Extraction of Blood Vessels Geometric Shape Features with Catheter Localization and Geodesic Distance Transform for Right Coronary Artery Detection.

X-ray angiography is considered the standard imaging sensory system for diagnosing coronary artery diseases. For automated, accurate diagnosis of such diseases, coronary vessels’ detection from the captured low quality and noisy angiography images is challenging. It is essential to detect the main branch of the coronary artery, to resolve such limitations along with the problems due to the sudden changes in the lumen diameter, and the abrupt changes in local artery direction. Accordingly, this paper solved these limitations by proposing a computer-aided detection system for the right coronary artery (RCA) extraction, where geometric shape features with catheter localization and geodesic distance transform in the angiography images through two parts. In part 1, the captured image was initially preprocessed for contrast enhancement using singular value decomposition-based contrast adjustment, followed by generating the vesselness map using Jerman filter, and for further segmentation the K-means was introduced. Afterward, in part 2, the geometric shape features of the RCA, as well as the skeleton gradient transform, and the start/end points were determined to extract the main blood vessel of the RCA. The analysis of the skeletonize image was performed using Geodesic distance transform to examine all branches starting from the predetermined start point and cover the branching till the predefined end points. A ranking matrix, and the inverse of skeletonization were finally carried out to get the actual main branch. The performance of the proposed system was then evaluated using different evaluation metrics on the angiography images...

Inferring Geodesic Cerebrovascular Graphs: Image Processing, Topological Alignment and Biomarkers Extraction

A vectorial representation of the vascular network that embodies quantitative features - location, direction, scale, and bifurcations - has many potential neuro-vascular applications. Patient-specific models support computer-assisted surgical procedures in neurovascular interventions, while analyses on multiple subjects are essential for group-level studies on which clinical prediction and therapeutic inference ultimately depend. This first motivated the development of a variety of methods to segment the cerebrovascular system. Nonetheless, a number of limitations, ranging from data-driven inhomogeneities, the anatomical intra- and inter-subject variability, the lack of exhaustive ground-truth, the need for operator-dependent processing pipelines, and the highly non-linear vascular domain, still make the automatic inference of the cerebrovascular topology an open problem. In this thesis, brain vessels’ topology is inferred by focusing on their connectedness. With a novel framework, the brain vasculature is recovered from 3D angiographies by solving a connectivity-optimised anisotropic level-set over a voxel-wise tensor field representing the orientation of the underlying vasculature. Assuming vessels joining by minimal paths, a connectivity paradigm is formulated to automatically determine the vascular topology as an over-connected geodesic graph. Ultimately, deep-brain vascular structures are extracted with geodesic minimum spanning trees. The inferred topologies are then aligned with similar ones for labelling and propagating information over a non-linear vectorial domain, where the branching pattern of a set of vessels transcends a subject-specific quantized grid. Using a multi-source embedding of a vascular graph, the pairwise registration of topologies is performed with the state-of-the-art graph matching techniques employed in computer vision. Functional biomarkers are determined over the neurovascular graphs with two complementary approaches. Efficient approximations of blood flow and pressure drop account for autoregulation and compensation mechanisms in the whole network in presence of perturbations, using lumped-parameters analog-equivalents from clinical angiographies. Also, a localised NURBS-based parametrisation of bifurcations is introduced to model fluid-solid interactions by means of hemodynamic simulations using an isogeometric analysis framework, where both geometry and solution profile at the interface share the same homogeneous domain. Experimental results on synthetic and clinical angiographies validated the proposed formulations. Perspectives and future works are discussed for the group-wise alignment of cerebrovascular topologies over a population, towards defining cerebrovascular atlases, and for further topological optimisation strategies and risk prediction models for therapeutic inference. Most of the algorithms presented in this work are available as part of the open-source package VTrails

Continuous roadmapping in liver TACE procedures using 2D–3D catheter-based registration

PURPOSE: Fusion of pre/perioperative images and intra-operative images may add relevant information during image-guided procedures. In abdominal procedures, respiratory motion changes the position of organs, and thus accurate image guidance requires a continuous update of the spatial alignment of the (pre/perioperative) information with the organ position during the intervention. METHODS: In this paper, we propose a method to register in real time perioperative 3D rotational angiography images (3DRA) to intra-operative single-plane 2D fluoroscopic images for improved guidance in TACE interventions. The method uses the shape of 3D vessels extracted from the 3DRA and the 2D catheter shape extracted from fluoroscopy. First, the appropriate 3D vessel is selected from the complete vascular tree using a shape similarity metric. Subsequently, the catheter is registered to this vessel, and the 3DRA is visualized based on the registration results. The method is evaluated on simulated data and clinical data. RESULTS: The first selected vessel, ranked with the shape similarity metric, is used more than 39 % in the final registration and the second more than 21 %. The median of the closest corresponding points distance between 2D angiography vessels and projected 3D vessels is 4.7–5.4 mm when using the brute force optimizer and 5.2–6.6 mm when using the Powell optimizer. CONCLUSION: We present a catheter-based registration method to continuously fuse a 3DRA roadmap arterial tree onto 2D fluoroscopic images with an efficient shape similarity

