137 research outputs found
Automatic Spatiotemporal Analysis of Cardiac Image Series
RÉSUMÉ
Ă€ 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
Vascular remodeling after endovascular treatment: quantitative analysis of medical images with a focus on aorta
In the last years, the convergence of advanced imaging techniques and endovascular procedures
has revolutionized the practice of vascular surgery. However, regardless the anatomical
district, several complications still occur after endovascular treatment and the impact of endovascular
repair on vessel morphology remains unclear. Starting from this background, the
aim of this thesis is to ll the gaps in the eld of vessel remodeling after endovascular procedure.
Main focus of the work will be the repair of the aorta and, in particular thoracic and
thoracoabdominal treatments. Furthermore an investigation of the impact of endovascular
repair on femoro-popliteal arterial segment will be reported in the present work. Analyses of
medical images will been conducted to extract anatomical geometric features and to compare
the changes in morphology before treatment and during follow-up.
After illustrating in detail the aims and the outline of the dissertation in Chapter 1, Chapter
2 will concern the anatomy and the physiology of the aorta along with the main aortic
pathologies and the related surgical treatments. Subsequently, an overview of the medical
image techniques for segmentation and vessel geometric quantication will be provided.
Chapter 3 will introduce the concept of remodeling of the aorta after endovascular procedure.
In particular, two types of aortic remodeling will be considered. On one side remodeling can
be seen as the shrinkage of the aneurysmal sac or false lumen thrombosis. On the other side,
aortic remodeling could be seen as the changes in the aortic morphology following endograft
placement which could lead to complications.
Chapter 4 will illustrate a study regarding the analysis of medical images to measure the geometrical
changes in the pathological aorta during follow-up in patients with thoracoabdominal
aortic aneurysms treated with endovascular procedure using a novel uncovered device, the Cardiatis
Multilayer Flow Modulator.
Chapter 5 will focus on the geometrical remodeling of the aortic arch and descending aorta in
patients who underwent hybrid arch treatment to treat thoracic aneurysms. The goal of the
work is to develop a pipeline for the processing of pre-operative and post-operative Computed
Tomography images in order to detect the changes in the aortic arch physiological curvature
due to endograft insertion.
Chapter 6 will focuse on the use of 3D printing technology as valuable tool to support patient's
follow-up. In particular, we report a case of a patient originally treated with endovascular
procedure for type B aortic dissection and which experimented several complications during
follow-up. 3D printing technology is used to show the remodeling of the aortic vasculature
during time.
Chapter 7 will concern patient-specic nite element simulations of aortic endovascular procedure.
In particular, starting from a clinical case where complication developed during followup,
the predictive value of computational simulations will be shown.
Chapter 8 will illustrate a study concerning the evaluation of morphological changes of the
femoro-popliteal arterial segment due to limb exion in patients undergoing endovascular
treatment of popliteal artery aneurysms
Automatic Spatiotemporal Analysis of Cardiac Image Series
RÉSUMÉ
Ă€ 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
Intravascular Ultrasound
Intravascular ultrasound (IVUS) is a cardiovascular imaging technology using a specially designed catheter with a miniaturized ultrasound probe for the assessment of vascular anatomy with detailed visualization of arterial layers. Over the past two decades, this technology has developed into an indispensable tool for research and clinical practice in cardiovascular medicine, offering the opportunity to gather diagnostic information about the process of atherosclerosis in vivo, and to directly observe the effects of various interventions on the plaque and arterial wall. This book aims to give a comprehensive overview of this rapidly evolving technique from basic principles and instrumentation to research and clinical applications with future perspectives
The prevalence and survival of children with congenital septal defects in the UK using CPRD
Background
Congenital heart disease (CHD) is a major contributor to infant mortality worldwide, accounting for a third of total congenital defects and a fifth of total global early neonatal mortality. Congenital septal defects (SD) are the most common CHD. This study assesses the prevalence and survival of children diagnosed with congenital septal defects in the UK.
