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Fonken J, Gillissen M, van Engelen E, van Sambeek M, van de Vosse F, Lopata R. On the feasibility of ultrasound Doppler-based personalized hemodynamic modeling of the abdominal aorta. Biomed Eng Online 2024; 23:71. [PMID: 39054524 PMCID: PMC11270776 DOI: 10.1186/s12938-024-01267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Personalized modeling is a promising tool to improve abdominal aortic aneurysm (AAA) rupture risk assessment. Computed tomography (CT) and quantitative flow (Q-flow) magnetic resonance imaging (MRI) are widely regarded as the gold standard for acquiring patient-specific geometry and velocity profiles, respectively. However, their frequent utilization is hindered by various drawbacks. Ultrasound is used extensively in current clinical practice and offers a safe, rapid and cost-effective method to acquire patient-specific geometries and velocity profiles. This study aims to extract and validate patient-specific velocity profiles from Doppler ultrasound and to examine the impact of the velocity profiles on computed hemodynamics. METHODS Pulsed-wave Doppler (PWD) and color Doppler (CD) data were successfully obtained for six volunteers and seven patients and employed to extract the flow pulse and velocity profile over the cross-section, respectively. The US flow pulses and velocity profiles as well as generic Womersley profiles were compared to the MRI velocities and flows. Additionally, CFD simulations were performed to examine the combined impact of the velocity profile and flow pulse. RESULTS Large discrepancies were found between the US and MRI velocity profiles over the cross-sections, with differences for US in the same range as for the Womersley profile. Differences in flow pulses revealed that US generally performs best in terms of maximum flow, forward flow and ratios between forward and backward flow, whereas it often overestimates the backward flow. Both spatial patterns and magnitude of the computed hemodynamics were considerably affected by the prescribed velocity boundary conditions. Larger errors and smaller differences between the US and generic CFD cases were observed for patients compared to volunteers. CONCLUSION These results show that it is feasible to acquire the patient-specific flow pulse from PWD data, provided that the PWD acquisition could be performed proximal to the aneurysm region, and resulted in a triphasic flow pattern. However, obtaining the patient-specific velocity profile over the cross-section using CD data is not reliable. For the volunteers, utilizing the US flow profile instead of the generic flow profile generally resulted in improved performance, whereas this was the case in more than half of the cases for the patients.
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Affiliation(s)
- Judith Fonken
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Eindhoven University of Technology, Groene Loper 3, Eindhoven, 5612AE, The Netherlands.
- Department of Vascular Surgery, Catharina hospital, Michelangelolaan 2, Eindhoven, 5623EJ, The Netherlands.
| | - Milan Gillissen
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Eindhoven University of Technology, Groene Loper 3, Eindhoven, 5612AE, The Netherlands
- Department of Vascular Surgery, Catharina hospital, Michelangelolaan 2, Eindhoven, 5623EJ, The Netherlands
| | - Eline van Engelen
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Eindhoven University of Technology, Groene Loper 3, Eindhoven, 5612AE, The Netherlands
| | - Marc van Sambeek
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Eindhoven University of Technology, Groene Loper 3, Eindhoven, 5612AE, The Netherlands
- Department of Vascular Surgery, Catharina hospital, Michelangelolaan 2, Eindhoven, 5623EJ, The Netherlands
| | - Frans van de Vosse
- Cardiovascular Biomechanics, Eindhoven University of Technology, Groene Loper 3, Eindhoven, 5612AE, The Netherlands
| | - Richard Lopata
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Eindhoven University of Technology, Groene Loper 3, Eindhoven, 5612AE, The Netherlands
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2
