Planning and Sizing with OsiriX/Horos

It is known that endovascular aneurysm repair (EVAR) requires a precise deployment of the graft and so the anatomical and morphological characteristic study of the aorta and its branches is mandatory. The increase of endovascular surgeons’ interest on tomography image edition through software is marked specially when the increasing frequency of these procedures and its complexity have impelled surgeons to face additional and successive risk to occupational radiation exposure. Thus, a meticulous study of the angio-CT during EVAR preparation allows the reduction of unnecessary radiation exposure, as it also reduces consecutive image acquisition and contrast use (that may be related to renal overload in susceptible patients). Although some studies propose effective strategies to optimize the procedure, they rely on the use of additional specific and advanced equipment, available only in major centers. As an alternative, a simpler technique through image manipulation on the software OsiriX/Horos, aiming to reduce both exposures, is presented

Morphologic evaluation of ruptured abdominal aortic aneurysm by 3D modeling

This thesis was created in Word and converted to PDF using Mac OS X 10.7.5 Quartz PDFContext.Abdominal aortic aneurysm (AAA) is defined as a dilatation of the abdominal aorta exceeding the normal diameter by more than 50%. The standard and widely used approach to assess AAA size is by measuring the maximal diameter (Dmax). Currently, the main predictors of rupture risk are the Dmax, sex, and the expansion rate of the aneurysm. Yet, Dmax has some limitations. AAAs of vastly different shapes may have the same maximal diameter. Dmax lacks sensitivity for rupture risk, especially among smaller AAAs. Thus, there is a need to evaluate the susceptibility of a given AAA to rupture on a patient-specific basis. We present the design concept and workflow of the AAA segmentation software developed at our institution. We describe the previous validation steps in which we evaluated the reproducibility of manual Dmax, compared software Dmax against manual Dmax, validated reproducibility of software Dmax and volume in cross-sectional and longitudinal studies for detection of AAA growth, and evaluated the reproducibility of software measurements in unenhanced computed tomographic angiography (CTA) and in the presence of stent-graft. In order to define new geometric features associated with rupture, we performed a case-control study in which we compared 63 cases with ruptured or symptomatic AAA and 94 controls with asymptomatic AAA. Univariate logistic regression analysis revealed 14 geometric indices associated with AAA rupture. In the multivariate logistic regression analysis, adjusting for Dmax and sex, the AAA with a higher bulge location and higher mean averaged surface area were associated with AAA rupture. Our preliminary results suggest that incorporating geometrical indices obtained by segmentation of CT shows a trend toward improvement of the classification accuracy of AAA with high rupture risk at CT over a traditional model based on Dmax and sex alone. Larger longitudinal studies are needed to verify the validity of the proposed model. Addition of flow and biomechanical simulations should be investigated to improve rupture risk prediction based on AAA modeling.Un anévrysme de l'aorte abdominale (AAA) est défini par une dilatation de plus de 50% par rapport au diamètre normal. La méthode standard et largement répandue pour mesurer la dimension d'un AAA consiste à mesurer le diamètre maximal (Dmax). Présentement, les principaux prédicteurs de risque de rupture sont le Dmax, le sexe et le taux d'expansion d'un anévrysme. Toutefois, le Dmax a certaines limitations. Des AAAs de formes très différentes peuvent avoir le même diamètre maximal. Le Dmax manque de sensibilité pour détecter le risque de rupture, en particulier pour les petits anévrysmes. Par conséquent, il y a un besoin d'évaluer de manière spécifique et individuelle la susceptibilité de rupture d'un AAA. Nous présentons le concept et le flux de travail d'un logiciel de segmentation des AAAs développé à notre institution. Nous décrivons les étapes antérieures de validation: évaluation de la reproductibilité du Dmax manuel, comparaison de Dmax par logiciel avec Dmax manuel, validation de la reproductibilité du Dmax et volume par logiciel dans des études transversale et longitudinale pour la détection de croissance et évaluation de la reproductibilité de mesures sur angiographie par tomodensitométrie et en présence d'endoprothèse. En vue d’identifier de nouveaux paramètres géométrique associés avec le risque de rupture, nous avons réalisé une étude cas-témoin comparant 63 cas avec AAA rompu ou symptomatique et 94 contrôles avec AAA asymptomatique. Une analyse de régression logistique univariée a identifié 14 indices géométriques associés avec une rupture de AAA. Dans l'analyse de régression logistique multivariée, en ajustant pour le Dmax et le sexe, les AAA avec un bombement plus haut situé et une surface moyenne plus élevée étaient associés à une rupture. Nos résultats préliminaires suggèrent que l'inclusion d'indices géométriques obtenus par segmentation de tomodensitométrie tend à améliorer la classification de AAA avec un risque de rupture par rapport à un modèle traditionnel seulement basé sur le Dmax et le sexe. De plus larges études longitudinales sont requises pour vérifier la validité du modèle proposé. Des simulations de flux et biomécaniques devraient être envisagées pour améliorer la prédiction du risque de rupture basée sur la modélisation d'anévrysmes

