Angiogenesis is the process of formation of new blood vessels as outgrowths of pre-existing ones. It occurs naturally
during development, tissue repair, and abnormally in pathologic diseases such as cancer. It is associated with
proliferation of blood vessels/tubular sprouts that penetrate deep into tissues to supply nutrients and remove waste
products. The process starts with migration of endothelial cells. As the cells move towards the target area they form
small tubular sprouts recruited from the parent vessel. The sprouts grow in length due to migration, proliferation, and
recruitment of new endothelial cells and the process continues until the target area becomes fully vascular. Accurate
quantification of sprout formation is very important for evaluation of treatments for ischemia as well as angiogenesis
inhibitors and plays a key role in the battle against cancer. This paper presents a technique for automatic quantification of
newly formed blood vessels from Micro-CT volumes of tumor samples. A semiautomatic technique based on
interpolation of Bezier curves was used to segment out the cancerous growths. Small vessels as determined by their
diameter within the segmented tumors were enhanced and quantified with a multi-scale 3-D line detection filter. The
same technique can be easily extended for quantification of tubular structures in other 3-D medical imaging modalities.
Experimental results are presented and discussed.
Interventional cardiac electrophysiology (EP) procedures are typically performed under X-ray fluoroscopy for
visualizing catheters and EP devices relative to other highly-attenuating structures such as the thoracic spine
and ribs. These projections do not however contain information about soft-tissue anatomy and there is a
recognized need for fusion of conventional fluoroscopy with pre-operatively acquired cardiac multislice computed
tomography (MSCT) volumes. Rapid 2D-3D integration in this application would allow for real-time visualization
of all catheters present within the thorax in relation to the cardiovascular anatomy visible in MSCT. We present a
method for rapid fusion of 2D X-ray fluoroscopy with 3DMSCT that can facilitate EP mapping and interventional
procedures by reducing the need for intra-operative contrast injections to visualize heart chambers and specialized
systems to track catheters within the cardiovascular anatomy. We use hardware-accelerated ray-casting to
compute digitally reconstructed radiographs (DRRs) from the MSCT volume and iteratively optimize the rigid-body
pose of the volumetric data to maximize the similarity between the MSCT-derived DRR and the intra-operative
X-ray projection data.
Static X-ray computed tomography (CT) volumes are often used as anatomic roadmaps during catheter-based cardiac
interventions performed under X-ray fluoroscopy guidance. These CT volumes provide a high-resolution depiction of
soft-tissue structures, but at only a single point within the cardiac and respiratory cycles. Augmenting these static CT
roadmaps with segmented myocardial borders extracted from live ultrasound (US) provides intra-operative access to
real-time dynamic information about the cardiac anatomy. In this work, using a customized segmentation method based
on a 3D active mesh, endocardial borders of the left ventricle were extracted from US image streams (4D data sets) at a
frame rate of approximately 5 frames per second. The coordinate systems for CT and US modalities were registered
using rigid body registration based on manually selected landmarks, and the segmented endocardial surfaces were
overlaid onto the CT volume. The root-mean squared fiducial registration error was 3.80 mm. The accuracy of the
segmentation was quantitatively evaluated in phantom and human volunteer studies via comparison with manual
tracings on 9 randomly selected frames using a finite-element model (the US image resolutions of the phantom and
volunteer data were 1.3 x 1.1 x 1.3 mm and 0.70 x 0.82 x 0.77 mm, respectively). This comparison yielded 3.70±2.5
mm (approximately 3 pixels) root-mean squared error (RMSE) in a phantom study and 2.58±1.58 mm (approximately 3
pixels) RMSE in a clinical study. The combination of static anatomical roadmap volumes and dynamic intra-operative
anatomic information will enable better guidance and feedback for image-guided minimally invasive cardiac
interventions.
Image-guided therapy for electrophysiology applications requires integration of pre-procedural volumetric imaging
data with intra-procedural electroanatomical mapping (EAM) information. Existing methods for fusion of
EAM and imaging data are based on fiducial landmark identification or point-to-surface distance minimization
algorithms, both of which require detailed EAM mapping. This mapping procedure requires specific selection
of points on the endocardial surface and this point acquisition process is skill-dependent, time-consuming and
labor-intensive. The mapping catheter tip must first be navigated to a landmark on the endocardium, tip contact
must be verified, and finally the tip location must be explicitly annotated within the EAM data record. This
process of individual landmark identification and annotation must be repeated carefully >50 times to define
endocardial and other vascular surfaces with sufficient detail for iterated-closest-point (ICP)-based registration.
