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Whitehead JF, Hoffman CA, Wagner MG, Periyasamy S, Meram E, Keller ME, Speidel MA, Laeseke PF. Quantitative Digital Subtraction Angiography Measurement of Arterial Velocity at Low Radiation Dose Rates. Cardiovasc Intervent Radiol 2024; 47:1119-1126. [PMID: 38992198 DOI: 10.1007/s00270-024-03809-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE Quantitative digital subtraction angiography (qDSA) has been proposed to quantify blood velocity for monitoring treatment progress during blood flow altering interventions. The method requires high frame rate imaging [~ 30 frame per second (fps)] to capture temporal dynamics. This work investigates performance of qDSA in low radiation dose acquisitions to facilitate clinical translation. MATERIALS AND METHODS Velocity quantification accuracy was evaluated at five radiation dose rates in vitro and in vivo. Angiographic technique ranged from 30 fps digital subtraction angiography ( 29.3 ± 1.7 mGy / s at the interventional reference point) down to a 30 fps protocol at 23% higher radiation dose per frame than fluoroscopy ( 1.1 ± 0.2 mGy / s ). The in vitro setup consisted of a 3D-printed model of a swine hepatic arterial tree connected to a pulsatile displacement pump. Five different flow rates (3.5-8.8 mL/s) were investigated in vitro. Angiography-based fluid velocity measurements were compared across dose rates using ANOVA and Bland-Altman analysis. The experiment was then repeated in a swine study (n = 4). RESULTS Radiation dose rate reductions for the lowest dose protocol were 99% and 96% for the phantom and swine study, respectively. No significant difference was found between angiography-based velocity measurements at different dose rates in vitro or in vivo. Bland-Altman analysis found little bias for all lower-dose protocols (range: [- 0.1, 0.1] cm/s), with the widest limits of agreement ([- 3.3, 3.5] cm/s) occurring at the lowest dose protocol. CONCLUSIONS This study demonstrates the feasibility of quantitative blood velocity measurements from angiographic images acquired at reduced radiation dose rates.
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Affiliation(s)
- Joseph F Whitehead
- Department of Medical Physics, University of Wisconsin Madison, Madison, WI, USA
| | - Carson A Hoffman
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Martin G Wagner
- Department of Medical Physics, University of Wisconsin Madison, Madison, WI, USA
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | | | - Ece Meram
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Marlin E Keller
- Department of Medical Physics, University of Wisconsin Madison, Madison, WI, USA
| | - Michael A Speidel
- Department of Medical Physics, University of Wisconsin Madison, Madison, WI, USA
- Department of Medicine, University of Wisconsin Madison, Madison, WI, USA
| | - Paul F Laeseke
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA.
- Department of Biomedical Engineering, University of Wisconsin Madison, Madison, WI, USA.
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Wagner MG, Whitehead JF, Periyasamy S, Laeseke PF, Speidel MA. Spatiotemporal frequency domain analysis for blood velocity measurement during embolization procedures. Med Phys 2024; 51:1726-1737. [PMID: 37665770 PMCID: PMC10909916 DOI: 10.1002/mp.16715] [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: 04/15/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Currently, determining procedural endpoints and treatment efficacy of vascular interventions is largely qualitative and relies on subjective visual assessment of digital subtraction angiography (DSA) images leading to large interobserver variabilities and poor reproducibility. Quantitative metrics such as the residual blood velocity in embolized vessel branches could help establish objective and reproducible endpoints. Recently, velocity quantification techniques based on a contrast enhanced X-ray sequence such as qDSA and 4D DSA have been proposed. These techniques must be robust, and, to avoid radiation dose concerns, they should be compatible with low dose per frame image acquisition. PURPOSE To develop and evaluate a technique for robust blood velocity quantification from low dose contrast enhanced X-ray image sequences that leverages the oscillating signal created by pulsatile blood flow. METHODS The proposed spatiotemporal frequency domain (STF) approach quantifies velocities from time attenuation maps (TAMs) representing the oscillating signal over time for all points along a vessel centerline. Due to the time it takes a contrast bolus to travel along the vessel centerline, the resulting TAM resembles a sheared sine wave. The shear angle is related to the velocity and can be determined in the spatiotemporal frequency domain after applying the 2D Fourier transform to the TAM. The approach was evaluated in a straight tube phantom using three different radiation dose levels and compared to ultrasound transit-time-based measurements. The STF velocity results were also compared to previously published approaches for the measurement of blood velocity from contrast enhanced X-ray sequences including shifted least squared (SLS) and phase shift (PHS). Additionally, an in vivo porcine study (n = 8) was performed where increasing amounts of embolic particles were injected into a hepatic or splenic artery with intermittent velocity measurements after each injection to monitor the resulting reduction in velocity. RESULTS At the lowest evaluated dose level (average air kerma rate 1.3 mGy/s at the interventional reference point), the Pearson correlation between ultrasound and STF velocity measurements was99 % $99\%$ . This was significantly higher (p < 0.0001 $p < 0.0001$ ) than corresponding correlation results between ultrasound and the previously published SLS and PHS approaches (91 $\hskip.001pt 91$ and93 % $93\%$ , respectively). In the in vivo study, a reduction in velocity was observed in85.7 % $85.7\%$ of cases after injection of 1 mL,96.4 % $96.4\%$ after 3 mL, and100.0 % $100.0\%$ after 4 mL of embolic particles. CONCLUSIONS The results show good agreement of the spatiotemporal frequency domain approach with ultrasound even in low dose per frame image sequences. Additionally, the in vivo study demonstrates the ability to monitor the physiological changes due to embolization. This could provide quantitative metrics during vascular procedures to establish objective and reproducible endpoints.
