Left Ventricular Viability Maps : Fusion of Multimodal Images of Coronary Morphology and Functional Information

RÉSUMÉ Les maladies coronariennes demeurent encore la première cause de décès aux Etats-Unis étant donné que le taux de mortalité lié à ces maladies enregistré en 2005 est d’une personne sur cinq. Les sténoses (obstructions des artères coronaires) se manifestent par un rétrécissement du diamètre des coronaires, produisant une ischémie soit une réduction du flot sanguin vers le myocarde (le muscle cardiaque). Dans les cas les plus graves, les cellules qui composent le myocarde meurent définitivement et perdent leur fonction contractile. En présence de cette maladie les cliniciens ont recours à l’imagerie médicale pour étudier l’état du myocarde afin de déterminer si les cellules qui le composent sont mortes ou non ainsi que pour diagnostiquer les sténoses dans les coronaires. Actuellement, le clinicien utilise l’imagerie nucléaire pour étudier la perfusion du myocarde afin de déterminer son état. Une projection de cette information sur un modèle segmenté du myocarde, soit le modèle à 17-segments, établie le lien entre les zones atteintes et les coronaires qui sont les plus responsables de leur irrigation. Ce n’est que par la suite, lors d’une angiographie, que le clinicien pourra identifier les sténoses et possiblement intervenir par revascularisation. Une autre méthode de visualisation de la structure coronarienne et de la présence de sténoses est la méthode Green Lane. Le clinicien reproduit la structure des coronaires sur une carte circulaire en se basant sur l’angiographie. L’objectif de notre projet de recherche est de créer un modèle spécifique au patient où il serait possible de voir les territoires coronariens sur la surface du myocarde fusionnés avec la viabilité myocardique. Ce modèle s’adapterait au patient et permettrait l’étude d’autres groupes de coronaires, ce qui n’est pas possible avec le modèle à 17-segments qui est fixe et ne présente que les trois groupes principaux de coronaires (coronaire droite, gauche et circonflexe). De plus, ce modèle divise la surface de l’épicarde en segments à partir de données statistiques qui sont limitées par la nature et la représentativité de l’échantillon de la population considérée et ne permet pas de visualiser la distribution de perte de viabilité sur la surface épicardique.---------- ABSTRACT Coronary heart disease (CHD) can be attributed to the build up of plaque in the coronary arteries (atherosclerosis) which leads to ischemia, an insufficient supply of blood to the heart wall, which results in myocardial dysfunction. When ischemia remains untreated an infarction may appear (areas of necrosis in cardiac tissues) and consequently the heart’s contractility is affected, which may lead to death. This disease is the basis of one of every five deaths in the United States during 2005, elevating this disease to the largest cause of death in United States. In standard clinical practice, perfusion and viability studies allow clinicians to examine the extent and the severity of CHD over the myocardium. Then, by consulting a population-based coronary territory model, such as the 17-segment model, the clinician mentally integrates affected areas of myocardium, found in nuclear or magnetic resonance imaging, to coronaries that typically irrigate this region with blood. However, population-based models do not fit every patient. There are individuals whose coronary tree structure deviates from that of the majority of the population. In addition, the 17-segment model limits the number of coronary groups to three: left coronary artery (LAD), right coronary artery (RCA) and left circumflex (LCX). Moreover this map is not continuous; it divides the myocardial surface in segments.Our objective is therefore to create a patient-specific map explicitly combining coronary territories and myocardial viability. This continuous model would adapt to the patient and allow the study of groups of coronary unavailable with standard models. After having identified loss of viability, the clinician would use this model to infer the most likely obstructed coronary artery responsible for myocardial damage. Visualization of the loss of viability along with coronary structure would replace the physician’s task of mentally integrating information from various sources

Doctor of Philosophy

dissertationImage-based biomechanics, particularly numerical modeling using subject-specific data obtained via imaging, has proven useful for elucidating several biomechanical processes, such as prediction of deformation due to external loads, applicable to both normal function and pathophysiology of various organs. As the field evolves towards applications that stretch the limits of imaging hardware and acquisition time, the information traditionally expected as input for numerical routines often becomes incomplete or ambiguous, and requires specific acquisition and processing strategies to ensure physical accuracy and compatibility with predictive mathematical modeling. These strategies, often derivatives or specializations of traditional mechanics, effectively extend the nominal capability of medical imaging hardware providing subject-specific information coupled with the option of using the results for predictive numerical simulations. This research deals with the development of tools for extracting mechanical measurements from a finite set of imaging data and finite element analysis in the context of constructing structural atlases of the heart, understanding the biomechanics of the venous vasculature, and right ventricular failure. The tools include: (1) application of Hyperelastic Warping image registration to displacement-encoded MRI for reconstructing absolute displacement fields, (2) combination of imaging and a material parameter identification approach to measure morphology, deformation, and mechanical properties of vascular tissue, and (3) extrapolation of diffusion tensor MRI acquired at a single time point for the prediction the structural changes across the cardiac cycle with mechanical simulations. Selected tools were then applied to evaluate structural changes in a reversible animal model for right ventricular failure due to pressure overload

