Aortic Size Assessment by Noncontrast Cardiac Computed Tomography: Normal Limits by Age, Gender, and Body Surface Area. Aortic root dimensions indexed by annulus. Background: eCollection 2022 Feb. Korean Circ J. BMI or BSA formulas can be used for body size, BSA was chosen as the adjusting body size variable for all subsequent analyses. Aortic valve area calculation by the Gorlin formula is an indirect method of determining AVA based on the flow through the valve during ventricular systole divided by the systolic pressure gradient across the valve times a constant (44.3). Multimodality Imaging to Explore Sex Differences in Aortic Stenosis. What Causes Enlarged Aortic Root? - Epainassist The flap should have a movement that is not parallel with any other cardio-thoracic structure. government site. Minners J, Gohlke-Baerwolf C, Kaufmann BA, Bahlmann E, Gerdts E, Boman K, Chambers JB, Nienaber CA, Willenheimer R, Wachtell K, Holme I, Pedersen TR, Neumann FJ, Jander N. Heart. U0# L _rels/.rels ( MO0HBKwAH!T~I$'TG~;#wqu*&rFqvGJy(v*K#FD.W =ZMYbBS7 ?9Lsbg|l!USh9ibr:"y_dlD|-NR"42G%Z4y7 PK ! All of the references Aortic Nomograms are described in the peer reviewed paper: Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons 15 years of age. Before Aortic Valve Annulus (mm): Sinus of Valsalva (mm): Sino-Tubular Junction (mm): Ascending Aorta (mm): Note: the study population had the following characteristics: age range: (0 - 17) bsa range: (0.12 - 2.12) Data entered for patients outside of these limits should be used with caution. Last, differences in aortic dimensions were also observed according to race: Asians had the smallest nonindexed aortic dimensions at all levels. Residuals of observed aortic diameters versus those predicted by multivariate models were calculated, and their relations to age, gender, body size (weight, height, or BSA) were assessed. Disclaimer. Standardized TTE and Doppler examinations were performed with market available equipment in all the subjects(Aloka 10; Aloka, Tokyo, Japan and Vivid 7; GE Healthcare, Milwaukee, Wisconsin). When compared with an aortic aneurysm, an aneurysm developing to the aortic root is fatal because it causes aortic valve leakage. The LV ejection fraction was calculated by the Simpson equation in the apical 4- and 2-chamber views. 2022 Aug 26. doi: 10.1007/s00392-022-02086-z. Additional studies have supported the use of BSA as a strong deter - minant of aortic dimensions.7-9 Sports with extremes of BSA and height, such as basketball and volleyball, have shown a higher prevalence of athletes with aortic roots Allometric scaling approach for normalization was applied. The Bland-Altman analysis gave a 95% confidence interval of5.1 1.1% for the aortic annulus, 4.1 1.2% for the sinuses of Valsalva, 4.3 1.1% for the sinotubular junction, and 5.1 1.5% for the maximum diameter of the proximal ascending aorta. A cornerstone of echocardiography is to ensure that normal reference intervals are available against which individual patients can be compared. BP= blood pressure; BSA= body surface area; LV= left ventricle. Clipboard, Search History, and several other advanced features are temporarily unavailable. the calculated cross-sectional aortic area. Berthelot-Richer M, Pibarot P, Capoulade R, Dumesnil JG, Dahou A, Thebault C, Le Ven F, Clavel MA. (PDF) Myocardial function after polarizing versus depolarizing cardiac Size-adjusted aortic valve area: refining the definition of severe aortic stenosis. 2016 Jul;9(7):797-805. doi: 10.1016/j.jcmg.2015.09.026. You should use a unique identifier, not the patients name to preserve confidentiality. Aorta Diameter Normal Range Data Data based on: Wolak A, Gransar H, Thomson LJ, et al. Left Atrial Volume Index (LAVI) Calculator - MDApp Any change in the value will pose trouble for any individual because the contraction and expansion make it difficult for the blood to flow smoothly through the aorta. There were no significant residual linear relations of age, gender, body size measurements (weight, height, or BSA) with thedifferences between observed and predicted aortic diameters. and transmitted securely. Differences among age, sex, and racial groups were evaluated using unpaired two-tailed Student's t tests. Athletes with an absolute aortic root