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Zecca F, Faa G, Sanfilippo R, Saba L. How to improve epidemiological trustworthiness concerning abdominal aortic aneurysms. Vascular 2024:17085381241257747. [PMID: 38842081 DOI: 10.1177/17085381241257747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Research on degenerative abdominal aortic aneurysms (AAA) is hampered by complex pathophysiology, sub-optimal pre-clinical models, and lack of effective medical therapies. In addition, trustworthiness of existing epidemiological data is impaired by elements of ambiguity, inaccuracy, and inconsistency. Our aim is to foster debate concerning the trustworthiness of AAA epidemiological data and to discuss potential solutions. METHODS We searched the literature from the last five decades for relevant epidemiological data concerning AAA development, rupture, and repair. We then discussed the main issues burdening existing AAA epidemiological figures and proposed suggestions potentially beneficial to AAA diagnosis, prognostication, and management. RESULTS Recent data suggest a heterogeneous scenario concerning AAA epidemiology with rates markedly varying by country and study cohorts. Overall, AAA prevalence seems to be decreasing worldwide while mortality is apparently increasing regardless of recent improvements in aortic-repair techniques. Prevalence and mortality are decreasing in high-income countries, whereas low-income countries show an increase in both. However, several pieces of information are missing or outdated, thus systematic renewal is necessary. Current AAA definition and surgical criteria do not consider inter-individual variability of baseline aortic size, further decreasing their reliability. CONCLUSIONS Switching from flat aortic-size thresholds to relative aortic indices would improve epidemiological trustworthiness regarding AAAs. Aortometry standardization focusing on simplicity, univocity, and accuracy is crucial. A patient-tailored approach integrating clinical data, multi-adjusted indices, and imaging parameters is desirable. Several novel imaging modalities boast promising profiles for investigating the aortic wall. New contrast agents, computational analyses, and artificial intelligence-powered software could provide further improvements.
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Affiliation(s)
- Fabio Zecca
- Department of Radiology, University Hospital "D. Casula", Cagliari, Italy
| | - Gavino Faa
- Department of Pathology, University Hospital "D. Casula", Cagliari, Italy
| | - Roberto Sanfilippo
- Department of Vascular Surgery, University Hospital "D. Casula", Cagliari, Italy
| | - Luca Saba
- Department of Radiology, University Hospital "D. Casula", Cagliari, Italy
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Hegner A, Wittek A, Derwich W, Huß A, Gámez AJ, Blase C. Using averaged models from 4D ultrasound strain imaging allows to significantly differentiate local wall strains in calcified regions of abdominal aortic aneurysms. Biomech Model Mechanobiol 2023; 22:1709-1727. [PMID: 37405538 PMCID: PMC10511614 DOI: 10.1007/s10237-023-01738-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/13/2023] [Indexed: 07/06/2023]
Abstract
Abdominal aortic aneurysms are a degenerative disease of the aorta associated with high mortality. To date, in vivo information to characterize the individual elastic properties of the aneurysm wall in terms of rupture risk is lacking. We have used time-resolved 3D ultrasound strain imaging to calculate spatially resolved in-plane strain distributions characterized by mean and local maximum strains, as well as indices of local variations in strains. Likewise, we here present a method to generate averaged models from multiple segmentations. Strains were then calculated for single segmentations and averaged models. After registration with aneurysm geometries based on CT-A imaging, local strains were divided into two groups with and without calcifications and compared. Geometry comparison from both imaging modalities showed good agreement with a root mean squared error of 1.22 ± 0.15 mm and Hausdorff Distance of 5.45 ± 1.56 mm (mean ± sd, respectively). Using averaged models, circumferential strains in areas with calcifications were 23.2 ± 11.7% (mean ± sd) smaller and significantly distinguishable at the 5% level from areas without calcifications. For single segmentations, this was possible only in 50% of cases. The areas without calcifications showed greater heterogeneity, larger maximum strains, and smaller strain ratios when computed by use of the averaged models. Using these averaged models, reliable conclusions can be made about the local elastic properties of individual aneurysm (and long-term observations of their change), rather than just group comparisons. This is an important prerequisite for clinical application and provides qualitatively new information about the change of an abdominal aortic aneurysm in the course of disease progression compared to the diameter criterion.
