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Computing and Visualization for Intravascular Imaging and Computer-Assisted Stenting

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Contents

Contributors

About the Editors

Preface

Section I: Clinical Introduction

Chapter 1: Intravascular Imaging to Assess Coronary Atherosclerosis and Percutaneous Coronary Interventions

1 Intravascular Imaging Development

1.1 Intravascular Ultrasound

1.2 Optical Coherence Tomography

2 Safety of Intravascular Imaging

3 Intravascular Imaging Versus Coronary Angiography

4 Intravascular Imaging Assessment of Plaque Progression/Regression

5 Intravascular Imaging Assessment of Lesions to Be Revascularized, or Not

5.1 Coronary Artery Stenosis Excluding the LMCA

5.2 Evaluation of the LMCA

6 Intravascular Imaging Assessment of Percutaneous Interventions

6.1 Early Experience After Balloon Angioplasty

6.2 Assessment of Bare Metal Stent

6.2.1 Randomized Studies and Registries

6.2.2 Metaanalysis of Available Studies

6.3 Assessment of DES

6.3.1 Randomized Studies and Registries

6.3.2 Metaanalysis of Available Studies

7 Future Developments and Final Word

References

Chapter 2: Atherosclerotic Plaque Progression and OCT/IVUS Assessment

1 Aims and Introduction

1.1 Aim of this Chapter

1.2 Introduction

2 Description of Atherosclerosis Lesions in Children, Adults, and Elderly Population

2.1 Atherosclerosis in Children

2.2 Atherosclerosis in Adults

2.3 Atherosclerosis in the Elderly

3 Atherosclerosis Histologist Classification

3.1 Early Lesions

3.2 Transitional Lesions

3.3 Complex Plaques

4 Phases of Progression of Atherosclerosis Disease

5 OCT

6 IVUS

6.1 Volcano IVUS and VH

6.2 BSC-IVUS and Tissue Classification

6.3 BSC-IVUS and iMap Versus Volcano 20MHz and VH Comparison

7 Vulnerable Plaques

8 Summary

References

Chapter 3: AAA Treatment Strategy Change Over Time

1 Introduction

2 Pathogenesis

2.1 Genetics

2.2 Inflammation

2.3 Biomechanical Aspects

2.3.1 Small AAA

2.3.2 Clinical Aspects and Epidemiology of AAA

2.3.3 Therapy

3 Open Surgical Repair

3.1 Indication

3.2 Preoperative Planning and Intraoperative Management

3.3 Outcome

3.4 Summary

4 Endovascular Aneurysm Repair

4.1 Blood Supply of the Abdominal Organs (Visceral and Renal)

4.2 Diameter of the Proximal Neck

4.3 Length of the Proximal Neck

4.4 Angulation of the Proximal Neck

4.5 Conical Configuration of the Proximal Neck

4.6 Calcifications and Mural Thrombus at the Proximal Neck

4.7 Anatomical Alterations of the Iliac Arteries

5 Preoperative Planning

5.1 CTA

5.2 Arterial Angiography

5.3 Magnetic Resonance Angiography

5.4 Selection of Stent Grafts

5.5 Components of the Endovascular Devices (Delivery System)

5.6 Graft Material

5.7 Vascular Stents

5.8 Surgical Technique

5.9 Imaging

5.10 Graft Insertion

5.11 Perioperative Complications

5.12 Specific EVAR-Complications

5.12.1 Endoleaks

6 Imaging for Planning the Intraoperative Procedure and Postoperative Follow-Up

6.1 Final Remarks

References

Chapter 4: Overview of Different Medical Imaging Techniques for the Identification of Coronary Atherosclerotic Plaques

1 Introduction

2 Clinical Overview

2.1 Coronary Arteries

2.1.1 Structure of Coronary Arteries

2.2 Coronary Artery Disease (CAD)

2.3 Vulnerable Plaque

2.3.1 Different Types of Vulnerable Plaques

3 Imaging Techniques

3.1 Noninvasive Imaging Techniques

3.1.1 Computed Tomography (CT)

Electron Beam Computed Tomography (EBCT)

CT Angiography (CTA)

Clinical Application of EBCT and CTA

3.1.2 Magnetic Resonance Imaging (MRI)

Clinical Application of MRI

3.1.3 Nuclear Imaging

Nuclear Scintigraphy

Positron Emission Tomography (PET)/Single-Photon Emission Computed Tomography (SPECT)

Clinical Application of Nuclear Imaging

3.2 Invasive Techniques

3.2.1 Intravascular Angiography

Clinical Application of Intravascular Angiography

3.2.2 Intravascular Angioscopy

Clinical Application of Intravascular Angioscopy

3.2.3 Thermography

Clinical Application of Thermography

3.2.4 Raman Spectroscopy

Clinical Application of Raman Spectroscopy

3.2.5 Intravascular Ultrasound (IVUS)

Clinical Application of IVUS

3.2.6 Optical Coherence Tomography (OCT)

Clinical Applications of OCT

4 Discussion

4.1 Summary

References

Section II: Vascular and Intravascular Analysis of Plaque

Chapter 5: Implications of the Kinematic Activity of the Atherosclerotic Plaque: Analysis Using a Comprehensive Framework f...

