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

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

Differential geometry methods for biomedical image processing : from segmentation to 2D/3D registration

This thesis establishes a biomedical image analysis framework for the advanced visualization of biological structures. It consists of two important parts: 1) the segmentation of some structures of interest in 3D medical scans, and 2) the registration of patient-specific 3D models with 2D interventional images. Segmenting biological structures results in 3D computational models that are simple to visualize and that can be analyzed quantitatively. Registering a 3D model with interventional images permits to position the 3D model within the physical world. By combining the information from a 3D model and 2D interventional images, the proposed framework can improve the guidance of surgical intervention by reducing the ambiguities inherent to the interpretation of 2D images. Two specific segmentation problems are considered: 1) the segmentation of large structures with low frequency intensity nonuniformity, and 2) the detection of fine curvilinear structures. First, we directed our attention toward the segmentation of relatively large structures with low frequency intensity nonuniformity. Such structures are important in medical imaging since they are commonly encountered in MRI. Also, the nonuniform diffusion of the contrast agent in some other modalities, such as CTA, leads to structures of nonuniform appearance. A level-set method that uses a local-linear region model is defined, and applied to the challenging problem of segmenting brain tissues in MRI. The unique characteristics of the proposed method permit to account for important image nonuniformity implicitly. To the best of our knowledge, this is the first time a region-based level-set model has been used to perform the segmentation of real world MRI brain scans with convincing results. The second segmentation problem considered is the detection of fine curvilinear structures in 3D medical images. Detecting those structures is crucial since they can represent veins, arteries, bronchi or other important tissues. Unfortunately, most currently available curvilinear structure detection filters incur significant signal lost at bifurcations of two structures. This peculiarity limits the performance of all subsequent processes, whether it be understanding an angiography acquisition, computing an accurate tractography, or automatically classifying the image voxels. This thesis presents a new curvilinear structure detection filter that is robust to the presence of X- and Y-junctions. At the same time, it is conceptually simple and deterministic, and allows for an intuitive representation of the structure’s principal directions. Once a 3D computational model is available, it can be used to enhance surgical guidance. A 2D/3D non-rigid method is proposed that brings a 3D centerline model of the coronary arteries into correspondence with bi-plane fluoroscopic angiograms. The registered model is overlaid on top of the interventional angiograms to provide surgical assistance during image-guided chronic total occlusion procedures, which reduces the uncertainty inherent in 2D interventional images. A fully non-rigid registration model is proposed and used to compensate for any local shape discrepancy. This method is based on a variational framework, and uses a simultaneous matching and reconstruction process. With a typical run time of less than 3 seconds, the algorithms are fast enough for interactive applications

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.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Model generation of coronary artery bifurcations from CTA and single plane angiography

International audiencePurpose: To generate accurate and realistic models of coronary artery bifurcations before and after percutaneous coronary intervention (PCI), using information from two image modalities. Because bifurcations are regions where atherosclerotic plaque appears frequently and intervention is more challenging, generation of such realistic models could be of high value to predict the risk of restenosis or thrombosis after stent implantation, and to study geometrical and hemodynamical changes. Methods: Two image modalities have been employed to generate the bifurcation models: computer tomography angiography (CTA) to obtain the 3D trajectory of vessels, and 2D conventional coronary angiography (CCA) to obtain radius information of the vessel lumen, due to its better contrast and image resolution. In addition, CCA can be acquired right before and after the intervention in the operation room; therefore, the combination of CTA and CCA allows the generation of realistic prepro-cedure and postprocedure models of coronary bifurcations. The method proposed is semiautomatic, based on landmarks manually placed on both image modalities. Results: A comparative study of the models obtained with the proposed method with models manually obtained using only CTA, shows more reliable results when both modalities are used together. The authors show that using preprocedure CTA and postprocedure CCA, realistic postprocedure models can be obtained. Analysis carried out of the Murray's law in all patient bifurcations shows the geometric improvement of PCI in our models, better than using manual models from CTA alone. An experiment using a cardiac phantom also shows the feasibility of the proposed method. Conclusions: The authors have shown that fusion of CTA and CCA is feasible for realistic generation of coronary bifurcation models before and after PCI. The method proposed is efficient, and relies on minimal user interaction, and therefore is of high value to study geometric and hemo-dynamic changes of treated patients

