3D reconstruction of a carotid bifurcation from 2D transversal ultrasound images

Real-Time Volumetric Free-Hand Ultrasound Imaging for Large-Sized Organs: A Study of Imaging the Whole Spine

OBJECTIVES

Three-dimensional (3D) ultrasound imaging can overcome the limitations of conventional two-dimensional (2D) ultrasound imaging in structural observation and measurement. However, conducting volumetric ultrasound imaging for large-sized organs still faces difficulties including long acquisition time, inevitable patient movement, and 3D feature recognition. In this study, we proposed a real-time volumetric free-hand ultrasound imaging system optimized for the above issues and applied it to the clinical diagnosis of scoliosis.

METHODS

This study employed an incremental imaging method coupled with algorithmic acceleration to enable real-time processing and visualization of the large amounts of data generated when scanning large-sized organs. Furthermore, to deal with the difficulty of image feature recognition, we proposed two tissue segmentation algorithms to reconstruct and visualize the spinal anatomy in 3D space by approximating the depth at which the bone structures are located and segmenting the ultrasound images at different depths.

RESULTS

We validated the adaptability of our system by deploying it to multiple models of ultrasound equipment and conducting experiments using different types of ultrasound probes. We also conducted experiments on six scoliosis patients and 10 normal volunteers to evaluate the performance of our proposed method. Ultrasound imaging of a volunteer spine from shoulder to crotch (more than 500 mm) was performed in 2 minutes, and the 3D imaging results displayed in real-time were compared with the corresponding X-ray images with a correlation coefficient of 0.96 in spinal curvature.

CONCLUSION

Our proposed volumetric ultrasound imaging system might hold the potential to be clinically applied to other large-sized organs.

Design of 3D printed chip to improve sensitivity of platelet adhesion through reinjection: Effect of alcohol consumption on platelet adhesion

Monitoring platelet aggregation is crucial for predicting thrombotic diseases and identifying the risk of bleeding or resistance to antiplatelet drugs. This study developed a microfluidic device to measure platelet activation with high sensitivity. By controlling exposure time through repeated reinjections, the device enables the detection of subtle changes in platelet activity influenced by lifestyle factors, such as alcohol consumption. Using computational fluid dynamics simulations, the design was optimized to achieve moderate shear stresses and fabricated with 3D printing. Experimental results revealed that pillars biased to one side partially accelerate the flow and inhibit platelet adhesion. A distinct difference in platelet adhesion was clearly observed before and after alcohol consumption. Despite the high standard deviations in platelet adhesion area, hematocrit, and viscosity after alcohol consumption, the area covered by adhered platelets increased by 3.12 times compared to that before alcohol consumption. This microfluidic chip offers potential for personalized health monitoring by distinguishing platelet variations caused by lifestyle or dietary habits. However, challenges such as reinjection procedures and large sample volumes require further investigation.

Software that combines deep learning, 3D reconstruction and CFD to analyze the state of carotid arteries from ultrasound imaging

BACKGROUND

Ultrasound is one of the non-invasive techniques that are used in clinical diagnostics of carotid artery disease.

OBJECTIVE

This paper presents software methodology that can be used in combination with this imaging technique to provide additional information about the state of patient-specific artery.

METHODS

Overall three modules are combined within the proposed methodology. A clinical dataset is used within the deep learning module to extract the contours of the carotid artery. This data is then used within the second module to perform the three-dimensional reconstruction of the geometry of the carotid bifurcation and ultimately this geometry is used within the third module, where the hemodynamic analysis is performed. The obtained distributions of hemodynamic quantities enable a more detailed analysis of the blood flow and state of the arterial wall and could be useful to predict further progress of present abnormalities in the carotid bifurcation.

RESULTS

The performance of the deep learning module was demonstrated through the high values of relevant common classification metric parameters. Also, the accuracy of the proposed methodology was shown through the validation of results for the reconstructed parameters against the clinically measured values.

CONCLUSION

The presented methodology could be used in combination with standard clinical ultrasound examination to quickly provide additional quantitative and qualitative information about the state of the patient's carotid bifurcation and thus ensure a treatment that is more adapted to the specific patient.