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Affiliation(s)
- Martin G Wagner
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Joseph F Whitehead
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
| | - Sarvesh Periyasamy
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Michael A Speidel
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
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Whitehead JF, Periyasamy S, Laeseke PF, Speidel MA, Wagner MG. Motion-compensation approach for quantitative digital subtraction angiography and its effect on in-vivo blood velocity measurement. J Med Imaging (Bellingham) 2024; 11:013501. [PMID: 38188936 PMCID: PMC10765039 DOI: 10.1117/1.jmi.11.1.013501] [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: 07/21/2023] [Revised: 11/13/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024] Open
Abstract
Purpose Quantitative monitoring of flow-altering interventions has been proposed using algorithms that quantify blood velocity from time-resolved two-dimensional angiograms. These algorithms track the movement of contrast oscillations along a vessel centerline. Vessel motion may occur relative to a statically defined vessel centerline, corrupting the blood velocity measurement. We provide a method for motion-compensated blood velocity quantification. Approach The motion-compensation approach utilizes a vessel segmentation algorithm to perform frame-by-frame vessel registration and creates a dynamic vessel centerline that moves with the vasculature. Performance was evaluated in-vivo through comparison with manually annotated centerlines. The method was also compared to a previous uncompensated method using best- and worst-case static centerlines chosen to minimize and maximize centerline placement accuracy. Blood velocities determined through quantitative DSA (qDSA) analysis for each centerline type were compared through linear regression analysis. Results Centerline distance errors were 0.3 ± 0.1 mm relative to gold standard manual annotations. For the uncompensated approach, the best- and worst-case static centerlines had distance errors of 1.1 ± 0.6 and 2.9 ± 1.2 mm , respectively. Linear regression analysis found a high R -squared between qDSA-derived blood velocities using gold standard centerlines and motion-compensated centerlines (R 2 = 0.97 ) with a slope of 1.15 and a small offset of - 0.6 cm / s . The use of static centerlines resulted in low coefficients of determination for the best case (R 2 = 0.35 ) and worst-case (R 2 = 0.20 ) scenarios, with slopes close to zero. Conclusions In-vivo validation of motion-compensated qDSA analysis demonstrated improved velocity quantification accuracy in vessels with motion, addressing an important clinical limitation of the current qDSA algorithm.