1 Introduction

2 Study Population and Ultrasound Image Data

3 A Comprehensive Framework for Quantifying the Arterial Wall Motion

4 Bilateral Asymmetry in Kinematic Features of Atherosclerotic Arteries

4.1 Image-Based Features of Bilateral Asymmetry in the Carotid Artery

4.2 Bilateral Asymmetry in a Cohort of Asymptomatic Carotid Atherosclerosis Subjects

5 Risk Stratification Driven by the Kinematic Activity of the Arterial Wall

5.1 Discriminating Symptomatic from Asymptomatic Plaques Using Motion and Strain Indices

5.2 Design of a Voice Recognition Analog for Motion and Strain Patterns

6 Data Mining of Association-Based Phenotypic Networks

7 Conclusion

Acknowledgments

References

Chapter 6: Right Generalized Cylinder Model for Vascular Segmentation

1 Motivation

2 Direct Model

2.1 Generating Curve

2.2 Piecewise Model

2.3 Contours Model

2.3.1 Fourier Series of Closed Contours

2.4 Surface Model

3 Parameters Inversion

3.1 Axial Parameters Inversion

3.2 Surface Parameters Calculation

3.3 Numerical Stability

3.3.1 Null Rotation

3.3.2 Complementary Rotations

3.3.3 Negative Length

3.3.4 Generating Curve Centering

3.4 Complete Inversion Algorithm

4 Model-Guided Image Segmentation

4.1 Kalman State Estimator

4.2 Kalman Equations for Vessel Tracking and RGC Construction

4.3 Tracking the Vessel Along the Approximate Axis

4.3.1 Tracking Step

4.3.2 Initialization

4.3.3 Stop Criterion

5 Conclusions

References

Chapter 7: Domain Adapted Model for In Vivo Intravascular Ultrasound Tissue Characterization

1 Introduction

2 State of the Art

2.1 In Vitro IVUS Tissue Characterization

Radio-Frequency-Based TC

Texture-Based TC

2.2 Domain Adaptation

3 Mathematical Modeling of Ultrasonic Backscattering and Signal Propagation Physics in Heterogeneous Tissues

3.1 Multiscale Nakagami Distribution

3.2 Ultrasonic Signal Confidence

3.3 In Vitro Tissue Characterization

3.4 Oblique Random Forests

3.5 In Vitro Learning and Prediction

4 Domain Adaptation for In Vivo TC

4.1 Hypothesis

4.2 Domain Adaptation of Decision Forests

Effect of Transfer Relaxation

4.3 Baselines

5 Experiments and Discussion

5.1 Data Description and Configuration Settings

Configuration Settings

5.2 Evaluation Metrics

5.3 Transfer Relaxation (Г) Versus Size of Target Database

Discussion

5.4 Transfer Relaxation Г Versus Number of Trees (M)

Discussion

6 Conclusions

Acknowledgments

References

Chapter 8: Intracoronary Optical Coherence Tomography

1 Introduction

1.1 Physical Principles of Optical Coherence Tomography

1.2 Coronary OCT Image Acquisition Techniques

1.2.1 Strategies to Limit Contrast Use

1.2.2 Coregistration of OCT and X-Ray Angiography

1.2.3 OCT in Assessment of the LMCA

1.3 Commercial OCT Systems

2 Coronary Imaging

2.1 Assessment of Lumen Morphology

2.2 Assessment of Coronary Atherosclerosis

2.3 Assessment of Intracoronary Stent

2.3.1 Bioresorbable Vascular Scaffolds

2.3.2 Assessment of Stent Failure

2.4 OCT-Guided PCI

2.5 Image Artifacts and Other Limitations

3 OCT Clinical Research

3.1 Clinical Trials

4 OCT Image Processing

4.1 Segmentation

4.2 Automated Tissue Analysis

4.3 Real-Time OCT Data Analysis

5 Future Outlook

5.1 High-Speed OCT

5.2 Polarization Sensitive OCT

5.3 Multimodality OCT Imaging

5.3.1 Endothelial Shear Stress

5.3.2 Combination of OCT and IVUS

5.3.3 Near-Infrared Spectroscopy

5.3.4 Near-Infrared Fluorescence

5.3.5 Combination of IVUS With Photoacoustics Imaging

5.3.6 High Resolution, Micro-OCT

5.4 Clinical Perspective

References

Section III: Vascular Biomechanics and Modeling

Chapter 9: Vascular Hemodynamics with Computational Modeling and Experimental Studies

