Mechanical Characterization of the Vessel Wall by Data Assimilation of Intravascular Ultrasound Studies

Atherosclerotic plaque rupture and erosion are the most important mechanisms underlying the sudden plaque growth, responsible for acute coronary syndromes and even fatal cardiac events. Advances in the understanding of the culprit plaque structure and composition are already reported in the literature, however, there is still much work to be done toward in-vivo plaque visualization and mechanical characterization to assess plaque stability, patient risk, diagnosis and treatment prognosis. In this work, a methodology for the mechanical characterization of the vessel wall plaque and tissues is proposed based on the combination of intravascular ultrasound (IVUS) imaging processing, data assimilation and continuum mechanics models within a high performance computing (HPC) environment. Initially, the IVUS study is gated to obtain volumes of image sequences corresponding to the vessel of interest at different cardiac phases. These sequences are registered against the sequence of the end-diastolic phase to remove transversal and longitudinal rigid motions prescribed by the moving environment due to the heartbeat. Then, optical flow between the image sequences is computed to obtain the displacement fields of the vessel (each associated to a certain pressure level). The obtained displacement fields are regarded as observations within a data assimilation paradigm, which aims to estimate the material parameters of the tissues within the vessel wall. Specifically, a reduced order unscented Kalman filter is employed, endowed with a forward operator which amounts to address the solution of a hyperelastic solid mechanics model in the finite strain regime taking into account the axially stretched state of the vessel, as well as the effect of internal and external forces acting on the arterial wall. Due to the computational burden, a HPC approach is mandatory. Hence, the data assimilation and computational solid mechanics computations are parallelized at three levels: (i) a Kalman filter level; (ii) a cardiac phase level; and (iii) a mesh partitioning level. To illustrate the capabilities of this novel methodology toward the in-vivo analysis of patient-specific vessel constituents, mechanical material parameters are estimated using in-silico and in-vivo data retrieved from IVUS studies. Limitations and potentials of this approach are exposed and discussed.Fil: Maso Talou, Gonzalo Daniel. Laboratorio Nacional de Computacao Cientifica; BrasilFil: Blanco, Pablo Javier. Laboratorio Nacional de Computacao Cientifica; BrasilFil: Ares, Gonzalo Damián. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Departamento de Mecanica. Grupo de Ingeniería Asistida Por Computador; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata; ArgentinaFil: Guedes Bezerra, Cristiano. Heart Institute (Incor); BrasilFil: Lemos, Pedro A.. Heart Institute (Incor); BrasilFil: Feijóo, Raúl Antonino. Laboratorio Nacional de Computacao Cientifica; Brasi

Automated lumen segmentation using multi-frame convolutional neural networks in Intravascular Ultrasound datasets

