Acceleration of Subtractive Non-contrast-enhanced Magnetic Resonance Angiography

Although contrast-enhanced magnetic resonance angiography (CE-MRA) is widely established as a clinical examination for the diagnosis of human vascular diseases, non-contrast-enhanced MRA (NCE-MRA) techniques have drawn increasing attention in recent years. NCE-MRA is based on the intrinsic physical properties of blood and does not require the injection of any exogenous contrast agents. Subtractive NCE-MRA is a class of techniques that acquires two image sets with different vascular signal intensity, which are later subtracted to generate angiograms. The long acquisition time is an important drawback of NCE-MRA techniques, which not only limits the clinical acceptance of these techniques but also renders them sensitive to artefacts from patient motion. Another problem for subtractive NCE-MRA is the unwanted residual background signal caused by different static background signal levels on the two raw image sets. This thesis aims at improving subtractive NCE-MRA techniques by addressing both these limitations, with a particular focus on three-dimensional (3D) femoral artery fresh blood imaging (FBI). The structure of the thesis is as follows: Chapter 1 describes the anatomy and physiology of the vascular system, including the characteristics of arteries and veins, and the MR properties and flow characteristics of blood. These characteristics are the foundation of NCE-MRA technique development. Chapter 2 introduces commonly used diagnostic angiographic methods, particularly CE-MRA and NCE-MRA. Current NCE-MRA techniques are reviewed and categorised into different types. Their principles, implementations and limitations are summarised. Chapter 3 describes imaging acceleration theories including compressed sensing (CS), parallel imaging (PI) and partial Fourier (PF). The Split Bregman algorithm is described as an efficient CS reconstruction method. The SPIRiT reconstruction for PI and homodyne detection for PF are also introduced and combined with Split Bregman to form the basis of the reconstruction strategy for undersampled MR datasets. Four image quality metrics are presented for evaluating the quality of reconstructed images. In Chapter 4, an intensity correction method is proposed to improve background suppression for subtractive NCE-MRA techniques. Residual signals of background tissues are removed by performing a weighted subtraction, in which the weighting factor is obtained by a robust regression method. Image sparsity can also be increased and thereby potentially benefit CS reconstruction in the following chapters. Chapter 5 investigates the optimal k-space sampling patterns for the 3D accelerated femoral artery FBI sequence. A variable density Poisson-disk with a fully sampled centre region and missing partial Fourier fractions is employed for k-space undersampling in the ky-kz plane. Several key parameters in sampling pattern design, such as partial Fourier sampling ratios, fully sampled centre region size and density decay factor, are evaluated and optimised. Chapter 6 introduces several reconstruction strategies for accelerated subtractive NCE-MRA. A new reconstruction method, k-space subtraction with phase and intensity correction (KSPIC), is developed. By performing subtraction in k-space, KSPIC can exploit the sparsity of subtracted angiogram data and potentially improve the reconstruction performance. A phase correction procedure is used to restore the polarity of negative signals caused by subtraction. The intensity correction method proposed in Chapter 4 is also incorporated in KSPIC as it improves background suppression and thereby sparsity. The highly accelerated technique can be used not only to reduce the acquisition time, but also to enable imaging with increased resolution with no time penalty. A time-efficient high-resolution FBI technique is proposed in Chapter 7. By employing KSPIC and modifying the flow-compensation/spoiled gradients, the image matrix size can be increased from 256×256 to up to 512×512 without prolonging the acquisition time. Chapter 8 summarises the overall achievements and limitations of this thesis, as well as outlines potential future research directions.Cambridge Trust China Scholarship Council Addenbrooke’s Charitable Trust National Institute of Health Research, Cambridge Biomedical Research Cente

