Reconstruction of time-varying 3-D left-ventricular shape from multiview X-ray cineangiocardiograms

Interventional heart wall motion analysis with cardiac C-arm CT systems

Today, quantitative analysis of three-dimensional (3D) dynamics of the left ventricle (LV) cannot be performed directly in the catheter lab using a current angiographic C-arm system, which is the workhorse imaging modality for cardiac interventions. Therefore, myocardial wall analysis is completely based on the 2D angiographic images or pre-interventional 3D/4D imaging. In this paper, we present a complete framework to study the ventricular wall motion in 4D (3D+t) directly in the catheter lab. From the acquired 2D projection images, a dynamic 3D surface model of the LV is generated, which is then used to detect ventricular dyssynchrony. Different quantitative features to evaluate LV dynamics known from other modalities (ultrasound, magnetic resonance imaging) are transferred to the C-arm CT data. We use the ejection fraction, the systolic dyssynchrony index a 3D fractional shortening and the phase to maximal contraction (ϕi, max) to determine an indicator of LV dyssynchrony and to discriminate regionally pathological from normal myocardium. The proposed analysis tool was evaluated on simulated phantom LV data with and without pathological wall dysfunctions. The LV data used is publicly available online at https://conrad.stanford.edu/data/heart. In addition, the presented framework was tested on eight clinical patient data sets. The first clinical results demonstrate promising performance of the proposed analysis tool and encourage the application of the presented framework to a larger study in clinical practice.

Automatic 3D motion estimation of left ventricle from C-arm rotational angiocardiography using a prior motion model and learning based boundary detector

Compared to pre-operative imaging modalities, it is more convenient to estimate the current cardiac physiological status from C-arm angiocardiography since C-arm is a widely used intra-operative imaging modality to guide many cardiac interventions. The 3D shape and motion of the left ventricle (LV) estimated from rotational angiocardiography provide important cardiac function measurements, e.g., ejection fraction and myocardium motion dyssynchrony. However, automatic estimation of the 3D LV motion is difficult since all anatomical structures overlap on the 2D X-ray projections and the nearby confounding strong image boundaries (e.g., pericardium) often cause ambiguities to LV endocardium boundary detection. In this paper, a new framework is proposed to overcome the aforementioned difficulties: (1) A new learning-based boundary detector is developed by training a boosting boundary classifier combined with the principal component analysis of a local image patch; (2) The prior LV motion model is learned from a set of dynamic cardiac computed tomography (CT) sequences to provide a good initial estimate of the 3D LV shape of different cardiac phases; (3) The 3D motion trajectory is learned for each mesh point; (4) All these components are integrated into a multi-surface graph optimization method to extract the globally coherent motion. The method is tested on seven patient scans, showing significant improvement on the ambiguous boundary cases with a detection accuracy of 2.87 +/- 1.00 mm on LV endocardium boundary delineation in the 2D projections.

Evaluation of interpolation methods for surface-based motion compensated tomographic reconstruction for cardiac angiographic C-arm data

PURPOSE

For interventional cardiac procedures, anatomical and functional information about the cardiac chambers is of major interest. With the technology of angiographic C-arm systems it is possible to reconstruct intraprocedural three-dimensional (3D) images from 2D rotational angiographic projection data (C-arm CT). However, 3D reconstruction of a dynamic object is a fundamental problem in C-arm CT reconstruction. The 2D projections are acquired over a scan time of several seconds, thus the projection data show different states of the heart. A standard FDK reconstruction algorithm would use all acquired data for a filtered backprojection and result in a motion-blurred image. In this approach, a motion compensated reconstruction algorithm requiring knowledge of the 3D heart motion is used. The motion is estimated from a previously presented 3D dynamic surface model. This dynamic surface model results in a sparse motion vector field (MVF) defined at control points. In order to perform a motion compensated reconstruction, a dense motion vector field is required. The dense MVF is generated by interpolation of the sparse MVF. Therefore, the influence of different motion interpolation methods on the reconstructed image quality is evaluated.

