyze the aorta in seconds instead of requiring lengthy manual measurements.

The aortic arch project, funded through a Jump ARCHES grant, is aimed at improving longitudinal surveillance and the diagnosis and the tracking of aortic aneurysms, so they don’t tear or rupture. The aorta is the main and largest artery in the human body, carrying oxygen-rich blood from the left ventricle of the heart to the rest of the body. An aneurysm is a large bulge in that artery.

Accurate measurements are critical

Dr. Bramlet says measurements that document any expansion of the aneurysm need to be obtained with clear imaging with an expert eye that is generating reproducible measurements. Since high-risk surgery can hinge on one measurement, the accuracy of that measurement at one point in time, or over years as the growth of the aneurysm is monitored, becomes critically important. Among the complications doctors trying to prevent is an aortic dissection which recently killed Senator Lindsey Graham of North Carolina.

Currently, physicians often compare scans taken over many years to determine whether an aneurysm has grown enough to justify preventative surgery — a decision that carries significant risks if performed too early or too late. Manually measuring the aorta can take about 30 minutes and depends heavily on specialist expertise like that of Dr. Bramlet.

The new software automates that process, which Dr. Bramlet explains can generate up to 300 measurements in about 30 seconds while improving consistency.

“If we can capture this aorta and generate those same measurements with fancy new math and machine learning programs, we can distribute the expertise that I have accumulated over years and years and years, essentially into a program that would allow this type of analysis to be distributed at a larger scale.”

The automated approach also could allow researchers to analyze thousands of patient scans, helping develop more personalized treatment guidelines for conditions such as Marfan syndrome and Turner syndrome.

Aorta library will be created

The project is also creating a library of 3D digital models of healthy and diseased aortas that could eventually support automated diagnosis.

"The model library that we will have, where we can compare a diseased aorta to a normal aorta and look for the differences, it's a much easier automated process to get toward automated diagnosis, automated analysis and this is really the mindset of the entire lab,” says Dr. Bramlet.

Dr. Bramlet directs the Advanced Imaging and Modeling Lab at OSF Jump Simulation.

Beyond aortic disease, the underlying technology is designed to create digital models of multiple organs, opening the door to broader AI-assisted imaging analysis across medicine.

For Dr. Bramlet, it is exciting to see how this will be able to help provide better guidance for diagnosis and surgery determinations. The team is continuing to validate the technology through research while working toward clinical deployment – something Dr. Bramlet says is unique to OSF HealthCare.

“To have a hospital institution assign operational resources towards a clinical tool but I believe it is the commitment to serve people and to actually see the fruits of that labor being deployed within this institution really makes it a special place.”

In research conducted, this tool showed that automated 3D measurements closely match those done by clinicians, paving the way for a shift from traditional 2D imaging to more advanced 3D analysis.

Dr. Mathew Bramlet is also an associate professor of Clinical Pediatrics at the University of Illinois College of Medicine in Peoria.

Video clips with Dr. Mathew Bramlet

B-roll-Aortic aneurysm detection

The death of U.S. Senator Lindsey Graham from an aortic dissection has brought renewed attention to a rare but life-threatening medical emergency that doctors say requires immediate diagnosis and treatment to improve the chance of survival.

An aortic dissection occurs when a tear develops in the wall of the aorta, the body's largest artery, allowing blood to separate the layers of the vessel wall. Bill Novak, MD, a cardiologist at OSF HealthCare, says it’s like a crack in a pipe and it can get bigger and create a tear with increased pressure, including from high blood pressure. Although uncommon, with it occurring in about 3 to 3.5 per 100,0000 people, aortic dissection can quickly become fatal if it is not recognized and treated.

“The aorta is the main artery that leaves your heart, and if you have a tear in the aorta, it can be potentially life-threatening. It can cause a heart attack. It can cause stroke. It can cause heart failure, rupture of the aorta, and sudden death.”

Many aortic dissection symptoms overlap with other medical emergencies. Actor John Ritter died after his aortic dissection was misdiagnosed and it was treated as a heart attack.

Challenge to diagnose

"It's dangerous because it's relatively uncommon," says Dr. Novak. "It can sometimes be a challenge to diagnose since a lot of the symptoms overlap with heart attack and other conditions such as pulmonary embolism, and it's obviously a potentially life-threatening type of a problem."

Diagnosis requires immediate emergency imaging such as an MRI or an echocardiogram.

Anyone experiencing sudden, excruciating pain or other unexplained symptoms to seek emergency care immediately. Dr. Novak says while severe chest or back pain is often considered the hallmark symptom, people can also experience shortness of breath, fainting, heart failure or reduced blood flow to the arms or legs.

Treatment varies depending on the location and severity of the tear. Some patients require emergency surgery, either through an open surgical procedure or an endovascular approach, while others can be managed with medications (like beta-blockers) to strictly lower blood pressure and reduce the force of heart contractions. Surgery or stent placement may be needed if complications arise.

Dr. Novak says people at the greatest risk include older adults.

Know the risks

“How old you are is important. That increases your risk. If you smoke, that’s going to increase your risk and obviously treating your cholesterol is going to reduce the chance you’re going to develop certain types of plaque in your arteries which can also put you at a higher risk for having this problem.”

Senator Graham had a history of atherosclerosis (plaque build-up), also known as hardening of the arteries.

There are other people Dr. Novak points out who need to be monitored regularly, including those with conditions such as Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome which weaken blood vessel walls and are the primary cause of aortic dissection in younger individuals.

“If you do have some risk factors such as a bicuspid valve, connective tissue disease, or an aneurysm, those things do have to be monitored on a regular basis."

An aneurysm is a bulging, weak area in the wall of a blood vessel. While it can occur in any blood vessel, it most often develops in an artery rather than a vein. An aortic aneurysm is the most common type.

While aortic dissection remains relatively rare, physicians say the national attention surrounding Graham's death serves as a reminder that recognizing warning signs and seeking emergency medical care without delay can save lives. Also, family history is important. If you have a close relative who has suffered from an aortic aneurysm or sudden arterial dissection, early testing and genetic counseling can be lifesaving.

Dr. Bill Novak is a cardiologist at OSF Cardiovascular Institute in Bloomington.

Video clips with Dr. Bill Novak