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HashemizadehKolowri S, Akcicek EY, Akcicek H, Ma X, Ferguson MS, Balu N, Hatsukami TS, Yuan C. Efficient and Accurate 3D Thickness Measurement in Vessel Wall Imaging: Overcoming Limitations of 2D Approaches Using the Laplacian Method. J Cardiovasc Dev Dis 2024; 11:249. [PMID: 39195157 DOI: 10.3390/jcdd11080249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/08/2024] [Accepted: 08/11/2024] [Indexed: 08/29/2024] Open
Abstract
The clinical significance of measuring vessel wall thickness is widely acknowledged. Recent advancements have enabled high-resolution 3D scans of arteries and precise segmentation of their lumens and outer walls; however, most existing methods for assessing vessel wall thickness are 2D. Despite being valuable, reproducibility and accuracy of 2D techniques depend on the extracted 2D slices. Additionally, these methods fail to fully account for variations in wall thickness in all dimensions. Furthermore, most existing approaches are difficult to be extended into 3D and their measurements lack spatial localization and are primarily confined to lumen boundaries. We advocate for a shift in perspective towards recognizing vessel wall thickness measurement as inherently a 3D challenge and propose adapting the Laplacian method as an outstanding alternative. The Laplacian method is implemented using convolutions, ensuring its efficient and rapid execution on deep learning platforms. Experiments using digital phantoms and vessel wall imaging data are conducted to showcase the accuracy, reproducibility, and localization capabilities of the proposed approach. The proposed method produce consistent outcomes that remain independent of centerlines and 2D slices. Notably, this approach is applicable in both 2D and 3D scenarios. It allows for voxel-wise quantification of wall thickness, enabling precise identification of wall volumes exhibiting abnormal wall thickness. Our research highlights the urgency of transitioning to 3D methodologies for vessel wall thickness measurement. Such a transition not only acknowledges the intricate spatial variations of vessel walls, but also opens doors to more accurate, localized, and insightful diagnostic insights.
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Affiliation(s)
| | - Ebru Yaman Akcicek
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84108, USA
| | - Halit Akcicek
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84108, USA
| | - Xiaodong Ma
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84108, USA
| | - Marina S Ferguson
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
| | - Thomas S Hatsukami
- Department of Surgery, Division of Vascular Surgery, University of Washington, Seattle, WA 98195, USA
| | - Chun Yuan
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84108, USA
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
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Shirakawa T, Kuratani T, Yoshitatsu M, Shimamura K, Fukui S, Kurata A, Koyama Y, Toda K, Fukuda I, Sawa Y. Towards a Clinical Implementation of Measuring the Elastic Modulus of the Aorta from Cardiac Computed Tomography Images. IEEE Trans Biomed Eng 2021; 68:3543-3553. [PMID: 33945468 DOI: 10.1109/tbme.2021.3077362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The elasticity of the aortic wall varies depending on age, vessel location, and the presence of aortic diseases. Noninvasive measurement will be a powerful tool to understand the mechanical state of the aorta in a living human body. This study aimed to determine the elastic modulus of the aorta using computed tomography images. METHODS We constructed our original formulae based on mechanics of materials. Then, we performed computed tomography scans of a silicon rubber tube by applying four pressure conditions to the lumen. The segment elastic modulus was calculated from the scanned images using our formulae. The actual modulus was measured using a tensile loading test for comparison. RESULTS The segment moduli of elasticity from the images were 0.525 [0.524, 0.527], 0.524 [0.520, 0.524], 0.520 [0.515, 0.523], and 0.522 [0.516, 0.532] (unit: MPa, median [25%, 75% quantiles]) for the four pressure conditions, respectively. The corresponding measurements in the tensile test were 0.548 [0.539, 0.566], 0.535 [0.528, 0.553], 0.526 [0.513, 0.543], and 0.523 [0.508, 0.530], respectively. These results indicated errors of 4.2%, 2.1%, 1.1%, and 0.2%, respectively. CONCLUSION Our formulae provided good estimations of the segment elastic moduli of a silicon rubber tube under physiological pressure conditions using the computed tomography images. SIGNIFICANCE In addition to the elasticity, the formulae provide the strain energy as well. These properties can be better predictors of aortic diseases. The formulae consist of clinical parameters commonly used in medical settings (pressure, diameter, and wall thickness).
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Siriapisith T, Kusakunniran W, Haddawy P. Outer Wall Segmentation of Abdominal Aortic Aneurysm by Variable Neighborhood Search Through Intensity and Gradient Spaces. J Digit Imaging 2019; 31:490-504. [PMID: 29352385 DOI: 10.1007/s10278-018-0049-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Aortic aneurysm segmentation remains a challenge. Manual segmentation is a time-consuming process which is not practical for routine use. To address this limitation, several automated segmentation techniques for aortic aneurysm have been developed, such as edge detection-based methods, partial differential equation methods, and graph partitioning methods. However, automatic segmentation of aortic aneurysm is difficult due to high pixel similarity to adjacent tissue and a lack of color information in the medical image, preventing previous work from being applicable to difficult cases. This paper uses uses a variable neighborhood search that alternates between intensity-based and gradient-based segmentation techniques. By alternating between intensity and gradient spaces, the search can escape from local optima of each space. The experimental results demonstrate that the proposed method outperforms the other existing segmentation methods in the literature, based on measurements of dice similarity coefficient and jaccard similarity coefficient at the pixel level. In addition, it is shown to perform well for cases that are difficult to segment.