size >99th percentile who also exhibited a Z score >3 did not show progressive aortic root enlargement over the follow-up period. Stroke volume index = Stroke volume in mL / Body surface area in m 2. Recent years have seen the publication of large, international, prospectively recruited studies from which the British Society of Echocardiography has now derived updated, robust reference intervals for use in echocardiographic practice within the UK. Mean Platelet Volume to Platelet Count Ratio Predicts Left Atrial All measurements were obtained in a zoomed parasternal long-axis view. Aorta and Pulmonary Artery Normal Diameter Size Range, Calculate Annulo-aortic ectasia can be an isolated condition or can occur as part of a generalised connective tissue disorder, e.g. BSA-indexed AR diameters stratified by age decades and gender are reported in Table4 . Sex Age [years] 60 Height [cm] 175 Weight [kg] 80 ascending aorta diameter, mean [mm] ascending aorta diameter, +2SD [mm] (threshold diameter) ascending aorta length, mean [mm] Our final study population therefore consisted of 1,043 healthy subjects (mean age 44.7 15.9years, range 16 to 92years, 503 men [48%]). LA Volume = (8 /3 ) x (A 1 x A 2 . Adjusting parameters of aortic valve stenosis severity by body size. Aortic Root Z-Scores for Children - The Marfan Foundation Specific measurements were made by the average of 5 cardiac cycles. Stay tuned! This website was funded in part by an education grant from the Chu and Chan Foundation | Website by: HeartSpark Design | Photography by: Tim Joyce Photography and Rick Guidotti. Aortic root | Radiology Reference Article | Radiopaedia.org three aortic sinuses of Valsalva: intraluminal . Stay tuned! Epub 2020 Nov 17. Height Alone, Rather Than Body Surface Area, Suffices for Risk Estimation in Ascending Aortic Aneurysm. Bethesda, MD 20894, Web Policies TAA size is the strongest predictor of acute aortic syndromes. National Library of Medicine Devereux RB, de Simone G, Arnett DK, Best LG, Boerwinkle E, Howard BV, Kitzman D, Lee ET, Mosley TH Jr, Weder A, Roman MJ. Among cardiovascular imaging techniques, 2-dimensional transthoracic color Doppler echocardiography (TTE) is widely available, safe, and cost-effective, and thus, it represents an excellent first-line screening tool toevaluate the aortic root (AR) morphology and dimensions. Full article: Is the aortic size index relevant as a predictor of Patients were stratified into four categories of yearly risk of complications based on ASI and AHI. The absolute aortic diameters were significantly greater in men than in women at all levels, whereas BSA-indexed aortic diameters were greater in women ( Table2 ). J Am Soc Echocardiogr. Specific views included the parasternal long- and short-axis views; apical 4-, 2-, and 3-chamber views; and subcostal views including respiratory motion of the inferior vena cava. Nomograms of aortic dimensions at the SoV level according to different heights for three age groups. Women were slightly older, lighter, and smaller than men. oculus quest 2 floor level too high Click To Call Now (270) 478-5489; battle of the bulge ww2 quizlet In international guidelines, risk estimation for thoracic ascending aortic aneurysm (TAAA) is based on aortic diameter. Aortic Root Diameter Calculator - CALCKP - Calckp.blogspot.com BCH Z-Score Calculator - Home Patient Info cm Height (cm) kg Weight (kg) Age (yr) Sex Male Female BSA (m^2) BMI (kg/m^2) Regression Info Context Echocardiography Group All Regression Select regression . The entire aorta divides into two parts: the thoracic aorta and the abdominal aorta. An enlarged aortic root is similar to that of an aneurysm. However, weight might not contribute substantially to aortic size and growth. It then runs up the chest, behind the breastbone, and down the . iOS privacy policy Posted on february 28, 2022, Source: openi.nlm.nih.gov. 1,2 This is based on a sharp rise in the risk of . PDF Aortic Size Assessment by Noncontrast Cardiac Computed Tomography Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons 15 years of age. Aortic dimensions now indexed for height and not BSA Should be obtained in end-diastole using inner-edge to inner-edge method Whereas previously there were different reference ranges for aortic dimensions