Using a distance map and an active contour model to segment the carotid artery boundary from the lumen contour in proton density weighted magnetic resonance images

Segmentation methods have assumed an important role in image-based diagnosis of several cardiovascular diseases. Particularly, the segmentation of the boundary of the carotid artery is demanded in the detection and characterization of atherosclerosis and assessment of the disease progression. In this article, a fully automatic approach for the segmentation of the carotid artery boundary in Proton Density Weighted Magnetic Resonance Images is presented. The approach relies on the expansion of the lumen contour based on a distance map built using the gray-weighted distance relative to the center of the identified lumen region in the image under analysis. Then, a Snake model with a modified weighted external energy based on the combination of a balloon force along with a Gradient Vector Flow-based external energy is applied to the expanded contour towards the correct boundary of the carotid artery. The average values of the Dice coefficient, Polyline distance, mean contour distance and centroid distance found in the segmentation of 139 carotid arteries were 0.83 ± 0.11, 2.70 ± 1.69 pixels, 2.79 ± 1.89 pixels and 3.44 ± 2.82 pixels, respectively. The segmentation results of the proposed approach were also compared against the ones obtained by related approaches found in the literature, which confirmed the outstanding performance of the new approach. Additionally, the proposed weighted external energy for the Snake model was shown to be also robust to carotid arteries with large thickness and weak boundary image edges. (c) 202

Determination of Aortic Elasticity from MR- and CT- Images Using an Automatic Active Contour Model

The possibility to monitor changes in aortic elasticity in humans has important applications for clinical trials predicting arterial diseases before they become morphologically apparent. The elasticity is usually quantified by compliance measurements. Therefore, the relative temporal change in vessel cross-sectional area through the cardiac cycle or alternatively, the pulse-wave velocity has to be determined. In this work we determined the compliance via 3 MR methods (FLASH, TrueFISP and pulse-wave) and additionally CT. We developed an algorithm for the automatic segmentation of the artery wall from MR and CT images. Thus, the reliable detection of the aortic cross sectional area over the entire heart cycle was possible for both MR and CT with a relative error of about 1% depending on image quality. The reliability of the method was evaluated by means of a CT phantom setup

A novel MRA-based framework for the detection of changes in cerebrovascular blood pressure.

Background: High blood pressure (HBP) affects 75 million adults and is the primary or contributing cause of mortality in 410,000 adults each year in the United States. Chronic HBP leads to cerebrovascular changes and is a significant contributor for strokes, dementia, and cognitive impairment. Non-invasive measurement of changes in cerebral vasculature and blood pressure (BP) may enable physicians to optimally treat HBP patients. This manuscript describes a method to non-invasively quantify changes in cerebral vasculature and BP using Magnetic Resonance Angiography (MRA) imaging. Methods: MRA images and BP measurements were obtained from patients (n=15, M=8, F=7, Age= 49.2 ± 7.3 years) over a span of 700 days. A novel segmentation algorithm was developed to identify brain vasculature from surrounding tissue. The data was processed to calculate the vascular probability distribution function (PDF); a measure of the vascular diameters in the brain. The initial (day 0) PDF and final (day 700) PDF were used to correlate the changes in cerebral vasculature and BP. Correlation was determined by a mixed effects linear model analysis. Results: The segmentation algorithm had a 99.9% specificity and 99.7% sensitivity in identifying and delineating cerebral vasculature. The PDFs had a statistically significant correlation to BP changes below the circle of Willis (p-value = 0.0007), but not significant (p-value = 0.53) above the circle of Willis, due to smaller blood vessels. Conclusion: Changes in cerebral vasculature and pressure can be non-invasively obtained through MRA image analysis, which may be a useful tool for clinicians to optimize medical management of HBP