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Affiliation(s)
- Thanongchai Siriapisith
- Department Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.,Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, 73170, Thailand
| | - Worapan Kusakunniran
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, 73170, Thailand.
| | - Peter Haddawy
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, 73170, Thailand
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Biasiolli L, Hann E, Lukaschuk E, Carapella V, Paiva JM, Aung N, Rayner JJ, Werys K, Fung K, Puchta H, Sanghvi MM, Moon NO, Thomson RJ, Thomas KE, Robson MD, Grau V, Petersen SE, Neubauer S, Piechnik SK. Automated localization and quality control of the aorta in cine CMR can significantly accelerate processing of the UK Biobank population data. PLoS One 2019; 14:e0212272. [PMID: 30763349 PMCID: PMC6375606 DOI: 10.1371/journal.pone.0212272] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/30/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Aortic distensibility can be calculated using semi-automated methods to segment the aortic lumen on cine CMR (Cardiovascular Magnetic Resonance) images. However, these methods require visual quality control and manual localization of the region of interest (ROI) of ascending (AA) and proximal descending (PDA) aorta, which limit the analysis in large-scale population-based studies. Using 5100 scans from UK Biobank, this study sought to develop and validate a fully automated method to 1) detect and locate the ROIs of AA and PDA, and 2) provide a quality control mechanism. Methods The automated AA and PDA detection-localization algorithm followed these steps: 1) foreground segmentation; 2) detection of candidate ROIs by Circular Hough Transform (CHT); 3) spatial, histogram and shape feature extraction for candidate ROIs; 4) AA and PDA detection using Random Forest (RF); 5) quality control based on RF detection probability. To provide the ground truth, overall image quality (IQ = 0–3 from poor to good) and aortic locations were visually assessed by 13 observers. The automated algorithm was trained on 1200 scans and Dice Similarity Coefficient (DSC) was used to calculate the agreement between ground truth and automatically detected ROIs. Results The automated algorithm was tested on 3900 scans. Detection accuracy was 99.4% for AA and 99.8% for PDA. Aorta localization showed excellent agreement with the ground truth, with DSC ≥ 0.9 in 94.8% of AA (DSC = 0.97 ± 0.04) and 99.5% of PDA cases (DSC = 0.98 ± 0.03). AA×PDA detection probabilities could discriminate scans with IQ ≥ 1 from those severely corrupted by artefacts (AUC = 90.6%). If scans with detection probability < 0.75 were excluded (350 scans), the algorithm was able to correctly detect and localize AA and PDA in all the remaining 3550 scans (100% accuracy). Conclusion The proposed method for automated AA and PDA localization was extremely accurate and the automatically derived detection probabilities provided a robust mechanism to detect low quality scans for further human review. Applying the proposed localization and quality control techniques promises at least a ten-fold reduction in human involvement without sacrificing any accuracy.
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Affiliation(s)
- Luca Biasiolli
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Evan Hann
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Valentina Carapella
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jose M. Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Jennifer J. Rayner
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Henrike Puchta
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mihir M. Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Niall O. Moon
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ross J. Thomson
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Katharine E. Thomas
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Matthew D. Robson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vicente Grau
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Steffen E. Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Wang Y, Seguro F, Kao E, Zhang Y, Faraji F, Zhu C, Haraldsson H, Hope M, Saloner D, Liu J. Segmentation of lumen and outer wall of abdominal aortic aneurysms from 3D black-blood MRI with a registration based geodesic active contour model. Med Image Anal 2017; 40:1-10. [PMID: 28549310 DOI: 10.1016/j.media.2017.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 05/05/2017] [Accepted: 05/12/2017] [Indexed: 11/24/2022]
Abstract
Segmentation of the geometric morphology of abdominal aortic aneurysm is important for interventional planning. However, the segmentation of both the lumen and the outer wall of aneurysm in magnetic resonance (MR) image remains challenging. This study proposes a registration based segmentation methodology for efficiently segmenting MR images of abdominal aortic aneurysms. The proposed methodology first registers the contrast enhanced MR angiography (CE-MRA) and black-blood MR images, and then uses the Hough transform and geometric active contours to extract the vessel lumen by delineating the inner vessel wall directly from the CE-MRA. The proposed registration based geometric active contour is applied to black-blood MR images to generate the outer wall contour. The inner and outer vessel wall are then fused presenting the complete vessel lumen and wall segmentation. The results obtained from 19 cases showed that the proposed registration based geometric active contour model was efficient and comparable to manual segmentation and provided a high segmentation accuracy with an average Dice value reaching 89.79%.
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Affiliation(s)
- Yan Wang
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States.
| | - Florent Seguro
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
| | - Evan Kao
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States; University of California, Berkeley; San Francisco, United States
| | - Yue Zhang
- Veterans Affairs Medical Center, San Francisco, United States
| | - Farshid Faraji
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
| | - Chengcheng Zhu
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
| | - Henrik Haraldsson
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
| | - Michael Hope
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
| | - David Saloner
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States; Veterans Affairs Medical Center, San Francisco, United States
| | - Jing Liu
- Radiology and Biomedical Imaging, University of California,San Francisco, San Francisco, United States
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Gao S, van 't Klooster R, Brandts A, Roes SD, Alizadeh Dehnavi R, de Roos A, Westenberg JJ, van der Geest RJ. Quantification of common carotid artery and descending aorta vessel wall thickness from MR vessel wall imaging using a fully automated processing pipeline. J Magn Reson Imaging 2016; 45:215-228. [DOI: 10.1002/jmri.25332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/20/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Shan Gao
- Division of Image Processing; Department of Radiology, Leiden University Medical Center; Leiden Netherlands
| | - Ronald van 't Klooster
- Division of Image Processing; Department of Radiology, Leiden University Medical Center; Leiden Netherlands
| | - Anne Brandts
- Department of Radiology; Leiden University Medical Center; Leiden Netherlands
| | - Stijntje D. Roes
- Department of Radiology; Leiden University Medical Center; Leiden Netherlands
| | | | - Albert de Roos
- Department of Radiology; Leiden University Medical Center; Leiden Netherlands
| | - Jos J.M. Westenberg
- Division of Image Processing; Department of Radiology, Leiden University Medical Center; Leiden Netherlands
| | - Rob J. van der Geest
- Division of Image Processing; Department of Radiology, Leiden University Medical Center; Leiden Netherlands
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Increasing the Spatial Resolution of 3T Carotid MRI Has No Beneficial Effect for Plaque Component Measurement Reproducibility. PLoS One 2015; 10:e0130878. [PMID: 26161783 PMCID: PMC4498614 DOI: 10.1371/journal.pone.0130878] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 05/26/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose Different in-plane resolutions have been used for carotid 3T MRI. We compared the reproducibility, as well as the within- and between reader variability of high and routinely used spatial resolution in scans of patients with atherosclerotic carotid artery disease. Since no consensus exists about the optimal segmentation method, we analysed all imaging data using two different segmentation methods. Materials and Methods In 31 patient with carotid atherosclerosis a high (0.25 × 0.25 mm2; HR) and routinely used (0.50 × 0.50 mm2; LR) spatial resolution carotid MRI scan were performed within one month. A fully blinded closed and a simultaneously open segmentation were used to quantify the lipid rich necrotic core (LRNC), calcified and loose matrix (LM) plaque area and the fibrous cap (FC) thickness. Results No significant differences were observed between scan-rescan reproducibility for HR versus LR measurements, nor did we find any significant difference between the within-reader and between-reader reproducibility. The same applies for differences between the open and closed reads. All intraclass correlation coefficients between scans and rescans for the LRNC, calcified and LM plaque area, as well as the FC thickness measurements with the open segmentation method were excellent (all above 0.75). Conclusions Increasing the spatial resolution at the expense of the contrast-to-noise ratio does not improve carotid plaque component scan-rescan reproducibility in patients with atherosclerotic carotid disease, nor does using a different segmentation method.