3D patient-specific modeling and structural finite element analysis of atherosclerotic carotid artery based on computed tomography angiography

The assessment of carotid plaque vulnerability is a relevant clinical information that can help prevent adverse cerebrovascular events. To this aim, in this study, we propose a patient-specific computational workflow to quantify the stress distribution in an atherosclerotic carotid artery, by means of geometric modeling and structural simulation of the plaque and vessel wall. Ten patients were involved in our study. Starting with segmentation of the lumen, calcific and lipid plaque components from computed tomography angiography images, the fibrous component and the vessel wall were semi-automatically reconstructed with an ad-hoc procedure. Finite element analyses were performed using local pressure values derived from ultrasound imaging. Simulation outputs were analyzed to assess how mechanical factors influence the stresses within the atherosclerotic wall. The developed reconstruction method was first evaluated by comparing the results obtained using the automatically generated fibrous component model and the one derived from image segmentation. The high-stress regions in the carotid artery wall around plaques suggest areas of possible rupture. In mostly lipidic and heterogeneous plaques, the highest stresses are localized at the interface between the lipidic components and the lumen, in the fibrous cap.

Enhancement of Ultrasound B-Mode Image Quality Using Nonlinear Filtered-Multiply-and-Sum Compounding for Improved Carotid Artery Segmentation

In ultrasound B-mode imaging, the axial resolution (AR) is commonly determined by the duration or bandwidth of an excitation signal. A shorter-duration pulse will produce better resolution compared to a longer one but with compromised penetration depth. Instead of relying on the pulse duration or bandwidth to improve the AR, an alternative method termed filtered multiply and sum (FMAS) has been introduced in our previous work. For spatial-compounding, FMAS uses the autocorrelation technique as used in filtered-delay multiply and sum (FDMAS), instead of conventional averaging. FMAS enables a higher frame rate and less computational complexity than conventional plane-wave compound imaging beamformed with delay and sum (DAS) and FDMAS. Moreover, it can provide an improved contrast ratio and AR. In previous work, no explanation was given on how FMAS was able to improve the AR. Thus, in this work, we discuss in detail the theory behind the proposed FMAS algorithm and how it is able to improve the spatial resolution mainly in the axial direction. Simulations, experimental phantom measurements and in vivo studies were conducted to benchmark the performance of the proposed method. We also demonstrate how the suggested new algorithm may be used in a practical biomedical imaging application. The balloon snake active contour segmentation technique was applied to the ultrasound B-mode image of a common carotid artery produced with FMAS. The suggested method is capable of reducing the number of iterations for the snake to settle on the region-of-interest contour, accelerating the segmentation process.

A Generalized Approach for Automatic 3-D Geometry Assessment of Blood Vessels in Transverse Ultrasound Images Using Convolutional Neural Networks

Accurate 3-D geometries of arteries and veins are important clinical data for diagnosis of arterial disease and intervention planning. Automatic segmentation of vessels in the transverse view suffers from the low lateral resolution and contrast. Convolutional neural networks are a promising tool for automatic segmentation of medical images, outperforming the traditional segmentation methods with high robustness. In this study, we aim to create a general, robust, and accurate method to segment the lumen-wall boundary of healthy central and peripheral vessels in large field-of-view freehand ultrasound (US) datasets. Data were acquired using the freehand US, in combination with a probe tracker. A total of ±36 000 cross-sectional images, acquired in the common, internal, and external carotid artery ( N = 37 ), in the radial, ulnar artery, and cephalic vein ( N = 12 ), and in the femoral artery ( N = 5 ) were included. To create masks (of the lumen) for training data, a conventional automatic segmentation method was used. The neural networks were trained on: 1) data of all vessels and 2) the carotid artery only. The performance was compared and tested using an open-access dataset. The recall, precision, DICE, and intersection over union (IoU) were calculated. Overall, segmentation was successful in the carotid and peripheral arteries. The Multires U-net architecture performs best overall with DICE = 0.93 when trained on the total dataset. Future studies will focus on the inclusion of vascular pathologies.