Computer Vision Techniques for Transcatheter Intervention

Minimally invasive transcatheter technologies have demonstrated substantial promise for the diagnosis and treatment of cardiovascular diseases. For example, TAVI is an alternative to AVR for the treatment of severe aortic stenosis and TAFA is widely used for the treatment and cure of atrial fibrillation. In addition, catheter-based IVUS and OCT imaging of coronary arteries provides important information about the coronary lumen, wall and plaque characteristics. Qualitative and quantitative analysis of these cross-sectional image data will be beneficial for the evaluation and treatment of coronary artery diseases such as atherosclerosis. In all the phases (preoperative, intraoperative, and postoperative) during the transcatheter intervention procedure, computer vision techniques (e.g., image segmentation, motion tracking) have been largely applied in the field to accomplish tasks like annulus measurement, valve selection, catheter placement control, and vessel centerline extraction. This provides beneficial guidance for the clinicians in surgical planning, disease diagnosis, and treatment assessment. In this paper, we present a systematical review on these state-of-the-art methods.We aim to give a comprehensive overview for researchers in the area of computer vision on the subject of transcatheter intervention. Research in medical computing is multi-disciplinary due to its nature, and hence it is important to understand the application domain, clinical background, and imaging modality so that methods and quantitative measurements derived from analyzing the imaging data are appropriate and meaningful. We thus provide an overview on background information of transcatheter intervention procedures, as well as a review of the computer vision techniques and methodologies applied in this area

Improved Image Guidance in TACE Procedures

Purpose of the work in this thesis is to improve the image guidance in TACE procedures. More specifically, we intend to develop and evaluate technology that permits dynamic roadmapping based on a 3D model of the liver vasculature

Blood Vessel Segmentation and shape analysis for quantification of Coronary Artery Stenosis in CT Angiography

This thesis presents an automated framework for quantitative vascular shape analysis of the coronary arteries, which constitutes an important and fundamental component of an automated image-based diagnostic system. Firstly, an automated vessel segmentation algorithm is developed to extract the coronary arteries based on the framework of active contours. Both global and local intensity statistics are utilised in the energy functional calculation, which allows for dealing with non-uniform brightness conditions, while evolving the contour towards to the desired boundaries without being trapped in local minima. To suppress kissing vessel artifacts, a slice-by-slice correction scheme, based on multiple regions competition, is proposed to identify and track the kissing vessels throughout the transaxial images of the CTA data. Based on the resulting segmentation, we then present a dedicated algorithm to estimate the geometric parameters of the extracted arteries, with focus on vessel bifurcations. In particular, the centreline and associated reference surface of the coronary arteries, in the vicinity of arterial bifurcations, are determined by registering an elliptical cross sectional tube to the desired constituent branch. The registration problem is solved by a hybrid optimisation method, combining local greedy search and dynamic programming, which ensures the global optimality of the solution and permits the incorporation of any hard constraints posed to the tube model within a natural and direct framework. In contrast with conventional volume domain methods, this technique works directly on the mesh domain, thus alleviating the need for image upsampling. The performance of the proposed framework, in terms of efficiency and accuracy, is demonstrated on both synthetic and clinical image data. Experimental results have shown that our techniques are capable of extracting the major branches of the coronary arteries and estimating the related geometric parameters (i.e., the centreline and the reference surface) with a high degree of agreement to those obtained through manual delineation. Particularly, all of the major branches of coronary arteries are successfully detected by the proposed technique, with a voxel-wise error at 0.73 voxels to the manually delineated ground truth data. Through the application of the slice-by-slice correction scheme, the false positive metric, for those coronary segments affected by kissing vessel artifacts, reduces from 294% to 22.5%. In terms of the capability of the presented framework in defining the location of centrelines across vessel bifurcations, the mean square errors (MSE) of the resulting centreline, with respect to the ground truth data, is reduced by an average of 62.3%, when compared with initial estimation obtained using a topological thinning based algorithm

