Three-dimensional coronary arteriography

Reconstruction of coronary arteries from X-ray angiography: A review

Despite continuous progress in X-ray angiography systems, X-ray coronary angiography is fundamentally limited by its 2D representation of moving coronary arterial trees, which can negatively impact assessment of coronary artery disease and guidance of percutaneous coronary intervention. To provide clinicians with 3D/3D+time information of coronary arteries, methods computing reconstructions of coronary arteries from X-ray angiography are required. Because of several aspects (e.g. cardiac and respiratory motion, type of X-ray system), reconstruction from X-ray coronary angiography has led to vast amount of research and it still remains as a challenging and dynamic research area. In this paper, we review the state-of-the-art approaches on reconstruction of high-contrast coronary arteries from X-ray angiography. We mainly focus on the theoretical features in model-based (modelling) and tomographic reconstruction of coronary arteries, and discuss the evaluation strategies. We also discuss the potential role of reconstructions in clinical decision making and interventional guidance, and highlight areas for future research.

Intra-procedural coronary intervention planning using hybrid 3-dimensional reconstruction techniques1

RATIONALE AND OBJECTIVES

The purpose of this study was to develop a method to assist the cardiologist in planning an interventional procedure while the patient is on the catheterization table.

MATERIALS AND METHODS

A rotational single plane x-ray system is used to acquire images while rapidly rotating the C-arm around the patient. Based on electrocardiogram-selected projections, both a volumetric cone-beam reconstruction of the coronary tree as well as a three-dimensional model of the vessel segment of interest is generated. This information is used to compute the appropriateness of a range of different viewing angles with respect to the overlap and foreshortening of the vessel segment of interest during the cardiac cycle which results in an interactive optimal view map.

RESULTS

The proposed method has been tested on patient data and several phantom objects. The results show that both an accurate 3D model of a vessel segment of interest and its associated optimal view map can be generated to predict an appropriate gantry angle for subsequent image acquisition.

CONCLUSION

The method provides an appropriate and feasible tool to assist interventional cardiologists in planning a coronary intervention while the patient is still on the catheterization table following diagnostic coronary angiography.

Kinematic and deformation analysis of 4-D coronary arterial trees reconstructed from cine angiograms

In the cardiovascular arena, percutaneous catheter-based interventional (i.e., therapeutic) procedures include a variety of coronary and other vascular system interventions. These procedures use two-dimensional (2-D) X-ray-based imaging as the sole or the major imaging modality for procedure guidance and quantification of key parameters. Coronary vascular curvilinearity is one key parameter that requires a four-dimensional (4-D) format, i.e., three-dimensional (3-D) anatomical representation that changes during the cardiac cycle. A new method has been developed for reconstruction and analysis of these patient-specific 4-D datasets utilizing routine cine angiograms. The proposed method consists of three major processes: 1) reconstruction of moving coronary arterial tree throughout the cardiac cycle; 2) establishment of temporal correspondence with smoothness constraints; and 3) kinematic and deformation analysis of the reconstructed 3-D moving coronary arterial trees throughout the cardiac cycle.

Three-dimensional tracking of coronary arteries from biplane angiographic sequences using parametrically deformable models

A new method for coronary artery tracking in biplane digital subtraction is presented. The dynamic tracking of nonrigid objects from two views is achieved using a generalization of parametrically deformable models. Three-dimensional (3-D) Fourier descriptors used for shape representation are obtained from the two-dimensional (2-D) descriptors of the projections. A new constraint inferred from epipolar geometry is applied to the contour model. Direct 3-D tracking is compared with the classical approach in two steps: independent 2-D tracking in each of the two projection planes; 3-D reconstruction using the epipolar constraint. Convergence quality and accuracy of the 3-D reconstruction are analyzed for several sequences showing different displacement amplitudes, deformation rates and image contrasts.

3D coronary reconstruction from routine single-plane coronary angiograms: clinical validation and quantitative analysis of the right coronary artery in 100 patients

BACKGROUND

Current coronary angiographic techniques display complex three-dimensional (3D) coronary structures in two dimensions (2D). We have developed a 3D reconstruction (3DR) algorithm using standard single-plane angiographic images that allows for 3D display of coronary structures. The purpose of this study was to validate our 3DR algorithm and quantify anatomic characteristics of the right coronary artery (RCA) in vivo.

METHODS

Accuracy and reproducibility studies were performed using 3DRs of a coronary phantom and in vivo following 3DRs in 40 patients. The anatomic features of the RCA were then quantified in 100 patients.