Automated 3D geometry segmentation of the healthy and diseased carotid artery in free-hand, probe tracked ultrasound images

PURPOSE

Rupture of an arterosclerotic plaque in the carotid artery is a major cause of stroke. Biomechanical analysis of plaques is under development aiming to aid the clinician in the assessment of plaque vulnerability. Patient-specific three-dimensional (3D) geometry assessment of the carotid artery, including the bifurcation, is required as input for these biomechanical models. This requires a high-resolution, 3D, noninvasive imaging modality such as ultrasound (US). In this study, a high-resolution two-dimensional (2D) linear array in combination with a magnetic probe tracking device and automatic segmentation method was used to assess the geometry of the carotid artery. The advantages of using this system over a 3D ultrasound probe are its higher resolution (spatial and temporal) and its larger field of view.

METHODS

A slow sweep (v = ± 5 mm/s) was made over the subject's neck so that the full geometry of the bifurcated geometry of the carotid artery is captured. An automated segmentation pipeline was developed. First, the Star-Kalman method was used to approximate the center and size of the vessels for every frame. Images were filtered with a Gaussian high-pass filter before conversion into the 2D monogenic signals, and multiscale asymmetry features were extracted from these data, enhancing low lateral wall-lumen contrast. These images, in combination with the initial ellipse contours, were used for an active deformable contour model to segment the vessel lumen. To segment the lumen-plaque boundary, Otsu's automatic thresholding method was used. Distension of the wall due to the change in blood pressure was removed using a filter approach. Finally, the contours were converted into a 3D hexahedral mesh for a patient-specific solid mechanics model of the complete arterial wall.

RESULTS

The method was tested on 19 healthy volunteers and on 3 patients. The results were compared to manual segmentation performed by three experienced observers. Results showed an average Hausdorff distance of 0.86 mm and an average similarity index of 0.91 for the common carotid artery (CCA) and 0.88 for the internal and external carotid artery. For the total algorithm, the success rate was 89%, in 4 out of 38 datasets the ICA and ECA were not sufficient visible in the US images. Accurate 3D hexahedral meshes were successfully generated from the segmented images .

CONCLUSIONS

With this method, a subject-specific biomechanical model can be constructed directly from a hand-held 2D US measurement, within 10 min, with a minimal user input. The performance of the proposed segmentation algorithm is comparable to or better than algorithms previously described in literature. Moreover, the algorithm is able to segment the CCA, ICA, and ECA including the carotid bifurcation in transverse B-mode images in both healthy and diseased arteries.

3D ultrasound imaging in frequency domain based on concepts of array beam and synthetic aperture

The high frame rate (HFR) imaging method has the ability to achieve a high frame rate. In this method, only one transmission is required to construct a frame of image. In our previous work, using a moved one-dimensional (1D) array transducer, a three-dimensional (3D) ultrasound imaging method in frequency domain was developed. This imaging method was designed based on the concepts of array beam and synthetic aperture, which can simplify the two-dimensional (2D) array transducer. In this paper, based on array beam and synthetic aperture, the HFR imaging method is demonstrated from a novel view. From this view, the relationship between the HFR imaging method and synthetic aperture is established with the weighting function of array beam. Besides, the HFR imaging method, the imaging method with a moved 1D array transducer, and the synthetic aperture imaging method with a moved single element transducer are unified in the same analytical method with different weighting functions. The same frequency domain signal processing flow can be applied to these imaging methods. Comparisons to these imaging methods are implemented with simulations. Simulation results show that, in the imaging depth of 45 mm, the resolutions calculated as the total width of the -6 dB main lobe in x-direction are 1.099 mm, 1.056 mm and 0.596 mm for the methods with 1D transducer, 2D transducer and the single element transducer, respectively. The resolution in y-direction is 1.054 mm for the methods with 2D transducer, and 0.565 mm, 0.593 mm for the 1D and single element transducers, respectively. The resolutions in z-direction are 0.493 mm, 0.451 mm and 0.452 mm for the 2D, 1D and single element transducers, respectively. The resolution in the moved-direction is improved with a moved transducer, but the contrast of the image is decreased.