Deep Learning for Vascular Segmentation and Applications in Phase Contrast Tomography Imaging

Automated blood vessel segmentation is vital for biomedical imaging, as vessel changes indicate many pathologies. Still, precise segmentation is difficult due to the complexity of vascular structures, anatomical variations across patients, the scarcity of annotated public datasets, and the quality of images. We present a thorough literature review, highlighting the state of machine learning techniques across diverse organs. Our goal is to provide a foundation on the topic and identify a robust baseline model for application to vascular segmentation in a new imaging modality, Hierarchical Phase Contrast Tomography (HiP CT). Introduced in 2020 at the European Synchrotron Radiation Facility, HiP CT enables 3D imaging of complete organs at an unprecedented resolution of ca. 20mm per voxel, with the capability for localized zooms in selected regions down to 1mm per voxel without sectioning. We have created a training dataset with double annotator validated vascular data from three kidneys imaged with HiP CT in the context of the Human Organ Atlas Project. Finally, utilising the nnU Net model, we conduct experiments to assess the models performance on both familiar and unseen samples, employing vessel specific metrics. Our results show that while segmentations yielded reasonably high scores such as clDice values ranging from 0.82 to 0.88, certain errors persisted. Large vessels that collapsed due to the lack of hydrostatic pressure (HiP CT is an ex vivo technique) were segmented poorly. Moreover, decreased connectivity in finer vessels and higher segmentation errors at vessel boundaries were observed. Such errors obstruct the understanding of the structures by interrupting vascular tree connectivity. Through our review and outputs, we aim to set a benchmark for subsequent model evaluations using various modalities, especially with the HiP CT imaging database

Deep Learning for Medical Image Segmentation using Prior Knowledge and Topology

Image segmentation refers to the division of a digital image into distinct segments or groups of pixels/voxels. However, most of the existing deep learning approaches lack the utilization of prior knowledge, such as shape information, which could improve segmentation accuracy. In addition, conventional image segmentation frequently falls short in preserving intricate spatial details, motivating the innovation of strategies for multi-scaled feature integration. Furthermore, traditional image segmentation methods primarily concentrate on pixel-level or region-level analysis. However, given the inherent morphological similarities among various image objects, the significance of topology information surpasses that of pixel-level data in the realm of medical image semantic segmentation, and the incorporation of topology information for image segmentation is important. The first aim of this dissertation is to incorporate shape priors into medical image segmentation. A shape-prior-V-Net (SP-V-Net) is proposed, which contains a shape transformation module to refine the segmentation results according to the shape prior. SP-V-Net has been applied to lung segmentation and proximal femur segmentation. The second aim aims to improve image segmentation by leveraging hierarchical features. Two approaches are proposed: the feature pyramid U-Net++ (FP-U-Net++), which dynamically aggregates the feature pyramid in the decoder of U-Net ++, and the multi-input multi-scale U-Net (MIMS U-Net), which integrates the features in the encoder of the U-Net. The third aim explores topology-based image semantic segmentation using graph neural networks. Three graph-matching networks have been developed, including association graph-based, edge attention graph matching, and hyper-association graph matching networks. The proposed graph-matching networks convert the graph-matching problems into a vertex classification problem using an association graph, where the positive vertex indicates the nodes from two individual graphs are matched. These models were applied to coronary artery semantic labeling on invasive coronary angiograms. Moreover, this study presents a pioneering approach for topology-based image semantic labeling using graph matching. The successful completion of these aims contributes technically accurate and clinically applicable algorithms and techniques for medical image segmentation. The outcomes of this dissertation provide valuable tools for the medical imaging and computer vision communities, advancing the field and improving patient care through accurate and efficient medical image segmentation