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Endothelial shear stress estimation in the human carotid artery based on Womersley versus Poiseuille flow. Int J Cardiovasc Imaging 2014; 31:585-93. [DOI: 10.1007/s10554-014-0571-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/10/2014] [Indexed: 11/27/2022]
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Turkbey EB, Jain A, Johnson C, Redheuil A, Arai AE, Gomes AS, Carr J, Hundley WG, Teixido-Tura G, Eng J, Lima JA, Bluemke DA. Determinants and normal values of ascending aortic diameter by age, gender, and race/ethnicity in the Multi-Ethnic Study of Atherosclerosis (MESA). J Magn Reson Imaging 2014; 39:360-8. [PMID: 23681649 PMCID: PMC3766427 DOI: 10.1002/jmri.24183] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 03/28/2013] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine the normal size and wall thickness of the ascending thoracic aorta (AA) and its relationship with cardiovascular risk factors in a large population-based study. MATERIALS AND METHODS The mean AA luminal diameter was measured in 3573 Multi-Ethnic Study of Atherosclerosis (MESA) participants (age: 45-84 years), using gradient echo phase contrast cine MRI. Multiple linear regression models were used to evaluate the associations between risk factors and AA diameter. The median and upper normal limit (95th percentile) was defined in a "healthy" subgroup as well as AA wall thickness. RESULTS The upper limits of body surface area indexed AA luminal diameter for age categories of 45-54, 55-64, 65-74, and 75-84 years are 21, 22, 22, and 28 mm/m(2) in women and 20, 21, 22, 23 mm/m(2) in men, respectively. The mean AA wall thickness was 2.8 mm. Age, gender, and body surface area were major determinants of AA luminal diameter (∼+1 mm/10 years; ∼+1.9 mm in men than women; ∼+1 mm/ 0.23 m(2) ; P < 0.001). The AA diameter in hypertensive subjects was +0.9 mm larger than in normotensives (P < 0.001). CONCLUSION AA diameter increases gradually with aging for both genders among all race/ethnicities. The normal value of AA diameter is provided.
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Affiliation(s)
- Evrim B. Turkbey
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center, 10 Center Drive, Building 10, Room B1N264B, Bethesda, MD 20892
| | - Aditya Jain
- Department of Radiology and Radiological Science, Johns Hopkins University, 600 N. Wolfe Street MRI room 110 Baltimore, MD 21287
| | - Craig Johnson
- Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, 6200 NE 74 Street, Building 29, Suite 310, Seattle, WA 98115
| | - Alban Redheuil
- HEGP Cardiovascular Imaging Department, Université Paris-Descartes and INSERM U678, Paris, France
| | - Andrew E. Arai
- Laboratory of Cardiac Energetics, National Hearth Lung and Blood Institute, National Institutes of Health, 10, Center Drive, Room B1D415, Bethesda, MD 20892
| | - Antoinette S. Gomes
- Department of Radiology, UCLA School of Medicine, 650, Circle Drive south, CHS BL 141, Box 951721, Los Angeles, CA 90095
| | - James Carr
- Division of Radiology, Northwestern University Medical School, 448, East Ontario Street, Suite 700, Chicago, IL 60611
| | - W. Gregory Hundley
- Department of Internal Medicine/Cardiology, Wake Forest University Health Sciences, Medical Center Blvd. Winston-Salem, NC 27157
| | - Gisela Teixido-Tura
- Department of Medicine/Cardiology, Johns Hopkins University, 600 N Wolfe Street, Blalock 524, Baltimore, MD 21205
| | - John Eng
- Department of Radiology and Radiological Science, Johns Hopkins University, 600 N. Wolfe Street MRI room 110 Baltimore, MD 21287
| | - Joao A.C. Lima
- Department of Radiology and Radiological Science, Johns Hopkins University, 600 N. Wolfe Street MRI room 110 Baltimore, MD 21287
- Department of Medicine/Cardiology, Johns Hopkins University, 600 N Wolfe Street, Blalock 524, Baltimore, MD 21205
| | - David A. Bluemke
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center, 10 Center Drive, Building 10, Room B1N264B, Bethesda, MD 20892
- Department of Radiology and Radiological Science, Johns Hopkins University, 600 N. Wolfe Street MRI room 110 Baltimore, MD 21287
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10
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Shang EK, Lai E, Pouch AM, Hinmon R, Gorman RC, Gorman JH, Sehgal CM, Ferrari G, Bavaria JE, Jackson BM. Validation of semiautomated and locally resolved aortic wall thickness measurements from computed tomography. J Vasc Surg 2014; 61:1034-40. [PMID: 24388698 DOI: 10.1016/j.jvs.2013.11.065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 11/07/2013] [Accepted: 11/19/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Aortic wall thickness (AWT) is important for anatomic description and biomechanical modeling of aneurysmal disease. However, no validated, noninvasive method for measuring AWT exists. We hypothesized that semiautomated image segmentation algorithms applied to computed tomography angiography (CTA) can accurately measure AWT. METHODS Aortic samples from 10 patients undergoing open thoracoabdominal aneurysm repair were taken from sites of the proximal or distal anastomosis, or both, yielding 13 samples. Aortic specimens were fixed in formalin, embedded in paraffin, and sectioned. After staining with hematoxylin and eosin and Masson's trichrome, sections were digitally scanned and measured. Patients' preoperative CTA Digital Imaging and Communications in Medicine (DICOM; National Electrical Manufacturers Association, Rosslyn, Va) images were segmented into luminal, inner arterial, and outer arterial surfaces with custom algorithms using active contours, isoline contour detection, and texture analysis. AWT values derived from image data were compared with measurements of corresponding pathologic specimens. RESULTS AWT determined by CTA averaged 2.33 ± 0.66 mm (range, 1.52-3.55 mm), and the AWT of pathologic specimens averaged 2.36 ± 0.75 mm (range, 1.51-4.16 mm). The percentage difference between pathologic specimens and CTA-determined AWT was 9.5% ± 4.1% (range, 1.8%-16.7%). The correlation between image-based measurements and pathologic measurements was high (R = 0.935). The 95% limits of agreement computed by Bland-Altman analysis fell within the range of -0.42 and 0.42 mm. CONCLUSIONS Semiautomated analysis of CTA images can be used to accurately measure regional and patient-specific AWT, as validated using pathologic ex vivo human aortic specimens. Descriptions and reconstructions of aortic aneurysms that incorporate locally resolved wall thickness are feasible and may improve future attempts at biomechanical analyses.