Sector-scanning 3D ultrasound imaging in frequency domain with 1D array transducer

Sector-scanning is a conventional scanning mode in ultrasound imaging, which can increase the area to observe. In three-dimensional (3D) ultrasound, freehand imaging system is usually used. This method uses a moving elevation focused one-dimensional (1D) transducer to construct a series of B-mode slice images, and then these B-mode slice images are combined to form a 3D volume image. When sector-scanning is used to acquire the B-mode slices, the elevation resolution is poor because of the elevation resolution of the probe and the interpolations between the slices. In this paper, based on the linear scanning method in our previous work, a sector-scanning 3D imaging method is proposed. In this imaging method, a linear array transducer without elevation focusing is also used, and the 1D transducer transmits limited diffraction beams and receives echo signals repeatedly when rotated around an axis parallel to the transducer. After finishing the scanning, all the received signals are combined to construct the 3D image in frequency domain with Fourier transform. Simulation results show that the new method can construct the 3D image effectively. Compared with the imaging method based on B-mode slices, the new method can improve the elevation resolution significantly. The elevation resolution can be promoted to less than 2 mm with the imaging depth 100 mm by one transmission at each position. Besides, because only one transmission is needed at each position, the frame rate can be increased to some extent.

Freehand 3-D Ultrasound Imaging: A Systematic Review

Two-dimensional ultrasound (US) imaging has been successfully used in clinical applications as a low-cost, portable and non-invasive image modality for more than three decades. Recent advances in computer science and technology illustrate the promise of the 3-D US modality as a medical imaging technique that is comparable to other prevalent modalities and that overcomes certain drawbacks of 2-D US. This systematic review covers freehand 3-D US imaging between 1970 and 2017, highlighting the current trends in research fields, the research methods, the main limitations, the leading researchers, standard assessment criteria and clinical applications. Freehand 3-D US systems are more prevalent in the academic environment, whereas in clinical applications and industrial research, most studies have focused on 3-D US transducers and improvement of hardware performance. This topic is still an interesting active area for researchers, and there remain many unsolved problems to be addressed.

3D ultrasound imaging in frequency domain with 1D array transducer

Freehand three-dimensional (3D) ultrasound imaging usually uses a moving elevation focused one-dimensional (1D) transducer to construct a series of B-mode slice images, and then these B-mode slice images are combined to form a 3D volume image. This method has poor elevation resolution and low frame rate. In this paper, a novel 3D imaging method with a moving 1D array transducer is proposed. Different from the freehand 3D reconstruction, a linear array transducer without elevation focusing is used in the proposed method, and the 1D transducer transmits limited diffraction beams and receives echo signals repeatedly when moving along the elevation direction. After finishing the scanning, all the received signals are combined to construct the 3D image in Frequency domain with Fourier transform. Simulation results show that compared with the freehand imaging method, the new method can improve the elevation resolution significantly, and the resolution keeps almost fixed in the axial direction. The elevation resolution can be promoted to less than 2mm with the imaging depth 100mm by one transmission at each position. Besides, because only one transmission is needed at each position, the frame rate can be increased to some extent.

Microfluidic measurement for blood flow and platelet adhesion around a stenotic channel: Effects of tile size on the detection of platelet adhesion in a correlation map

Platelet aggregation affects the surrounding blood flow and usually occurs where a blood vessel is narrowed as a result of atherosclerosis. The relationship between blood flow and platelet aggregation is not yet fully understood. This study proposes a microfluidic method to measure the velocity and platelet aggregation simultaneously by combining the micro-particle image velocimetry technique and a correlation mapping method. The blood flow and platelet adhesion procedure in a stenotic micro-channel with 90% severity were observed for a relatively long period of 4 min. In order to investigate the effect of tile size on the detection of platelet adhesion, 2D correlation coefficients were evaluated with binary images obtained by manual labeling and the correlation mapping method with different sizes of the square tile ranging from 3 to 50 pixels. The maximum 2D correlation coefficient occurred with the optimum tile size of 5 × 5 pixels. Since the blood flow and platelet aggregation are mutually influenced by each other, blood flow and platelet adhesion were continuously varied. When there was no platelet adhesion (t = 0 min), typical blood flow is observed. The blood flow passes through the whole channel smoothly, and jet-like flow occurs in the post-stenosis region. However, the flow pattern changes when platelet adhesion starts at the stenosis apex and after the stenosis. These adhesions induce narrow high velocity regions to become wider over a range of area from upstream to downstream of the stenosis. Separated jet-like flows with two high velocity regions are also created. The changes in flow patterns may alter the patterns of platelet adhesion. As the area of the plate adhesion increases, the platelets plug the micro-channel and there is only a small amount of blood flow, finally. The microfluidic method could provide new insights for better understanding of the interactions between platelet aggregation and blood flow in various physiological conditions.