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Affiliation(s)
- Achim Hegner
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cadiz, Cadiz, Spain
| | - Andreas Wittek
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| | - Wojciech Derwich
- Department of Vascular and Endovascular Surgery, Goethe University Hospital, Frankfurt am Main, Germany
| | - Armin Huß
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| | - Antonio J. Gámez
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cadiz, Cadiz, Spain
| | - Christopher Blase
- Personalized Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Cell and Vascular Mechanics, Goethe University, Frankfurt am Main, Germany
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4
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Margaretha Nievergeld AH, Maas EJ, de Ruijter J, Cornelia Fonken JH, Henricus Maria van Sambeek MR, Paulus Lopata RG. Automatic Segmentation and Mechanical Characterisation of the Intraluminal Thrombus and Arterial Wall of Abdominal Aortic Aneurysms Using Time Resolved 3D Ultrasound Images. Eur J Vasc Endovasc Surg 2023; 66:418-427. [PMID: 36963747 DOI: 10.1016/j.ejvs.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/19/2023] [Accepted: 03/17/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE This study proposed a method for semi-automatic segmentation of abdominal aortic aneurysms (AAAs) and their intraluminal thrombus (ILT), based on time resolved 3D ultrasound (US), and validated results with computed tomography (CT). Mechanical properties of both wall and ILT were determined, and possible correlations with ILT size and blood pressure were investigated. METHODS A semi-automatic segmentation algorithm was developed combining a star-Kalman approach with a 3D snake algorithm. The segmented geometries of both lumen and inner vessel wall were validated with both manual US based segmentations and CT based segmentations. Finally, the lumen and vessel wall distensibility and ILT compressibility were estimated and correlated with ILT size and blood pressure. RESULTS For the vessel wall and lumen, the median Similarity Index (SI) was 92% (IQR 90, 94%) and 83% (IQR 75, 87%), respectively. The distensibility of the vessel wall could be determined in 37 of 40 cases and had a median value of 0.28 10-5 Pa-1 (IQR 0.18, 0.51 ×10-5). The median systolic to diastolic volume change of the ILT was determined successfully in 21 of 40 patients, and was -0.57% (IQR -1.1, 1.2%). The vessel and lumen distensibility showed a strong correlation with the systolic pressure (p < .010), rather than with the diastolic pressure. Lumen distensibility was strongly correlated with ILT thickness (p = .023). The performance of the semi-automatic segmentation algorithm was shown to be as good as the manual segmentations and highly dependent on the visibility of the ILT (limited contrast in seven patients and clutter in nine patients). CONCLUSION This study has shown promising results for mechanical characterisation of the vessel, and ILT, including a correlation between distensibility, ILT size, and blood pressure. For future work, the inclusion rate needs to be increased by improving the image contrast with novel US techniques.
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Affiliation(s)
- Arjet Helena Margaretha Nievergeld
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Esther Jorien Maas
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Joerik de Ruijter
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Judith Helena Cornelia Fonken
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Marcus Rodolph Henricus Maria van Sambeek
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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5
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Zielinski AH, Bredahl KK, Ghulam QM, Broda MA, Rouet L, Dufour C, Sillesen HH, Eiberg JP. One-year volume growth of abdominal aortic aneurysms measured by extended field-of-view ultrasound. INT ANGIOL 2023; 42:80-87. [PMID: 36744424 DOI: 10.23736/s0392-9590.23.04963-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Measurement of volume has the potential to detect subtle growth not recognized in the current surveillance paradigm of abdominal aortic aneurysms (AAAs). Currently available three-dimensional ultrasound allows for estimation of AAA volume, but for most patients, the AAA extends beyond the ultrasound field-of-view and only allows visualization of a partial AAA volume. A new extended field-of-view three-dimensional ultrasound protocol (XFoV US) has been found to improve the proportion of patients with visualization of the full AAA volume. METHODS To investigate the applicability of the XFoV US protocol in estimating AAA volume growth in follow-up, 86 patients with AAAs were recruited from the surveillance program at a university hospital. All were imaged by XFoV US at baseline and at one-year follow-up. RESULTS Assessment of full volume, based on visualization of the AAA neck and bifurcation at both baseline and one-year follow-up, was achieved in 67/86 (78%) of patients. One-year mean growth in maximum diameter was 2.8 mm (6%/year), in centerline length 2.9 mm (4%/year), and in volume 15.9 mL (19%/year). In 17/67 (25%) of patients, volume growth was detected in diameter-stable AAAs. Baseline XFoV US volume was associated with one-year AAA volume growth, while, conversely, maximum baseline diameter was not associated with one-year AAA diameter growth. CONCLUSIONS This study concludes that the XFoV US protocol provides a safe and repeatable modality for assessing AAA volume growth, and that AAA volume is a promising predictive measure of AAA growth.