Aims: Assessment of minimum lumen areas in intravascular ultrasound (IVUS) pullbacks is time-consuming and demands adequately trained personnel. In this work, we introduce a novel and fully automated pipeline to segment the lumen boundary in IVUS datasets. Methods and results First, an automated gating is applied to select end-diastolic frames and bypass saw-tooth artefacts. Second, within a machine learning (ML) environment, we automatically segment the lumen boundary using a multi-frame (MF) convolutional neural network (MFCNN). Finally, we use the theory of Gaussian processes (GPs) to regress the final lumen boundary. The dataset consisted of 85 IVUS pullbacks (52 patients). The dataset was partitioned at the pullback-level using 73 pullbacks for training (20 586 frames), 6 pullbacks for validation (1692 frames), and 6 for testing (1692 frames). The degree of overlapping, between the ground truth and ML contours, median (interquartile range, IQR) systematically increased from 0.896 (0.874–0.933) for MF1 to 0.925 (0.911–0.948) for MF11. The median (IQR) of the distance error was also reduced from 3.83 (2.94–4.98)% for MF1 to 3.02 (2.25–3.95)% for MF11-GP. The corresponding median (IQR) in the lumen area error remained between 5.49 (2.50–10.50)% for MF1 and 5.12 (2.15–9.00)% for MF11-GP. The dispersion in the relative distance and area errors consistently decreased as we increased the number of frames, and also when the GP regressor was coupled to the MFCNN output. Conclusion: These results demonstrate that the proposed ML approach is suitable to effectively segment the lumen boundary in IVUS scans, reducing the burden of costly and time-consuming manual delineation.Fil: Ziemer, Paulo G. P.. Laboratorio Nacional de Computacao Cientifica; BrasilFil: Bulant, Carlos Alberto. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; ArgentinaFil: Orlando, José Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Exactas. Grupo de Plasmas Densos Magnetizados. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Grupo de Plasmas Densos Magnetizados; ArgentinaFil: Maso Talou, Gonzalo D.. University of Auckland; Nueva ZelandaFil: Mansilla Álvarez, Luis A.. Laboratorio Nacional de Computacao Cientifica; BrasilFil: Guedes Bezerra, Cristiano. Universidade de Sao Paulo; BrasilFil: Lemos, Pedro A.. Universidade de Sao Paulo; BrasilFil: García García, Héctor M.. Georgetown University School of Medicine; Estados UnidosFil: Blanco, Pablo J.. Laboratorio Nacional de Computacao Cientifica; Brasi

500.05 Comparison Between Fractional Flow Reserve (FFR) vs. Computational Fractional Flow Reserve Derived from Three-dimensional Intravascular Ultrasound (IVUSFR) and Quantitative Flow Ratio (QFR)

BACKGROUND The determination of the ischemic status of a coronary artery by wireless physiologic assessment derived from angiography has been validated and approved in the US. However, the use ofplain angiography quantitative variables does not add much to thephysiology data since it has low correlation with fractional flowreserve (FFR) and predicts clinical outcomes poorly. Recently, a grayscale intravascular ultrasound (IVUS) derived physiology method(IVUSFR) was developed and showed a good correlation with invasiveFFR by combining the geometric advantages of IVUS with physiology.The aim of this study is to assess the coefficient of correlation (R) ofinvasive FFR compared to IVUSFR and quantitative flow ratio (QFR).METHODS Stable coronary artery disease (CAD) patients with intermediate lesions (i.e. 40?80% of diameter stenosis) were assessed by angiography and IVUS. QFR was derived from the angiography images, andIVUSFR was derived from quantitative IVUS data using computationalfluid dynamics. Coefficient of correlation (R) was used in this report.RESULTS Twenty-four patients with 34 lesions were included in theanalysis. The IVUSFR, invasive FFR, Vessel QFR fixed flow (vQFRf),and Vessel QFR contrast flow (vQFRc) values varied from 0.52 to 1.00,0.71 to 0.99, 0.55 to 1.00, and 0.34 to 1.00, respectively. The coefficient of correlation (R) of FFR vs. IVUSFR was 0.79; FFR vs. vQFRf was0.72; FFR vs. vQFRc was 0.65 (Figure).CONCLUSION Compared to invasive FFR, IVUSFR and vQFRf showed asimilar coefficient of correlation and were better than vQFR contrast flowFil: Kajita, Alexandre. Medstart; Estados UnidosFil: Bezerra, Cristiano Guedes. Universidade Federal da Bahia; BrasilFil: Ozaki, Yuichi. Medstart; Estados UnidosFil: Dan, Kazuhiro. Medstart; Estados UnidosFil: Melaku, Gebremedhin D.. Medstart; Estados UnidosFil: Pinton, Fabio A.. Universidade de Sao Paulo; BrasilFil: Falcão, Breno A. A.. Hospital of Messejana; BrasilFil: Mariani, José. Universidade de Sao Paulo; BrasilFil: Bulant, Carlos Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. National Laboratory For Scientific Computing; BrasilFil: Maso Talou, Gonzalo Daniel. National Laboratory For Scientific Computing; BrasilFil: Esteves, Antonio. Universidade de Sao Paulo; BrasilFil: Blanco, Pablo Javier. National Laboratory For Scientific Computing; BrasilFil: Waksman, Ron. Medstart; Estados UnidosFil: Garcia Garcia, Hector M.. Medstart; Estados UnidosFil: Lemons, Pedro Alves. Universidade de Sao Paulo; Brasi