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Affiliation(s)
- Eric K Shang
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Eric Lai
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Alison M Pouch
- Division of Ultrasound Research, Department of Radiology, University of Pennsylvania, Philadelphia, Pa
| | - Robin Hinmon
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Robert C Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Joseph H Gorman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Chandra M Sehgal
- Division of Ultrasound Research, Department of Radiology, University of Pennsylvania, Philadelphia, Pa
| | - Giovanni Ferrari
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Joseph E Bavaria
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Benjamin M Jackson
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania, Philadelphia, Pa.
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Avila-Montes OC, Kurkure U, Nakazato R, Berman DS, Dey D, Kakadiaris IA. Segmentation of the Thoracic Aorta in Noncontrast Cardiac CT Images. IEEE J Biomed Health Inform 2013; 17:936-49. [DOI: 10.1109/jbhi.2013.2269292] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Site-specific coupling between vascular wall thickness and function: an observational MRI study of vessel wall thickening and stiffening in hypertension. Invest Radiol 2013; 48:86-91. [PMID: 23262794 DOI: 10.1097/rli.0b013e31827f6410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate associations between aortic pulse wave velocity (PWV) and aortic and carotid vessel wall thickness (VWT) using cardiovascular magnetic resonance imaging (MRI) in patients with hypertension as compared with healthy adult volunteers. MATERIALS AND METHODS Local medical ethics approval was obtained and the participants gave informed consent. Fifteen patients with hypertension (5 men and 10 women; mean [SD] age, 49 [14] years) and 15 age- and sex-matched healthy volunteers were prospectively included and compared. All participants underwent MRI examination for measuring aortic and carotid VWT and aortic PWV with well-validated MRI techniques at 1.5- and 3-T MRI systems: PWV was assessed from velocity-encoded MRI and VWT was assessed by using dual-inversion black-blood gradient-echo imaging techniques. Paired t tests were used for testing differences between the volunteers and the patients and Pearson correlation (r) and univariable and multivariable stepwise linear regression analyses were used to test associations between aortic and carotid arterial wall thickness and stiffness. RESULTS Mean values for aortic PWV and aortic and carotid VWT (indexed for body surface area [BSA]) were all significantly higher in patients with hypertension as compared with the healthy volunteers (ie, aortic PWV, 7.0 ± 1.4 m/s vs 5.7 ± 1.3 m/s; aortic VWT/BSA, 0.12 ± 0.03 mL/m vs 0.10 ± 0.03 mL/m; carotid VWT/BSA, 0.04 ± 0.01 mL/m vs 0.03 ± 0.01 mL/m; all P < 0.01). Aortic PWV was highly correlated with aortic VWT/BSA (r = 0.76 and P = 0.002 in the patients vs r = 0.63 and P = 0.02 in the volunteers), and in the patients, aortic PWV was moderately correlated with carotid VWT/BSA (r = 0.50; P = 0.04). In the volunteers, correlation between aortic PWV and carotid VWT/BSA was not significant (r = 0.40; P = 0.13). In addition, aortic VWT/BSA was significantly correlated with carotid VWT/BSA, in both the patients (r = 0.60; P = 0.005) and volunteers (r = 0.57; P = 0.007). CONCLUSIONS In the patients with hypertension and the healthy volunteers, the aortic PWV is associated more strongly with aortic wall thickness than with carotid wall thickness, reflecting site-specific coupling between vascular wall thickness and function.
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Maroules CD, Rosero E, Ayers C, Peshock RM, Khera A. Abdominal aortic atherosclerosis at MR imaging is associated with cardiovascular events: the Dallas heart study. Radiology 2013; 269:84-91. [PMID: 23781118 DOI: 10.1148/radiol.13122707] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the value of two abdominal aortic atherosclerosis measurements at magnetic resonance (MR) imaging for predicting future cardiovascular events. MATERIALS AND METHODS This study was approved by the institutional review board and complied with HIPAA regulations. The study consisted of 2122 participants from the multiethnic, population-based Dallas Heart Study who underwent abdominal aortic MR imaging at 1.5 T. Aortic atherosclerosis was measured by quantifying mean aortic wall thickness (MAWT) and aortic plaque burden. Participants were monitored for cardiovascular death, nonfatal cardiac events, and nonfatal extracardiac vascular events over a mean period of 7.8 years ± 1.5 (standard deviation [SD]). Cox proportional hazards regression was used to assess independent associations of aortic atherosclerosis and cardiovascular events. RESULTS Increasing MAWT was positively associated with male sex (odds ratio, 3.66; P < .0001), current smoking (odds ratio, 2.53; P < .0001), 10-year increase in age (odds ratio, 2.24; P < .0001), and hypertension (odds ratio, 1.66; P = .0001). A total of 143 participants (6.7%) experienced a cardiovascular event. MAWT conferred an increased risk for composite events (hazard ratio, 1.28 per 1 SD; P = .001). Aortic plaque was not associated with increased risk for composite events. Increasing MAWT and aortic plaque burden both conferred an increased risk for nonfatal extracardiac events (hazard ratio of 1.52 per 1 SD [P < .001] and hazard ratio of 1.46 per 1 SD [P = .03], respectively). CONCLUSION MR imaging measures of aortic atherosclerosis are predictive of future adverse cardiovascular events.