METHODS

Four different interpolation methods, thin-plate splines (TPS), Shepard's method, a smoothed weighting function, and a simple averaging, were evaluated. The reconstruction quality was measured on phantom data, a porcine model as well as on in vivo clinical data sets. As a quality index, the 2D overlap of the forward projected motion compensated reconstructed ventricle and the segmented 2D ventricle blood pool was quantitatively measured with the Dice similarity coefficient and the mean deviation between extracted ventricle contours. For the phantom data set, the normalized root mean square error (nRMSE) and the universal quality index (UQI) were also evaluated in 3D image space.

RESULTS

The quantitative evaluation of all experiments showed that TPS interpolation provided the best results. The quantitative results in the phantom experiments showed comparable nRMSE of ≈0.047 ± 0.004 for the TPS and Shepard's method. Only slightly inferior results for the smoothed weighting function and the linear approach were achieved. The UQI resulted in a value of ≈ 99% for all four interpolation methods. On clinical human data sets, the best results were clearly obtained with the TPS interpolation. The mean contour deviation between the TPS reconstruction and the standard FDK reconstruction improved in the three human cases by 1.52, 1.34, and 1.55 mm. The Dice coefficient showed less sensitivity with respect to variations in the ventricle boundary.

CONCLUSIONS

In this work, the influence of different motion interpolation methods on left ventricle motion compensated tomographic reconstructions was investigated. The best quantitative reconstruction results of a phantom, a porcine, and human clinical data sets were achieved with the TPS approach. In general, the framework of motion estimation using a surface model and motion interpolation to a dense MVF provides the ability for tomographic reconstruction using a motion compensation technique.

Motion-compensated mega-voltage cone beam CT using the deformation derived directly from 2D projection images

This paper presents a novel method for respiratory motion compensated reconstruction for cone beam computed tomography (CBCT). The reconstruction is based on a time sequence of motion vector fields, which is generated by a dynamic geometrical object shape model. The dynamic model is extracted from the 2D projection images of the CBCT. The process of the motion extraction is converted into an optimal 3D multiple interrelated surface detection problem, which can be solved by computing a maximum flow in a 4D directed graph. The method was tested on 12 mega-voltage (MV) CBCT scans from three patients. Two sets of motion-artifact-free 3D volumes, full exhale (FE) and full inhale (FI) phases, were reconstructed for each daily scan. The reconstruction was compared with three other motion-compensated approaches based on quantification accuracy of motion and size. Contrast-to-noise ratio (CNR) was also quantified for image quality. The proposed approach has the best overall performance, with a relative tumor volume quantification error of 3.39 ± 3.64% and 8.57 ± 8.31% for FE and FI phases, respectively. The CNR near the tumor area is 3.85 ± 0.42 (FE) and 3.58 ± 3.33 (FI). These results show the clinical feasibility to use the proposed method to reconstruct motion-artifact-free MVCBCT volumes.

3D lung tumor motion model extraction from 2D projection images of mega-voltage cone beam CT via optimal graph search

In this paper, we propose a novel method to convert segmentation of objects with quasi-periodic motion in 2D rotational cone beam projection images into an optimal 3D multiple interrelated surface detection problem, which can be solved by a graph search framework. The method is tested on lung tumor segmentation in projection images of mega-voltage cone beam CT (MVCBCT). A 4D directed graph is constructed based on an initialized tumor mesh model, where the cost value for this graph is computed from the point location of a silhouette outline of projected tumor mesh in 2D projection images. The method was first evaluated on four different sized phantom inserts (all above 1.9 cm in diameter) with a predefined motion of 3.0 cm to mimic the imaging of lung tumors. A dice coefficient of 0.87 +/- 0.03 and a centroid error of 1.94 +/- 1.31 mm were obtained. Results based on 12 MVCBCT scans from 3 patients obtained 0.91 +/- 0.03 for dice coefficient and 1.83 +/- 1.31 mm for centroid error, compared with a difference between two sets of independent manual contours of 0.89 +/- 0.03 and 1.61 +/- 1.19 mm, respectively.