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Affiliation(s)
- Joseph F. Whitehead
- University of Wisconsin – Madison, Department of Medical Physics, Madison, Wisconsin, United States
| | - Sarvesh Periyasamy
- University of Wisconsin – Madison, Department of Radiology, Madison, Wisconsin, United States
| | - Paul F. Laeseke
- University of Wisconsin – Madison, Department of Radiology, Madison, Wisconsin, United States
| | - Michael A. Speidel
- University of Wisconsin – Madison, Department of Medical Physics, Madison, Wisconsin, United States
- University of Wisconsin – Madison, Department of Medicine, Madison, Wisconsin, United States
| | - Martin G. Wagner
- University of Wisconsin – Madison, Department of Medical Physics, Madison, Wisconsin, United States
- University of Wisconsin – Madison, Department of Radiology, Madison, Wisconsin, United States
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Meram E, Hoffman C, Periyasamy S, Hetzel S, Kutlu AZ, Pieper AA, Laeseke PF. Quantification of Iliac Arterial Blood Velocity in Stenotic Phantom and Porcine Models Using Quantitative Digital Subtraction Angiography. J Vasc Interv Radiol 2023:S1051-0443(23)00907-7. [PMID: 38141780 DOI: 10.1016/j.jvir.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023] Open
Abstract
PURPOSE To assess the feasibility of using quantitative digital subtraction angiography (qDSA) to quantify arterial velocity in phantom and porcine stenotic iliac artery models. MATERIALS AND METHODS Varying stenoses (mild, <50%; moderate, 50%-70%; and severe, >70%) were created in a silicone iliac artery phantom using vessel loops. Two-dimensional digital subtraction angiographies (DSAs) were performed, with velocities calculated using qDSA. qDSA velocities were compared with flow rates and velocities measured with an ultrasonic flow probe. Two-dimensional DSAs of the common and external iliac arteries were then performed in 4 swine (mean weight, 63 kg) before and after a severe stenosis (>70%) was created in the iliac artery using 3-0 silk suture. Peak systolic velocities on pulsed wave Doppler ultrasound (US) before and after stenosis creation were correlated with the qDSA velocities. Pearson correlation, linear regression, and analysis of variance were used for analysis. RESULTS In the phantom study, ultrasonic probe velocities positively correlated with downstream qDSA (r = 0.65; P < .001) and negatively correlated with peristenotic qDSA velocities (r = -0.80; P < .001). In the swine study, statistically significant reductions in external iliac arterial velocity were noted on US and qDSA after stenosis creation (P < .05). US and qDSA velocities strongly correlated for all flow states with both 50% and 100% contrast concentrations (r = 0.82 and r = 0.74, respectively), with an estimated US-to-qDSA ratio of 1.3-1.5 (P < .001). qDSA velocities with 50% and 100% contrast concentrations also strongly correlated (r = 0.78; P < .001). CONCLUSIONS In both phantom and swine stenosis models, changes in iliac arterial velocity could be quantified with qDSA, which strongly correlated with standard-of-care US.
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Affiliation(s)
- Ece Meram
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Carson Hoffman
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sarvesh Periyasamy
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Ayca Zeynep Kutlu
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Alexander A Pieper
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Paul F Laeseke
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
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Thurner A, Augustin AM, Bley TA, Kickuth R. 2D-perfusion angiography for intra-procedural endovascular treatment response assessment in chronic mesenteric ischemia: a feasibility study. BMC Med Imaging 2022; 22:90. [PMID: 35578260 PMCID: PMC9109376 DOI: 10.1186/s12880-022-00820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endovascular revascularization has become the first-line treatment of chronic mesenteric ischemia (CMI). The qualitative visual analysis of digital subtraction angiography (DSA) is dependent on observer experience and prone to interpretation errors. We evaluate the feasibility of 2D-Perfusion Angiography (2D-PA) for objective, quantitative treatment response assessment in CMI. METHODS 49 revascularizations in 39 patients with imaging based evidence of mesenteric vascular occlusive disease and clinical signs of CMI were included in this retrospective study. To assess perfusion changes by 2D-PA, DSA-series were post-processed using a dedicated, commercially available software. Regions of interest (ROI) were placed in the pre- and post-stenotic artery segment. In aorto-ostial disease, the inflow ROI was positioned at the mesenteric artery orifice. The ratios outflow to inflow ROI for peak density (PD), time to peak and area-under-the-curve (AUC) were computed and compared pre- and post-interventionally. We graded motion artifacts by means of a four-point scale. Feasibility of 2D-PA and changes of flow parameters were evaluated. RESULTS Motion artifacts due to a mobile vessel location beneath the diaphragm or within the mesenteric root, branch vessel superimposition and inadequate contrast enhancement at the inflow ROI during manually conducted DSA-series via selective catheters owing to steep vessel angulation, necessitated exclusion of 26 measurements from quantitative flow evaluation. The feasibility rate was 47%. In 23 technically feasible assessments, PDoutflow/PDinflow increased by 65% (p < 0.001) and AUCoutflow/AUCinflow increased by 85% (p < 0.001). The time to peak density values in the outflow ROI accelerated only minimally without reaching statistical significance. Age, BMI, target vessel (celiac trunk, SMA or IMA), stenosis location (ostial or truncal), calcification severity, plaque composition or the presence of a complex stenosis did not reach statistical significance in their distribution among the feasible and non-feasible group (p > 0.05). CONCLUSIONS Compared to other vascular territories and indications, the feasibility of 2D-PA in mesenteric revascularization for CMI was limited. Unfavorable anatomic conditions contributed to a high rate of inconclusive 2D-PA results.
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Affiliation(s)
- Annette Thurner
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Anne Marie Augustin
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Ralph Kickuth
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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