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Affiliation(s)
- Christopher D Maroules
- Departments of Radiology, Anesthesiology, Clinical Sciences, and Internal Medicine, Division of Cardiology and the Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
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Jang S, Yong HS, Doo KW, Kang EY, Woo OH, Choi EJ. Relation of aortic calcification, wall thickness, and distensibility with severity of coronary artery disease: evaluation with coronary CT angiography. Acta Radiol 2012; 53:839-44. [PMID: 22821955 DOI: 10.1258/ar.2012.110604] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Three known risk factors for aortic atherosclerosis predict the severity of coronary artery disease (CAD): aortic calcification (AC), aortic wall thickness (AWT), and aortic distensibility (AD). PURPOSE To determine the relationship of AC, AWT, and AD with the severity of CAD. MATERIAL AND METHODS A total of 104 patients who underwent both coronary CT angiography (CCTA) and invasive coronary angiography were enrolled. The severity of CAD was assessed by three methods: the segment involvement score (SIS), the segment stenosis score (SSS), and the modified Gensini score (mG). We quantified AC using the Agatston method on low-dose ungated chest CT (LDCT). We measured AWT at the thickest portion of the descending thoracic aorta on CCTA. AD was calculated as the difference between the maximum and minimum areas of the ascending aorta and the pulse pressure. The relationships between the severity of CAD and the three aortic factors were assessed. RESULTS The AC and AWT of the thoracic aorta were significantly higher in the occlusive CAD (OCAD) group (1984.21 ± 2986.10 vs. 733.00 ± 1648.71, P = 0.01; 4.13 ± 1.48 vs. 3.40 ± 1.01, P = 0.22). Patients with OCAD had more than one epicardial coronary artery with >50% luminal stenosis. The AC (r = 0.453 with SIS; r = 0.454 with SSS; r = 0.427 with mG) and the AWT (r = 0.279 with SIS; r = 0.324 with SSS; r = 0.304 with mG) were significantly correlated with all three methods, and the AD was negatively correlated with the SIS (r = - 0.221, P < 0.05, respectively) in the unadjusted model. After adjustment for cardiovascular risk factors, only the correlations between AC and all three methods assessing CAD remained significant. CONCLUSION There are significant relationships between AC, AWT and AD and severity of CAD. In particular, AC measured on LDCT is the most consistent predictor of severity of CAD.
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Affiliation(s)
- Seonah Jang
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung Won Doo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun-Young Kang
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun Jung Choi
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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15
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Raman B, Raman R, Rubin GD, Napel S. Automated tracing of the adventitial contour of aortoiliac and peripheral arterial walls in CT angiography (CTA) to allow calculation of non-calcified plaque burden. J Digit Imaging 2012; 24:1078-86. [PMID: 21547519 DOI: 10.1007/s10278-011-9373-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aortoiliac and lower extremity arterial atherosclerotic plaque burden is a risk factor for the development of visceral and peripheral ischemic and aneurismal vascular disease. While prior research allows automated quantification of calcified plaque in these body regions using CT angiograms, no automated method exists to quantify soft plaque. We developed an automatic algorithm that defines the outer wall contour and wall thickness of vessels to quantify non-calcified plaque in CT angiograms of the chest, abdomen, pelvis, and lower extremities. The algorithm encodes the search space as a constrained graph and calculates the outer wall contour by deriving a minimum cost path through the graph, following the visible outer wall contour while minimizing path tortuosity. Our algorithm was statistically equivalent to a reference standard made by two reviewers. Absolute error was 1.9 ± 2.3% compared to the inter-observer variability of 3.9 ± 3.6%. Wall thickness in vessels with atherosclerosis was 3.4 ± 1.6 mm compared to 1.2 ± 0.4 mm in normal vessels. The algorithm shows promise as a tool for quantification of non-calcified plaque in CT angiography. When combined with previous research, our method has the potential to quantify both non-calcified and calcified plaque in all clinically significant systemic arteries, from the thoracic aorta to the arteries of the calf, over a wide range of diameters. This algorithm has the potential to enable risk stratification of patients and facilitate investigations into the relationships between asymptomatic atherosclerosis and a variety of behavioral, physiologic, pathologic, and genotypic conditions.
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Affiliation(s)
- Bhargav Raman
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305-5105, USA.
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16
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Delgado-Gonzalo R, Thévenaz P, Seelamantula CS, Unser M. Snakes with an ellipse-reproducing property. IEEE TRANSACTIONS ON IMAGE PROCESSING : A PUBLICATION OF THE IEEE SIGNAL PROCESSING SOCIETY 2012; 21:1258-1271. [PMID: 21965208 DOI: 10.1109/tip.2011.2169975] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present a new class of continuously defined parametric snakes using a special kind of exponential splines as basis functions. We have enforced our bases to have the shortest possible support subject to some design constraints to maximize efficiency. While the resulting snakes are versatile enough to provide a good approximation of any closed curve in the plane, their most important feature is the fact that they admit ellipses within their span. Thus, they can perfectly generate circular and elliptical shapes. These features are appropriate to delineate cross sections of cylindrical-like conduits and to outline bloblike objects. We address the implementation details and illustrate the capabilities of our snake with synthetic and real data.
