Plaque constitution on computed tomography coronary angiography (CTA) is associated with prognosis. At present only visual assessment of plaque constitution is possible. An accurate automatic, quantitative approach for CTA plaque constitution assessment would improve reproducibility and allows higher accuracy. The present study assessed the feasibility of a fully automatic and quantitative analysis of atherosclerosis on CTA. Clinically derived CTA and intravascular ultrasound virtual histology (IVUS VH) datasets were used to investigate the correlation between quantitatively automatically derived CTA parameters and IVUS VH. A total of 57 patients underwent CTA prior to IVUS VH. First, quantitative CTA quantitative computed tomography (QCT) was performed. Per lesion stenosis parameters and plaque volumes were assessed. Using predefined HU thresholds, CTA plaque volume was differentiated in 4 different plaque types necrotic core (NC), dense calcium (DC), fibrotic (FI) and fibro-fatty tissue (FF). At the identical level of the coronary, the same parameters were derived from IVUS VH. Bland-Altman analyses were performed to assess the agreement between QCT and IVUS VH. Assessment of plaque volume using QCT in 108 lesions showed excellent correlation with IVUS VH (r = 0.928, p < 0.001) (Fig. 1). The correlation of both FF and FI volume on IVUS VH and QCT was good (r = 0.714, p < 0.001 and r = 0.695, p < 0.001 respectively) with corresponding bias and 95 % limits of agreement of 24 mm(3) (-42; 90) and 7.7 mm(3) (-54; 70). Furthermore, NC and DC were well-correlated in both modalities (r = 0.523, p < 0.001) and (r = 0.736, p < 0.001). Automatic, quantitative CTA tissue characterization is feasible using a dedicated software tool. Fig. 1 Schematic illustration of the characterization of coronary plaque on CTA: cross-correlation with IVUS VH. First, the 3-dimensional centerline was generated from the CTA data set using an automatic tree extraction algorithm (Panel I). Using a unique registration a complete pullback series of IVUS images was mapped on the CTA volume using true anatomical markers (Panel II). Fully automatic lumen and vessel wall contour detection was performed for both imaging modalities (Panel III). Finally, fusion-based quantification of atherosclerotic lesions was based on the lumen and vessel wall contours as well as the corresponding reference lines (estimate of normal tapering of the coronary artery), as shown in panel IV. At the level of the minimal lumen area (MLA) (yellow lines), stenosis parameters, could be calculated for both imaging techniques. Additionally, plaque volumes and plaque types were derived for the whole coronary artery lesion, ranging from the proximal to distal lesion marker (blue markers). Fibrotic tissue was labeled in dark green, Fibro-fatty tissue in light green, dense calcium in white and necrotic core was labeled in red.
Though conventional coronary angiography (CCA) has been the standard of reference for diagnosing coronary artery disease in the past decades, computed tomography angiography (CTA) has rapidly emerged, and is nowadays widely used in clinical practice. Here, we introduce a standardized evaluation framework to reliably evaluate and compare the performance of the algorithms devised to detect and quantify the coronary artery stenoses, and to segment the coronary artery lumen in CTA data. The objective of this evaluation framework is to demonstrate the feasibility of dedicated algorithms to: (1) (semi-)automatically detect and quantify stenosis on CTA, in comparison with quantitative coronary angiography (QCA) and CTA consensus reading, and (2) (semi-)automatically segment the coronary lumen on CTA, in comparison with expert's manual annotation. A database consisting of 48 multicenter multivendor cardiac CTA datasets with corresponding reference standards are described and made available. The algorithms from 11 research groups were quantitatively evaluated and compared. The results show that (1) some of the current stenosis detection/quantification algorithms may be used for triage or as a second-reader in clinical practice, and that (2) automatic lumen segmentation is possible with a precision similar to that obtained by experts. The framework is open for new submissions through the website, at http://coronary.bigr.nl/stenoses/.