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Affiliation(s)
| | - Kim K Bredahl
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Qasam M Ghulam
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Henrik H Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Jonas P Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark.,Philips Research, Suresnes, France
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Fonken J, Maas E, Nievergeld A, van Sambeek M, van de Vosse F, Lopata R. The Impact of a Limited Field-of-View on Computed Hemodynamics in Abdominal Aortic Aneurysms: Evaluating the Feasibility of Completing Ultrasound Segmentations with Parametric Geometries. Ann Biomed Eng 2023; 51:1296-1309. [PMID: 36709232 PMCID: PMC10172266 DOI: 10.1007/s10439-022-03133-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/25/2022] [Indexed: 01/30/2023]
Abstract
To improve abdominal aortic aneurysm (AAA) rupture risk assessment, a large, longitudinal study on AAA hemodynamics and biomechanics is necessary, using personalized fluid-structure interaction (FSI) modeling. 3-dimensional, time-resolved ultrasound (3D+t US) is the preferred image modality to obtain the patient-specific AAA geometry for such a study, since it is safe, affordable and provides temporal information. However, the 3D+t US field-of-view (FOV) is limited and therefore often fails to capture the inlet and aorto-iliac bifurcation geometry. In this study, a framework was developed to add parametric inlet and bifurcation geometries to the abdominal aortic aneurysm geometry by employing dataset statistics and parameters of the AAA geometry. The impact of replacing the patient-specific inlet and bifurcation geometries, acquired using computed tomography (CT) scans, by parametric geometries was evaluated by examining the differences in hemodynamics (systolic and time-averaged wall shear stress and oscillatory shear index) in the aneurysm region. The results show that the inlet geometry has a larger effect on the AAA hemodynamics (median differences of 7.5 to 18.8%) than the bifurcation geometry (median differences all below 1%). Therefore, it is not feasible to replace the patient-specific inlet geometry by a generic one. Future studies should investigate the possibilities of extending the proximal FOV of 3D+t US. However, this study did show the feasibility of adding a parametric bifurcation geometry to the aneurysm geometry. After extending the proximal FOV, the obtained framework can be used to extract AAA geometries from 3D+t US for FSI simulations, despite the absence of the bifurcation geometry.