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Affiliation(s)
- Ricard Delgado-Gonzalo
- Biomedical Imaging Group, École polytechnique fédérale de Lausanne, Lausanne, Switzerland
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17
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Rosero EB, Peshock RM, Khera A, Clagett P, Lo H, Timaran CH. Sex, race, and age distributions of mean aortic wall thickness in a multiethnic population-based sample. J Vasc Surg 2011; 53:950-7. [PMID: 21211932 DOI: 10.1016/j.jvs.2010.10.073] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 10/14/2010] [Accepted: 10/14/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reference values and age-related changes of the wall thickness of the abdominal aorta have not been described in the general population. We characterized age-, race-, and gender-specific distributions, and yearly rates of change of mean aortic wall thickness (MAWT), and associations between MAWT and cardiovascular risk factors in a multi-ethnic population-based probability sample. METHODS Magnetic resonance imaging measurements of MAWT were performed on 2466 free-living white, black, and Hispanic adult subjects. MAWT race/ethnicity- and gender-specific percentile values across age were estimated using regression analyses. RESULTS MAWT was greater in men than in women and increased linearly with age in all the groups and across all the percentiles. Hispanic women had the thinnest and black men the thickest aortas. Black men had the highest and white women the lowest age-related MAWT increase. Age, gender, ethnicity, smoking status, systolic blood pressure, low-density lipoprotein-cholesterol levels, high-density lipoprotein-cholesterol levels, and fasting glucose levels were independent predictors of MAWT. CONCLUSIONS Age, gender, and racial/ethnic differences in MAWT distributions exist in the general population. Such differences should be considered in future investigations assessing aortic atherosclerosis and the effects of anti-atherosclerotic therapies.
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Affiliation(s)
- Eric B Rosero
- Division of Vascular and Endovascular Surgery, Department of Surgery, Donald W. Reynolds Cardiovascular Clinical Research Center, University Of Texas Southwestern Medical School, Dallas, TX 75390-9157, USA
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18
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van Langevelde K, Šrámek A, Rosendaal FR. The Effect of Aging on Venous Valves. Arterioscler Thromb Vasc Biol 2010; 30:2075-80. [DOI: 10.1161/atvbaha.110.209049] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Age is the strongest risk factor for venous thrombosis. Vessel wall changes such as thickening of venous valves may be one of the contributing mechanisms. We determined thickness and function of venous valves in the popliteal vein with ultrasound in 77 healthy individuals.
Methods and Results—
The study included 6 age groups ranging from 20 to 80 years old. Thickness of the valves was compared between age groups. Valve closure time was assessed as an indicator for valve function. In 69 of 77 participants, valve parameters could be measured. We found an increasing thickness of the valves with age, with a mean thickness of 0.35 mm (range, 0.25 to 0.44 mm) in the group of 20 to 30 years and 0.59 mm (range, 0.30 to 1.21 mm) in the group of 71 to 80 years. The increase in valve thickness per year (linear regression coefficient) was 0.004 mm (95% CI, 0 to 0.009). Valve function was not directly associated with age. Valve thickness, however, was inversely associated with valve function.
Conclusion—
Our results show that deep venous valves change with age, with thicker valves in older individuals. The increase of valve thickness with age may be part of the explanation for the age gradient seen in the incidence of venous thrombosis.
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Affiliation(s)
- Kirsten van Langevelde
- From the Departments of Clinical Epidemiology (K.v.L., F.R.R.), Radiology (A.Š.), and Thrombosis and Haemostasis (F.R.R.), Leiden University Medical Center, Leiden, the Netherlands
| | - Alexandr Šrámek
- From the Departments of Clinical Epidemiology (K.v.L., F.R.R.), Radiology (A.Š.), and Thrombosis and Haemostasis (F.R.R.), Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R. Rosendaal
- From the Departments of Clinical Epidemiology (K.v.L., F.R.R.), Radiology (A.Š.), and Thrombosis and Haemostasis (F.R.R.), Leiden University Medical Center, Leiden, the Netherlands
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van Schooten BW, van Dijk EMAG, Suinesiaputra A, Reiber JHC. Interactive navigation of segmented MR angiograms using simultaneous curved planar and volume visualizations. Int J Comput Assist Radiol Surg 2010; 6:591-9. [PMID: 20882360 DOI: 10.1007/s11548-010-0534-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 09/06/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Interactive visualization is required to inspect and monitor the automatic segmentation of vessels derived from contrast-enhanced magnetic resonance angiography (CE-MRA). A dual-view visualization scheme consisting of curved planar reformation (CPR) and direct volume rendering (DVR) was developed for this purpose and tested. METHODS A dual view visualization scheme was developed using the vessel pathline for both camera position and rotation in 3D, greatly reducing the degrees of freedom (DOF) required for navigation. Pathline-based navigation facilitates coupling of the CPR and DVR views, as local position and orientation can be matched precisely. The new technique was compared to traditional techniques in a user study. Layperson users were required to perform a visual search task that involves checking for (minor) errors in segmentations of MRA data from a software phantom. The task requires the user to examine both views. RESULTS Pathline-based navigation and coupling of CPR and DVR provide user speed performance improvements in a vessel inspection task. Interactive MRA visualization with this method, where rotational degrees of freedom were reduced, had no negative effect. CONCLUSIONS The DOF reduction achieved by the new navigation technique is beneficial to user performance. The technique is promising and merits comprehensive evaluation in a realistic clinical setting.
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Affiliation(s)
- B W van Schooten
- Human Media Interaction, University of Twente, Enschede, The Netherlands.
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20
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Duivenvoorden R, Vanbavel E, de Groot E, Stroes ESG, Disselhorst JA, Hutten BA, Laméris JS, Kastelein JJP, Nederveen AJ. Endothelial shear stress: a critical determinant of arterial remodeling and arterial stiffness in humans--a carotid 3.0-T MRI study. Circ Cardiovasc Imaging 2010; 3:578-85. [PMID: 20576811 DOI: 10.1161/circimaging.109.916304] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Low endothelial shear stress (ESS) elicits endothelial dysfunction. However, the relationship between ESS and arterial remodeling and arterial stiffness is unknown in humans. We developed a 3.0-T MRI protocol to evaluate the contribution of ESS to arterial remodeling and stiffness. METHODS AND RESULTS Fifteen young (aged 26 ± 3 years) and 15 older (aged 57 ± 3 years) healthy volunteers as well as 15 patients with cardiovascular disease (aged 63 ± 10 years) were enrolled. Phase-contrast MRI of the common carotid arteries was used to derive ESS data from the spatial velocity gradients close to the arterial wall. ESS measurements were performed on 3 occasions and showed excellent reproducibility (intraclass correlation coefficient, 0.79). Multiple linear regression analysis accounting for age and blood pressure revealed that ESS was an independent predictor of the following response variables: carotid wall thickness (regression coefficient [b], -0.19 mm(2) per N/m(2); P=0.02), lumen area (b, -15.5 mm(2) per N/m(2); P<0.001), and vessel size (b, -24.0 mm(2) per N/m(2); P<0.001). Segments of the artery wall exposed to lower ESS were significantly thicker than segments exposed to higher ESS within the same artery (P=0.009). Furthermore, ESS was associated with arterial compliance, accounting for age, blood pressure, and wall thickness (b, -0.003 mm(2)/mm Hg per N/m(2); P=0.04). CONCLUSIONS Our carotid MRI data show that ESS is an important determinant of arterial remodeling and arterial stiffness in humans. The data warrant further studies to evaluate use of carotid ESS as a noninvasive tool to improve the understanding of individual cardiovascular disease risk and to assess novel drug therapies in cardiovascular disease prevention.