Coronary Artery Calcium Quantification in Contrast-enhanced Computed Tomography Angiography

Coronary arteries are the blood vessels supplying oxygen-rich blood to the heart muscles. Coronary artery calcium (CAC), which is the total amount of calcium deposited in these arteries, indicates the presence or the future risk of coronary artery diseases. Quantification of CAC is done by using computed tomography (CT) scan which uses attenuation of x-ray by different tissues in the body to generate three-dimensional images. Calcium can be easily spotted in the CT images because of its higher opacity to x-ray compared to that of the surrounding tissue. However, the arteries cannot be identified easily in the CT images. Therefore, a second scan is done after injecting a patient with an x-ray opaque dye known as contrast material which makes different chambers of the heart and the coronary arteries visible in the CT scan. This procedure is known as computed tomography angiography (CTA) and is performed to assess the morphology of the arteries in order to rule out any blockage in the arteries. The CT scan done without the use of contrast material (non-contrast-enhanced CT) can be eliminated if the calcium can be quantified accurately from the CTA images. However, identification of calcium in CTA images is difficult because of the proximity of the calcium and the contrast material and their overlapping intensity range. In this dissertation first we compare the calcium quantification by using a state-of-the-art non-contrast-enhanced CT scan method to conventional methods suggesting optimal quantification parameters. Then we develop methods to accurately quantify calcium from the CTA images. The methods include novel algorithms for extracting centerline of an artery, calculating the threshold of calcium adaptively based on the intensity of contrast along the artery, calculating the amount of calcium in mixed intensity range, and segmenting the artery and the outer wall. The accuracy of the calcium quantification from CTA by using our methods is higher than the non-contrast-enhanced CT thus potentially eliminating the need of the non-contrast-enhanced CT scan. The implications are that the total time required for the CT scan procedure, and the patient\u27s exposure to x-ray radiation are reduced

A Deep Learning Approach to Evaluating Disease Risk in Coronary Bifurcations

Cardiovascular disease represents a large burden on modern healthcare systems, requiring significant resources for patient monitoring and clinical interventions. It has been shown that the blood flow through coronary arteries, shaped by the artery geometry unique to each patient, plays a critical role in the development and progression of heart disease. However, the popular and well tested risk models such as Framingham and QRISK3 current cardiovascular disease risk models are not able to take these differences when predicting disease risk. Over the last decade, medical imaging and image processing have advanced to the point that non-invasive high-resolution 3D imaging is routinely performed for any patient suspected of coronary artery disease. This allows for the construction of virtual 3D models of the coronary anatomy, and in-silico analysis of blood flow within the coronaries. However, several challenges still exist which preclude large scale patient-specific simulations, necessary for incorporating haemodynamic risk metrics as part of disease risk prediction. In particular, despite a large amount of available coronary medical imaging, extraction of the structures of interest from medical images remains a manual and laborious task. There is significant variation in how geometric features of the coronary arteries are measured, which makes comparisons between different studies difficult. Modelling blood flow conditions in the coronary arteries likewise requires manual preparation of the simulations and significant computational cost. This thesis aims to solve these challenges. The "Automated Segmentation of Coronary Arteries (ASOCA)" establishes a benchmark dataset of coronary arteries and their associated 3D reconstructions, which is currently the largest openly available dataset of coronary artery models and offers a wide range of applications such as computational modelling, 3D printed for experiments, developing, and testing medical devices such as stents, and Virtual Reality applications for education and training. An automated computational modelling workflow is developed to set up, run and postprocess simulations on the Left Main Bifurcation and calculate relevant shape metrics. A convolutional neural network model is developed to replace the computational fluid dynamics process, which can predict haemodynamic metrics such as wall shear stress in minutes, compared to several hours using traditional computational modelling reducing the computation and labour cost involved in performing such simulations