Quantitative imaging in cardiovascular CT angiography

In de afgelopen decennia is computertomografie (CT) een prominente niet-invasieve modaliteit om hart- en vaatziekten te evalueren geworden. Dit proefschrift heeft als doel de rol van CT in de therapeutische behandeling van coronaire hartziekte (CAD) en klepaandoeningen te onderzoeken.De relatie tussen kransslagadergeometrie (statisch en dynamisch) en aanwezigheid en omvang van CAD met CT werd onderzocht. De resultaten suggereren dat de statische geometrie van de kransslagader significant gerelateerd is aan de aanwezigheid van plaque en stenose. Er was echter geen verband tussen dynamische verandering van de coronaire arterie-geometrie en de ernst van CAD. Een algoritme om de invloed van intraluminair contrastmiddel op niet-verkalkte atherosclerotische plaque Hounsfield-Unit-waarden te corrigeren werd gepresenteerd en gevalideerd met behulp van fantomen.Diagnose en operatieplanning kunnen cruciale gevolgen hebben voor de klinische uitkomst van chirurgische ingrepen. In dit proefschrift wordt beschreven dat halfautomatische softwareprogramma’s het kwantificeren van het aortaklepgebied betere reproduceerbare resultaten toonden in vergelijking met handmatige metingen, en vergelijkbare resultaten met de huidige gouden standaard, de echocardiografie. Een systematische review over het dynamische gedrag van de aorta-annulus toont aan dat de vorm van de aorta-annulus tijdens de hartcyclus verandert, wat impliceert dat er bij het bepalen van een prothese rekening moet worden gehouden met meerdere fasen. Een andere review beschrijft het gebruik van 3D-printen in de chirurgische planning samen met andere toepassingen voor de behandeling van hartklepaandoeningen.CT is de belangrijkste beeldvormingsmodaliteit in deze onderzoeken, die gericht waren op de therapeutische behandeling van hart- en vaatziekten, van vroege risicobepaling tot diagnose en chirurgische planning.In the recent decades computed tomography (CT) has emerged as a dominant non-invasive modality to evaluate cardiovascular diseases. This thesis aimed to explore the role of CT in the therapeutic management of coronary artery disease (CAD) and valvular diseases.The relationship between both static and dynamic coronary artery geometry and presence and extent of CAD using CT was investigated. The results suggest that the static coronary artery geometry is significantly related to presence of plaque and significant stenosis. However, there were no such relationship between dynamic change of coronary artery geometry and severity of CAD. As part of this thesis an algorithm to correct the influence of lumen contrast enhancement on non-calcified atherosclerotic plaque Hounsfield-Unit values was presented. The algorithm was validated using phantoms. The diagnosis and surgical planning may have crucial impact on clinical outcome. Semi-automatic software for aortic valve area quantification presented in this thesis was proven to be more repeatable and similar to gold standard echocardiography in comparison to manual measurements. The systematic review regarding the dynamic behavior of aortic annulus revealed that aortic annulus geometry changes throughout the cardiac cycle which implies that multiple phases should be taken into account for prosthesis sizing. Another review in this thesis discusses the use of 3D printing in the surgical planning along with other applications for the treatment of valvular diseases.CT is the main imaging modality in these studies which were focused on the therapeutic management of cardiovascular diseases from early risk determination to diagnosis and surgical planning

Intracranial fluids dynamics: a quantitative evaluation by means of phase-contrast magnetic resonance imaging

El volumen intracraneal lo integran el volumen de líquido cefalorraquídeo (LCR), el de la sangre y el del parénquima cerebral. La entrada de sangre al cráneo en la sístole incrementa el volumen intracraneal. Según la ley de Monroe-Kellie debe ocurrir una descompensación en los volúmenes restantes para mantener constante el volumen total. Los desequilibrios que se producen en este proceso de la homeostasis cerebral se han asociado tanto a enfermedades neurodegenerativas como a cerebrovasculares. Por tanto, es necesario contar con metodologías adecuadas para analizar la dinámica de los fluidos intracraneales (LCR y sangre). Las secuencias dinámicas de resonancia magnética en contraste de fase (RM-CF) con sincronismo cardíaco permiten cuantificar el flujo de LCR y de sangre durante un ciclo cardíaco. La medición de flujo mediante secuencias de RM-CF es precisa y reproducible siempre que se use un protocolo de adquisición adecuado. La reproducibilidad y exactitud de las medidas dependen también del uso de técnicas adecuadas de posproceso que permitan segmentar las regiones de interés (ROI) independientemente del operador y admitan corregir los errores de fondo introducidos por la supresión imperfecta de las corrientes inducidas y la contribución a la señal de los pequeños movimientos que presenta el mesencéfalo por la transmisión del pulso vascular así como el submuestreo (aliasing), reflejado como un cambio abrupto y opuesto del sentido original del flujo. Estas técnicas de análisis deben también tener en cuenta los errores relacionados con el efecto de volumen parcial (EVP), causado por la presencia de tejido estacionario y de flujo en el interior de los vóxeles de la periferia de la región a estudiar El objetivo principal de esta tesis es desarrollar una metodología reproducible para evaluar cuantitativamente la dinámica de los fluidos intracraneales dentro de espacios de LCR (acueducto de Silvio, cisterna prepontina y espacio perimedular C2C3) y principales vaFlórez Ordóñez, YN. (2009). Intracranial fluids dynamics: a quantitative evaluation by means of phase-contrast magnetic resonance imaging [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/6029Palanci

The study of blood flow in human arterial bifurcations by the combination of CFD and MRI