Methods
All children who survived to at least the first 30 days after birth and registered with a GP within their first year of birth diagnosed with any CHD at any time in England between January 1998 and June 2017 were extracted from Clinical Practice Research Datalink (CPRD). Similar records for children diagnosed with other congenital anomalies were also obtained as well as children without any congenital anomaly constituting as the control group. These records were matched with the Office for National Statistics (ONS) death registration data, and the Index of Multiple Deprivation (IMD) data to allow assessment of death records and deprivation records, respectively. Prevalence risk ratios were calculated according to specific sociodemographic factors such as gender, year of birth, ethnicity, socioeconomic status, and geographical location for SD and its variants. Mortality risk ratios were calculated by gender, ethnicity, and socioeconomic status for SD and its variants. Also, in the absence of Hospital Episode Statistics (HES) data, I assessed the recording of CHD-related procedures/interventions in children’s GP records as a measure of disease severity within the CPRD-based birth cohort used in this thesis.
Results
The prevalence of any CHD was 86.1 per 10,000 live GP-registered births (95% CI, 83.7 – 88.4). SD accounted for 53.4% of the total CHD within this population and the overall prevalence of SD was 48.64 per 10,000 live GP-registered births (95% CI 46.90-50.44). Of all SD diagnosis identified, 59.1% had a VSD diagnosis (35.50 per 10,000 live GP-registered births, 95% CI 34.02-37.04), 28.8% ASD (17.31 per 10,000 live GP-registered births, 95% CI 16.29-18.40), 6.5% for ToF (3.91 per 10,000 live GP-registered births, 95% CI 3.44-4.45), 0.3% for AoSD (0.17 per 10,000 live GP-registered births, 95% CI 0.09-0.31), 3.2% for AVSD (1.93 per 10.000 live GP-registered births, 95% CI 1.61-2.32), and 2.1% for unspecified SD (1.28 per 10.000 live GP-registered births, 95% CI 1.02-1.60). For any SD, gender was significantly associated with occurrence, with the prevalence in females being 15% more than males (PR (Male-Female) 1.15, 95% CI 1.07-1.24), however, there was considerable variation across specific SD variants. Whilst there was no evidence of an association with the year of birth, ethnicity, or socioeconomic status on the prevalence of overall SD, specific sub-analysis of the SD variants showed some associations. The prevalence of SD and its variants varied by geographical regions in England with the highest prevalence of any SD observed in the East Midlands.
The total number of deaths due to CHD from 30 days after birth to 19 years between January 1998 and June 2017 was 166 and the mortality rate was 5.6 (95% CI, 4.8-6.5) per 1,000 person-years. By SD variants, children with Aortopulmonary septal defect (54.9; 95% CI 13.7-219.6), Atrioventricular septal defect (7.2; 95% CI, 3.0-17.3), and Tetralogy of Fallot (8.1; 95% 4.6-14.3) had the highest mortality rates compared to other defects, although small numbers of children resulted in large confidence limits for some of these estimations.
The hazard of death for children with any septal defect was over 16-fold higher than for children without a CA (HR 16.2; 95% CI, 12.8-20.6); aHR 16.4, 95% CI, 13.0-20.9, p<0.001). Of this, children with Aortopulmonary septal defect had the highest hazard of death with a 160-fold increase compared to children without a CA (HR, 164.6, 95% CI, (41.1-659.5); aHR 159.3, 95% CI, 39.7-641.4, p<0.001) and was lowest for children with VSD (HR, 15.5, 95% CI, (11.7-20.5); aHR 14.9, 95% CI, 12.0-21.0, p<0.001). For overall septal defects, whilst there was no difference in the hazard of death or mortality rate by ethnicity, there was a significant association with socioeconomic status largely driven by ASD. Mortality rates by age groups between 0 and 9 years were also considered; whilst there was substantial variation within the various defects and age groups, there was a 12-fold increased risk of post neonatal death for all SD compared to children with no CA across age groups.