Virtuelle endovaskuläre Versorgung von abdominalen Aortenaneurysmen

This thesis is focused on computational methods that predict the outcome of endovascular repair of abdominal aortic aneurysms. Novelties include improvements of the aneurysm model, the stent-graft model as well as the in-silico stent-graft placement methodology. The newly developed methods are applied to patient-specific cases and are validated against real-world postinterventional data. Further, directions for using the in-silico model of endovascular aneurysm repair as personalized preinterventional planning tool in clinical practice are provided.Die vorliegende Arbeit beschäftigt sich mit numerischen Methoden um den Ausgang einer endovaskulären Versorgung von abdominalen Aortenaneurysmen vorherzusagen. Neuheiten umfassen Verbesserungen des Aneurysmenmodells, des Stentgraftmodells sowie der virtuellen Platzierungsmethode des Stentgrafts. Die neu entwickelten Methoden werden auf patientenspezifische Fälle angewandt und werden mit realen postoperativen Daten validiert. Weiterhin werden klinische Anwendungen des Modells der endovaskulären Aneurysmenversorgung als personalisiertes präoperatives Planungswerkzeug präsentiert

Virtuelle endovaskuläre Versorgung von abdominalen Aortenaneurysmen

This thesis is focused on computational methods that predict the outcome of endovascular repair of abdominal aortic aneurysms. Novelties include improvements of the aneurysm model, the stent-graft model as well as the in-silico stent-graft placement methodology. The newly developed methods are applied to patient-specific cases and are validated against real-world postinterventional data. Further, directions for using the in-silico model of endovascular aneurysm repair as personalized preinterventional planning tool in clinical practice are provided.Die vorliegende Arbeit beschäftigt sich mit numerischen Methoden um den Ausgang einer endovaskulären Versorgung von abdominalen Aortenaneurysmen vorherzusagen. Neuheiten umfassen Verbesserungen des Aneurysmenmodells, des Stentgraftmodells sowie der virtuellen Platzierungsmethode des Stentgrafts. Die neu entwickelten Methoden werden auf patientenspezifische Fälle angewandt und werden mit realen postoperativen Daten validiert. Weiterhin werden klinische Anwendungen des Modells der endovaskulären Aneurysmenversorgung als personalisiertes präoperatives Planungswerkzeug präsentiert

Analysis of Influence of Collagen Organization on Mechanical Properties of Arteries

Tato disertační práce se zabývá Vlivem uspořádání kolagenu na mechanické vlastnosti tepen a je rozdělena do tří nejdůležitějších částí. Motivace pro tuto doktorskou práci byla ve studii revidující vliv modelu materiálu na výsledné napětí v AAA. Určení vlivu modelu materiálu bylo provedeno na 70 geometriích AAA, což o řád přesahuje množství geometrií použitých v jiných publikacích. Byly využity dva modely materiálu, tj. reálný a 100× tužší a výsledné hodnoty napětí byly porovnány. Bylo vyhodnoceno, že v analyzované skupině 70 pacientů existuje ~10 % pacientů, u kterých odchylka maximálního napětí od referenčního modelu přesahuje 20 %. Výsledky napětí mohou tedy být závislé na zvoleném modelu materiálu a je vhodné upřednostnit ten reálný, ačkoliv práce s ním je náročnější. Druhá oblast práce se věnuje identifikaci strukturních parametrů (orientaci a disperzi kolagenních vláken) z prasečí aorty pomocí upraveného algoritmu rychlé Fourierovy transformace. Získané strukturní parametry byly vloženy do dvouvrstvého strukturně motivovaného konstitutivního modelu Martufi-Gasser. Tento model byl validován a měl výborné predikční schopnosti. Nejpodstatnější z analýzy obrazu provedené na ~9000 mikrosnímcích je zjištění, že ve stěně zdravé prasečí hrudní aorty existuje jen jedna rodina kolagenních vláken s rozptylem, což boří dogma o dvou rodinách kolagenních vláken zavedené ve světové literatuře. Třetí část práce je věnována návrhu automatického algoritmu pro detekci lokálních směrů kolagenních vláken ze snímků pořízených pomocí polarizované mikroskopie na základě fázové korelace obrazu. Navrhnutý algoritmus byl verifikován a validován. Výsledkem algoritmu jsou histogramy orientací obsahující nesrovnatelně větší množství bodů, než umožňují jakákoli manuální měření. Limitací u původního algoritmu byl rozsah úhlů 0°–90° na základě principiálních omezení periodou intensity samotné polarizované mikroskopie. Závěr práce je věnován rozšíření zmíněného algoritmu na rozsah úhlů 0°–180°. Za tímto účelem bylo změněno nastavení mikroskopu a algoritmus byl podle tohoto nastavení přeprogramován. Původní i nový algoritmus jsou velmi rychlé, přesné a specifické pro opticky dvojlomné struktury. I přes veškerou snahu autora této dizertační práce zůstává otázka automatického měření vlnitosti kolagenních vláken přímo z výsledných histogramů zatím ve stádiu výzkumu.This dissertation thesis concerns with Analysis of Influence of Collagen Organization on Mechanical Properties of Arteries and it is divided into three main parts. Motivation for this dissertation thesis was in a study reviewing effect of material model upon resulting stresses in AAA. The effect was calculated in 70 patient-specific geometries of AAA, which exceeds the number of geometries in other scientific papers by one order. Within this study, two material models were used, i.e. real one and 100× stiffer, and obtained stresses were mutually compared. It was quantified that peak stress difference can be higher than 20 % in 10% of patients and therefore the real material model should be preferred over the artificial one although operation with this model is more demanding. The second part of this thesis deals with an identification of structural parameters (orientation and dispersion of collagen fibres) of porcine aortic tissue by using adjusted Fast Fourier Transform based algorithm. The extracted structural parameters were inserted into two-layer structure-motivated constitutive model Martufi-Gasser. This model was validated and its predictive capabilities were also tested with fine results. The most important information obtained from the digital image processing of ~9000 micrographs is existence of only one family of dispersed collagen fibres which breaks the current dogma present in many scientific papers about two families of collagen fibres. The third part concerns with a proposal of an automated phase-correlation based algorithm for obtaining collagen fibre direction from polarized light microscopy images. The proposed algorithm was verified and validated and it yields histograms of collagen fibre directions with overall number of measured points larger than it would be possible to get from any manual measurement. The limitation of the original proposed algorithm is in 90° period of polarized light intensity, thus the method results in angles in the range of 0°–90. Therefore the end of the thesis is dedicated resolving this problem and obtaining real angles in a span of 0°–180°. To this end, the microscope set-up was changed and the algorithm was adjusted accordingly. The original and the adjusted algorithms are collagen-specific, fast and an operator independent. Despite all the author´s effort put into collagen fibre waviness quantification directly from the histograms, the waviness has not been quantified yet in this way and it remains at the stage of research.