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Affiliation(s)
- Raphaël Duivenvoorden
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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21
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Shum J, DiMartino ES, Goldhamme A, Goldman DH, Acker LC, Patel G, Ng JH, Martufi G, Finol EA. Semiautomatic vessel wall detection and quantification of wall thickness in computed tomography images of human abdominal aortic aneurysms. Med Phys 2010; 37:638-48. [PMID: 20229873 DOI: 10.1118/1.3284976] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Quantitative measurements of wall thickness in human abdominal aortic aneurysms (AAAs) may lead to more accurate methods for the evaluation of their biomechanical environment. METHODS The authors describe an algorithm for estimating wall thickness in AAAs based on intensity histograms and neural networks involving segmentation of contrast enhanced abdominal computed tomography images. The algorithm was applied to ten ruptured and ten unruptured AAA image data sets. Two vascular surgeons manually segmented the lumen, inner wall, and outer wall of each data set and a reference standard was defined as the average of their segmentations. Reproducibility was determined by comparing the reference standard to lumen contours generated automatically by the algorithm and a commercially available software package. Repeatability was assessed by comparing the lumen, outer wall, and inner wall contours, as well as wall thickness, made by the two surgeons using the algorithm. RESULTS There was high correspondence between automatic and manual measurements for the lumen area (r = 0.978 and r = 0.996 for ruptured and unruptured aneurysms, respectively) and between vascular surgeons (r = 0.987 and r = 0.992 for ruptured and unruptured aneurysms, respectively). The authors' automatic algorithm showed better results when compared to the reference with an average lumen error of 3.69%, which is less than half the error between the commercially available application Simpleware and the reference (7.53%). Wall thickness measurements also showed good agreement between vascular surgeons with average coefficients of variation of 10.59% (ruptured aneurysms) and 13.02% (unruptured aneurysms). Ruptured aneurysms exhibit significantly thicker walls (1.78 +/- 0.39 mm) than unruptured ones (1.48 +/- 0.22 mm), p = 0.044. CONCLUSIONS While further refinement is needed to fully automate the outer wall segmentation algorithm, these preliminary results demonstrate the method's adequate reproducibility and low interobserver variability.
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Affiliation(s)
- Judy Shum
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
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22
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Jackson CE, Shirodaria CC, Lee JMS, Francis JM, Choudhury RP, Channon KM, Noble JA, Neubauer S, Robson MD. Reproducibility and accuracy of automated measurement for dynamic arterial lumen area by cardiovascular magnetic resonance. Int J Cardiovasc Imaging 2009; 25:797-808. [PMID: 19779977 DOI: 10.1007/s10554-009-9495-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 08/17/2009] [Indexed: 10/20/2022]
Abstract
Bright blood cine images acquired using magnetic resonance imaging contain simple contrast that is tractable to automated analysis, which can be used to derive a measure of arterial compliance that is known to correlate with disease severity. The purpose of this work was to evaluate whether automated methods could be used reliably on a clinically relevant population, and to assess the precision of these measurements so that it could be compared with expert manual assessment. In this paper we apply an algorithm similar to that used by Krug et al., and the exact processing steps are described in detail to allowing easy reproduction of our methods. Phantoms of different sizes have been assessed and the MRI measurements are found to correlate well (r = 0.9998) with physical measurement. Reproducibility assessment was performed on 33 CAD subjects in three anatomical locations along the aorta. Six normal volunteers and ten patients with more severe aortic plaques were investigated to assess reproducibility and sensitivity to pathological changes, respectively. The performance was also assessed on carotid vessels in 40 patients with known arterial plaques. In the human aorta the method is found to be robust (failing in only 7% of cases, all due to clear errors with image acquisition), and to be quantifiably consistent with expert clinical measurement, but showing smaller errors than that approach [<1.21% (5.62 mm(2)) manual vs. <0.58% (2.71 mm(2)) automated, for the aortic area] and with reduced bias, and operated correctly in advanced disease. We have proved over a large number of subjects the superiority of this automated method for evaluating dynamic area changes over the Gold-standard manual approach.
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Affiliation(s)
- Clare E Jackson
- Department of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research , Oxford, OX3 9DU, UK
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23
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Duivenvoorden R, de Groot E, Afzali H, VanBavel ET, de Boer OJ, Laméris JS, Fayad ZA, Stroes ES, Kastelein JJ, Nederveen AJ. Comparison of In Vivo Carotid 3.0-T Magnetic Resonance to B-Mode Ultrasound Imaging and Histology in a Porcine Model. JACC Cardiovasc Imaging 2009; 2:744-50. [DOI: 10.1016/j.jcmg.2008.12.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 12/15/2008] [Accepted: 12/19/2008] [Indexed: 11/26/2022]
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24
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Duivenvoorden R, de Groot E, Elsen BM, Laméris JS, van der Geest RJ, Stroes ES, Kastelein JJP, Nederveen AJ. In vivo quantification of carotid artery wall dimensions: 3.0-Tesla MRI versus B-mode ultrasound imaging. Circ Cardiovasc Imaging 2009; 2:235-42. [PMID: 19808598 DOI: 10.1161/circimaging.108.788059] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Our aim was to compare common carotid mean wall thickness (MWT) measurements by 3.0-T MRI with B-mode ultrasound common carotid intima-media thickness (CCIMT) measurements, a validated surrogate marker for cardiovascular disease. METHODS AND RESULTS B-mode ultrasound and 3.0-T MRI scans of the left and right common carotid arteries were repeated 3 times in 15 healthy younger volunteers (age, 26+/-2.6 years), 15 healthy older volunteers (age, 57+/-3.2 years), and 15 subjects with cardiovascular disease and carotid atherosclerosis (age, 63+/-9.8 years). MWT was 0.711 (SD, 0.229) mm and mean CCIMT was 0.800 (SD, 0.206) mm. MWT and CCIMT were highly correlated (r=0.89, P<0.001). The intraclass correlation coefficients for interscan and interobserver and intraobserver agreements of MRI MWT measurements were larger than 0.95 with small confidence intervals, indicating excellent reproducibility. Power calculations indicate that 89 subjects are required to detect a 4% difference in MRI MWT compared with 469 subjects to detect similar differences with ultrasound IMT in follow-up studies. CONCLUSIONS The study data for carotid MRI and ultrasound IMT showed strong agreement, indicating that both modalities measure the thickness of the intima and media. The advantage of MRI over ultrasound is that the measurement variability is smaller, enabling smaller sample sizes and potentially shorter study duration in cardiovascular prevention trials.
