Quantitative analysis of reconstructed 3-D coronary arterial tree and intracoronary devices

Traditional quantitative coronary angiography is performed on two-dimensional (2-D) projection views. These views are chosen by the angiographer to minimize vessel overlap and foreshortening. With 2-D projection views that are acquired in this nonstandardized fashion, however, there is no way to know or estimate how much error occurs in the QCA process. Furthermore, coronary arteries possess a curvilinear shape and undergo a cyclical deformation due to their attachment to the myocardium. Therefore, it is necessary to obtain three-dimensional (3-D) information to best describe and quantify the dynamic curvilinear nature of the human coronary artery. Using a patient-specific 3-D coronary reconstruction algorithm and routine angiographic images, a new technique is proposed to describe: 1) the curvilinear nature of 3-D coronary arteries and intracoronary devices; 2) the magnitude of the arterial deformation caused by intracoronary devices and due to heart motion; and 3) optimal view(s) with respect to the desired "pathway" for delivering intracoronary devices.     

Reconstruction of coronary arteries from a single rotational X-ray projection sequence

Cardiovascular diseases remain the primary cause of death in developed countries. In most cases, exploration of possibly underlying coronary artery pathologies is performed using X-ray coronary angiography. Current clinical routine in coronary angiography is directly conducted in two-dimensional projection images from several static viewing angles. However, for diagnosis and treatment purposes, coronary artery reconstruction is highly suitable. The purpose of this study is to provide physicians with a three-dimensional (3-D) model of coronary arteries, e.g., for absolute 3-D measures for lesion assessment, instead of direct projective measures deduced from the images, which are highly dependent on the viewing angle. In this paper, we propose a novel method to reconstruct coronary arteries from one single rotational X-ray projection sequence. As a side result, we also obtain an estimation of the coronary artery motion. Our method consists of three main consecutive steps: 1) 3-D reconstruction of coronary artery centerlines, including respiratory motion compensation; 2) coronary artery four-dimensional motion computation; 3) 3-D tomographic reconstruction of coronary arteries, involving compensation for respiratory and cardiac motions. We present some experiments on clinical datasets, and the feasibility of a true 3-D Quantitative Coronary Analysis is demonstrated.     

Evaluation of iterative sparse object reconstruction from few projections for 3-D rotational coronary angiography

A 3-D reconstruction of the coronary arteries offers great advantages in the diagnosis and treatment of cardiovascular disease, compared to 2-D X-ray angiograms. Besides improved roadmapping, quantitative vessel analysis is possible. Due to the heart's motion, rotational coronary angiography typically provides only 5–10 projections for the reconstruction of each cardiac phase, which leads to a strongly undersampled reconstruction problem. Such an ill-posed problem can be approached with regularized iterative methods. The coronary arteries cover only a small fraction of the reconstruction volume. Therefore, the minimization of the ${mbi L}_1$ norm of the reconstructed image, favoring spatially sparse images, is a suitable regularization. Additional problems are overlaid background structures and projection truncation, which can be alleviated by background reduction using a morphological top-hat filter. This paper quantitatively evaluates image reconstruction based on these ideas on software phantom data, in terms of reconstructed absorption coefficients and vessel radii. Results for different algorithms and different input data sets are compared. First results for electrocardiogram-gated reconstruction from clinical catheter-based rotational X-ray coronary angiography are presented. Excellent 3-D image quality can be achieved.      

Reconstruction of three-dimensional coronary arterial dynamics from multi-view angiogram sequences

Since actual cardiac and arterial motion is non-rigidand non-uniformbothin space andinti me[1],the quan-tification of dynamic 3-Dcurves with 2-D projections isinaccurate and sensitive to view angles . Ruan[2]andPuentes[3]reconstructed 3-D arterial centerl…     

The effect of image distortion on 3-D reconstruction of coronary bypass grafts from angiographic views

Three-dimensional (3-D) reconstructions of coronary bypass grafts performed from X-ray angiographic images may become increasingly important for the investigation of damaging mechanical stresses imposed to these vessels by the cyclic movement of the heart. Contrary to what we had experienced with coronary arteries, appreciable reconstruction artifacts frequently occur with grafts. In order to verify the hypothesis that those are caused by distortions present in the angiographic images (acquired with image intensifiers), we have implemented a grid correction technique in our 3-D reconstruction method and studied its efficiency with phantom experiments. In this article, the nature of the encountered artifacts and the way in which the dewarping correction eliminates them are illustrated by a phantom experiment and by the reconstruction of a real coronary bypass vein graft.     

