AIMTo investigate the accuracy of a rotational C-arm CT-based 3D heart model to predict an optimal C-arm configuration during transcatheter aortic valve replacement (TAVR).METHODSRotational C-arm CT (RCT) under rapid ventricular pacing was performed in 57 consecutive patients with severe aortic stenosis as part of the pre-procedural cardiac catheterization. With prototype software each RCT data set was segmented using a 3D heart model. From that the line of perpendicularity curve was obtained that generates a perpendicular view of the aortic annulus according to the right-cusp rule. To evaluate the accuracy of a model-based overlay we compared model- and expert-derived aortic root diameters.RESULTSFor all 57 patients in the RCT cohort diameter measurements were obtained from two independent operators and were compared to the model-based measurements. The inter-observer variability was measured to be in the range of 0°-12.96° of angular C-arm displacement for two independent operators. The model-to-operator agreement was 0°-13.82°. The model-based and expert measurements of aortic root diameters evaluated at the aortic annulus (r = 0.79, P < 0.01), the aortic sinus (r = 0.93, P < 0.01) and the sino-tubular junction (r = 0.92, P < 0.01) correlated on a high level and the Bland-Altman analysis showed good agreement. The interobserver measurements did not show a significant bias.CONCLUSIONAutomatic segmentation of the aortic root using an anatomical model can accurately predict an optimal C-arm configuration, potentially simplifying current clinical workflows before and during TAVR.
Cardiac catheterisation including LV-RCT offers complementary assessment of left ventricular function, aortic valve anatomy, coronary angiography and arterial access routes. LV-RCT for aortic root measurements shows better correlation to MDCT than standard Ao-RCT protocols.
We propose a novel registration method, which combines well-known vessel detection techniques with aspects of model adaptation. The proposed method is tailored to the requirements of 2D-3D-registration of interventional angiographic X-ray data such as acquired during abdominal procedures. As prerequisite, a vessel centerline is extracted out of a rotational angiography (3DRA) data set to build an individual model of the vascular tree. Following the two steps of local vessel detection and model transformation the centerline model is matched to one dynamic subtraction angiography (DSA) target image. Thereby, the in-plane position and the 3D orientation of the centerline is related to the vessel candidates found in the target image minimizing the residual error in least squares manner. In contrast to feature-based methods, no segmentation of the vessel tree in the 2D target image is required. First experiments with synthetic angiographies and clinical data sets indicate that matching with the proposed model-to-image based registration approach is accurate and robust and is characterized by a large capture range.
Abstract.With automated image analysis tools entering rapidly the clinical practice, the demands regarding reliability, accuracy, and speed are strongly increasing. Systematic testing approaches to determine optimal parameter settings and to select algorithm design variants become essential in this context. We present an approach to optimize organ localization in a complex segmentation chain consisting of organ localization, parametric organ model adaptation, and deformable adaptation. In particular, we consider the Generalized Hough Transformation (GHT) and 3D heart segmentation in Computed Tomography Angiography (CTA) images. We rate the performance of our GHT variant by the initialization error and by computation time. Systematic parameter testing on a compute cluster allows to identify a parametrization with a good tradeoff between reliability and speed. This is achieved with coarse image sampling, a coarse Hough space resolution and a filtering step that we introduced to remove unspecific edges. Finally we show that optimization of the GHT parametrization results in a segmentation chain with reduced failure rates.
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