Motion Calculations on Stent Grafts in AAA

Endovascular aortic repair (EVAR) is a technique which uses stent grafts to treat aortic aneurysms in patients at risk of aneurysm rupture. Although this technique has been shown to be very successful on the short term, the long term results are less optimistic due to failure of the stent graft. The pulsating blood flow applies stresses and forces to the stent graft, which can cause problems such as breakage, leakage, and migration. Therefore it is of importance to gain more insight into the in vivo motion behavior of these devices. If we know more about the motion patterns in well-behaved stent graft as well as ill-behaving devices, we shall be better able to distinguish between these type of behaviors These insights will enable us to detect stent-related problems and might even be used to predict problems beforehand. Further, these insights will help in designing the next generation stent grafts. Firstly, this work discusses the applicability of ECG-gated CT for measuring the motions of stent grafts in AAA. Secondly, multiple methods to segment the stent graft from these data are discussed. Thirdly, this work proposes a method that uses image registration to apply motion to the segmented stent mode

Detectability of motions in AAA with ECG-gated CTA: A quantitative study

Purpose: ECG-gated CT enables the visualization of motions caused by the beating of the heart. Although ECG gating is frequently used in cardiac CT imaging, this technique is also very promising for evaluating vessel wall motion of the aortic artery and the motions of (stent grafts inside) abdominal aortic aneurysms (AAA). Late stent graft failure is a serious complication in endovascular repair of aortic aneurysms. Better understanding of the motion characteristics of stent grafts will be beneficial for designing future devices. In addition, these data can be valuable in predicting stent graft failure in patients. To be able to reliably quantify the motion, however, it is of importance to know the performance and limitations of ECG gating, especially when the motions are small, as is the case in AAA. Since the details of the reconstruction algorithms are proprietary information on the CT manufacturers and not in the public domain, empirical experiments are required. The goal of this study is to investigate as to what extent the motions in AAA can be measured using ECG-gated CT. The authors quantitatively investigate four aspects of motion in ECG-gated CT: The detectability of the motion of objects at different amplitudes and different periodic motions, the temporal resolution, and the volume gaps that occur as a function of heart rate.\ud \ud Methods: They designed an experiment on a standard static phantom to empirically determine temporal resolution. To investigate motion amplitude and frequency, as well as patient heart rate, they designed dynamic experiments in which a home-made phantom driven by a motion unit moves in a predetermined pattern.\ud \ud Results: The duration of each ECG-gated phase was found to be 185 ms, which corresponds to half of the rotation time and is thus in accordance with half scan reconstruction applied by the scanner. By using subpixel localization, motions become detectable from amplitudes of as small as 0.4 mm in the x direction and 0.7 mm in the z direction. With the rotation time used in this study, motions up to 2.7 Hz can be reliably detected. The reconstruction algorithm fills volume gaps with noisy data using interpolation, but objects within these gaps remain hidden.\ud \ud Conclusions: This study gives insight into the possibilities and limitations for measuring small motions using ECG-gated CT. Application of the experimental method is not restricted to the CT scanner of a single manufacturer. From the results, they conclude that ECG-gated CTA is a suitable technique for studying the expected motions of the stent graft and vessel wall in AAA.\u

Phosphorylated guanidinoacetate partly compensates for the lack of phosphocreatine in skeletal muscle of mice lacking guanidinoacetate methyltransferase

The effects of creatine (Cr) absence in skeletal muscle caused by a deletion of guanidinoacetate methyltransferase (GAMT) were studied in a knockout mouse model by in vivo (31)P magnetic resonance (MR) spectroscopy. (31)P MR spectra of hindleg muscle of GAMT-deficient (GAMT–/–) mice showed no phosphocreatine (PCr) signal and instead showed the signal for phosphorylated guanidinoacetate (PGua), the immediate precursor of Cr, which is not normally present. Tissue pH did not differ between wild-type (WT) and GAMT–/– mice, while relative inorganic phosphate (P(i)) levels were increased in the latter. During ischaemia, PGua was metabolically active in GAMT–/– mice and decreased at a rate comparable to the decrease of PCr in WT mice. However, the recovery rate of PGua in GAMT–/– mice after ischaemia was reduced compared to PCr in WT mice. Saturation transfer measurements revealed no detectable flux from PGua to γ-ATP, indicating severely reduced enzyme kinetics. Supplementation of Cr resulted in a rapid increase in PCr signal intensity until only this resonance was visible, along with a reduction in relative P(i) values. However, the PGua recovery rate after ischaemia did not change. Our results show that despite the absence of Cr, GAMT–/– mice can cope with mild ischaemic stress by using PGua for high energy phosphoryl transfer. The reduced affinity of creatine kinase (CK) for (P)Gua only becomes apparent during recovery from ischaemia. It is argued that absence of Cr causes the higher relative P(i) concentration also observed in animals lacking muscle CK, indicating an important role of the CK system in P(i) homeostasis

Comparison of dynamic susceptibility contrast-MRI perfusion quantification methods in the presence of delay and dispersion