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Affiliation(s)
- Judith Fonken
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands. .,Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Esther Maas
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Arjet Nievergeld
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Marc van Sambeek
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Frans van de Vosse
- Cardiovascular Biomechanics, Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Richard Lopata
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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7
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Jansen LC, Schwab HM, van de Vosse FN, van Sambeek MRHM, Lopata RGP. Local and global distensibility assessment of abdominal aortic aneurysms in vivo from probe tracked 2D ultrasound images. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 4:1052213. [PMID: 36699662 PMCID: PMC9869420 DOI: 10.3389/fmedt.2022.1052213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/28/2022] [Indexed: 01/11/2023] Open
Abstract
Rupture risk estimation of abdominal aortic aneurysm (AAA) patients is currently based on the maximum diameter of the AAA. Mechanical properties that characterize the mechanical state of the vessel may serve as a better rupture risk predictor. Non-electrocardiogram-gated (non-ECG-gated) freehand 2D ultrasound imaging is a fast approach from which a reconstructed volumetric image of the aorta can be obtained. From this 3D image, the geometry, volume, and maximum diameter can be obtained. The distortion caused by the pulsatility of the vessel during the acquisition is usually neglected, while it could provide additional quantitative parameters of the vessel wall. In this study, a framework was established to semi-automatically segment probe tracked images of healthy aortas (N = 10) and AAAs (N = 16), after which patient-specific geometries of the vessel at end diastole (ED), end systole (ES), and at the mean arterial pressure (MAP) state were automatically assessed using heart frequency detection and envelope detection. After registration AAA geometries were compared to the gold standard computed tomography (CT). Local mechanical properties, i.e., compliance, distensibility and circumferential strain, were computed from the assessed ED and ES geometries for healthy aortas and AAAs, and by using measured brachial pulse pressure values. Globally, volume, compliance, and distensibility were computed. Geometries were in good agreement with CT geometries, with a median similarity index and interquartile range of 0.91 [0.90-0.92] and mean Hausdorff distance and interquartile range of 4.7 [3.9-5.6] mm. As expected, distensibility (Healthy aortas: 80 ± 15·10-3 kPa-1; AAAs: 29 ± 9.6·10-3 kPa-1) and circumferential strain (Healthy aortas: 0.25 ± 0.03; AAAs: 0.15 ± 0.03) were larger in healthy vessels compared to AAAs. Circumferential strain values were in accordance with literature. Global healthy aorta distensibility was significantly different from AAAs, as was demonstrated with a Wilcoxon test (p-value = 2·10-5). Improved image contrast and lateral resolution could help to further improve segmentation to improve mechanical characterization. The presented work has demonstrated how besides accurate geometrical assessment freehand 2D ultrasound imaging is a promising tool for additional mechanical property characterization of AAAs.
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Affiliation(s)
- Larissa C. Jansen
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands,Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands,Correspondence: Larissa C. Jansen
| | - Hans-Martin Schwab
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Frans N. van de Vosse
- Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Marc R. H. M. van Sambeek
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands,Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Richard G. P. Lopata
- Photoacoustics and Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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8
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Sjoerdsma M, Verstraeten SCFPM, Maas EJ, van de Vosse FN, van Sambeek MRHM, Lopata RGP. Spatiotemporal Registration of 3-D Multi-perspective Ultrasound Images of Abdominal Aortic Aneurysms. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:318-332. [PMID: 36441033 DOI: 10.1016/j.ultrasmedbio.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/02/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Methods for patient-specific abdominal aortic aneurysm (AAA) progression monitoring and rupture risk assessment are widely investigated. Three-dimensional ultrasound can visualize the AAA's complex geometry and displacement fields. However, ultrasound has a limited field of view and low frame rate (i.e., 3-8 Hz). This article describes an approach to enhance the temporal resolution and the field of view. First, the frame rate was increased for each data set by sequencing multiple blood pulse cycles into one cycle. The sequencing method uses the original frame rate and the estimated pulse wave rate obtained from AAA distension curves. Second, the temporal registration was applied to multi-perspective acquisitions of the same AAA. Third, the field of view was increased through spatial registration and fusion using an image feature-based phase-only correlation method and a wavelet transform, respectively. Temporal sequencing was fully correct in aortic phantoms and was successful in 51 of 62 AAA patients, yielding a factor 5 frame rate increase. Spatial registration of proximal and distal ultrasound acquisitions was successful in 32 of 37 different AAA patients, based on the comparison between the fused ultrasound and computed tomography segmentation (95th percentile Haussdorf distances and similarity indices of 4.2 ± 1.7 mm and 0.92 ± 0.02 mm, respectively). Furthermore, the field of view was enlarged by 9%-49%.