Conceptual framework of a novel hybrid methodology between computational fluid dynamics and data mining techniques for medical dataset application

This thesis proposes a novel hybrid methodology that couples computational fluid dynamic (CFD) and data mining (DM) techniques that is applied to a multi-dimensional medical dataset in order to study potential disease development statistically. This approach allows an alternate solution for the present tedious and rigorous CFD methodology being currently adopted to study the influence of geometric parameters on hemodynamics in the human abdominal aortic aneurysm. This approach is seen as a “marriage” between medicine and computer domains

Automated Patient-Specific Modeling of Blood Flow and Vessel Wall Mechanics in Aortic

This work presents a numerical approach to non-invasively help the diagnosis of patients with vascular pathologies on an individual basis. Patient-specific computational modeling of cardiovascular biomechanics was conducted to simulate the hemodynamics, the elastomechanics and their interaction within the vessels. For the blood flow and vessel wall computations, individual mesh generation techniques and numerical models for CSM, CFD and FSI were generated and implemented based on CT/MRI images

The role of altered cyclic strain patterns on proliferation and apoptosis of vascular smooth muscle cells - implications for in-stent restenosis

Currently, Percutaneous Transluminal Coronary Angioplasty (PTCA) followed by stent implantation is the frontline treatment in the management of coronary artery disease. To-date the main drawback of stent implantation is in-stent restenosis. Restenosis is a partial re-occlusion of the arterial wall predominantly due to vascular smooth muscle cells (SMC) migration from the media to the intima and subsequent SMC proliferation. A stent procedure dramatically alters the level of strains and stresses in the coronary artery and hence the mechanical environment of the SMC. We hypothesised that there exists a direct causal relationship between the level of strain and vascular SMC proliferation and apoptosis within the vessel wall. Cyclic strain can be seen as made by different independent components: mean strain, amplitude and frequency. In this work, the role of each strain component (mean strain, amplitude and frequency) in controlling Bovine Aortic Smooth Muscle Cells (BASMC) proliferative and apoptotic capacity was investigated. Cyclic strain decreased SMC proliferation and increased apoptosis in a temporal manner. The mean cyclic strain had no significant effect on the proliferative and apoptotic behaviour of SMC whereas SMC behaviour was highly dependent on strain amplitude. This observation was further validated using human SMC. The role of mean strain and strain amplitude was further investigated using a novel in-house phantom mock arterial system where BASMC were cultured inside a perfused stented Sylgard mock artery under physiological levels of strain. Vascular SMC proliferation was significantly increased (+40%) and apoptosis decreased within the stented region in comparison to the more compliant upstream and downstream non-stented regions of the mock Sylgard artery. We therefore conclude that the decrease in strain amplitude experienced by vascular SMC within the stented region may be responsible for SMC accumulation due to enhanced proliferation and decreased apoptosis. This study provides important evidence for the use of more compliant stent designs to maintain the anti-proliferative effect of cyclic strain on vascular SMC and therefore reduce restenosis