Automatic extraction of 3D dynamic left ventricle model from 2D rotational angiocardiogram

In this paper, we propose an automatic method to directly extract 3D dynamic left ventricle (LV) model from sparse 2D rotational angiocardiogram (each cardiac phase contains only five projections). The extracted dynamic model provides quantitative cardiac function for analysis. The overlay of the model onto 2D real-time fluoroscopic images provides valuable visual guidance during cardiac intervention. Though containing severe cardiac motion artifacts, an ungated CT reconstruction is used in our approach to extract a rough static LV model. The initialized LV model is projected onto each 2D projection image. The silhouette of the projected mesh is deformed to match the boundary of LV blood pool. The deformation vectors of the silhouette are back-projected to 3D space and used as anchor points for thin plate spline (TPS) interpolation of other mesh points. The proposed method is validated on 12 synthesized datasets. The extracted 3D LV meshes match the ground truth quite well with a mean point-to-mesh error of 0.51 +/- 0.11 mm. The preliminary experiments on two real datasets (included a patient and a pig) show promising results too.

Markov random field modeling for three-dimensional reconstruction of the left ventricle in cardiac angiography

This paper reports on a method for left ventricle three-dimensional (3-D) reconstruction from two orthogonal ventriculograms. The proposed algorithm is voxel-based and takes into account the conical projection geometry associated with the biplane image acquisition equipment. The reconstruction process starts with an initial ellipsoidal approximation derived from the input ventriculograms. This model is subsequently deformed in such a way as to match the input projections. To this end, the object is modeled as a 3-D Markov-Gibbs random field, and an energy function is defined so that it includes one term that models the projections compatibility and another one that includes the space-time regularity constraints. The performance of this reconstruction method is evaluated by considering the reconstruction of mathematically synthesized phantoms and two 3-D binary databases from two orthogonal synthesized projections. The method is also tested using real biplane ventriculograms. In this case, the performance of the reconstruction is expressed in terms of the projection error, which attains values between 9.50% and 11.78 % for two biplane sequences including a total of 55 images.

Towards cardiac C-arm computed tomography

Cardiac interventional procedures would benefit tremendously from sophisticated three-dimensional image guidance. Such procedures are typically performed with C-arm angiography systems, and tomographic imaging is currently available only by using preprocedural computed tomography (CT) or magnetic resonance imaging (MRI) scans. Recent developments in C-arm CT (Angiographic CT) allow three-dimensional (3-D) imaging of low contrast details with angiography imaging systems for noncardiac applications. We propose a new approach for cardiac imaging that takes advantage of this improved contrast resolution and is based on intravenous contrast injection. The method is an analogue to multisegment reconstruction in cardiac CT adapted to the much slower rotational speed of C-arm CT. Motion of the heart is considered in the reconstruction process by retrospective electrocardiogram (ECG)-gating, using only projections acquired at a similar heart phase. A series of N almost identical rotational acquisitions is performed at different heart phases to obtain a complete data set at a minimum temporal resolution of 1/N of the heart cycle time. First results in simulation, using an experimental phantom, and in preclinical in vivo studies showed that excellent image quality can be achieved.

3D Reconstruction of Coronary Stents in Vivo Based on Motion Compensated X-Ray Angiograms

A new method is introduce for the three-dimensional (3D) reconstruction of the coronary stents in-vivo utilizing two-dimensional projection images acquired during rotational angiography (RA). The method is based on the application of motion compensated techniques to the acquired angiograms resulting in a temporal snapshot of the stent within the cardiac cycle. For the first time results of 3D reconstructed coronary stents in vivo, with high spatial resolution are presented. The proposed method allows for a comprehensive and unique quantitative 3D assessment of stent expansion that rivals current x-ray and intravascular ultrasound techniques.

Extraction of left ventricular contours from left ventriculograms by means of a neural edge detector

We propose a method for extracting the left ventricular (LV) contours from left ventriculograms by means of a neural edge detector (NED) in order to extract the contours which accord with those traced by a cardiologist. The NED is a supervised edge detector based on a modified multilayer neural network, and is trained by use of a modified back-propagation algorithm. The NED can acquire the function of a desired edge detector through training with a set of input images and the desired edges obtained from the contours traced by a cardiologist. The proposed contour-extraction method consists of 1) detection of "subjective edges" by use of the NED; 2) extraction of rough contours by use of low-pass filtering and edge enhancement; and 3) a contour-tracing method based on the contour candidates synthesized from the edges detected by the NED and the rough contours. Through experiments, it was shown that the proposed method was able to extract the contours in agreement with those traced by an experienced cardiologist, i.e., we achieved an average contour error of 6.2% for left ventriculograms at end-diastole and an average difference between the ejection fractions obtained from the manually traced contours and those obtained from the computer-extracted contours of 4.1%.