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Affiliation(s)
- R Duivenvoorden
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Roes SD, Westenberg JJM, Doornbos J, van der Geest RJ, Angelié E, de Roos A, Stuber M. Aortic vessel wall magnetic resonance imaging at 3.0 Tesla: a reproducibility study of respiratory navigator gated free-breathing 3D black blood magnetic resonance imaging. Magn Reson Med 2009; 61:35-44. [PMID: 19097222 DOI: 10.1002/mrm.21798] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to evaluate a free-breathing three-dimensional (3D) dual inversion-recovery (DIR) segmented k-space gradient-echo (turbo field echo [TFE]) imaging sequence at 3T for the quantification of aortic vessel wall dimensions. The effect of respiratory motion suppression on image quality was tested. Furthermore, the reproducibility of the aortic vessel wall measurements was investigated. Seven healthy subjects underwent 3D DIR TFE imaging of the aortic vessel wall with and without respiratory navigator. Subsequently, this sequence with respiratory navigator was performed twice in 10 healthy subjects to test its reproducibility. The signal-to-noise (SNR), contrast-to-noise ratio (CNR), vessel wall sharpness, and vessel wall volume (VWV) were assessed. Data were compared using the paired t-test, and the reproducibility of VWV measurements was evaluated using intraclass correlation coefficients (ICCs). SNR, CNR, and vessel wall sharpness were superior in scans performed with respiratory navigator compared to scans performed without. The ICCs concerning intraobserver, interobserver, and interscan reproducibility were excellent (0.99, 0.94, and 0.95, respectively). In conclusion, respiratory motion suppression substantially improves image quality of 3D DIR TFE imaging of the aortic vessel wall at 3T. Furthermore, this optimized technique with respiratory motion suppression enables assessment of aortic vessel wall dimensions with high reproducibility.
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Affiliation(s)
- Stijntje D Roes
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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26
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Rosero EB, Peshock RM, Khera A, Clagett GP, Lo H, Timaran C. Agreement between methods of measurement of mean aortic wall thickness by MRI. J Magn Reson Imaging 2009; 29:576-82. [DOI: 10.1002/jmri.21697] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Aortic and coronary atherosclerosis: a natural association? Int J Cardiovasc Imaging 2008; 25:219-22. [DOI: 10.1007/s10554-008-9389-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Accepted: 11/06/2008] [Indexed: 10/21/2022]
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28
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Burtea C, Laurent S, Murariu O, Rattat D, Toubeau G, Verbruggen A, Vansthertem D, Vander Elst L, Muller RN. Molecular imaging of alpha v beta3 integrin expression in atherosclerotic plaques with a mimetic of RGD peptide grafted to Gd-DTPA. Cardiovasc Res 2008; 78:148-57. [PMID: 18174291 DOI: 10.1093/cvr/cvm115] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The integrin alpha v beta3 is highly expressed in atherosclerotic plaques by medial and intimal smooth muscle cells and by endothelial cells of angiogenic microvessels. In this study, we have assessed non-invasive molecular magnetic resonance imaging (MRI) of plaque-associated alpha v beta3 integrin expression on transgenic ApoE-/- mice with a low molecular weight peptidomimetic of Arg-Gly-Asp (mimRGD) grafted to gadolinium diethylenetriaminepentaacetate (Gd-DTPA-g-mimRGD). The analogous compound Eu-DTPA-g-mimRGD was employed for an in vivo competition experiment and to confirm the molecular targeting. The specific interaction of mimRGD conjugated to Gd-DTPA or to 99mTc-DTPA with alpha v beta3 integrin was furthermore confirmed on Jurkat T lymphocytes. METHODS AND RESULTS The mimRGD was synthesized and conjugated to DTPA. DTPA-g-mimRGD was complexed with GdCl3.6H2O, EuCl3.6H2O, or with [99mTc(CO)3(H2O)3]+. MRI evaluation was performed on a 4.7 T Bruker imaging system. Blood pharmacokinetics of Gd-DTPA-g-mimRGD were assessed in Wistar rats and in c57bl/6j mice. The presence of angiogenic blood vessels and the expression of alpha v beta3 integrin were confirmed in aorta specimens by immunohistochemistry. Gd-DTPA-g-mimRGD produced a strong enhancement of the external structures of the aortic wall and of the more profound layers (possibly tunica media and intima). The aortic lumen seemed to be restrained and distorted. Pre-injection of Eu-DTPA-g-mimRGD diminished the Gd-DTPA-g-mimRGD binding to atherosclerotic plaque and confirmed the specific molecular targeting. A slower blood clearance was observed for Gd-DTPA-g-mimRGD, as indicated by a prolonged elimination half-life and a diminished total clearance. CONCLUSION The new compound is potentially useful for the diagnosis of vulnerable atherosclerotic plaques and of other pathologies characterized by alpha v beta3 integrin expression, such as cancer and inflammation. The delayed blood clearance, the significant enhancement of the signal-to-noise ratio, and the low immunogenicity of the mimetic molecule highlight its potential for an industrial and clinical implementation.
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Affiliation(s)
- Carmen Burtea
- Department of General, Organic and Biomedical Chemistry, NMR and Molecular Imaging Laboratory, University of Mons-Hainaut, 24, Avenue du Champ de Mars, B-7000 Mons, Belgium
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