Nervous form of caprine arthritis-encephalitis

São descritos dois casos de caprinos, fêmeas, mestiços da raça Saanen de dois meses de idade com sinais clínicos de paresia de membros posteriores, incoordenação, dificuldade respiratória e caquexia, que foram submetidos à eutanásia, devido ao prognóstico desfavorável. Na necropsia, observou-se congestão do sistema nervoso central (SNC) e consolidação pulmonar nos dois caprinos. Microscopicamente, as alterações foram caracterizadas por leucoencefalomielite linfoplasmocítica multifocal, com vacuolização do neurópilo e esferoides axonais, leptomeningite, pneumonia intersticial não supurativa no caprino A e broncopneumonia bacteriana no caprino B. O exame de imuno-histoquímica (IHQ) foi positivo para o vírus da artrite-encefalite caprina em fragmento de tálamo. A prova de imunodifusão em gel de ágar (IDGA) foi realizada em vinte animais do rebanho de origem e dezesseis animais foram positivos. O diagnóstico da forma nervosa da infecção pelo vírus da artrite-encefalite caprina (CAEV) foi baseado no quadro clínico-patológico, IHQ e IDGA. Esta apresentação clínica da CAE pode ser pouco comum no Brasil, mas deve ser considerada em caso de doenças neurológicas em pequenos ruminantes.Two cases are described of female goats, Saanen crossbreds, two months old, with clinical signs of hind limb paresis, incoordination, difficulty breathing and cachexia, which were subjected to euthanasia due to unfavorable prognosis. At necropsy it was possible to observe that there was congestion of the central nervous system (CNS) and pulmonary consolidation in both goats. Microscopic changes were characterized by multifocal lymphoplasmacytic leucoencephalomielitis, with vacuolization of neuropile and axonal spheroids, leptomeningitis, interstitial nonsupurative pneumonia in goat A and bacterial bronchopneumonia in goat B. Immunohistochemistry (IHC) was positive for the caprine arthritis - encephalitis virus in thalamus fragments. The agar gel immunodiffusion (AGID) test was performed in sera sample of twenty animals and sixteen resulted positive. Diagnosis of the nervous form of caprine arthritis-encephalitis virus (CAEV) infection was based on clinical and pathological status, IHC and AGID. This clinical presentation of CAE could be uncommon in Brazil, but must be considered in case of neurologic diseases in small ruminants