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Affiliation(s)
- Marloes Sjoerdsma
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Sabine C F P M Verstraeten
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Esther J Maas
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Frans N van de Vosse
- Cardiovascular Biomechanics Group, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marc R H M van Sambeek
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Richard G P Lopata
- Photoacoustics & Ultrasound Laboratory Eindhoven (PULS/e), Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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9
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Li X, Cokkinos D, Gadani S, Rafailidis V, Aschwanden M, Levitin A, Szaflarski D, Kirksey L, Staub D, Partovi S. Advanced ultrasound techniques in arterial diseases. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1711-1721. [PMID: 35195805 DOI: 10.1007/s10554-022-02558-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/08/2022] [Indexed: 12/24/2022]
Abstract
Ultrasound (US) remains a valuable modality for the assessment of vascular diseases, with conventional sonographic techniques such as grayscale and Doppler US used extensively to assess carotid atherosclerosis and abdominal aortic aneurysms. However, conventional US techniques are inherently limited by factors such as operator dependency and limited field of view. There is an increasing interest in the use of advanced sonographic techniques such as contrast-enhanced US (CEUS) and 3-dimensional (3D) US to mitigate some of these limitations. Clinical applications of advanced sonographic techniques include surveillance of abdominal aortic aneurysm, post-endovascular aortic repair, and carotid atherosclerotic plaques. Recently published studies have demonstrated that CEUS and 3D US are superior to conventional US and comparable to computed tomography for certain vascular applications. Further research is required to fully validate the application of advanced sonographic techniques in evaluating various atherosclerotic diseases.
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Affiliation(s)
- Xin Li
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sameer Gadani
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Vasileios Rafailidis
- Department of Radiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Markus Aschwanden
- Department of Vascular Medicine/Angiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Abraham Levitin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Diane Szaflarski
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Levester Kirksey
- Department of Vascular Surgery, Cleveland Clinic Main Campus, Cleveland, OH, USA
| | - Daniel Staub
- Department of Vascular Medicine/Angiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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10
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Zielinski AH, Bredahl KK, Ghulam QM, Rouet L, Dufour C, Sillesen HH, Eiberg JP. Full-Volume Assessment of Abdominal Aortic Aneurysm by Improved-Field-of-View 3-D Ultrasound Performs Comparably to Computed Tomographic Angiography. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:283-292. [PMID: 34823944 DOI: 10.1016/j.ultrasmedbio.2021.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/07/2021] [Accepted: 10/26/2021] [Indexed: 06/13/2023]
Abstract
Three-dimensional ultrasound (US) of abdominal aortic aneurysms (AAAs) is limited by the field-of-view of the 3D-US transducer. To obtain an extended field-of-view (XFoV), two transducer navigation system-assisted US protocols have been developed: XFoV-2D and XFoV-3D. In this study, the XFoV US protocols were compared with the currently available 3D-US protocol with standard field-of-view (FoV-st) and the established gold standard, computed tomography angiography (CTA). A total of 65 patients with AAA were included, and AAA imaging was processed offline with prototype software. The novel XFoV-2D and XFoV-3D protocols allowed for assessment of full AAA volume in significantly more patients (45/65 [69%] and 43/65 [66%], respectively), compared with the current 3D-US standard, FoV-st (30/65 [46%] patients). The mean difference in AAA volume estimation between each XFoV US protocol and 3-D CTA differed significantly (XFoV-2D: 16.9 mL, XFoV-3D: 7.6 mL, p = 0.002), indicating that XFoV-3D agreed best with 3D-CTA. No significant difference was found in the variance of full AAA volume quantification between each XFoV US protocol and CTA (p = 0.49). It is concluded that the XFoV US protocols improved the generation of full AAA volumes compared with the currently available 3D-US technology, with AAA volume estimates comparable to CTA estimates.