SPECT/CT analysis of splenic function in genistein-treated malaria-infected mice

Spleen traps malaria-infected red blood cells, thereby leading to splenomegaly. Splenomegaly induces impairment in splenic function, i.e., rupture. Therefore, splenomegaly inhibition is required to protect the spleen. In our previous study, genistein was found to have an influence on malaria-induced splenomegaly. However, the effect of genistein in malaria-induced splenomegaly, especially on the function of spleen, has not been fully investigated. In this study, hematoxylin and eosin (H&E) staining images show that genistein partially prevents malaria-induced architectural disruption of spleen. In addition, genistein decreases transgenic Plasmodium parasites accumulation in the spleen. Genistein treatment can protect splenic function from impairment caused by malaria infection. To examine the functions of malaria-infected spleen, we employed single-photon emission computed tomography/computed tomography (SPECT/CT) technology. Red blood cells are specifically radiolabeled with Technetium-99m pertechnetate (^99mTcO₄^-) and trapped inside the spleen. The standardized uptake values (SUVs) in the spleen of infected mice are higher than those of naive and genistein-treated mice. However, genistein reduces the malaria-induced trapping capacity of spleen for heat-damaged radiolabeled RBCs, while exhibiting a protective effect against malaria. Considering these results, we suggested that genistein could be effectively used in combination therapy for malaria-induced splenic impairment.

Asymmetric pulsation of rat carotid artery bifurcation in three-dimension observed by ultrasound imaging

The arterial structure cyclically fluctuates in three-dimensions (3-D) caused by pulsatile blood flow. The evaluation of arterial wall motion and hemodynamics contributes to early diagnosis of carotid atherosclerosis. Ultrasound is one of the most appropriate imaging modalities to evaluate arterial wall motion in real time. Although many previous studies have discussed the mechanical properties of the carotid artery bifurcation (CAB) from the two-dimensional (2-D) view, the spatio-temporal variation of carotid artery geometry in 3-D has not yet been investigated in detail. In this study, the 3-D data set of CAB from rats was acquired using a high spatio-temporal resolution ultrasound imaging system with a 40 MHz probe using mechanical sector scanning. A total of 31 slices of cross-section images were stored and a spoke scan algorithm was implemented to radially scan the lumen area in polar coordinates based on a pre-tracked seed point. The boundary of the arterial lumen was segmented using intensity-threshold-based boundary detection and fitted by polynomial regression. Two operators, who were trained with the same protocol to minimize inter- and intra-operator variability, manually segmented the lumen boundary on systolic and diastolic phase from the gray-scale images. Finally, the 3-D lumen geometries of CAB during one cardiac cycle were constructed based on the segmented lumen boundaries. From this constructed 3-D geometry, we observed that the CAB geometry favorably expanded to the anterior/posterior direction, parallel to the sagittal plane; and the manually segmented geometry also confirmed the asymmetrical change in bifurcation geometry. This is the first study on visualization and quantification on the asymmetrical variation of the CAB geometry of a rat in 3-D during a whole cardiac cycle. This finding may be useful in understanding hemodynamic etiology of various cardiovascular diseases such as arterial stenosis and its complications, and also provides reference information for numerical simulation studies on arterial wall motion.

Microfluidics for simultaneous quantification of platelet adhesion and blood viscosity

Platelet functions, including adhesion, activation, and aggregation have an influence on thrombosis and the progression of atherosclerosis. In the present study, a new microfluidic-based method is proposed to estimate platelet adhesion and blood viscosity simultaneously. Blood sample flows into an H-shaped microfluidic device with a peristaltic pump. Since platelet aggregation may be initiated by the compression of rotors inside the peristaltic pump, platelet aggregates may adhere to the H-shaped channel. Through correlation mapping, which visualizes decorrelation of the streaming blood flow, the area of adhered platelets (A_Platelet) can be estimated without labeling platelets. The platelet function is estimated by determining the representative index I_A·T based on A_Platelet and contact time. Blood viscosity is measured by monitoring the flow conditions in the one side channel of the H-shaped device. Based on the relation between interfacial width (W) and pressure ratio of sample flows to the reference, blood sample viscosity (μ) can be estimated by measuring W. Biophysical parameters (I_A·T, μ) are compared for normal and diabetic rats using an ex vivo extracorporeal model. This microfluidic-based method can be used for evaluating variations in the platelet adhesion and blood viscosity of animal models with cardiovascular diseases under ex vivo conditions.