Processing of medical imaging and hemodynamic parameters: clinical

Introdução: A doença arterial coronária (DAC) é avaliada através dos aspectos anatômicos da placa aterosclerótica ou a partir da repercussão funcional da estenose, por métodos diagnósticos diversos. O ultrassom intravascular (IVUS) fornece uma avaliação anatômica precisa do lúmen e da parede do vaso, tendo sido validado como uma ferramenta útil para guiar a intervenção coronária percutânea (ICP). No entanto, do ponto de vista diagnóstico, o IVUS representa mal o estado funcional (isto é, informação relacionada ao comprometimento de fluxo) do vaso interrogado. A reserva de fluxo fracionada (FFR) é método importante para identificação de isquemia, discriminando as estenoses coronárias que podem se beneficiar de ICP. Objetivamos desenvolver e avaliar o desempenho diagnóstico de um novo algoritmo computacional para estimar a FFR à partir das imagens do IVUS tridimensional (IVUSFR), comparando-o com o método padrão ouro para estimação de fluxo coronário invasivo (FFRPW). Métodos: Pacientes com DAC estável conhecida ou suspeita encaminhados para cateterismo cardíaco eletivo foram submetidos a avaliação complementar com medida de fluxo coronário pelo FFRPW e com imagem intravascular pelo IVUS, no mesmo procedimento, a fim de avaliar lesões intermediárias. As imagens do IVUS foram processadas para gerar uma malha computacional tridimensional que condensa as características geométricas do vaso. O IVUSFR foi obtido utilizando dinâmica de fluido computacional, configurando-se as condições de contorno a partir de características específicas do paciente e do território coronário irrigado. As medidas de FFRPW foram dicotomizadas no limiar de 0,80 para definir lesões hemodinamicamente significativas e avaliar o desempenho diagnóstico do IVUSFR. Resultados: Um total de 34 artérias coronárias de 24 pacientes foi analisado. A área luminal mínima média avaliada pelo IVUS de 4,14 ± 1,74 mm2, e carga de placa média de 66±10% caracterizam o grau intermediário das lesões. O IVUSFR correlacionou significativamente (r = 0,79; p < 0,001) e mostrou boa concordância com a FFRPW, apresentando diferença média de -0,008 ± 0,067 (p = 0,47). O IVUSFR apresentou acurácia, sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 91%, 89%, 92%, 80% e 96%, respectivamente, para detectar estenoses hemodinamicamente significativas. Conclusão: O processamento computacional do IVUSFR é um novo método que permite a avaliação funcional da estenose coronária intermediária de forma acurada, enriquecendo as informações anatômicas do IVUSIntroduction: Coronary artery disease (CAD) is assessed through the anatomical aspects of the atherosclerotic plaque or through the functional impairment of the stenosis, by different diagnostic methods. Intravascular ultrasound (IVUS) provides accurate anatomic assessment of lumen and vessel wall and has been validated as a useful tool to guide percutaneous coronary intervention (PCI). However, from the diagnostic point of view, IVUS poorly represents the functional status (i.e. flow-related information) of the imaged vessel. Fractional flow reserve (FFR) is an important tool to identify ischemia, discriminating coronary stenosis that may benefit from PCI. We aimed to develop and evaluate the diagnostic performance of a novel computational algorithm based on three-dimensional IVUS imaging in estimating fractional flow reserve (IVUSFR), compared to gold-standard invasive measurements (FFRPW). Methods: Patients with known or suspected stable coronary disease scheduled for elective cardiac catheterization underwent FFRPW measurement and IVUS imaging in the same procedure to evaluate intermediate lesions. A processing methodology was applied on IVUS to generate a computational mesh condensing the geometric characteristics of the vessel. Through computational fluid dynamics, IVUSFR was obtained from patient-level morphological definition of arterial districts and from territory-specific boundary conditions. FFRPW measurements were dichotomized at the 0.80 thresholds to define hemodynamically significant lesions and evaluate diagnostic performance of IVUSFR. Results: A total of 24 patients with 34 vessels were analyzed. The mean minimum luminal area assessed by IVUS was 4.14 ± 1.74 mm2, and mean plaque burden was 66 ± 10%, characterizing intermediate lesions. IVUSFR significantly correlated (r = 0.79; p < 0.001) and showed good agreement with FFRPW, with a mean difference of -0.008 ± 0.067 (p = 0.47). IVUSFR presented an overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 89%, 92%, 80%, and 96% respectively to detect significant stenosis. Conclusion: The computational processing of IVUSFR is a new method that allows the evaluation of the functional significance of coronary stenosis in an accurate way, enriching the anatomical information of IVU

Simultaneous assessment of coronary stenosis relevance with automated computed tomography angiography and intravascular ultrasound analyses and fractional flow reserve