according to age, the Society now produces age-independent ranges for men and women Read the guideline Poster orders BSA was calculated according to the DuBois formula [0.20247 height (m) 0.725 weight (kg) 0.425]. Aortic Size Assessment by Noncontrast Cardiac Computed Tomography: Normal Limits by Age, Gender, and Body Surface Area. Cuspidi C, Facchetti R, Bombelli M, Seravalle G, Grassi G, Mancia G. Clin Res Cardiol. Step 3: The BSA and Maximum SOV Diameter (Aortic Root Diameter) is Calculated. aortic root size indexed to bsa calculator Aortic Root Z-Scores for Adults. However, especially among obese individuals, weight probably does not play as important a role as does height in indexing various measures to body size. Am J Cardiol. The Society no longer advocates division into mild or moderate LV impairment, Measured using the Biplane Simpsons method and indexed to BSA, A new borderline LA volume range of 34-38ml/m. 2008;1 (2):200-209. The aorta gradually narrows as it moves down through the chest. Similarities and Differences in Left Ventricular Size and Function among Races and Nationalities: Results of the World Alliance Societies of Echocardiography Normal Values Study. aortic root size indexed to bsa calculator Calculator How to get Maximum SOV Diameter. #^ NpnL9+>IUKsuIu)7[.p`,%K&LXA9 ++-/964^Td[@? No significant gender differences were registered for sinuses of Valsalva and sinotubular junction to annulus diameter ratios (p= 0.9), whereas ascending aorta to annulus diameter ratio was higher in women (p= 0.0001). Published by Elsevier Inc. All rights reserved. sharing sensitive information, make sure youre on a federal An official website of the United States government. To determine whether we were allowed to calculate common scaling exponents for the whole group of men and women, gender was included as a dummy variable in the analysis. What is the Normal Size of the Aortic Root? Aortic Dilatation and Dissection in Turner Syndrome | Circulation An online calculator for the borderline left ventricle: consolidated reporting of the Rhodes score, Discriminant score, and the CHSS scores. ( 20 ), in which the diameter of each segment of the aorta and BSA International guidelines use uncorrected aortic diameter to estimate the risks of aortic dissection, rupture, or death among patients with TAAA. The .gov means its official. This group previously published data that used aortic diameter indexed to BSA as a more patient-specific predictor of risk. J Am Coll Cardiol Img. 2016 Nov;9(11):e005121. AHI categories 3.05-3.69, 3.70-4.34, and 4.35 cm/m were associated with a significantly increased risk of complications (p < 0.05). FOIA J Am Soc Echocardiogr. Current echocardiographic guidelines for identification of aortic root dilatation are limited because current normative values were derived predominantly from white individuals in narrow age ranges, and based partially on M-mode measurements. Aorta dimensions are variably dependent on age, gender, and body size. Ascending aortic aneurysms: pathophysiology and indications for surgery A total of 190 untreated and treated essential hypertensive patients (mean age, 5511 years) were considered for this analysis. The overall fit of the model using AHI was modestly superior based on the concordance statistic. Indexing aortic valve area by body surface area increases the - PubMed 2019 Jun 15;123(12):2015-2021. doi: 10.1016/j.amjcard.2019.03.013. Epub 2020 Jan 9. Don't worry, my wisdom won't change. Background To account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVA index ). Currently, different echocardiographic nomograms are used to calculate aortic root Z-scores. sharing sensitive information, make sure youre on a federal A diameter of < 40 mm and a ratio left atrium/aortic root of < 1.3 are considered normal. Join us in the fight for victory over genetic aortic and vascular conditions. Borderline LV | dev.parameterz.com The annulus, which lacks a planar structure, is compressed to the round-shaped prosthesis after conventional AVR. The BSA and Maximum SOV Diameter (Aortic Root Diameter) is Calculated. Disclaimer. Aortic root dilation (AoD) is frequently an incidentally discovered, asymptomatic finding in that is seen on various imaging modalities [].The anatomy of the aortic root includes the annulus, sinuses of Valsalva, sinotubular junction and ascending aorta [], with the size being a function of a patient's biologic variables such as height, age, BSA, and gender [1, 2]. Discordant Grading of AorticStenosisSeverity: Echocardiographic Predictors of Survival Benefit AssociatedWith Aortic Valve Replacement. 