Of the total SD cases in this dataset, 5% were recorded to have had an intervention within the first year of life. Of the SD sub variants, 4% of each of the total VSD and ASD had an intervention recorded in population. The proportion of interventions was higher for the other SD sub variants with ToF, AVSD and AoSD at 29%, 36% and 40% respectively. Of the 381 CHD patients who had a recording of at least one CHD-related intervention, only eight (8) patients died. The subsequent analysis of the severity of SD variants in relation to mortality was therefore precluded as for all variants the number of deaths recorded was less than 5.
Conclusion
Using a study population derived through data linkage between CPRD, ONS, and IMD in England, this study reinforces broadly that AoSD, ToF, AVSD whilst being the least prevalent SD, constitute the highest mortality variants of SD whilst VSD and ASD (the more prevalent forms) are not as lethal. Regardless, all SD variants considered had higher mortality than children without SD. Considerable effort is required to further improve the survival rates of children with these defects and ultimately improve the prognosis for children diagnosed with these defects. This study further raises the need for the consideration and development of region-specific and ethnicity-specific strategies to improving diagnosis and disease outcomes for children with a septal defect in England. As the dataset was not linked to HES, the ability to adequately assess the severity of septal defects in the study population was impaired. Using the limited codes for recording of CHD-related procedures within the GP-based dataset as a measure of severity unmasked the likely under-reporting of hospital events or procedures as children who should have received interventions based on their diagnosis did not always have this recorded in their GP record. Further studies incorporating the available information from HES are required to effectively determine the severity of septal defects and its variants especially with regards to how it affects mortality and mortalit
Current Issues and Recent Advances in Pacemaker Therapy
Patients with implanted pacemakers or defibrillators are frequently encountered in various healthcare settings. As these devices may be responsible for, or contribute to a variety of clinically significant issues, familiarity with their function and potential complications facilitates patient management. This book reviews several clinically relevant issues and recent advances of pacemaker therapy: implantation, device follow-up and management of complications. Innovations and research on the frontiers of this technology are also discussed as they may have wider utilization in the future. The book should provide useful information for clinicians involved in the management of patients with implanted antiarrhythmia devices and researchers working in the field of cardiac implants
3D Imaging for Planning of Minimally Invasive Surgical Procedures
Novel minimally invasive surgeries are used for treating cardiovascular diseases and are performed under 2D fluoroscopic guidance with a C-arm system. 3D multidetector row computed tomography (MDCT) images are routinely used for preprocedural planning and postprocedural follow-up. For preprocedural planning, the ability to integrate the MDCT with fluoroscopic images for intraprocedural guidance is of clinical interest. Registration may be facilitated by rotating the C-arm to acquire 3D C-arm CT images. This dissertation describes the development of optimal scan and contrast parameters for C-arm CT in 6 swine. A 5-s ungated C-arm CT acquisition during rapid ventricular pacing with aortic root injection using minimal contrast (36 mL), producing high attenuation (1226), few artifacts (2.0), and measurements similar to those from MDCT (p\u3e0.05) was determined optimal. 3D MDCT and C-arm CT images were registered to overlay the aortic structures from MDCT onto fluoroscopic images for guidance in placing the prosthesis. This work also describes the development of a methodology to develop power equation (R2\u3e0.998) for estimating dose with C-arm CT based on applied tube voltage. Application in 10 patients yielded 5.48┬▒177 2.02 mGy indicating minimal radiation burden. For postprocedural follow-up, combinations of non-contrast, arterial, venous single energy CT (SECT) scans are used to monitor patients at multiple time intervals resulting in high cumulative radiation dose. Employing a single dual-energy CT (DECT) scan to replace two SECT scans can reduce dose. This work focuses on evaluating the feasibility of DECT imaging in the arterial phase. The replacement of non-contrast and arterial SECT acquisitions with one arterial DECT acquisition in 30 patients allowed generation of virtual non-contrast (VNC) images with 31 dose savings. Aortic luminal attenuation in VNC (32┬▒177 2 HU) was similar to true non-contrast images (35┬▒177 4 HU) indicating presence of unattenuated blood. To improve discrimination between c
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