1 Vascular Hemodynamics and Atherosclerosis

1.1 A Brief Description of Coronary Artery Disease

1.2 Study of Coronary Artery Flow

2 Vessel Geometry

2.1 Coronary Artery Geometry

2.2 Stented Vessels

3 Computational (CFD) Modeling

3.1 Governing Equations and Modeling Assumptions

3.1.1 Flow Characterization

3.1.2 Simplifying Assumptions

3.2 Mesh Discretization

3.3 Boundary and Initial Conditions

3.3.1 Inlet Boundary Conditions

3.3.2 Outlet Boundary Conditions

3.3.3 Shear-Thinning Behavior

4 Experimental Studies

4.1 Dynamic Scaling

4.1.1 Steady State

4.1.2 Transient Considerations

4.2 Phantoms

4.3 Compliance and Cardiac Motion

4.3.1 Coronary Compliance

4.3.2 Coronary Motion

4.4 Newtonian Versus Non-Newtonian Fluids

4.4.1 Xanthan Gum as Blood-Mimicking Fluid

4.4.2 Viscosity Properties

4.5 Experimental Design with PC-MRI

4.5.1 Circuit Design

4.5.2 MRI Scan Protocol

5 Data Postprocessing, Co-Registration, and Comparison

5.1 Segmentation of the Imaging Data

5.2 Co-Registration

5.3 Statistical Analysis

6 Accuracy and Reliability

6.1 Validation with Experimental Data

6.2 Validation with In Vivo Data

6.3 Ongoing Limitations

7 Current Developments

Acknowledgments

References

Chapter 10: Arterial Flow Impact on Aneurysmal Hemodynamics

1 Introduction

1.1 Cerebral Aneurysms: The Pathology

1.2 Cerebral Aneurysms: The Clinical Problem

1.3 Cerebral Aneurysms: Hemodynamics

2 Modeling Aneurysm Hemodynamics

3 Contributions of this Chapter

3.1 General Aspects

3.2 Image Acquisition

3.3 Surface and Volumetric Mesh Generations

3.4 Morphological Descriptor

3.5 CFD Modeling

3.5.1 Common CFD Configuration

3.5.2 Arterial Flow Rate Curve Generation

4 Part 1: Peak-Systolic and Maximum Hemodynamic Condition

4.1 Data Analysis

4.2 Arterial Hemodynamics

4.3 Aneurysm Hemodynamics

4.3.1 Statistical Analysis

4.4 Discussion of Part 1

4.4.1 Maximum Versus Peak-Systolic Value

4.5 Direct Implication

4.6 Indirect Implication

4.7 Normalization Strategy Using an Arterial Segment

5 Part 2: Characteristic Curves of Intra-Aneurysmal Hemodynamics

5.1 Data Analysis

5.2 Spatiotemporal Arterial Hemodynamics

5.3 Spatiotemporal Aneurysmal Hemodynamics

5.4 Characteristic Curves

5.5 Generalization

5.6 Discussion of Part 2

5.7 Spatiotemporal Averaged Variables and Mean Arterial Flow Rate

5.8 Waveform-Dependent Variables

5.9 Clinical Applications of the Curves

5.9.1 Hemodynamic Comparison at Any Flow Condition

5.9.2 Physiological Value or Range

5.9.3 Normalization

5.9.4 Patient-Specific Flow Condition

5.10 Limitations and Further Comments

6 Conclusions

Acknowledgments

References

Chapter 11: Toward a Mechanical Mapping of the Arterial Tree: Challenges and Potential Solutions