8600 Rockville Pike Asch FM, Miyoshi T, Addetia K, Citro R, Daimon M, Desale S, Fajardo PG, Kasliwal RR, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Ronderos RE, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Tude Rodrigues AC, Vivekanandan A, Zhang Y, Blitz A, Lang RM; WASE Investigators. You may email this form to yourself to include in your patient file. Twenty anaesthetized young pigs, 42 2 (standard deviation) kg on standardized tepid cardiopulmonary bypass (CPB) were randomized (10 per group) to depolarizing or polarizing cardiac arrest for 60 min with cardioplegia administered in the aortic root every 20 min as freshly mixed cold, intermittent, oxygenated blood. Normal Aortic Dimensions: From A-to-Z Score. The site is secure. Using aortic size index, patients were stratified into three risk groups: less than 2.75 cm/m 2 are at low risk (approximately 4% per year), 2.75 to 4.24 cm/m 2 are at moderate risk (approximately 8% per year), and those above 4.25 cm/m 2 are at high risk (approximately 20% per year). Introduction. Copyright 2015 - 2016 Radiology Universe Institute, a public benefit corporation. Soulat-Dufour L, Addetia K, Miyoshi T, Citro R, Daimon M, Fajardo PG, Kasliwal RR, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Ronderos RE, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Tude Rodrigues AC, Vivekanandan A, Zhang Y, Diehl M, Schreckenberg M, Mor-Avi V, Asch FM, Lang RM; WASE Investigators. Web at an aortic root size in the small normal range of 2.0 to 2.4 cm, the prevalence of aortic regurgitation was 0% to 15%. Principally, the Society wanted to ensure that reference intervals were derived from the most contemporaneous and prospectively acquired data; that reference intervals were derived from evidence that best applies to the British population; and finally that echo guidance and cut-offs reflect UK practice. Aortic diameters were independently associated with age, gender (model A), and BSA (model B); weight and height did not have any additional significant impact on aortic dimension (model C; Table6 ). The function of the normal sinuses is to prevent occlusion of the coronary artery ostia during systole when the aortic valve opens. 2022 Oct;52(10):721-736. doi: 10.4070/kcj.2022.0234. Observational study of regional aortic size referenced to body size Careers. Indexing of aortic root diameters to BSA had a reverse effect and revealed significantly larger aortic root diameters for women (Table 2 ). There were no differences between athletes and controls when the aortic diameter was indexed for BSA (15.52.0 mm/m 2 (range 8.5-26.0 mm/m 2) . in aortic root dimensions are small and fall within the established limits for the general population. Results. The specific manner in which these measurements are obtained is of obvious importance. An aneurysm is a weak spot in a blood vessel wall. Published by at june 13, 2022. Charity number:1093808, Our office is open SE1 0LH, Company number:04480121 PDF Aortic size index enlargement is associated with central hemodynamics MeSH Design. Federal government websites often end in .gov or .mil. and transmitted securely. This site needs JavaScript to work properly. Invasive Cardiovascular Angiography and Intervention, Screening for CAD in Cancer Survivors: Key Points, Findings From NCDR AFib Ablation Registry, Outcomes of Simultaneous Heart and Kidney Transplantation, Cardiac Damage and Quality of Life After Aortic Valve Replacement, Pregnancy in Women With Congenital Heart Disease and Pulmonary Hypertension, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism. The Bland-Altman analysis gave a 95% confidence interval of 4.1 1.1% for the aortic annulus, 3.9 1.1% for the sinuses of Valsalva, 4.1 1.1% for the sinotubular junction, and 4.8 1.3% for the maximum diameter of the proximal ascending aorta. Median age was 52 years, and 396 (40%) were men. All rights reserved. Knowledge of upper physiological