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

Recalage rigide 3D-2D par intensité pour le traitement percutané des cardiopathies congénitales

Les cardiopathies congénitales cyanogènes sont des malformations cardiaques infantiles qui, dans leurs formes les plus complexes, sont aggravées par des artères morbides partant de l’aorte et appelées collatérales aorto-pulmonaires majeures (MAPCAs). Pour corriger ces malformations, les cardiologues insèrent un cathéter dans une artère du patient puis, le guident jusqu’à atteindre la structure vasculaire d’intérêt. Le cathéter est visualisé grâce à des angiographies acquises lors de l’opération. Néanmoins, ces interventions, dîtes percutanées, sont délicates à réaliser. L’emploi des angiographies 2D limite le champ de vision des cardiologues et les oblige à mentalement reconstruire la structure vasculaire en mouvement. Afin d’améliorer les conditions d’intervention, des techniques d’imagerie médicale exploitant des données tomographiques acquis avant l’intervention sont développées. Les données tomographiques forment un modèle 3D fiable de la structure vasculaire qui, une fois précisément aligné avec les angiographies, définit un outil de navigation virtuel 3D qui augmente le champ de vision des cardiologues. Dans ce mémoire, une nouvelle méthode automatique de recalage rigide 3D-2D par intensité de données tomographiques 3D avec des angiographies 2D est présentée. Aussi, une technique d’alignement semi-automatique permettant d’accélérer l’initialisation de la méthode automatique est développée. Les résultats de la méthode de recalage proposée, obtenus avec deux jeux de données de patient atteints de malformations cardiaques, sont prometteurs. Un alignement précis et robuste des données tomographique de l’artère aorte et des MAPCAs (0;265�0;647mm et 99 % de succès) à partir d’un déplacement rigide d’amplitude maximale (20mm et 20°) est obtenu en un temps de calcul raisonnable (13,7 secondes)

Myocardial fibrosis in repaired tetralogy of Fallot; Predicting ventricular arrhythmia and sudden cardiac death

We are faced with new challenges in the growing population of adult survivors with repaired tetralogy of Fallot (rTOF). The risk of premature death persists and drives eager pursuit for the accurate identification of patients at high-risk of malignant ventricular tachycardia (VT) and sudden cardiac death (SCD). It is previously known that inducible VT predicts mortality in rTOF patients. We show that the burden of right ventricular (RV) late gadolinium enhancement (LGE) defined fibrosis > 25cm3 quantified by high-sensitivity 3D LGE can predict inducible VT as a proxy endpoint for mortality. Patients with minimal RV LGE < 10cm3 were extremely unlikely to have inducible VT suggesting those with minimal RVLGE avoid an invasive study. In a prospective study of 550 rTOF patients, a high-risk subgroup of patients with a 4.4% annualised risk of death and 3.7% annualised risk of life-threatening VT/SCD were identified. RVLGE was a strong predictor of outcome. We demonstrated how RVLGE can be integrated with other independent predictors into weighted risk scores ready for clinical use. Diffuse fibrosis defined by RV T1 shows promise as a subtle biomarker of adverse remodelling. An imbalance in the expression of fibrosis biomarkers suggests that a state of high-collagen turnover exists and correlates with adverse remodelling. In conclusion, myocardial fibrosis plays a central role in predicting death and malignant VT in rTOF. This work identifies biomarkers to help risk stratify and enable more personalised and targeted care in the life-long follow up of adult rTOF patients.Open Acces

Molecular Mechanism of Congenital Heart Disease and Pulmonary Hypertension

This open access book focuses on the molecular mechanism of congenital heart disease and pulmonary hypertension, offering new insights into the development of pulmonary circulation and the ductus arteriosus. It describes in detail the molecular mechanisms involved in the development and morphogenesis of the heart, lungs and ductus arteriosus, covering a range of topics such as gene functions, growth factors, transcription factors and cellular interactions, as well as stem cell engineering technologies. The book also presents recent advances in our understanding of the molecular mechanism of lung development, pulmonary hypertension and molecular regulation of the ductus arteriosus. As such, it is an ideal resource for physicians, scientists and investigators interested in the latest findings on the origins of congenital heart disease and potential future therapies involving pulmonary circulation/hypertension and the ductus arteriosus

Medical-Data-Models.org:A collection of freely available forms (September 2016)

MDM-Portal (Medical Data-Models) is a meta-data repository for creating, analysing, sharing and reusing medical forms, developed by the Institute of Medical Informatics, University of Muenster in Germany. Electronic forms for documentation of patient data are an integral part within the workflow of physicians. A huge amount of data is collected either through routine documentation forms (EHRs) for electronic health records or as case report forms (CRFs) for clinical trials. This raises major scientific challenges for health care, since different health information systems are not necessarily compatible with each other and thus information exchange of structured data is hampered. Software vendors provide a variety of individual documentation forms according to their standard contracts, which function as isolated applications. Furthermore, free availability of those forms is rarely the case. Currently less than 5 % of medical forms are freely accessible. Based on this lack of transparency harmonization of data models in health care is extremely cumbersome, thus work and know-how of completed clinical trials and routine documentation in hospitals are hard to be re-used. The MDM-Portal serves as an infrastructure for academic (non-commercial) medical research to contribute a solution to this problem. It already contains more than 4,000 system-independent forms (CDISC ODM Format, www.cdisc.org, Operational Data Model) with more than 380,000 dataelements. This enables researchers to view, discuss, download and export forms in most common technical formats such as PDF, CSV, Excel, SQL, SPSS, R, etc. A growing user community will lead to a growing database of medical forms. In this matter, we would like to encourage all medical researchers to register and add forms and discuss existing forms