Vessel surface reconstruction with a tubular deformable model

Three-dimensional (3-D) angiographic methods are gaining acceptance for evaluation of atherosclerotic disease. However, measurement of vessel stenosis from 3-D angiographic methods can be problematic due to limited image resolution and contrast. We present a method for reconstructing vessel surfaces from 3-D angiographic methods that allows for objective measurement of vessel stenosis. The method is a deformable model that employs a tubular coordinate system. Vertex merging is incorporated into the coordinate system to maintain even vertex spacing and to avoid problems of self-intersection of the surface. The deformable model was evaluated on clinical magnetic resonance (MR) images of the carotid (n=6) and renal (n=2) arteries, on an MR image of a physical vascular phantom and on a digital vascular phantom. Only one gross error occurred for all clinical images. All reconstructed surfaces had a realistic, smooth appearance. For all segments of the physical vascular phantom, vessel radii from the surface reconstruction had an error of less than 0.2 of the average voxel dimension. Variability of manual initialization of the deformable model had negligible effect on the measurement of the degree of stenosis of the digital vascular phantom     

Three-dimensional quantitative coronary angiography

A method for reconstructing the three-dimensional coronary arterial tree structure from biplane two-dimensional angiographic images is presented. This method exploits the geometrical mathematics of X-ray imaging and the tracking of leading edges of injected contrast material into each vessel for identification of corresponding points on two images taken from orthogonal views. Accurate spatial position and dimension of each vessel in three-dimensional space can be obtained by this reconstruction procedure. The reconstructed arterial configuration is displayed as a shaded surface model, which can be viewed from various angles. Such three-dimensional vascular information provides accurate and reproducible measurements of vascular morphology and function. Flow measurements are obtained by tracking the leading edge of contrast material down the three-dimensional arterial tree. A quantitative analysis of coronary stenosis based on transverse area narrowing and regional blood flow, including the effect of vasoactive drugs, is described. Reconstruction experiments on actual angiographic images of the human coronary artery yield encouraging results toward a realization of computer-assisted three-dimensional quantitative angiography.     

Three-dimensional trajectory assessment of an IVUS transducer from single-plane cineangiograms: a phantom study

The recovery of the three-dimensional (3-D) path of the transducer used during an intravascular ultrasound (IVUS) examination is of primary importance to assess the exact 3-D shape of the vessel under study. Traditionally, the reconstruction is done by simply stacking the images during the pullback, or more recently using biplane angiography to recover the vessel curvature. In this paper, we explain, how single-plane angiography can be used with two projection models, to perform this task. Two types of projection geometry are analyzed: weak-perspective and full-perspective. In weak-perspective projection geometry, the catheter path can be reconstructed without prior transducer depth information. With full-perspective projection geometry, precise depth location of reference points are needed in order to minimize the error of the recovered transducer angle of incidence. The transducer angulation reconstruction is based on the foreshortening effect as seen from the X-ray images. By comparing the measured to the true transducer length, we are able to get its incidence angle. The transducer trajectory is reconstructed by stitching together the different estimated angulations obtained from each image in a cineangiogram sequence. The method is described and validated on two helical vessel phantoms, giving on average a reconstructed path that is less than 2 mm distant from the true path when using full-perspective projection.     

3-D reconstruction of coronary arterial tree to optimize angiographic visualization

Due to vessel overlap and foreshortening, multiple projections are necessary to adequately evaluate the coronary tree with arteriography. Catheter-based interventions can only be optimally performed when these visualization problems are successfully solved. The traditional method provides multiple selected views in which overlap and foreshortening are subjectively minimized based on two dimensional (2-D) projections. A pair of images acquired from routine angiographic study at arbitrary orientation using a single-plane imaging system were chosen for three-dimensional (3-D) reconstruction. After the arterial segment of interest (e.g., a single coronary stenosis or bifurcation lesion) was selected, a set of gantry angulations minimizing segment foreshortening was calculated. Multiple computer-generated projection images with minimized segment foreshortening were then used to choose views with minimal overlapped vessels relative to the segment of interest. The optimized views could then be utilized to guide subsequent angiographic acquisition and interpretation. Over 800 cases of coronary arterial trees have been reconstructed, in which more than 40 cases were performed in room during cardiac catheterization. The accuracy of 3-D length measurement was confirmed to be within an average root-mean-square (rms) 3.5% error using eight different pairs of angiograms of an intracoronary guidewire of 105-mm length with eight radiopaque markers of 15-mm interdistance. The accuracy of similarity between the additional computer-generated projections versus the actual acquired views was demonstrated with the average rms errors of 3.09 mm and 3.13 mm in 20 LCA and 20 RCA cases, respectively. The projections of the reconstructed patient-specific 3-D coronary tree model can be utilized for planning optimal clinical views: minimal overlap and foreshortening. The assessment of lesion length and diameter narrowing can be optimized in both interventional cases and studies of disease progression and regression.     