A study of the anatomical variations of the carotid arterial tree in Equidae

The internal carotid artery in the horse is of significant veterinary importance due to its intimate relationship with the guttural pouch, and mycotic disease thereof. The relevance of recognising and identifying variations involving the internal carotid artery lies in the fact that surgical occlusion of the artery is the treatment of choice for guttural pouch mycosis. However, occlusion could be hampered when there is doubt about the anatomy of this vessel and its variation. Conventional angiography and automatic rotational angiographic techniques were used to study the anatomy of the carotid trifurcation and the internal carotid artery on cadavers of three species included in the genus Equus; 50 horses, 26 donkeys and one zebra. Following angiography, arterial latex casting was performed on the horse and donkey specimens with subsequent dissection to harvest the hardened arterial casts. Rotational angiography with 3-dimensional image reconstruction represent a major advantage in the angiographic diagnosis of carotid and cerebral vascular variation compared to conventional angiography. This technique generated superior angiographic images of the carotid and cerebral vascular system of horses, donkey and zebra. In the horse, five variations of the internal carotid artery were identified as follows: [1] the internal carotid artery and occipital artery arising as a common trunk, [2] an aberrant branch of the internal carotid artery that unites with the basilar artery, [3] an aberrant branch of the internal carotid artery that does not unite with the basilar artery, [4] aberrant branch of the internal carotid artery that gives rise to several satellite branches, [5] aberrant branch of the internal carotid artery that has a satellite branch connected to the caudal branch of the ipsilateral occipital artery. Variations of the carotid arterial tree in donkeys were identified as follow: [1] the internal carotid and occipital arteries shared a common trunk, [2] the linguofacial trunk originated from the common carotid artery causing the common carotid artery to terminate as four branches, [3] a short external carotid artery before giving rise to the linguofacial trunk, mimicking the appearance of the common carotid artery terminating into four branches, [4] the internal carotid artery originating far more caudal from the common carotid artery termination. The carotid arterial anatomy of the one zebra studied here showed no discrepancy to the accepted common anatomical pattern of this structure. Aneurysm formation was not identified in any of the specimens

A framework for intracranial saccular aneurysm detection and quantification using morphological analysis of cerebral angiograms

Reliable early prediction of aneurysm rupture can greatly help neurosurgeons to treat aneurysms at the right time, thus saving lives as well as providing significant cost reduction. Most of the research efforts in this respect involve statistical analysis of collected data or simulation of hemodynamic factors to predict the risk of aneurysmal rupture. Whereas, morphological analysis of cerebral angiogram images for locating and estimating unruptured aneurysms is rarely considered. Since digital subtraction angiography (DSA) is regarded as a standard test by the American Stroke Association and American College of Radiology for identification of aneurysm, this paper aims to perform morphological analysis of DSA to accurately detect saccular aneurysms, precisely determine their sizes, and estimate the probability of their ruptures. The proposed diagnostic framework, intracranial saccular aneurysm detection and quantification, first extracts cerebrovascular structures by denoising angiogram images and delineates regions of interest (ROIs) by using watershed segmentation and distance transformation. Then, it identifies saccular aneurysms among segmented ROIs using multilayer perceptron neural network trained upon robust Haralick texture features, and finally quantifies aneurysm rupture by geometrical analysis of identified aneurysmic ROI. De-identified data set of 59 angiograms is used to evaluate the performance of algorithms for aneurysm detection and risk of rupture quantification. The proposed framework achieves high accuracy of 98% and 86% for aneurysm classification and quantification, respectively

Digital ocular fundus imaging: a review

Ocular fundus imaging plays a key role in monitoring the health status of the human eye. Currently, a large number of imaging modalities allow the assessment and/or quantification of ocular changes from a healthy status. This review focuses on the main digital fundus imaging modality, color fundus photography, with a brief overview of complementary techniques, such as fluorescein angiography. While focusing on two-dimensional color fundus photography, the authors address the evolution from nondigital to digital imaging and its impact on diagnosis. They also compare several studies performed along the transitional path of this technology. Retinal image processing and analysis, automated disease detection and identification of the stage of diabetic retinopathy (DR) are addressed as well. The authors emphasize the problems of image segmentation, focusing on the major landmark structures of the ocular fundus: the vascular network, optic disk and the fovea. Several proposed approaches for the automatic detection of signs of disease onset and progression, such as microaneurysms, are surveyed. A thorough comparison is conducted among different studies with regard to the number of eyes/subjects, imaging modality, fundus camera used, field of view and image resolution to identify the large variation in characteristics from one study to another. Similarly, the main features of the proposed classifications and algorithms for the automatic detection of DR are compared, thereby addressing computer-aided diagnosis and computer-aided detection for use in screening programs.Fundação para a Ciência e TecnologiaFEDErPrograma COMPET

The Role of 3 Tesla MRA in the Detection of Intracranial Aneurysms

Intracranial aneurysms constitute a common pathological entity, affecting approximately 1–8% of the general population. Their early detection is essential for their prompt treatment. Digital subtraction angiography is considered the imaging method of choice. However, other noninvasive methodologies such as CTA and MRA have been employed in the investigation of patients with suspected aneurysms. MRA is a noninvasive angiographic modality requiring no radiation exposure. However, its sensitivity and diagnostic accuracy were initially inadequate. Several MRA techniques have been developed for overcoming all these drawbacks and for improving its sensitivity. 3D TOF MRA and contrast-enhanced MRA are the most commonly employed techniques. The introduction of 3 T magnetic field further increased MRA's sensitivity, allowing detection of aneurysms smaller than 3 mm. The development of newer MRA techniques may provide valuable information regarding the flow characteristics of an aneurysm. Meticulous knowledge of MRA's limitations and pitfalls is of paramount importance for avoiding any erroneous interpretation of its findings