Coronary computed tomographic angiography (CCTA) is a non-invasive imaging modality for the visualization of the heart and coronary arteries. To fully exploit the potential of the CCTA datasets and apply it in clinical practice, an automated coronary artery extraction approach is needed. The purpose of this paper is to present and validate a fully automatic centerline extraction algorithm for coronary arteries in CCTA images. The algorithm is based on an improved version of Frangi’s vesselness filter which removes unwanted step-edge responses at the boundaries of the cardiac chambers. Building upon this new vesselness filter, the coronary artery extraction pipeline extracts the centerlines of main branches as well as side-branches automatically. This algorithm was first evaluated with a standardized evaluation framework named Rotterdam Coronary Artery Algorithm Evaluation Framework used in the MICCAI Coronary Artery Tracking challenge 2008 (CAT08). It includes 128 reference centerlines which were manually delineated. The average overlap and accuracy measures of our method were 93.7% and 0.30 mm, respectively, which ranked at the 1st and 3rd place compared to five other automatic methods presented in the CAT08. Secondly, in 50 clinical datasets, a total of 100 reference centerlines were generated from lumen contours in the transversal planes which were manually corrected by an expert from the cardiology department. In this evaluation, the average overlap and accuracy were 96.1% and 0.33 mm, respectively. The entire processing time for one dataset is less than 2 min on a standard desktop computer. In conclusion, our newly developed automatic approach can extract coronary arteries in CCTA images with excellent performances in extraction ability and accuracy.
In this proof-of-principle study, the MBF index performed better than visual CTCA and QCT in the identification of functionally significant coronary lesions. The MBF index had additional value beyond CTCA anatomy in intermediate coronary lesions. This may have a potential to support patient management.
The large size of the hyperspectral datasets that are produced with modern mass spectrometric imaging techniques makes it difficult to analyze the results. Unsupervised statistical techniques are needed to extract relevant information from these datasets and reduce the data into a surveyable overview. Multivariate statistics are commonly used for this purpose. Computational power and computer memory limit the resolution at which the datasets can be analyzed with these techniques. We introduce the use of a data format capable of efficiently storing sparse datasets for multivariate analysis. This format is more memory-efficient and therefore it increases the possible resolution together with a decrease of computation time. Three multivariate techniques are compared for both sparse-type data and non-sparse data acquired in two different imaging ToF-SIMS experiments and one LDI-ToF imaging experiment. There is no significant qualitative difference in the use of different data formats for the same multivariate algorithms. All evaluated multivariate techniques could be applied on both SIMS and the LDI imaging datasets. Principal component analysis is shown to be the fastest choice; however a small increase of computation time using a VARIMAX optimization increases the decomposition quality significantly. PARAFAC analysis is shown to be very effective in separating different chemical components but the calculations take a significant amount of time, limiting its use as a routine technique. An effective visualization of the results of the multivariate analysis is as important for the analyst as the computational issues. For this reason, a new technique for visualization is presented, combining both spectral loadings and spatial scores into one three-dimensional view on the complete datacube.
Background
Coronary computed tomography angiography (CTA) can be used to detect and quantitatively assess high-risk plaque features.
Objective
To validate the ROMICAT score, which was derived using semi-automated quantitative measurements of high-risk plaque features, for the prediction of ACS.
Material and methods
We performed quantitative plaque analysis in 260 patients who presented to the emergency department with suspected ACS in the ROMICAT II trial. The readers used a semi-automated software (QAngio, Medis medical imaging systems BV) to measure high-risk plaque features (volume of <60HU plaque, remodeling index, spotty calcium, plaque length) and diameter stenosis in all plaques. We calculated a ROMICAT score, which was derived from the ROMICAT I study and applied to the ROMICAT II trial. The primary outcome of the study was diagnosis of an ACS during the index hospitalization.
Results
Patient characteristics (age 57±8 vs. 56±8 years, cardiovascular risk factors) were not different between those with and without ACS (prevalence of ACS 7.8%). There were more men in the ACS group (84% vs. 59%, p=0.005). When applying the ROMICAT score derived from the ROMICAT I trial to the patient population of the ROMICAT II trial, the ROMICAT score (OR 2.9, 95%CI 1.4–6.0, p=0.003) was a predictor of ACS after adjusting for gender and ≥50% stenosis. The AUC of the model containing ROMICAT score, gender, and ≥50% stenosis was 0.91 (95%CI 0.86–0.96) and was better than with a model that included only gender and ≥50% stenosis (AUC 0.85, 95%CI 0.77–0.92; p=0.002)
Conclusions
The ROMICAT score derived from semi-automated quantitative measurements of high-risk plaque features was an independent predictor of ACS during the index hospitalization and was incremental to gender and presence of ≥50% stenosis.
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