Model-guided labeling of coronary structure

Assigning anatomic labels to coronary arteries in X-ray angiograms is an important task in medical imaging, motivated by the desire to standardize the assessment of coronary artery disease and to facilitate the three-dimensional (3-D) reconstruction and visualization of the coronary vasculature. However, automatic labeling poses a number of significant challenges, including the presence of noise, artifacts, competing structures, misleading visual cues, and other difficulties associated with a dynamic and inherently complex structure. The authors have developed a model-guided approach that addresses these challenges and automatically labels the vascular structure in coronary angiographic images. The approach consists of two models: (1) a symbolic model, represented through a directed acyclic graph, that captures vascular tree hierarchies and branch interrelationships and (2) a generalized 3-D model that captures spatial and geometric relationships. Importantly, the approach detects ambiguities (such as vessel overlaps) that may be found in a frame of a cine sequence, and resolves these ambiguities by considering the information derived from other (unambiguous) frames in the temporal sequence, employing dynamic programming methods to match the image features found in the different (ambiguous and unambiguous) frames. This paper presents this model-guided labeling algorithm and discusses the experimental results obtained from implementing and applying the resulting labeling system to a variety of clinical images. The results indicate the feasibility of achieving robust and consistently accurate image labeling through this model-guided, temporal disambiguation method     

Three-dimensional motion tracking of coronary arteries in biplane cineangiograms

A three-dimensional (3-D) method for tracking the coronary arteries through a temporal sequence of biplane X-ray angiography images is presented. A 3-D centerline model of the coronary vasculature is reconstructed from a biplane image pair at one time frame, and its motion is tracked using a coarse-to-fine hierarchy of motion models. Three-dimensional constraints on the length of the arteries and on the spatial regularity of the motion field are used to overcome limitations of classical two-dimensional vessel tracking methods, such as tracking vessels through projective occlusions. This algorithm was clinically validated in five patients by tracking the motion of the left coronary tree over one cardiac cycle. The root mean square reprojection errors were found to be submillimeter in 93% (54/58) of the image pairs. The performance of the tracking algorithm was quantified in three dimensions using a deforming vascular phantom. RMS 3-D distance errors were computed between centerline models tracked in the X-ray images and gold-standard centerline models of the phantom generated from a gated 3-D magnetic resonance image acquisition. The mean error was 0.69 (+/- 0.06) mm over eight temporal phases and four different biplane orientations.     

基于造影图像的冠状动脉三维定量分析的研究

由于X射线造影成像把血管三维空间结构投影到二维图像上,基于二维造影图像的传统诊治方法存在很大局限性.本文在冠状动脉树三维重建的基础上,研究了冠状动脉的三维定量分析方法,提出血管直径、分支夹角和血管段长度的三维测量方法.并利用冠状动脉树实物模型进行实验,对二维和三维定量分析结果进行了比较.实验结果表明,三维定量分析能够有效地提高临床医学参数的测量精度.因此,在冠心病的临床诊断和介入治疗中,该方法能够可靠地诊断血管狭窄及选择和放置支架.     

Interactive virtual endoscopy in coronary arteries based on multimodality fusion

A novel approach for platform-independent virtual endoscopy in human coronary arteries is presented in this paper. It incorporates previously developed and validated methodology for multimodality fusion of two X-ray angiographic images with pullback data from intravascular ultrasound (IVUS). These modalities pose inherently different challenges than those present in many tomographic modalities that provide parallel slices. The fusion process results in a three- or four-dimensional (3-D/4-D) model of a coronary artery, specifically of its lumen/plaque and media/adventitia surfaces. The model is used for comprehensive quantitative hemodynamic, morphologic, and functional analyses. The resulting quantitative indexes are then used to supplement the model. Platform-independent visualization is achieved through the use of the ISO/IEC-standardized Virtual Reality Modeling Language (VRML). The visualization includes an endoscopic fly-through animation that enables the user to interactively select vessel location and fly-through speed, as well as to display image pixel data or quantification results in 3-D. The presented VRML virtual-endoscopy system is used in research studies of coronary atherosclerosis development, quantitative assessment of coronary morphology and function, and vascular interventions.     