limits of aortic dimensions is mandatory to detect aorta dilatation, follow up the disease over time, and plan appropriate therapeutic interventions. The following model wasfitted: log(diameter)= log a+ b log(weight)+ c log(height)+ d sex (coded 1 for men and 2 for women) or, in its exponential form: diameter= a weight b height c sex d . Conclusions: According to these criteria, 76 subjects were excluded: 2 for coronary artery disease, 10 for systemic arterial hypertension, 4 for diabetes mellitus, 8 for body mass index >30kg/m 2 , 7 for more than mild valvular insufficiency (3 mitral, 2 aortic, and 2 tricuspid), 2 for aortic stenosis, 4 for bicuspid aortic valve, 1 for hypertrophic cardiomyopathy, 1 for AR dilation, 1 for dilated cardiomyopathy, 8 for the use of pharmacologic treatment (hyperlipidemia, breast cancer, thyroid, gout, and prostate disease), 20 elite athletes, and 8 for inadequate echocardiographic image quality. T32 HL007381/HL/NHLBI NIH HHS/United States. calculator - aorticcalculator Normal Values of Aortic Root Dimensions in Healthy Adults Risk stratification was performed using regression models. Select a calculator from the menu above. Keywords: The aim of this study was to explore the full spectrum of AR diameters by 2-dimensional transthoracic color Doppler echocardiography (TTE) in a large cohort of healthy adults. Accessibility Cut-off values for severe stenosis are <1.0 cm 2 for AVA and <0.6 cm 2 /m 2 for AVA index. BSA is calculated using the method of Dubois and Dubois. Cells | Free Full-Text | Insights into the Role of a Cardiomyopathy However, weight might not contribute substantially to aortic size and growth. HHS Vulnerability Disclosure, Help Hypertension has also been frequently reported to increase the diameters of large arteries . Changes in the assessment of the aortic root: Aortic dimensions now indexed for height and not BSA, Should be obtained in end-diastole using inner-edge to inner-edge method, Whereas previously there were different reference ranges for aortic dimensions according to age, the Society now produces age-independent ranges for men and women. Ligurian Group of SIEC (Italian Society of Echocardiography)]. 2021 Sep 20;22(10):1142-1148. doi: 10.1093/ehjci/jeaa295. All ct short axis measurements of the aortic root had excellent. Ring L, Shah BN, Bhattacharyya S, Harkness A, Belham M, Oxborough D, Pearce K, Rana BS, Augustine DX, Robinson S, Tribouilloy C. Echo Res Pract. What are the parts of the ascending aorta? BCH Z-Score Calculator - Home Reproducibility of aortic measurements was determined in 50 subjects randomly selected. Normal Values of Aortic Root Dimensions in Healthy Adults doi: 10.1530/ERP-20-0035. (PDF) Sex-specific Morphometric Analysis of Ascending Aorta and Aortic The biological variables recognized to influence aortic root size include age, sex, indexes of body size, systolic and diastolic blood pressures, and stroke volume. To investigate the influence of indexation on the prevalence of severe aortic stenosis and on the predictive accuracy regarding clinical outcome. Indexed body surface area aortic diameters, stratified by age and gender, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Normal Values of Aortic Root Dimensions in Healthy Adults, Aortic Root Dimensions and Stiffness in Healthy Subjects, Advances in Catheter Ablation of Primary Ventricular Fibrillation, Normal Values and Differences in Ascending Aortic Diameter in a Healthy Population of Adults as Measured by the Pediatric versus Adult American Society of Echocardiography Guidelines, Heart Rate Recovery After Exercise in Adults With the Down Syndrome, Standardizing the Method of Measuring by Echocardiogram the Diameter of the Ascending Aorta in Patients With a Bicuspid Aortic Valve, Reference Values of Tricuspid Annular Peak Systolic Velocity in Healthy Pediatric Patients, Calculation of Z Score, and Comparison to Tricuspid Annular Plane Systolic Excursion, Left Ventricular and Ascending Aortic Function After Stenting of Native Coarctation of Aorta, American Journal of Cardiology Volume 114 Issue 6. Enter the Height, Weight, and Age of the Patient. 