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Affiliation(s)
| | - Kim Kargaard Bredahl
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Henrik Hegaard Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jones Peter Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Capital Region of Denmark, Copenhagen, Denmark
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11
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Li T, Liu X, Sun H, Ning H, Yang J, Ma C. Assessment of the Global and Regional Circumferential Strain of Abdominal Aortic Aneurysm with Different Size by Speckle-Tracking Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2619-2627. [PMID: 33555036 DOI: 10.1002/jum.15651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We aimed to use speckle-tracking echocardiography (STE) to quantify circumferential aortic strain of abdominal aortic aneurysms (AAA) with different size. METHODS A total of 87 AAA patients were included. The morphological variables, including aortic maximum diameter (MD), end systolic area (ESA), end diastolic area (EDA), and thickness and area of intraluminal thrombus (ILT), were measured by ultrasound. STE was applied to calculate circumferential strain (CS) at 6 equally divided segments of the aorta at MD. We evaluated the mean value of peak strain along the 6 segments as global circumferential strain (GCS). RESULTS Large AAA (≥5.5 cm) patients had higher MD, ESA, EDA, AAA length, ILT thickness, and area, but lower fractional area change, GCS, and segmental CSs than small AAA (<5.5 cm) subjects (all P < .05). Compared with AAA <4.5 cm group, AAA patients ≥4.5 cm possessed increased MD, ESA, EDA, AAA length, ILT thickness, and area, which results were also reflected in the comparison between AAA <6.5 and ≥6.5 cm group. In small AAA patients, GCS and regional strains in CS1, CS3, and CS5 segments were lower in AAA subjects ≥4.5 cm than those <4.5 cm (all P<.05). However, no significant differences in the GCS and regional CS between ≥6.5 and <6.5 cm group were found. Correlation analysis revealed a significant negative association of GCS with MD, ESA, and EDA, even after adjusting the potential confounding factors (all P < .05). CONCLUSIONS Our findings may yield insight into the structural strain characteristics of AAA wall with different size, which adds the benefit of using simple echocardiography-derived biomechanics to stratify AAA patients.
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Affiliation(s)
- Tan Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xiaozheng Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Haiyang Sun
- Department of Ultrasound, Shenyang Women's and Children's Hospital, Shenyang, China
| | - Hongxia Ning
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
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12
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Derwich W, Wiedemann A, Wittek A, Filmann N, Blase C, Schmitz-Rixen T. Intra- and Interobserver Variability of 4D Ultrasound Examination of the Infrarenal Aorta. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2391-2402. [PMID: 33452839 DOI: 10.1002/jum.15622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/01/2020] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The four-dimensional ultrasound (4D-US) enables imaging of the aortic segment and simultaneous determination of the wall expansion. The method shows a high spatial and temporal resolution, but its in vivo reliability is so far unknown for low-measure values. The present study determines the intraobserver repeatability and interobserver reproducibility of 4D-US in the atherosclerotic and non-atherosclerotic infrarenal aorta. METHODS In all, 22 patients with non-aneurysmal aorta were examined by an experienced examiner and a medical student. After registration of 4D images, both the examiners marked the aortic wall manually before the commercially implemented speckle tracking algorithm was applied. The cyclic changes of the aortic diameter and circumferential strain were determined with the help of custom-made software. The reliability of 4D-US was tested by the intraclass correlation coefficient (ICC). RESULTS The 4D-US measurements showed very good reliability for the maximum aortic diameter and the circumferential strain for all patients and for the non-atherosclerotic aortae (ICC >0.7), but low reliability for circumferential strain in calcified aortae (ICC = 0.29). The observer- and masking-related variances for both maximum diameter and circumferential strain were close to zero. CONCLUSIONS Despite the low-measured values, the high spatial and temporal resolution of the 4D-US enables a reliable evaluation of cyclic diameter changes and circumferential strain in non-aneurysmal aortae independent from the observer experience but with some limitations for calcified aortae. The 4D-US opens up a new perspective with regard to noninvasive, in vivo assessment of kinematic properties of the vessel wall in the abdominal aorta.