The perfusion of the brain is essential to maintain brain function. Stroke is an example of a decrease in blood flow and reduced perfusion. During ischemic stroke the blood flow to tissue is hampered due to a clot inside a vessel. To investigate the recovery of stroke patients, follow up studies are necessary. MRI is the preferred imaging modality for follow up because of the absence of radiation dose concerns, contrary to CT. Dynamic Susceptibility Contrast (DSC) MRI is an imaging technique used for measuring perfusion of the brain, however, is not standard applied in the clinical routine due to lack of immediate patient benefit. Several post processing algorithms are described in the literature to obtain cerebral blood flow (CBF). The quantification of CBF relies on the deconvolution of a tracer concentration-time curve in an arterial and a tissue voxel. There are several methods to obtain this deconvolution based on singular-value decomposition (SVD). This contribution describes a comparison between the different approaches as currently there is no best practice for (all) clinical relevant situations. We investigate the influence of tracer delay, dispersion and recirculation on the performance of the methods. In the presence of negative delays, the truncated SVD approach overestimates the CBF. Block-circulant and reformulated SVD are delay-independent. Due to its delay dependent behavior, the truncated SVD approach performs worse in the presence of dispersion as well. However all SVD approaches are dependent on the amount of dispersion. Moreover, we observe that the optimal truncation parameter varies when recirculation is added to noisy data, suggesting that, in practice, these methods are not immune to tracer recirculation. Finally, applying the methods to clinical data resulted in a large variability of the CBF estimates. Block-circulant SVD will work in all situations and is the method with the highest potential

Multimodal image registration by edge attraction and regularization using a B-spline grid

Multi modal image registration enables images from different modalities to be analyzed in the same coordinate system. The class of B-spline-based methods that maximize the Mutual Information between images produce satisfactory result in general, but are often complex and can converge slowly. The popular Demons algorithm, while being fast and easy to implement, produces unrealistic deformation fields and is sensitive to illumination differences between the two images, which makes it unsuitable for multi-modal registration in its original form. We propose a registration algorithm that combines a B-spline grid with deformations driven by image forces. The algorithm is easy to implement and is robust against large differences in the appearance between the images to register. The deformation is driven by attraction-forces between the edges in both images, and a B-spline grid is used to regularize the sparse deformation field. The grid is updated using an original approach by weighting the deformation forces for each pixel individually with the edge strengths. This approach makes the algorithm perform well even if not all corresponding edges are present. We report preliminary results by applying the proposed algorithm to a set of (multi-modal) test images. The results show that the proposed method performs well, but is less accurate than state of the art registration methods based on Mutual Information. In addition, the algorithm is used to register test images to manually drawn line images in order to demonstrate the algorithm's robustness

Comparison of dynamic susceptibility contrast-MRI perfusion quantification methods in the presence of delay and dispersion

The perfusion of the brain is essential to maintain brain function. Stroke is an example of a decrease in blood flow and reduced perfusion. During ischemic stroke the blood flow to tissue is hampered due to a clot inside a vessel. To investigate the recovery of stroke patients, follow up studies are necessary. MRI is the preferred imaging modality for follow up because of the absence of radiation dose concerns, contrary to CT. Dynamic Susceptibility Contrast (DSC) MRI is an imaging technique used for measuring perfusion of the brain, however, is not standard applied in the clinical routine due to lack of immediate patient benefit. Several post processing algorithms are described in the literature to obtain cerebral blood flow (CBF). The quantification of CBF relies on the deconvolution of a tracer concentration-time curve in an arterial and a tissue voxel. There are several methods to obtain this deconvolution based on singular-value decomposition (SVD). This contribution describes a comparison between the different approaches as currently there is no best practice for (all) clinical relevant situations. We investigate the influence of tracer delay, dispersion and recirculation on the performance of the methods. In the presence of negative delays, the truncated SVD approach overestimates the CBF. Block-circulant and reformulated SVD are delay-independent. Due to its delay dependent behavior, the truncated SVD approach performs worse in the presence of dispersion as well. However all SVD approaches are dependent on the amount of dispersion. Moreover, we observe that the optimal truncation parameter varies when recirculation is added to noisy data, suggesting that, in practice, these methods are not immune to tracer recirculation. Finally, applying the methods to clinical data resulted in a large variability of the CBF estimates. Block-circulant SVD will work in all situations and is the method with the highest potential

Automatic segmentation of the wire frame of stent grafts from CT data

Endovascular aortic replacement (EVAR) is an established technique, which uses stent grafts to treat aortic aneurysms in patients at risk of aneurysm rupture. Late stent graft failure is a serious complication in endovascular repair of aortic aneurysms. Better understanding of the motion characteristics of stent grafts will be beneficial for designing future devices. In addition, analysis of stent graft movement in individual patients in vivo can be valuable for predicting stent graft failure in these patients

The accuracy and safety aspects of a novel robotic needle guide manipulator to perform transrectal prostate biopsies.

Contains fulltext : 88990.pdf (publisher's version ) (Closed access)PURPOSE: To introduce a new in-house developed pneumatically controlled magnetic field compatible manipulator as an aid to perform magnetic resonance (MR)-guided biopsies of the prostate. METHODS: A pneumatic controlled manipulator with five degrees of freedom constructed of plastic to achieve magnetic field compatibility was developed to guide biopsies. A risk analysis, mechanical tests, and RF safety tests with respect to needle tip heating were performed to assure future patient safety and to meet standard safety requirements for the use in a medical environment. The accuracy of needle positioning with the needle guide manipulator to sample a predefined target was measured in agar phantoms on a 3 T whole body MR system. The in-plane error was used to evaluate the accuracy, which is defined as the orthogonal distance between target and biopsy needle. The time for each step in the biopsy procedure was recorded to evaluate the procedure time. The influence of the insertion angle with respect to the static field of the MR scanner on the needle artifact was investigated. RESULTS: The risk analyses met patient safety requirements. No RF induced local heating around the needle tip was observed. The average in-plane error in 19 measurements was 3.0 mm (range 0-5.6 mm). The average time needed for manipulation to place the needle guide in the desired position was 5 min (range 3-8 min). Total procedure time was 30 min. The needle artifact size increases with the insertion angle with respect to the static field of the MR scanner. CONCLUSIONS: The new MR compatible manipulator can be used safely for patient care. It showed a high accuracy and short total procedure time, demonstrating great potential to improve the transrectal prostate biopsy procedure.01 september 201