Automatic Spatiotemporal Analysis of Cardiac Image Series

RÉSUMÉ À ce jour, les maladies cardiovasculaires demeurent au premier rang des principales causes de décès en Amérique du Nord. Chez l’adulte et au sein de populations de plus en plus jeunes, la soi-disant épidémie d’obésité entraînée par certaines habitudes de vie tels que la mauvaise alimentation, le manque d’exercice et le tabagisme est lourde de conséquences pour les personnes affectées, mais aussi sur le système de santé. La principale cause de morbidité et de mortalité chez ces patients est l’athérosclérose, une accumulation de plaque à l’intérieur des vaisseaux sanguins à hautes pressions telles que les artères coronaires. Les lésions athérosclérotiques peuvent entraîner l’ischémie en bloquant la circulation sanguine et/ou en provoquant une thrombose. Cela mène souvent à de graves conséquences telles qu’un infarctus. Outre les problèmes liés à la sténose, les parois artérielles des régions criblées de plaque augmentent la rigidité des parois vasculaires, ce qui peut aggraver la condition du patient. Dans la population pédiatrique, la pathologie cardiovasculaire acquise la plus fréquente est la maladie de Kawasaki. Il s’agit d’une vasculite aigüe pouvant affecter l’intégrité structurale des parois des artères coronaires et mener à la formation d’anévrismes. Dans certains cas, ceux-ci entravent l’hémodynamie artérielle en engendrant une perfusion myocardique insuffisante et en activant la formation de thromboses. Le diagnostic de ces deux maladies coronariennes sont traditionnellement effectués à l’aide d’angiographies par fluoroscopie. Pendant ces examens paracliniques, plusieurs centaines de projections radiographiques sont acquises en séries suite à l’infusion artérielle d’un agent de contraste. Ces images révèlent la lumière des vaisseaux sanguins et la présence de lésions potentiellement pathologiques, s’il y a lieu. Parce que les séries acquises contiennent de l’information très dynamique en termes de mouvement du patient volontaire et involontaire (ex. battements cardiaques, respiration et déplacement d’organes), le clinicien base généralement son interprétation sur une seule image angiographique où des mesures géométriques sont effectuées manuellement ou semi-automatiquement par un technicien en radiologie. Bien que l’angiographie par fluoroscopie soit fréquemment utilisé partout dans le monde et souvent considéré comme l’outil de diagnostic “gold-standard” pour de nombreuses maladies vasculaires, la nature bidimensionnelle de cette modalité d’imagerie est malheureusement très limitante en termes de spécification géométrique des différentes régions pathologiques. En effet, la structure tridimensionnelle des sténoses et des anévrismes ne peut pas être pleinement appréciée en 2D car les caractéristiques observées varient selon la configuration angulaire de l’imageur. De plus, la présence de lésions affectant les artères coronaires peut ne pas refléter la véritable santé du myocarde, car des mécanismes compensatoires naturels (ex. vaisseaux----------ABSTRACT Cardiovascular disease continues to be the leading cause of death in North America. In adult and, alarmingly, ever younger populations, the so-called obesity epidemic largely driven by lifestyle factors that include poor diet, lack of exercise and smoking, incurs enormous stresses on the healthcare system. The primary cause of serious morbidity and mortality for these patients is atherosclerosis, the build up of plaque inside high pressure vessels like the coronary arteries. These lesions can lead to ischemic disease and may progress to precarious blood flow blockage or thrombosis, often with infarction or other severe consequences. Besides the stenosis-related outcomes, the arterial walls of plaque-ridden regions manifest increased stiffness, which may exacerbate negative patient prognosis. In pediatric populations, the most prevalent acquired cardiovascular pathology is Kawasaki disease. This acute vasculitis may affect the structural integrity of coronary artery walls and progress to aneurysmal lesions. These can hinder the blood flow’s hemodynamics, leading to inadequate downstream perfusion, and may activate thrombus formation which may lead to precarious prognosis. Diagnosing these two prominent coronary artery diseases is traditionally performed using fluoroscopic angiography. Several hundred serial x-ray projections are acquired during selective arterial infusion of a radiodense contrast agent, which reveals the vessels’ luminal area and possible pathological lesions. The acquired series contain highly dynamic information on voluntary and involuntary patient movement: respiration, organ displacement and heartbeat, for example. Current clinical analysis is largely limited to a single angiographic image where geometrical measures will be performed manually or semi-automatically by a radiological technician. Although widely used around the world and generally considered the gold-standard diagnosis tool for many vascular diseases, the two-dimensional nature of this imaging modality is limiting in terms of specifying the geometry of various pathological regions. Indeed, the 3D structures of stenotic or aneurysmal lesions may not be fully appreciated in 2D because their observable features are dependent on the angular configuration of the imaging gantry. Furthermore, the presence of lesions in the coronary arteries may not reflect the true health of the myocardium, as natural compensatory mechanisms may obviate the need for further intervention. In light of this, cardiac magnetic resonance perfusion imaging is increasingly gaining attention and clinical implementation, as it offers a direct assessment of myocardial tissue viability following infarction or suspected coronary artery disease. This type of modality is plagued, however, by motion similar to that present in fluoroscopic imaging. This issue predisposes clinicians to laborious manual intervention in order to align anatomical structures in sequential perfusion frames, thus hindering automation o