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Affiliation(s)
- Wojciech Derwich
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt Goethe University, Frankfurt am Main, Germany
| | - Antonia Wiedemann
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt Goethe University, Frankfurt am Main, Germany
| | - Andreas Wittek
- Personalised Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Department of Mechanical Engineering, University of Siegen, Siegen, Germany
| | - Natalie Filmann
- Institute for Biostatistics and Mathematical Modeling, Goethe University, Frankfurt am Main, Germany
| | - Christopher Blase
- Personalised Biomedical Engineering Lab, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Department of Biological Sciences, Goethe University, Frankfurt am Main, Germany
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, University Hospital Frankfurt Goethe University, Frankfurt am Main, Germany
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13
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Broda M, Rouet L, Zielinski A, Sillesen H, Eiberg J, Ghulam Q. Profiling abdominal aortic aneurysm growth with three-dimensional ultrasound. INT ANGIOL 2021; 41:33-40. [PMID: 34672485 DOI: 10.23736/s0392-9590.21.04724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND "Profiling" is a new method based on three-dimensional ultrasound (3D-US) allowing for direct comparison of baseline and follow-up diameters along the AAA length. This study aimed to evaluate the feasibility of profiling to visualize AAA changes at sub-maximum diameters, and to categorize the growth profiles. METHODS Retrospective analysis of prospectively and consecutively included patients under AAA surveillance at a tertiary referral centre. 3D-US images of AAAs at baseline and at one-year follow-up were segmented, generating a centerline and a mesh of the aneurysm geometry. The mesh was processed to illustrate diameter changes of a given AAA. Three growth profiles were identified: A) Peak Growth: the largest, significant (≥3.6 mm) diameter difference occurred within a 10 mm margin to either side of the maximum baseline diameter; B) Edge Growth: at least one significant diameter difference and the criteria for Peak Growth did not apply; C) No Growth: all diameter differences were nonsignificant. A centerline length of ≥60 mm was assumed to capture a comparable segment of the wall geometry at baseline and follow-up. Cohen's kappa and Kaplan Meier analysis were used to analyze data. RESULTS In total, 186 patients had growth profiles generated. Of these, 28 (15%) were discarded, mainly based on inadequate centerline lengths (n= 21, 11.3%). The remaining patients were categorized into Edge Growth (n=83, 52%), No Growth (n=47, 30%), and Peak Growth (n=28, 18%). CONCLUSIONS Profiling interprets AAA growth at sub-maximum diameters. Half of the cohort had Edge Growth. These AAAs risk being classified as stable.
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Affiliation(s)
- Magdalena Broda
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark - .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark -
| | | | - Alexander Zielinski
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Academy of Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Qasam Ghulam
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
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14
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Mylonas SN, Moulakakis KG, Kadoglou N, Antonopoulos C, Kotsis TE, Kakisis J, Katsenis K, Liapis C. Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment. Vasc Endovascular Surg 2021; 55:804-810. [PMID: 34114528 DOI: 10.1177/15385744211023281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. MATERIALS AND METHODS A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. RESULTS CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. CONCLUSION Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA.
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Affiliation(s)
- Spyridon N Mylonas
- Department of Vascular and Endovascular Surgery, 61059University of Cologne, Cologne, Germany.,Department of Vascular Surgery, Medical School, 68989University of Athens, Athens, Greece
| | - Konstantinos G Moulakakis
- Department of Vascular Surgery, Medical School, 68989University of Athens, Athens, Greece.,Department of Vascular Surgery, Medical School, 484358University of Patras, Patras, Greece
| | - Nikolaos Kadoglou
- Department of Cardiology, Medical School, 371002University of Cyprus, Nicosia, Cyprus
| | | | - Thomas E Kotsis
- Department of Vascular Surgery, Medical School, 68989University of Athens, Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, Medical School, 68989University of Athens, Athens, Greece
| | - Konstantinos Katsenis
- Department of Vascular Surgery, Medical School, 68989University of Athens, Athens, Greece
| | - Christos Liapis
- Department of Vascular Surgery, Medical School, 68989University of Athens, Athens, Greece
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15
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Kore SS, Kadam AB. A novel incomplete sparse least square optimized regression model for abdominal mass detection in ultrasound images. EVOLUTIONARY INTELLIGENCE 2020. [DOI: 10.1007/s12065-020-00431-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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