To achieve this, 30-45 minutes of mapping just for the registration procedure can be necessary before the interventional
component of the patient study begins. Any acquired EAM point location that is not in contact with
the chamber surface can adversely impact the quality of registration. Significantly faster point acquisition can be
achieved by recording catheter tip locations automatically and continuously without requiring explicit navigation
to and annotation of fiducial landmarks. We present a novel registration framework in which EAM locations
are rapidly acquired and recorded in a continuous, untriggered fashion while the electrophysiologist manipulates
the catheter tip within the heart. Results from simulation indicate that mean registration errors are on the order
of 3-4mm, comparable in magnitude to conventional registration procedures which take significantly longer to
perform. Qualitative assessment in clinical data also reflects good agreement with physician expectations.
This work presents an integrated system for multimodality image guidance of minimally invasive medical procedures.
This software and hardware system offers real-time integration and registration of multiple image streams with
localization data from navigation systems. All system components communicate over a local area Ethernet network,
enabling rapid and flexible deployment configurations. As a representative configuration, we use X-ray fluoroscopy
(XF) and ultrasound (US) imaging. The XF imaging system serves as the world coordinate system, with gantry geometry
derived from the imaging system, and patient table position tracked with a custom-built measurement device using linear
encoders. An electromagnetic (EM) tracking system is registered to the XF space using a custom imaging phantom that
is also tracked by the EM system. The RMS fiducial registration error for the EM to X-ray registration was 2.19 mm,
and the RMS target registration error measured with an EM-tracked catheter was 8.81 mm. The US image stream is
subsequently registered to the XF coordinate system using EM tracking of the probe, following a calibration of the US
image within the EM coordinate system. We present qualitative results of the system in operation, demonstrating the
integration of live ultrasound imaging spatially registered to X-ray fluoroscopy with catheter localization using
electromagnetic tracking.
KEYWORDS: Image segmentation, Heart, Atrial fibrillation, Data modeling, Magnetic resonance imaging, 3D modeling, X-ray imaging, Veins, Data acquisition, 3D acquisition
Catheter-based ablation in the left atrium and pulmonary veins (LAPV) for treatment of atrial fibrillation
in cardiac electrophysiology (EP) are complex and require knowledge of heart chamber anatomy. Electroanatomical
mapping (EAM) is typically used to define cardiac structures by combining electromagnetic
spatial catheter localization with surface models which interpolate the anatomy between EAM point locations
in 3D. Recently, the incorporation of pre-operative volumetric CT or MR data sets has allowed for more detailed
maps of LAPV anatomy to be used intra-operatively. Preoperative data sets are however a rough guide
since they can be acquired several days to weeks prior to EP intervention. Due to positional and physiological
changes, the intra-operative cardiac anatomy can be different from that depicted in the pre-operative data.
We present an application of contrast-enhanced rotational X-ray imaging for CT-like reconstruction of 3D
LAPV anatomy during the intervention itself. Depending on the heart size a single or two selective contrastenhanced
rotational acquisitions are performed and CT-like volumes are reconstructed with 3D filtered back
projection. In case of dual injection, the two volumes depicting the left and right portions of the LAPV are
registered and fused. The data sets are visualized and segmented intra-procedurally to provide anatomical
data and surface models for intervention guidance. Our results from animal and human experiments indicate
that the anatomical information from intra-operative CT-like reconstructions compares favorably with preacquired
imaging data and can be of sufficient quality for intra-operative guidance.
A method for detection, quantification, and visualization of brain shift in serial MR and CT images is presented. The method consists of three steps. It first establishes correspondence between a number of point landmarks in the images. It then uses the correspondences to determine a transformation function that warps one image to the geometry of the other. It finally uses the obtained transformation to create a vector flow that represents the local motion or deformation of one image with respect to the other. The method does not require the solution of a system of equations and, therefore, is especially effective when a large number of correspondences is needed to represent complex brain deformations.
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