Morphologic Assessment of the Left Atrial Appendage in Patients with Atrial Fibrillation by Gray Values–Inverted Volume-Rendered Imaging of Three-Dimensional Transesophageal Echocardiography: A Comparative Study with Computed Tomography

Song, Hongning; Zhou, Qing; Deng, Qing; Chen, Jinling; Zhang, Lan; Tan, Tao; Guo, Ruiqiang

doi:10.1016/j.echo.2016.08.003

Cited by 11 publications

(19 citation statements)

References 18 publications

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“…The procedure is guided through fluoroscopy and transesophageal echocardiography (TEE) imaging, requiring a pre-procedural TEE examination to rule out thrombus and to evaluate the LAA morphology. Moreover, recently, researchers [8]- [12] have proven the added-value of computed tomography (CT) acquisition for assessment of the LAA shape.…”

Section: Introductionmentioning

confidence: 99%

“…For this reason, during the real intervention, the experts perform multiple image acquisitions (both fluoroscopy and TEE) and visually assess the resulting images to identify the device [17]. However, such approach still presents several disadvantages, namely: 1) it is time-consuming, requiring several minutes to correctly identify the optimal device; 2) the correct identification of the 3D LAA shape through peri-procedural data is not straightforward; and 3) the clinical analysis is totally manual, lacking intra-and inter-observer reproducibility [8].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, a few studies focusing on novel planning techniques for LAA occlusion were presented [8], [9], [18]. The majority of them rely on 3D-printed models.…”

Section: Introductionmentioning

confidence: 99%

“…Although this valuable approach has gained, recently, particular attention, it is complex, time demanding (several hours to print the 3D model) and not automated, requiring user-interaction at multiple stages. Other researchers developed image processing techniques to segment the target anatomy, particularly for CT datasets, using simple imagebased techniques [8], deformable models [19] or machine learning strategies [20], [21]. Interestingly, the image-based technique from Song et al [8] was also applied in TEE images, extracting realistic LAA shapes but being extremely timedemanding due to the high number of manual corrections required.…”

Section: Introductionmentioning

confidence: 99%

“…Other researchers developed image processing techniques to segment the target anatomy, particularly for CT datasets, using simple imagebased techniques [8], deformable models [19] or machine learning strategies [20], [21]. Interestingly, the image-based technique from Song et al [8] was also applied in TEE images, extracting realistic LAA shapes but being extremely timedemanding due to the high number of manual corrections required. Indeed, taking into consideration the state-of-theart, efficient and automated strategies to segment the LAA in TEE images were, to the authors' best knowledge, not described, particularly due to: 1) the complex curvilinear and tubular anatomical shape of the LAA; 2) the high anatomical variability of this structure; and 3) the low image quality.…”

Section: Introductionmentioning

confidence: 99%

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Fast Segmentation of the Left Atrial Appendage in 3-D Transesophageal Echocardiographic Images

Morais

Queirós

Meester

et al. 2018

IEEE Trans. Ultrason., Ferroelect., Freq. Contr.

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Left atrial appendage (LAA) has been generally described as "our most lethal attachment", being considered the major source of thromboembolism in patients with non-valvular atrial fibrillation. Currently, LAA occlusion can be offered as a treatment for these patients, obstructing the LAA through a percutaneously delivered device. Nevertheless, correct device sizing is not straightforward, requiring the manual analysis of peri-procedural images. This approach is sub-optimal, time demanding and highly variable between experts, which can result in lengthy procedures and excess manipulations. In this article, a semi-automatic LAA segmentation technique for 3D transesophageal echocardiography (TEE) images is presented. Specifically, the proposed technique relies on a novel segmentation pipeline where a curvilinear blind-ended model is optimized through a double stage strategy: 1) fast contour evolution using global terms and 2) contour refinement based on regional energies. To reduce its computational cost, and thus make it more attractive to real interventions, the B-spline Explicit Active Surface framework was used. This novel method was evaluated in a clinical database of 20 patients. Manual analysis performed by two observers was used as ground truth. The 3D segmentation results corroborated the accuracy, robustness to the variation of the parameters and computationally attractiveness of the proposed method, taking approximately 14 seconds to segment

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Recently, a few studies focusing on novel planning techniques for LAA occlusion were presented [8], [9], [18]. The majority of them rely on 3D-printed models.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Fast Segmentation of the Left Atrial Appendage in 3-D Transesophageal Echocardiographic Images

Morais

Queirós

Meester

et al. 2018

IEEE Trans. Ultrason., Ferroelect., Freq. Contr.

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Left atrial appendage segmentation from 3D CCTA images for occluder placement procedure

Leventić

Babin

Velicki

et al. 2019

Computers in Biology and Medicine

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Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review

Anfinogenova

Vasiltseva

Vrublevsky

et al. 2020

Semin Thromb Hemost

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Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

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Morphologic Assessment of the Left Atrial Appendage in Patients with Atrial Fibrillation by Gray Values–Inverted Volume-Rendered Imaging of Three-Dimensional Transesophageal Echocardiography: A Comparative Study with Computed Tomography

Cited by 11 publications

References 18 publications

Fast Segmentation of the Left Atrial Appendage in 3-D Transesophageal Echocardiographic Images

Fast Segmentation of the Left Atrial Appendage in 3-D Transesophageal Echocardiographic Images

Left atrial appendage segmentation from 3D CCTA images for occluder placement procedure

Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review

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