3.4.3 Left atrial size | 123 Sonography Two-tailed p value <0.05 was considered statistically significant. Results from 88 thoracic and 110 abdominal contrast material-enhanced CT examinations were analyzed in children without known cardiovascular disease who ranged in age from 0 to 20 years (mean, 9.9 years; standard deviation, 5.7), with BSA ranging from 0.19 to 2.52 m 2.Excellent interrater reliability was present (correlation coefficients ranged from 0.95 to 0.98). Valvular regurgitation was quantified from color Doppler imaging and categorized as absent, minimal (within normal limits), mild, moderate, or severe. doi: 10.1161/CIRCIMAGING.116.005121. X X-Axis value Y Y-Axis value Calculate Age Range (yr) Unspecified BSA Range (m^2) Unspecified BMI Range (kg/m^2) Unspecified Z-Score (Undefined) After indexing to BSA, all measured dimensions were significantly larger in women, whereas men continued to show larger dimensions after indexing to height. I just wanted to let you know that even though I'm looking quite old, I'm still a millenial. Pathogenic variants in ACTN2, coding for alpha-actinin 2, are known to be rare causes of Hypertrophic Cardiomyopathy. Am J Cardiol. We previously introduced the aortic size index (ASI), defined as aortic size/body surface area (BSA), as a predictor of aortic dissection, rupture, and death. Sinus of Valsalva aneurysms can be either congenital or acquired. The https:// ensures that you are connecting to the 2014 Jul-Aug;57(1):47-54. doi: 10.1016/j.pcad.2014.05.006. Z-Score for Adults - Marfan Foundation Copyright 2000-2023 JLS Interactive, LLC. Size-Adjusted Left Ventricular Outflow Tract Diameter Reference Values To account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVAindex). The normal sinus diameter is less than 4.0 cm for men and 3.6 cm for women. Colored area represents upper and lower limits of normal, with the equation for the former (ULN) shown below each plot. The aortic size index (ASI) is defined as the AD divided by BSA. The ascending aorta is about 5 to 8 centimeters (or close to 2 to 3 inches) long. All aortic root dimensions were larger in men compared with women. Pulsed and continuous-wave Doppler interrogations were performed on all 4 cardiac valves. Am J Cardiol. 2008;1(2):200-209. 164-180 Union Street Prog Cardiovasc Dis. The intraobserver variability analysis revealed Pearson correlations as follows: r= 0.90 (p <0.0001) for the aortic annulus, r= 0.97 (p <0.0001) for the sinuses of Valsalva, r= 0.96 (p <0.0001) for the sinotubular junction, and r= 0.86 (p <0.0001) for the maximum diameter of the proximal ascending aorta. The hearts were formalin-fixed and the valve circumference data were transformed into valve diameters. Three models were developed in multiple regression analysis to explain aortic dimensions. Federal government websites often end in .gov or .mil. Exclusion criteria were coronary artery disease, systemic arterial hypertension, diabetes mellitus, valvular or congenital heart disease, bicuspid aortic valve, congestive heart failure, cardiomyopathies, sinus tachycardia, use of illicit drugs, elite athletes, and inadequate echocardiographic image quality. Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons 15 years of age. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Please enable it to take advantage of the complete set of features! So I just had a "New Year, New Me" moment and my resolution is to become a new and improved version of myself in a couple of weeks. Epub 2021 Dec 14. Look up reference values adjusted for age, gender, and body size for the aortic root (aortic valve and sinus of valsalva) using data published in the american journal of. . doi: 10.1016/j.echo.2019.08.012. Last updated: 30 Mar 2013|Home|About|Contact|Disclaimer|Top, measurements are made in systole, at the moment of maximum expansion, measurements are made from "inside edge-to-inside" edge, i.e., the intraluminal dimension, the aortic valve is measured from the hinge points (inner edges), vascular measurements are made perpendicular to the long axis of the vessel, vascular measurements are made at end-diastole, measurements are made from "leading edge-to-leading edge". Dashed lines show existing guideline data ; colored area represents the upper and lower limits of normal, with the equation for the former (ULN) shown below each plot.
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