Objectives: To assess the diagnostic performance of computed tomography angiography (CTA) and intravascular ultrasound (IVUS) derived minimum lumen areas (MLA) from the same lesions that correspond to an FFR ≤0.80. Methods and results: A total of 24 patients (33 arteries) were collected retrospectively according to the following inclusion criteria: presence of a CTA diagnostic followed by an IVUS and FFR percutaneous coronary procedures. CTA and IVUS lumen contours were automatically performed using previously validated methods. The correlation between CTA and IVUS for the MLA was r = 0.45. In terms of MLA, the mean difference between CTA and IVUS was 0.81 mm2. Of note, a much smaller CTA-derived MLA (2.10 mm2) was found to be related to significant FFR lesions compared to that of the MLA derived from IVUS (3.19 mm2). The area under the curve, accuracy, sensitivity and specificity for this CTA-derived MLA were 0.80, 0.76, 0.50 and 0.87, respectively, while these values for IVUS-derived MLA were 0.87, 0.85, 0.80 and 0.87. Conclusions: Computed tomography angiography and intravascular ultrasound-derived minimum lumen areas have moderate diagnostic efficiency, albeit slightly better for IVUS, in identifying hemodynamically severe coronary stenoses. The utility of MLA, automatically derived from either CTA or IVUS as an alternative to FFR to guide the decision to revascularize, should be tested clinically.Fil: Blanco, Pablo J.. National Laboratory for Scientific Computing. Department of Mathematical and Computational Methods; Brasil. National Institute of Science and Technology in Medicine Assisted by Scientific Computing; BrasilFil: Bulant, Carlos Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires; Argentina. National Institute of Science and Technology in Medicine Assisted by Scientific Computing; BrasilFil: Bezerra, Cristiano Guedes. University of São Paulo Medical School; Brasil. Hospital Israelita Albert Einstein; BrasilFil: Lemos, Pedro A.. National Institute of Science and Technology in Medicine Assisted by Scientific Computing; Brasil. University of São Paulo Medical School; Brasil. Hospital Israelita Albert Einstein; BrasilFil: García García, Héctor M.. MedStar Washington Hospital Center; Estados Unidos. Georgetown University School of Medicine; Estados Unido

Improving Cardiac Phase Extraction in IVUS Studies by Integration of Gating Methods

Goal: Coronary intravascular ultrasound (IVUS) is a fundamental imaging technique for atherosclerotic plaque assessment. However, volume-based data retrieved from IVUS studies can be misleading due to the artifacts generated by the cardiac motion, hindering diagnostic, and visualization of the vessel condition. Then, we propose an image-based gating method that improves the performance of the preexisting methods, delivering a gating in an appropriate time for clinical practice. Methods: We propose a fully automatic method to synergically integrate motion signals from different gating methods to improve the cardiac phase estimation. Additionally, we present a local extrema identification method that provides a more accurate extraction of a cardiac phase and, also, a scheme for multiple phase extraction mandatory for elastography-type studies. Results: A comparison with three state-of-the-art methods is performed over 61 in-vivo IVUS studies including a wide range of physiological situations. The results show that the proposed strategy offers: 1) a more accurate cardiac phase extraction; 2) a lower frame oversampling and/or omission in the extracted phase data (error of 1.492 ± 0.977 heartbeats per study, mean ± SD); 3) a more accurate and robust heartbeat period detection with a Bland-Altman coefficient of reproducibility (RPC) of 0.23 s, while the second closest method presents an RPC of 0.36 s. Significance: The integration of motion signals performed by our method shown an improvement of the gating accuracy and reliability.Fil: Maso Talou, Gonzalo D.. Laboratorio Nacional de Computacao Cientifica; BrasilFil: Larrabide, Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Centro de la Provincia de Buenos Aires; ArgentinaFil: Blanco, Pablo Javier. Laboratorio Nacional de Computacao Cientifica; BrasilFil: Bezerra, Cristiano Guedes. Universidade de Sao Paulo; BrasilFil: Lemos, Pedro A.. Universidade de Sao Paulo; BrasilFil: Feijóo, Raúl Antonino. Laboratorio Nacional de Computacao Cientifica; Brasi