Three-dimensional guide-wire reconstruction from biplane image sequences for integrated display in 3-D vasculature

Using three-dimensional rotational X-ray angiography (3DRA), three-dimensional (3-D) information of the vasculature can be obtained prior to endovascular interventions. However, during interventions, the radiologist has to rely on fluoroscopy images to manipulate the guide wire. In order to take full advantage of the 3-D information from 3DRA data during endovascular interventions, a method is presented that yields an integrated display of the position of the guide wire and vasculature in 3-D. The method relies on an automated method that tracks the guide wire simultaneously in biplane fluoroscopy images. Based on the calibrated geometry of the C-arm, the 3-D guide-wire position is determined and visualized in the 3-D coordinate system of the vasculature. The method is evaluated in an intracranial anthropomorphic vascular phantom. The influence of the angle between projections, distortion correction of the projection images, and accuracy of geometry knowledge on the accuracy of 3-D guide-wire reconstruction from biplane images is determined. If the calibrated geometry information is used and the images are corrected for distortion, a mean distance to the reference standard of 0.42 mm and a tip distance of 0.65 mm is found, which means that accurate guide-wire reconstruction from biplane images can be performed.     

Guide wire reconstruction and visualization in 3DRA using monoplane fluoroscopic imaging

A method has been developed that, based on the guide wire position in monoplane fluoroscopic images, visualizes the approximate guide wire position in the three-dimensional (3-D) vasculature, that is obtained prior to the intervention with 3-D rotational X-ray angiography (3DRA). The method assumes the position of the guide wire in the fluoroscopic images is known. A two-dimensional feature image is determined from the 3DRA data. In this feature image, the guide wire position is determined in a two-step approach: a mincost algorithm is used to determine a suitable position for the guide wire, and subsequently a snake optimization technique is applied to move the guide wire to a better position. The resulting guide wire can then be visualized in 3-D in combination with the 3DRA dataset. The reconstruction accuracy of the method has been evaluated using a 3DRA image of a vascular phantom filled with contrast, and monoplane fluoroscopic images of the same phantom without contrast and with a guide wire inserted. The evaluation has been performed for different projection angles, and with different parameters for the method. The final result does not appear to be very sensitive to the parameters of the method. The average mean error of the estimated 3-D guide wire position is 1.5 mm, and the average tip distance is 2.3 mm. The effect of inaccurate C-arm geometry information is also investigated. Small errors in geometry information (up to 1 degrees) will slightly decrease the 3-D reconstruction accuracies, with an error of at most 1 mm. The feasibility of this approach on clinical data is demonstrated.     

基于OpenGL的冠脉树在最佳视角下的投影显示

在冠脉树三维重建的基础上研究了感兴趣血管段最佳视角的计算方法,该方法首先获得满足感兴趣血管段最小投影缩短的造影角度范围,然后在该范围内进一步选取满足最小血管遮盖的造影角度.对造影系统的X射线透视投影原理和OpenGL中的透视投影原理进行分析比较后,利用OpenGL显示冠脉树在感兴趣血管段最佳视角下的投影图像.实验结果表明,在最佳视角下的投影图像中,血管损伤长度和直径狭窄能更好地估计,从而用于指导介入性治疗.     

A quantitative analysis of 3-D coronary modeling from two or more projection images

A method is introduced to examine the geometrical accuracy of the three-dimensional (3-D) representation of coronary arteries from multiple (two and more) calibrated two-dimensional (2-D) angiographic projections. When involving more then two projections, (multiprojection modeling) a novel procedure is presented that consists of fully automated centerline and width determination in all available projections based on the information provided by the semi-automated centerline detection in two initial calibrated projections. The accuracy of the 3-D coronary modeling approach is determined by a quantitative examination of the 3-D centerline point position and the 3-D cross sectional area of the reconstructed objects. The measurements are based on the analysis of calibrated phantom and calibrated coronary 2-D projection data. From this analysis a confidence region (alpha degrees approximately equal to [35 degrees - 145 degrees]) for the angular distance of two initial projection images is determined for which the modeling procedure is sufficiently accurate for the applied system. Within this angular border range the centerline position error is less then 0.8 mm, in terms of the Euclidean distance to a predefined ground truth. When involving more projections using our new procedure, experiments show that when the initial pair of projection images has an angular distance in the range alpha degrees approximately equal to [35 degrees - 145 degrees], the centerlines in all other projections (gamma = 0 degrees - 180 degrees) were indicated very precisely without any additional centering procedure. When involving additional projection images in the modeling procedure a more realistic shape of the structure can be provided. In case of the concave segment, however, the involvement of multiple projections does not necessarily provide a more realistic shape of the reconstructed structure.     

