Image and Signal Processing in Intravascular Ultrasound

Intravascular ultrasound (rvUS) is a new imaging mOdality providing real-time, crosssectional, high-resolution images of the arterial lumen and vessel wall. In contrast to conventional x-ray angiography that only displays silhouette views of the vessel lumen, IVUS imaging permits visualization of lesion morphology and accurate measurements of arterial cross-sectional dimensions in patients. These unique capabilities have led to many important clinical applications including quantitative assessment of the severity, restenosis, progression of atherosclerosis, selection and guidance of catheterbased therapeutic procedures and short- and long-term evaluation of the outcome of an intravascular intervention. Like the progress of other medial imaging modalities, the advent of IVUS techniques has brought in new challenges in the field of signal and image processing. Quantitative analysis of IVUS images requires the identification of arterial structures such as the lumen and plaque within an image. Manual contour tracing is well known to be time consuming and subjective. Development of an automated contour detection method may improve the reproducibility of quantitative IVUS and avoid a tedious manual procedure. Computerized three-dimensional (3D) reconstruction of an IVUS image series may extend the tomographic data to a more powerful volumetric assessment of the vessel segment. Obviously, this could not be achieved without the advance of 3D image processing techniques. Furthermore, it is demonstrated that processing of the original radio frequency (RF) echo signals provides an efficient means to improve the IVUS image quality as well as a new approach to extract volumetric flow information. The goals of the studies reported in this thesis are therefore directed toward development of video image and RF signal processing techniques for image enhancement, automated contour detection, 3D reconstruction and flow imaging. In this chapter several IVUS scanning mechanisms and some background information about ultrasonic imaging are briefly introduced. The principles of different video-based contour detection approaches and examples of contour detection in echocardiograms are discussed. Subsequently, applications of RF analysis in IVUS images are reviewed, followed by the scope of this thesis in the final part

Temporal averaging for quantification of lumen dimensions in intravascular ultrasound images

Quantitative analysis of arterial dimensions from high frequency intravascular ultrasound images (30 MHz) may be hampered by strong blood scattering. Replacement of blood by saline is one method to provide a clear view of the arterial lumen; another method is that of temporal averaging of successive ultrasound images. The accuracy of this latter method was tested by comparing the lumen area measurements on the temporal-averaged image, with the data of the same cross-section obtained from the single-frame and saline-filled images. The mean lumen area measured on the temporal-averaged images was similar to that measured on the single-frame images (mean difference: −0.02 ± 1.16 mm2; p = ns). The mean lumen a

ECG-Gated Three-dimensional Intravascular Ultrasound

Background Automated systems for the quantitative analysis of three-dimensional (3D) sets of intravascular ultrasound (IVUS) images have been developed to reduce the time required to perform volumetric analyses; however, 3D image reconstruction by these nongated systems is frequently hampered by cyclic artifacts. Methods and Results We used an ECG-gated 3D IVUS image acquisition workstation and a dedicated pullback device in atherosclerotic coronary segments of 30 patients to evaluate (1) the feasibility of this approach of image acquisition, (2) the reproducibility of an automated contour detection algorithm in measuring lumen, external elastic membrane, and plaque+media cross-sectional areas (CSAs) and volumes and the cross-sectional and volumetric plaque+media burden, and (3) the agreement between the automated area measurements and the results of manual tracing. The gated image acquisition took 3.9±1.5 minutes. The length of the segments analyzed was 9.6 to 40.0 mm, with 2.3±1.5 side branches per segment. The minimum lumen CSA measured 6.4±1.7 mm2, and the maximum and average CSA plaque+media burden measured 60.5±10.2% and 46.5±9.9%, respectively. The automated contour-detection required 34.3±7.3 minutes per segment. The differences between these measurements and manual tracing did not exceed 1.6% (SD<6.8%). Intraobserver and interobserver differences in area measurements (n=3421; r=.97 to.99) were <1.6% (SD<7.2%); intraobserver and interobserver differences in volumetric measurements (n=30; r=.99) were <0.4% (SD<3.2%). Conclusions ECG-gated acquisition of 3D IVUS image sets is feasible and permits the application of automated contour detection to provide reproducible measurements of the lumen and atherosclerotic plaque CSA and volume in a relatively short analysis time

Intravascular ultrasound predictors of outcome after peripheral balloon angioplasty

Objective:This study investigates the potential role of intravascular ultrasound (IVUS) in the outcome in patients undergoing percutaneous transluminal angioplasty (PTA) of the superficial femoral artery.Materials:Angiographic and the qualitative and quantitative IVUS data obtained at the narrowest site derived from 39 patients before and after PTA were analysed.Results:Angiographically the diameter of the remaining stenosis seen after PTA was classified as < 50% in 31 patients (success); in eight patients a failure was encountered. Evaluating at 6 months the functional and anatomic results of the PTA in 31 patients, the intervention was a success in 14 patients (Group I) and a failure in 17 patients (Group II). The remaining eight patients defined as angiographic failure following PTA comprised Group III. Neither qualitative nor quantitative IVUS data obtained before PTA could predict outcome. Conversely, after PTA, the extent of dissection was significantly more severe in Groups II and III than in Group I. Similarly, significant differences were found between Groups I and II for mean free lumen area (13.2 vs. 9.7 mm2, respectively) and mean free lumen diameter (4.1 vs. 3.5 mm, respectively). Quantitative data obtained in Group II were similar to those in Group III.Conclusion:This preliminary study demonstrates that following PTA the extent of dissection, free lumen area and diameter seen with IVUS are predictive factors of patency. Future studies with more patients are mandatory to further highlight the sensitivity of these observations