Mechanical Characterization of the Vessel Wall by Data Assimilation of Intravascular Ultrasound Studies

Atherosclerotic plaque rupture and erosion are the most important mechanisms underlying the sudden plaque growth, responsible for acute coronary syndromes and even fatal cardiac events. Advances in the understanding of the culprit plaque structure and composition are already reported in the literature, however, there is still much work to be done toward in-vivo plaque visualization and mechanical characterization to assess plaque stability, patient risk, diagnosis and treatment prognosis. In this work, a methodology for the mechanical characterization of the vessel wall plaque and tissues is proposed based on the combination of intravascular ultrasound (IVUS) imaging processing, data assimilation and continuum mechanics models within a high performance computing (HPC) environment. Initially, the IVUS study is gated to obtain volumes of image sequences corresponding to the vessel of interest at different cardiac phases. These sequences are registered against the sequence of the end-diastolic phase to remove transversal and longitudinal rigid motions prescribed by the moving environment due to the heartbeat. Then, optical flow between the image sequences is computed to obtain the displacement fields of the vessel (each associated to a certain pressure level). The obtained displacement fields are regarded as observations within a data assimilation paradigm, which aims to estimate the material parameters of the tissues within the vessel wall. Specifically, a reduced order unscented Kalman filter is employed, endowed with a forward operator which amounts to address the solution of a hyperelastic solid mechanics model in the finite strain regime taking into account the axially stretched state of the vessel, as well as the effect of internal and external forces acting on the arterial wall. Due to the computational burden, a HPC approach is mandatory. Hence, the data assimilation and computational solid mechanics computations are parallelized at three levels: (i) a Kalman filter level; (ii) a cardiac phase level; and (iii) a mesh partitioning level. To illustrate the capabilities of this novel methodology toward the in-vivo analysis of patient-specific vessel constituents, mechanical material parameters are estimated using in-silico and in-vivo data retrieved from IVUS studies. Limitations and potentials of this approach are exposed and discussed

Analysis of the Influence of Deforestation on the Microphysical Parameters of Clouds in the Amazon

Studies have shown that deforestation can cause changes in energy, moisture, and precipitation flows, with implications for local and regional climate. These studies generally focus on understanding how the hydrological cycle is impacted by deforestation, but few studies have investigated these impacts on cloud microphysics in tropical forest regions. The objective of this study was to quantitatively evaluate the impacts of deforestation on the microphysical parameters of clouds, based on data extracted from active and passive orbital sensors from the TRMM satellite. The study area comprised the state of Rond&ocirc;nia, Brazil. The analyses of the microphysical parameters extracted from the Microwave Imager (TMI) and Precipitation Radar (PR) sensors of the 2A-CLIM and 2A25 products were performed considering a period of 14 years. The parameters analyzed were Rain Water Path (RWP), Ice Water Path (IWP), Surface Precipitation (SP), Freezing Level Height (FH), and Rainfall Type (RT). Land cover type data were extracted from the Project to Monitor Deforestation in the Legal Amazon (PMDA). Our results showed that local deforestation significantly altered the microphysical parameters of the study region. In general, the values of the microphysical parameters of the clouds in the transition areas (locations where forest pixels are neighbors to deforested pixels) were about 5&ndash;25% higher compared to forested and deforested areas associated with a higher frequency of episodes of convective rainfall possibly driven by mesoscale circulations. Correspondingly, forested areas had higher rainfall rates compared to deforested areas. Meanwhile, deforested areas had higher amounts for IWP, of around 1&ndash;16%, and FH, of around 2&ndash;8%, in relation to forested areas. Conversely, the RWP showed a decrease of around 2&ndash;20%. These results suggest that the microphysical structure of clouds has different characteristics when related to forested and deforested areas in the Amazon. This is useful for evaluation of simulations of cloud microphysical parameters in numerical models of weather and climate