1 Overview and Objectives

2 Arterial Pathophysiology, Mechanics, and Stiffness Assessment

2.1 Arterial Pathophysiology

2.1.1 ``Occult'' Arteriopathies Undermining Health Status

2.1.2 The Importance of Early Detection of CVD Risk

2.2 Arterial Mechanics and Stiffness Assessment

2.2.1 Indirect Measurement of Stiffness

2.2.2 Ultrasound Elastography for Direct Measurement of Stiffness

2.2.3 Noninvasive Vascular Elastography

2.2.4 B-Mode Imaging-Based NIVE

3 Method: Imaging-Based Biomarker (ImBioMark)

3.1 Optical Flow-Based B-Mode Elastography

3.1.1 Tissue-Motion Model

3.1.2 Speckle as a Material Property

3.1.3 Imaging-Based BioMarker (ImBioMark)

3.1.4 Qualitative and Quantitative Illustrations of ImBioMark

4 ImBioMark: Applications on Carotid, Brachial, and Aorta Arteries

4.1 Common Carotid Artery Study

4.1.1 Study Population

4.1.2 Materials

4.1.3 CCA Stiffness as a Function of Aging

4.1.4 Anticipated Problems and Potential Solutions

4.2 Brachial Artery Study

4.2.1 Study Population

4.2.2 Materials

4.2.3 BA Stiffness Assessment

4.2.4 Anticipated Problems and Potential Solutions

4.3 Abdominal Aorta Artery Study

4.3.1 Study Population

4.3.2 Materials

4.3.3 AAA Stiffness Assessment

4.3.4 Anticipated Problems and Potential Solutions

5 Discussion

6 Conclusion

Acknowledgments

References

Section IV: Computer-Assisted Stenting

Chapter 12: Computerized Navigation Support for Endovascular Procedures

1 Introduction

2 Simulation for Training

2.1 Overview of Simulators

2.2 Training and Education

2.3 Skills Assessment

2.4 Outlook and Conclusion

3 Interventional Navigation Support

3.1 Tracking and Detection in Electrophysiology

3.2 Computer-Assisted Stenting

3.2.1 Intraoperative Challenges

3.2.2 Detection and Tracking of Stents and Stent Grafts

Automatic Candidate Region and Feature Extraction

Registration Algorithm

Global Registration

Local Registration

3.3 Outlook and Conclusion

References

Chapter 13: Interventional Quantification of Blood Flow

1 Introduction to the Clinical Value of Blood Flow Quantification

1.1 Blood Flow and Perfusion

1.2 Selected Diseases Related to Abnormal Flow and Perfusion Patterns in the Brain

2 Blood Flow Assessment Using Angiographic X-Ray Imaging

2.1 Overview of Angiographic X-Ray Imaging

2.2 Blood Flow Assessment in 2D

2.2.1 Analysis of Vascular Flow

2.2.2 Analysis of Flow Patterns in Cerebral Aneurysms

2.3 Blood Flow Assessment in 3D

2.3.1 4D DSA—Generation of Time-Resolved Vascular Volumes

2.3.2 Computational Fluid Dynamics (CFD)

References

Chapter 14: Virtual Stenting for Intracranial Aneurysms A Risk-Free, Patient-Specific Treatment Planning Support for Neuror...

1 Intracranial Aneurysms

2 Existing Approaches—From Precise to Pragmatic

2.1 Explicit Description

2.1.1 Finite Element Analysis (FEA)

2.1.2 Fast Virtual Stenting (FVS)

2.2 Implicit Description

3 Validation—The Curse of Computational Predictions

4 Selected Applications—How Numerical Models Can Assist

4.1 Individualized Optimization of Intracranial Aneurysm Treatment

4.1.1 Treatment Process

4.1.2 Expert-Driven Computer Aided Stent Evaluation (ECASE)

Mesh and CFD Setup

Postprocessing

4.1.3 Exemplary Case

Preparations for the Optimization Process

Mesh Generation and CFD Computations

Optimization Results

4.1.4 Conclusions and Summary

4.2 Effects of Over- and Undersizing on Jailed Animal Arteries

4.2.1 Experimental Setup

Digital Subtraction Angiography (DSA)

Four-Dimension (Time Resolved 3D) Phase Contrast MRA

Scanning Electron Microscopy (SEM)

4.2.2 Computational Setup

Vascular Reconstruction and Device Modeling

Hemodynamic Simulations

4.2.3 Experimental and Numerical Results

4.2.4 Conclusions and Summary

5 Future Directions—Chances and Limitations

Acknowledgments

References

Chapter 15: Preoperative Planning of Endovascular Procedures in Aortic Aneurysms

1 Introduction

2 Overview of Endograft Sizing for Aortic Aneurysms

3 Vascular Segmentation

3.1 Challenges When Segmenting the Abdominal Aorta

3.2 State of the Art of Abdominal Aorta Segmentation

3.3 Practical Issues

4 Vascular Analysis

4.1 Centerline Extraction and Regularization

4.2 Vessel Graph Analysis

4.3 Cross-Section Extraction

5 Quantitative Image Analysis

5.1 Aortic Characterization for Endograft Sizing

5.1.1 Vessel Diameter, Length, and Area Quantification

5.1.2 Aortic Neck Angulation

5.2 Aortic Characterization for Intervention Risk Assessment

5.2.1 Iliac Tortuosity

5.2.2 Calcification Score

5.3 Postoperative Control Parameters: AAA Maximum Diameter and Volume

5.4 Conclusions

6 Visualization and Workflow

6.1 Visualization

6.2 Workflow

6.2.1 Vessel Segmentation

6.2.2 Vessel Analysis

6.2.3 Verification and Manual Editing

6.2.4 Vessel Identification

6.2.5 Planning (Endograft Sizing)

6.2.6 C-Arm Gantry Angle Selection

6.2.7 Reporting and Device Model Selection

6.2.8 Model 3D Printing

7 Endograft Sizing Software

8 Conclusions and Future Perspectives

References

Index

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