Effect of diabetic duration on hemorheological properties and platelet aggregation in streptozotocin-induced diabetic rats

Diabetes mellitus with abnormal glucose concentration is associated with changes in hemorheological properties, endothelial function, and platelets hyperactivity. Disturbances may significantly be responsible for diabetes-related vascular complications. In this study, hemorheological and hemodynamic properties were measured according to diabetic duration after streptozotocin treatment in rats. For ex vivo measurements, an extracorporeal model was adopted. Flow rate and blood viscosity were measured using a microfluidic device. Erythrocyte aggregation and morphological parameters of erythrocytes were measured by modified erythrocyte sedimentation rate and the phase-contrast holography under in vitro conditions. The platelet aggregation and mean pressure in the femoral artery were estimated under ex vivo conditions. Hemorheological properties including blood viscosity, erythrocyte aggregation and shape parameters for the control group are significantly different with those for diabetic groups. The changes with respect to diabetic duration were relatively unnoticeable. However, the platelet aggregation is strongly dependent on the diabetic duration. Based on these results, hyperglycemia exposure may induce hemorheological variations in early stages of diabetes mellitus. High platelet aggregation may become more pronounced according to the diabetic duration caused by variations in hemorheological properties resulting in endothelial dysfunction. This study would be helpful in understanding the effects of diabetic duration on biophysical properties.

Association of Early Atherosclerosis with Vascular Wall Shear Stress in Hypercholesterolemic Zebrafish

Although atherosclerosis is a multifactorial disease, the role of hemodynamic information has become more important. Low and oscillating wall shear stress (WSS) that changes its direction is associated with the early stage of atherosclerosis. Several in vitro and in vivo models were proposed to reveal the relation between the WSS and the early atherosclerosis. However, these models possess technical limitations in mimicking real physiological conditions and monitoring the developmental course of the early atherosclerosis. In this study, a hypercholesterolaemic zebrafish model is proposed as a novel experimental model to resolve these limitations. Zebrafish larvae are optically transparent, which enables temporal observation of pathological variations under in vivo condition. WSS in blood vessels of 15 days post-fertilisation zebrafish was measured using a micro particle image velocimetry (PIV) technique, and spatial distribution of lipid deposition inside the model was quantitatively investigated after feeding high cholesterol diet for 10 days. Lipids were mainly deposited in blood vessel of low WSS. The oscillating WSS was not induced by the blood flows in zebrafish models. The present hypercholesterolaemic zebrafish would be used as a potentially useful model for in vivo study about the effects of low WSS in the early atherosclerosis.

Imaging of small animal peripheral artery disease models: recent advancements and translational potential

Peripheral artery disease (PAD) is a broad disorder encompassing multiple forms of arterial disease outside of the heart. As such, PAD development is a multifactorial process with a variety of manifestations. For example, aneurysms are pathological expansions of an artery that can lead to rupture, while ischemic atherosclerosis reduces blood flow, increasing the risk of claudication, poor wound healing, limb amputation, and stroke. Current PAD treatment is often ineffective or associated with serious risks, largely because these disorders are commonly undiagnosed or misdiagnosed. Active areas of research are focused on detecting and characterizing deleterious arterial changes at early stages using non-invasive imaging strategies, such as ultrasound, as well as emerging technologies like photoacoustic imaging. Earlier disease detection and characterization could improve interventional strategies, leading to better prognosis in PAD patients. While rodents are being used to investigate PAD pathophysiology, imaging of these animal models has been underutilized. This review focuses on structural and molecular information and disease progression revealed by recent imaging efforts of aortic, cerebral, and peripheral vascular disease models in mice, rats, and rabbits. Effective translation to humans involves better understanding of underlying PAD pathophysiology to develop novel therapeutics and apply non-invasive imaging techniques in the clinic.