RESULTS

Comparison of length and bifurcation angles (BA) from the phantom to the 3DRs revealed good accuracy and correlation for both (r = 0.95 and 0.93 respectively), with diameter error of < 7%. In vivo, the average root mean square (RMS) error in the spatial coordinates of the vessel centerlines was 3.12 +/- 0.77 and 3.16 +/- 0.75 mm in 20 left coronary arteries (LCA) and 20 RCAs respectively. Interobserver average RMS error was 3.47 +/- 1.96 mm and intraobserver average RMS error was 3.02 +/- 1.07 and 3.44 +/- 1.57 mm for two different operators (p = NS). The average RCA length was 10.2 +/- 1.7 cm, average radius of curvature (ROC) was 52 +/- 9 degrees, and the average 3D bifurcation angle of the posterior descending artery (PDA) from the RCA was 55 +/- 22 degrees. Foreshortening (FS) of the segments of the RCA in three 'standard' projections ranged from 0-60, 0-75, and 0-82% respectively.

CONCLUSIONS

Using our 3DR algorithm patient-specific anatomic characteristics can be accurately displayed and quantified, expanding the information that can be derived from routine coronary angiography.

3-D reconstruction of coronary arterial tree to optimize angiographic visualization

Due to vessel overlap and foreshortening, multiple projections are necessary to adequately evaluate the coronary tree with arteriography. Catheter-based interventions can only be optimally performed when these visualization problems are successfully solved. The traditional method provides multiple selected views in which overlap and foreshortening are subjectively minimized based on two dimensional (2-D) projections. A pair of images acquired from routine angiographic study at arbitrary orientation using a single-plane imaging system were chosen for three-dimensional (3-D) reconstruction. After the arterial segment of interest (e.g., a single coronary stenosis or bifurcation lesion) was selected, a set of gantry angulations minimizing segment foreshortening was calculated. Multiple computer-generated projection images with minimized segment foreshortening were then used to choose views with minimal overlapped vessels relative to the segment of interest. The optimized views could then be utilized to guide subsequent angiographic acquisition and interpretation. Over 800 cases of coronary arterial trees have been reconstructed, in which more than 40 cases were performed in room during cardiac catheterization. The accuracy of 3-D length measurement was confirmed to be within an average root-mean-square (rms) 3.5% error using eight different pairs of angiograms of an intracoronary guidewire of 105-mm length with eight radiopaque markers of 15-mm interdistance. The accuracy of similarity between the additional computer-generated projections versus the actual acquired views was demonstrated with the average rms errors of 3.09 mm and 3.13 mm in 20 LCA and 20 RCA cases, respectively. The projections of the reconstructed patient-specific 3-D coronary tree model can be utilized for planning optimal clinical views: minimal overlap and foreshortening. The assessment of lesion length and diameter narrowing can be optimized in both interventional cases and studies of disease progression and regression.

Three-dimensional multi-scale line filter for segmentation and visualization of curvilinear structures in medical images

This paper describes a method for the enhancement of curvilinear structures such as vessels and bronchi in three-dimensional (3-D) medical images. A 3-D line enhancement filter is developed with the aim of discriminating line structures from other structures and recovering line structures of various widths. The 3-D line filter is based on a combination of the eigenvalues of the 3-D Hessian matrix. Multi-scale integration is formulated by taking the maximum among single-scale filter responses, and its characteristics are examined to derive criteria for the selection of parameters in the formulation. The resultant multi-scale line-filtered images provide significantly improved segmentation and visualization of curvilinear structures. The usefulness of the method is demonstrated by the segmentation and visualization of brain vessels from magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), bronchi from a chest CT, and liver vessels (portal veins) from an abdominal CT.

A viewpoint determination system for stenosis diagnosis and quantification in coronary angiographic image acquisition

This paper describes the usefulness of computer assistance in the acquisition of "good" images for stenosis diagnosis and quantification in coronary angiography. The system recommends the optimal viewpoints from which stenotic lesions can be observed clearly based on images obtained from initial viewpoints. First, the viewpoint dependency of the apparent severity of a stenotic lesion is experimentally analyzed using software phantoms in order to show the seriousness of the problem. The implementation of the viewpoint determination system is then described. The system provides good user-interactive tools for the semiautomated estimation of the orientation and diameter of stenotic segments and the three-dimensional (3-D) reconstruction of vessel structures. Using these tools, viewpoints that will not give rise to foreshortening and vessel overlap can be efficiently determined. Experiments using real coronary angiograms show the system to be capable of the reliable diagnosis and quantification of stenosis.