Shengxian (Sanven)Tu, PhD

Transcription

1 Three-dimensional Reconstruction and Centerline-guided Assessment of Coronary Bifurcation by Fusion of X-ray Angiography and Optical Coherence Tomography Shengxian (Sanven)Tu, PhD Division of Image Processing (LKEB) Department of Radiology Leiden University Medical Center & Department of Applied Research Medis medical imaging systems bv

2 How to assess SB ostium? D2 LAD Interval: 0.2 mm Courtesy: Niels R. Holm (Aarhus University Hospital)

3 SB Quantification by 3D OCT function 1 function 2 function 3 Impact of transfer function (style) in 3D volume rendering

4 SB ostium area QCA: 1.78 mm 2 OCT: 1.67 mm 2

5 Centerline-guided Cut Plane Analysis Cut Plane automatically guided by 3D QCA reconstructed SB centerline. Quantification by Cut Plane Analysis is independent from transfer function.

6 Vessel sizing by 3D QCA, OCT, or IVUS?

7 In-vivo Comparison of Arterial Lumen Dimensions Assessed by Co-registered Three-dimensional (3D) Quantitative Coronary Angiography, Intravascular Ultrasound and Optical Coherence Tomography Shengxian Tu 1, Liang Xu 2, Jurgen Ligthart 3, Bo Xu 2, Karen Witberg 3, Zhongwei Sun 2, Gerhard Koning 1, Johan H. C. Reiber 1, Evelyn Regar 3 1 Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands 2 Catheterization Lab, National Center for Cardiovascular Diseases of China and Fu Wai Hospital, Beijing, China 3 Department of Cardiology, ErasmusMC, Rotterdam, the Netherlands International Journal of Cardiovascular Imaging 2012; 8:

8 Background Coronary lumen dimensions often show discrepancies when assessed by X-ray angiography, IVUS and OCT; One source of error consists of a possible mismatch in the selection of corresponding regions for comparison. Therefore, We developed a real-time and on-line co-registration approach to guarantee the point-to-point correspondence between the X-ray and IVUS/OCT images.

9 Aims To compare lumen size as assessed in-vivo by co-registered 3D QCA and by IVUS or OCT; To investigate the impact of vessel curvature on the discrepancy. Vessel centerline Pullback trajectory Confounder: Catheter Looseness = lumen diameter catheter diameter

10 Materials 74 patients with indication for cardiac catheterization were retrospectively included. Inclusion criteria: Images were acquired by digital image intensifiers; Two projections at least 25ºapart were recorded; Motorized IVUS/OCT pullbacks at constant speed; The vessel of interest was not totally occluded; No history of coronary bypass surgery; IVUS/OCT covered at least one non-stented lesion.

11 Methods X-ray images were recorded by AXIOM-Artis (Siemens), AlluraXper (Philips), and Safair (Shimadzu); IVUS used a 40 MHz transducer and a 2.9 F imaging sheath with a dedicated workstation (Atlantis SR Pro and Galaxy, Boston Scientific); OCT used a 2.7 F imaging catheter with a dedicated workstation (C7 Dragonfly and C7-XR, Lightlab). The registration was performed by an experienced analyst; Results were verified by an expert in intracoronary imaging.

12 Methods Curvature * Co-registration was performed using QAngioOCT Research Edition 1.0 (Medis Specials bv, Leiden, The Netherlands) 2. 2 Tu, et al. Fusion of 3D. Fusion of 3D QCA and IVUS/OCT. Int J Cardiovasc imaging 2011; 27:

13 Methods Frame selection A constant stepping interval depending on the length of the vessel of interest was initially applied. Adjacent frames were considered for: Thrombosis; Plaque erosion or edge dissection; Severe overlap in X-ray images; Predilation; Thrombectomy; Bifurcation. 3D QCA and quantitative IVUS were performed at image frames corresponding to the end-diastolic stage.

14 Methods Quantitative analysis 3D QCA by QAngio XA 3D Research Edition 1.0 (Medis Specials bv, Leiden, The Netherlands) 3 ; Quantitative IVUS by QIvus 2.1 (Medis medical imaging systems bv, Leiden, The Netherlands) 4 ; Quantitative OCT by a new mincost algorithm for edge detection. Intra- and inter-observer variabilities were analyzed on the first 10 vessels. 3 Tu, et al. The impact of acquisition angle difference on three-dimensional quantitative coronary angiography. Catheter Cardiovasc Interv 2011; 78: Koning, et al. Advanced contour detection for three-dimensional intracoronary ultrasound: a validation in vitro and in vivo. Int J Cardiovasc Imaging 2002; 18:

15 Results

16 Results

17 Results

18 Results

19 Results

20 Results Vessel-based comparison between 3D QCA and IVUS/OCT

21 Results

22 Limitations Retrospective in-vivo design; IVUS and OCT from different patients; Administration of intracoronary glyceryl trinitrate was not standardized; The vessel-based comparison was limited by the small sample size (n = 40).

23 Conclusions Our comparison of co-registered 3D QCA and invasive imaging data suggested a bias towards larger lumen dimensions by IVUS and by OCT, which was more pronounced in larger and tortuous vessels. Fusion of 3D-reconstructed X-ray angiography and centerline adjusted OCT may improve evaluation of tortuous vessels and ostial lesions, and might limit the need for SB acquisitions in bifurcation lesion assessments.

24 QCA research team in Leiden Johan H. C. Reiber, PhD, FACC, FESC Gerhard Koning, MSc Joan Tuinenburg, MSc Johannes P. Janssen, MSc Shengxian (Sanven) Tu, PhD