Analysis of cardiac motion using MRI and nonrigid image registration

Imperial Users onl

Analysis of myocardial contractility with magnetic resonance

Heart failure has considerable morbidity and poor prognosis. An understanding of the underlying mechanics governing myocardial contraction is a prerequisite for interpreting and predicting changes induced by heart disease. Gross changes in contractile behaviour of the myocardium are readily detected with existing techniques. For more subtle changes during early stages of cardiac dysfunction, however, it requires a sensitive method for measuring, as well as a precise criterion for quantifying, normal and impaired myocardial function. Cardiovascular Magnetic Resonance (CMR) imaging is emerging as an important clinical tool because of its safety, versatility, and the high quality images it produces that allow accurate and reproducible quantification of cardiac structure and function. Traditional CMR approaches for measuring contractility rely on tagging of the myocardium with fiducial markers and require a lengthy and often subjective dependant post-processing procedure. The aim of this research is to develop a new technique, which uses velocity as a marker for the visualisation and assessment of myocardial contractility. Two parallel approaches have been investigated for the assessment of myocardial velocity. The first of these is haimonic phase (HARP) imaging. HARP imaging allows direct derivation of myocardial velocity and strain without the need of further user interaction. We investigated the effect of respiration on the accuracy of the derived contractility, and assessed the clinical applicability and potential pitfalls of the technique by analysing results from a group of patients with hypertrophic cardiomyopathy. The second technique we have investigated is the direct measurement of myocardial velocity with phase contrast myocardial velocity mapping. The imaging sequence used employs effective blood saturation for reducing flow induced phase errors within the myocardium. View sharing was used to improve the temporal resolution, which permitted acquisition of 3D velocity information throughout the cardiac cycle in a single breath-hold, enabling a comprehensive assessment of strain rate of the left ventricle. One key factor that affects the derivation of myocardial contractility based on myocardial velocity is the practical inconsistency of the velocity data. A novel iterative optimisation scheme by incorporating the incompressibility constraint was developed for the restoration of myocardial velocity data. The method allowed accurate assessment of both in-plane and through-plan strain rates, as demonstrated with both synthetic and in vivo data acquired from normal subjects and ischaemic patients. To further enhance the clinical potential of the technique and facilitate the visual assessment of contractile abnormality with myocardial velocity mapping, a complementary analysis framework, named Virtual Tagging, has been developed. The method used velocity data in all directions combined with a finite element mesh incorporating geometrical and physical constraints. The Virtual Tagging framewoik allowed velocity measurements to be used for calculating strain distribution within the 3D volume. It also permitted easy visualisation of the displacement of the tissue, akin to traditional CMR tagging. Detailed validation of the technique is provided, which involves both numerical simulation and in vitro phantom experiments. The main contribution of this thesis is in the improvement of the effectiveness and quality of quantitative myocardial contractility analysis from both sequence design and medical image computing perspectives. It is aimed at providing a sensitive means of detecting subtle as well as gross changes in contractile behaviour of the myocardium. The study is expected to provide a clinically viable platform for functional correlation with other functional measures such as myocardial perfusion and diffusion, and to serve as an aid for further understanding of the links between intrinsicOpen acces

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

An image segmentation and registration approach to cardiac function analysis using MRI