Atherosclero8is represents a major health problem in the western world. The local haemodynamics is believed to be an initiating and localizing factor in this multilactorial disease process. To fully understand this interaction it is important to obtain detailed information about the local haemodynamics in accurate models of the hnrnan vascular system. Because of the complexity of arterial geometry, in mvo velocity measurements are subject to large errors by currently available techniques. It is also difficult to construct the highly irregular arterial bifurcation model for in vitro investigations. By using a combination of two new methodologies,namely magnetic resonance angiography (MRA) and computational fluid dynamics CFD), the precise patterns of flow anticipating the onset of disease at arterial bifurcations can now, in principle, be determined. However, flow simulations based on in vzvo data directly acquired from clinical measurements have rarely been performed, due to difficulties involved in converting medical images into a data set that CFD software packages can accept. ,In this study, a computer modelling technique, which integrates dinically acquired MR angiograms, image processing and CFD, for the reconstruction of 3D blood flow patterns in realistic arterial geometry, was developed. In the procedure, human arteries are scanned non-invasively by MR angiography. With the MR angiograms, image processing and 3D reconstruction are performed and structured numerical grid is generated for the arteries scanned. Together with MR in tnvo measured velocity profiles at the boundary planes of the model, CFD simulations are undertaken. To test the capability and reliability of the whole procedure, two examples are given, of the human abdominal and right carotid bifurcations. The complete haemodynamic patterns obtained allow a full clinical understanding to be gained of individual patient behaviour. Aspects such as wall shear stress variation, secondary flow and flow separations are demonstrated. The problem of quantitative reliability of the predictions is discussed in some depth

Vascular Segmentation Algorithms for Generating 3D Atherosclerotic Measurements

Atherosclerosis manifests as plaques within large arteries of the body and remains as a leading cause of mortality and morbidity in the world. Major cardiovascular events may occur in patients without known preexisting symptoms, thus it is important to monitor progression and regression of the plaque burden in the arteries for evaluating patient\u27s response to therapy. In this dissertation, our main focus is quantification of plaque burden from the carotid and femoral arteries, which are major sites for plaque formation, and are straight forward to image noninvasively due to their superficial location. Recently, 3D measurements of plaque burden have shown to be more sensitive to the changes of plaque burden than one-/two-dimensional measurements. However, despite the advancements of 3D noninvasive imaging technology with rapid acquisition capabilities, and the high sensitivity of the 3D plaque measurements of plaque burden, they are still not widely used due to the inordinate amount of time and effort required to delineate artery walls plus plaque boundaries to obtain 3D measurements from the images. Therefore, the objective of this dissertation is developing novel semi-automated segmentation methods to alleviate measurement burden from the observer for segmentation of the outer wall and lumen boundaries from: (1) 3D carotid ultrasound (US) images, (2) 3D carotid black-blood magnetic resonance (MR) images, and (3) 3D femoral black-blood MR images. Segmentation of the carotid lumen and outer wall from 3DUS images is a challenging task due to low image contrast, for which no method has been previously reported. Initially, we developed a 2D slice-wise segmentation algorithm based on the level set method, which was then extended to 3D. The 3D algorithm required fewer user interactions than manual delineation and the 2D method. The algorithm reduced user time by ≈79% (1.72 vs. 8.3 min) compared to manual segmentation for generating 3D-based measurements with high accuracy (Dice similarity coefficient (DSC)\u3e90%). Secondly, we developed a novel 3D multi-region segmentation algorithm, which simultaneously delineates both the carotid lumen and outer wall surfaces from MR images by evolving two coupled surfaces using a convex max-flow-based technique. The algorithm required user interaction only on a single transverse slice of the 3D image for generating 3D surfaces of the lumen and outer wall. The algorithm was parallelized using graphics processing units (GPU) to increase computational speed, thus reducing user time by 93% (0.78 vs. 12 min) compared to manual segmentation. Moreover, the algorithm yielded high accuracy (DSC \u3e 90%) and high precision (intra-observer CV \u3c 5.6% and inter-observer CV \u3c 6.6%). Finally, we developed and validated an algorithm based on convex max-flow formulation to segment the femoral arteries that enforces a tubular shape prior and an inter-surface consistency of the outer wall and lumen to maintain a minimum separation distance between the two surfaces. The algorithm required the observer to choose only about 11 points on its medial axis of the artery to yield the 3D surfaces of the lumen and outer wall, which reduced the operator time by 97% (1.8 vs. 70-80 min) compared to manual segmentation. Furthermore, the proposed algorithm reported DSC greater than 85% and small intra-observer variability (CV ≈ 6.69%). In conclusion, the development of robust semi-automated algorithms for generating 3D measurements of plaque burden may accelerate translation of 3D measurements to clinical trials and subsequently to clinical care

Classification approach for diagnosis of arteriosclerosis using B-mode ultrasound carotid images

Tese de mestrado. Engenharia Biomédica. Faculdade de Engenharia. Universidade do Porto. 201