Registration and tracking to integrate X-ray and MR images in an XMR facility

We describe a registration and tracking technique to integrate cardiac X-ray images and cardiac magnetic resonance (MR) images acquired from a combined X-ray and MR interventional suite (XMR). Optical tracking is used to determine the transformation matrices relating MR image coordinates and X-ray image coordinates. Calibration of X-ray projection geometry and tracking of the X-ray C-arm and table enable three-dimensional (3-D) reconstruction of vessel centerlines and catheters from bi-plane X-ray views. We can, therefore, combine single X-ray projection images with registered projection MR images from a volume acquisition, and we can also display 3-D reconstructions of catheters within a 3-D or multi-slice MR volume. Registration errors were assessed using phantom experiments. Errors in the combined projection images (two-dimensional target registration error--TRE) were found to be 2.4 to 4.2 mm, and the errors in the integrated volume representation (3-D TRE) were found to be 4.6 to 5.1 mm. These errors are clinically acceptable for alignment of images of the great vessels and the chambers of the heart. Results are shown for two patients. The first involves overlay of a catheter used for invasive pressure measurements on an MR volume that provides anatomical context. The second involves overlay of invasive electrode catheters (including a basket catheter) on a tagged MR volume in order to relate electrophysiology to myocardial motion in a patient with an arrhythmia. Visual assessment of these results suggests the errors were of a similar magnitude to those obtained in the phantom measurements.     

Digital flashing tomosynthesis: a promising technique for angiocardiographic screening

A system for digital flashing tomosynthesis (DFTS) consists of four ECG-gated simultaneously flashed X-ray tubes, a 14-in image intensifier, a unit for digital subtraction angiography (DSA), a PC-hosted transputer network for three-dimensional (3-D) reconstruction as well as for quantitative coronary angiography and ventriculography, a display unit, and an individual digital archive. A presentation of DFTS tomoangiograms as a single slice or multiple slices of arbitrary thickness is available. DFTS also offers rotating and stereographic presentation of 3-D images. DFTS represents a system for standardized digital angiocardiography with digital archiving, and assures optimal reproducibility and safety. This system is feasible for both an ambulatory basis to allow high-volume cardiovascular angiographic screening by only one X-ray snapshot, and for quantification of natural progression or potential regression of coronary artery disease resulting from interventional or pharmacological therapy.     

Parallelized Bayesian inversion for three-dimensional dental X-ray imaging

Diagnostic and operational tasks based on dental radiology often require three-dimensional (3-D) information that is not available in a single X-ray projection image. Comprehensive 3-D information about tissues can be obtained by computerized tomography (CT) imaging. However, in dental imaging a conventional CT scan may not be available or practical because of high radiation dose, low-resolution or the cost of the CT scanner equipment. In this paper, we consider a novel type of 3-D imaging modality for dental radiology. We consider situations in which projection images of the teeth are taken from a few sparsely distributed projection directions using the dentist's regular (digital) X-ray equipment and the 3-D X-ray attenuation function is reconstructed. A complication in these experiments is that the reconstruction of the 3-D structure based on a few projection images becomes an ill-posed inverse problem. Bayesian inversion is a well suited framework for reconstruction from such incomplete data. In Bayesian inversion, the ill-posed reconstruction problem is formulated in a well-posed probabilistic form in which a priori information is used to compensate for the incomplete information of the projection data. In this paper we propose a Bayesian method for 3-D reconstruction in dental radiology. The method is partially based on Kolehmainen et al. 2003. The prior model for dental structures consist of a weighted /spl lscr//sup 1/ and total variation (TV)-prior together with the positivity prior. The inverse problem is stated as finding the maximum a posteriori (MAP) estimate. To make the 3-D reconstruction computationally feasible, a parallelized version of an optimization algorithm is implemented for a Beowulf cluster computer. The method is tested with projection data from dental specimens and patient data. Tomosynthetic reconstructions are given as reference for the proposed method.