Cardiovascular diseases (CVDs) are one of the major causes of death in the world. In recent years, significant progress has been made in the care and treatment of patients with such diseases. A crucial factor for this progress has been the development of magnetic resonance (MR) imaging which makes it possible to diagnose and assess the cardiovascular function of the patient. The ability to obtain high-resolution, cine volume images easily and safely has made it the preferred method for diagnosis of CVDs. MRI is also unique in its ability to introduce noninvasive markers directly into the tissue being imaged(MR tagging) during the image acquisition process. With the development of advanced MR imaging acquisition technologies, 3D MR imaging is more and more clinically feasible. This recent development has allowed new potentially 3D image analysis technologies to be deployed. However, quantitative analysis of cardiovascular system from the images remains a challenging topic. The work presented in this thesis describes the development of segmentation and motion analysis techniques for the study of the cardiac anatomy and function in cardiac magnetic resonance (CMR) images. The first main contribution of the thesis is the development of a fully automatic cardiac segmentation technique that integrates and combines a series of state-of-the-art techniques. The proposed segmentation technique is capable of generating an accurate 3D segmentation from multiple image sequences. The proposed segmentation technique is robust even in the presence of pathological changes, large anatomical shape variations and locally varying contrast in the images. Another main contribution of this thesis is the development of motion tracking techniques that can integrate motion information from different sources. For example, the radial motion of the myocardium can be tracked easily in untagged MR imaging since the epi- and endocardial surfaces are clearly visible. On the other hand, tagged MR imaging allows easy tracking of both longitudinal and circumferential motion. We propose a novel technique based on non-rigid image registration for the myocardial motion estimation using both untagged and 3D tagged MR images. The novel aspect of our technique is its simultaneous use of complementary information from both untagged and 3D tagged MR imaging. The similarity measure is spatially weighted to maximise the utility of information from both images. The thesis also proposes a sparse representation for free-form deformations (FFDs) using the principles of compressed sensing. The sparse free-form deformation (SFFD) model can capture fine local details such as motion discontinuities without sacrificing robustness. We demonstrate the capabilities of the proposed framework to accurately estimate smooth as well as discontinuous deformations in 2D and 3D CMR image sequences. Compared to the standard FFD approach, a significant increase in registration accuracy can be observed in datasets with discontinuous motion patterns. Both the segmentation and motion tracking techniques presented in this thesis have been applied to clinical studies. We focus on two important clinical applications that can be addressed by the techniques proposed in this thesis. The first clinical application aims at measuring longitudinal changes in cardiac morphology and function during the cardiac remodelling process. The second clinical application aims at selecting patients that positively respond to cardiac resynchronization therapy (CRT). The final chapter of this thesis summarises the main conclusions that can be drawn from the work presented here and also discusses possible avenues for future research

Three-dimensional echocardiography in coronary artery disease

Two-dimensional echocardiography has proven to be a very useful tool in the evaluation of global and regional left ventricular function in patients with coronary artcry disease. It has also been used in recognizing viable versus non-viable myocardium, combined with exercise or pharmacological stress. Recent development in transpulmonary ultrasound contrast agents inspired new interest in the cardiologists in myocardial perfusion imaging. Though most agents have proven helpful in (a few agents, including Optison and Leovist , have been approved for clinical application in several continents) left ventricular border delineation, their roles in myocardial perfusion imaging has not been studied extensively. The ability of two-dimensional methods in accurate assessment of the site and extent of wall motion and perfusion abnormalities is limited to the use of a few selected cross-sectional views of the left ventricle and employment of geometric assumptions of the ventricular cavity and walls. This leads to source of errors in quantitative studies of non-symmetric ventricles such as those undergone myocardial infarction and geometric remodeling. Twodimensional echocardiography is also limited in the evaluation of the mechanism of and in quantifying the severity of mitral regurgitation in patients with ischemic heart diseasc. Other complications of ischemic heart disease such as intracardiac thrombus can be diagnosed by two-dimensional echocardiography, but a more reproducible technique, such as three-dimensional echocardiography, may provide more reliable data on the therapeutic results in serial follow-up studies. Imaging of the blood vessels inc1uding coronary and carotid arteries has been relied mainly on invasive techniques. Two-dimensional ultrasound has shown limited promises in vascular imaging. Both the heart and the blood vessels are three-dimensional structures. An ideal approach in accurate and comprehensive examination of the heart and blood vessels is one that can collect volumetric information of the heart or vessels and is able to display them in three dimensions. Threedimensional echocardiography has demonstrated its superiority over two-dimensional methods in quantification of chamber volumes and function and in display of congenital or valvular abnormalities. Its role in the evaluation of coronary artery disease has not been fully explored. The purpose of this thesis was to examine the potential of three-dimensional echocardiography in qualitative and quantitative evaluation of coronary artery disease and related abnormalities

3D reconstruction of coronary arteries from angiographic sequences for interventional assistance

Introduction -- Review of literature -- Research hypothesis and objectives -- Methodology -- Results and discussion -- Conclusion and future perspectives