Coronary Artery Segmentation and Motion Modelling

Conventional coronary artery bypass surgery requires invasive sternotomy and the use of a cardiopulmonary bypass, which leads to long recovery period and has high infectious potential. Totally endoscopic coronary artery bypass (TECAB) surgery based on image guided robotic surgical approaches have been developed to allow the clinicians to conduct the bypass surgery off-pump with only three pin holes incisions in the chest cavity, through which two robotic arms and one stereo endoscopic camera are inserted. However, the restricted field of view of the stereo endoscopic images leads to possible vessel misidentification and coronary artery mis-localization. This results in 20-30% conversion rates from TECAB surgery to the conventional approach. We have constructed patient-specific 3D + time coronary artery and left ventricle motion models from preoperative 4D Computed Tomography Angiography (CTA) scans. Through temporally and spatially aligning this model with the intraoperative endoscopic views of the patient's beating heart, this work assists the surgeon to identify and locate the correct coronaries during the TECAB precedures. Thus this work has the prospect of reducing the conversion rate from TECAB to conventional coronary bypass procedures. This thesis mainly focus on designing segmentation and motion tracking methods of the coronary arteries in order to build pre-operative patient-specific motion models. Various vessel centreline extraction and lumen segmentation algorithms are presented, including intensity based approaches, geometric model matching method and morphology-based method. A probabilistic atlas of the coronary arteries is formed from a group of subjects to facilitate the vascular segmentation and registration procedures. Non-rigid registration framework based on a free-form deformation model and multi-level multi-channel large deformation diffeomorphic metric mapping are proposed to track the coronary motion. The methods are applied to 4D CTA images acquired from various groups of patients and quantitatively evaluated

multicenter intraindividual comparison of single dose gadobenate dimeglumine and double dose gadopentetate dimeglumine for mr angiography of the supra aortic arteries the supra aortic value study

BACKGROUND AND PURPOSE: Gadobenate dimeglumine has markedly higher R1 relaxivity compared to gadopentetate dimeglumine meaning that lower doses can be used to achieve similar contrast enhancement. Our aim was to prospectively compare single-dose gadobenate dimeglumine with double-dose gadopentetate dimeglumine for contrast-enhanced MRA of the supra-aortic vasculature. MATERIALS AND METHODS: Forty-six patients (37 men, 9 women; mean age, 63.5 ± 10.1 years) with known or suspected steno-occlusive disease of the supra-aortic vessels underwent 2 identical CE-MRA examinations at 1.5T. Contrast agents were administered in randomized order, with the 2-fold greater volume of gadopentetate dimeglumine injected at a 2 times faster rate. Image assessment was performed by 3 independent blinded readers for vessel anatomic delineation, detection/exclusion of pathology, and global preference. Diagnostic performance (sensitivity, specificity, accuracy, PPV, and NPV) for detection of ≥60% stenosis was determined for 39/46 patients who underwent preinterventional DSA. Data were analyzed by using the Wilcoxon signed-rank, McNemar, and Wald tests in terms of the noninferiority of single-dose gadobenate dimeglumine compared with double-dose gadopentetate dimeglumine. Quantitative enhancement (signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)) was also compared. RESULTS: All images were technically adequate. No differences (P = 1.0) were noted by any reader for any qualitative parameter. All readers considered single-dose gadobenate dimeglumine and double-dose gadopentetate dimeglumine equivalent in at least 42/46 patients (91.3% three-reader agreement) for all parameters. Nonsignificant superiority for gadobenate dimeglumine was reported for all diagnostic performance indicators (sensitivity: 82.7%–88.5% versus 75.0%–80.8%; specificity: 96.4%–98.6% versus 94.6%–98.6%; accuracy: 94.6%–96.1% versus 92.4%–94.9%; PPV: 81.5%–91.5% versus 73.7%–90.7%; NPV: 96.8%–97.8% versus 95.4%–96.4%). No differences (P > .05) in quantitative enhancement were noted. CONCLUSIONS: The image quality and diagnostic performance achieved with 0.1-mmol/kg gadobenate dimeglumine is at least equivalent to that achieved with 0.2-mmol/kg gadopentetate dimeglumine