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Simone Balocco, Francesco Ciompi, Juan Rigla, Xavier Carrillo, J. Mauri, & Petia Radeva. (2019). Assessment of intracoronary stent location and extension in intravascular ultrasound sequences. MEDPHYS - Medical Physics, 46(2), 484–493.
Abstract: PURPOSE:
An intraluminal coronary stent is a metal scaffold deployed in a stenotic artery during percutaneous coronary intervention (PCI). In order to have an effective deployment, a stent should be optimally placed with regard to anatomical structures such as bifurcations and stenoses. Intravascular ultrasound (IVUS) is a catheter-based imaging technique generally used for PCI guiding and assessing the correct placement of the stent. A novel approach that automatically detects the boundaries and the position of the stent along the IVUS pullback is presented. Such a technique aims at optimizing the stent deployment.
METHODS:
The method requires the identification of the stable frames of the sequence and the reliable detection of stent struts. Using these data, a measure of likelihood for a frame to contain a stent is computed. Then, a robust binary representation of the presence of the stent in the pullback is obtained applying an iterative and multiscale quantization of the signal to symbols using the Symbolic Aggregate approXimation algorithm.
RESULTS:
The technique was extensively validated on a set of 103 IVUS of sequences of in vivo coronary arteries containing metallic and bioabsorbable stents acquired through an international multicentric collaboration across five clinical centers. The method was able to detect the stent position with an overall F-measure of 86.4%, a Jaccard index score of 75% and a mean distance of 2.5 mm from manually annotated stent boundaries, and in bioabsorbable stents with an overall F-measure of 88.6%, a Jaccard score of 77.7 and a mean distance of 1.5 mm from manually annotated stent boundaries. Additionally, a map indicating the distance between the lumen and the stent along the pullback is created in order to show the angular sectors of the sequence in which the malapposition is present.
CONCLUSIONS:
Results obtained comparing the automatic results vs the manual annotation of two observers shows that the method approaches the interobserver variability. Similar performances are obtained on both metallic and bioabsorbable stents, showing the flexibility and robustness of the method.
Keywords: IVUS; malapposition; stent; ultrasound
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Simone Balocco, O. Camara, E. Vivas, T. Sola, L. Guimaraens, H. A. van Andel, et al. (2010). Feasibility of Estimating Regional Mechanical Properties of Cerebral Aneurysms In Vivo. MEDPHYS - Medical Physics, 37(4), 1689–1706.
Abstract: PURPOSE:
In this article, the authors studied the feasibility of estimating regional mechanical properties in cerebral aneurysms, integrating information extracted from imaging and physiological data with generic computational models of the arterial wall behavior.
METHODS:
A data assimilation framework was developed to incorporate patient-specific geometries into a given biomechanical model, whereas wall motion estimates were obtained from applying registration techniques to a pair of simulated MR images and guided the mechanical parameter estimation. A simple incompressible linear and isotropic Hookean model coupled with computational fluid-dynamics was employed as a first approximation for computational purposes. Additionally, an automatic clustering technique was developed to reduce the number of parameters to assimilate at the optimization stage and it considerably accelerated the convergence of the simulations. Several in silico experiments were designed to assess the influence of aneurysm geometrical characteristics and the accuracy of wall motion estimates on the mechanical property estimates. Hence, the proposed methodology was applied to six real cerebral aneurysms and tested against a varying number of regions with different elasticity, different mesh discretization, imaging resolution, and registration configurations.
RESULTS:
Several in silico experiments were conducted to investigate the feasibility of the proposed workflow, results found suggesting that the estimation of the mechanical properties was mainly influenced by the image spatial resolution and the chosen registration configuration. According to the in silico experiments, the minimal spatial resolution needed to extract wall pulsation measurements with enough accuracy to guide the proposed data assimilation framework was of 0.1 mm.
CONCLUSIONS:
Current routine imaging modalities do not have such a high spatial resolution and therefore the proposed data assimilation framework cannot currently be used on in vivo data to reliably estimate regional properties in cerebral aneurysms. Besides, it was observed that the incorporation of fluid-structure interaction in a biomechanical model with linear and isotropic material properties did not have a substantial influence in the final results.
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Francesco Ciompi, Simone Balocco, Juan Rigla, Xavier Carrillo, J. Mauri, & Petia Radeva. (2016). Computer-Aided Detection of Intra-Coronary Stent in Intravascular Ultrasound Sequences. MP - Medical Physics, 43(10).
Abstract: Purpose: An intraluminal coronary stent is a metal mesh tube deployed in a stenotic artery during Percutaneous Coronary Intervention (PCI), in order to prevent acute vessel occlusion. The identi cation of struts location and the de nition of the stent shape are relevant for PCI planning 15 and for patient follow-up. We present a fully-automatic framework for Computer-Aided Detection
(CAD) of intra-coronary stents in Intravascular Ultrasound (IVUS) image sequences. The CAD system is able to detect stent struts and estimate the stent shape.
Methods: The proposed CAD uses machine learning to provide a comprehensive interpretation of the local structure of the vessel by means of semantic classi cation. The output of the classi cation 20 stage is then used to detect struts and to estimate the stent shape. The proposed approach is validated using a multi-centric data-set of 1,015 images from 107 IVUS sequences containing both metallic and bio-absorbable stents.
Results: The method was able to detect structs in both metallic stents with an overall F-measure of 77.7% and a mean distance of 0.15 mm from manually annotated struts, and in bio-absorbable 25 stents with an overall F-measure of 77.4% and a mean distance of 0.09 mm from manually annotated struts.
Conclusions: The results are close to the inter-observer variability and suggest that the system has the potential of being used as method for aiding percutaneous interventions.
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Simone Balocco, Carlo Gatta, Marina Alberti, Xavier Carrillo, Juan Rigla, & Petia Radeva. (2012). Relation between plaque type, plaque thickness, blood shear stress and plaque stress in coronary arteries assessed by X-ray Angiography and Intravascular Ultrasound. MEDPHYS - Medical Physics, 39(12), 7430–7445.
Abstract: PMID 23231293
PURPOSE:
Atheromatic plaque progression is affected, among others phenomena, by biomechanical, biochemical, and physiological factors. In this paper, the authors introduce a novel framework able to provide both morphological (vessel radius, plaque thickness, and type) and biomechanical (wall shear stress and Von Mises stress) indices of coronary arteries.
METHODS:
First, the approach reconstructs the three-dimensional morphology of the vessel from intravascular ultrasound (IVUS) and Angiographic sequences, requiring minimal user interaction. Then, a computational pipeline allows to automatically assess fluid-dynamic and mechanical indices. Ten coronary arteries are analyzed illustrating the capabilities of the tool and confirming previous technical and clinical observations.
RESULTS:
The relations between the arterial indices obtained by IVUS measurement and simulations have been quantitatively analyzed along the whole surface of the artery, extending the analysis of the coronary arteries shown in previous state of the art studies. Additionally, for the first time in the literature, the framework allows the computation of the membrane stresses using a simplified mechanical model of the arterial wall.
CONCLUSIONS:
Circumferentially (within a given frame), statistical analysis shows an inverse relation between the wall shear stress and the plaque thickness. At the global level (comparing a frame within the entire vessel), it is observed that heavy plaque accumulations are in general calcified and are located in the areas of the vessel having high wall shear stress. Finally, in their experiments the inverse proportionality between fluid and structural stresses is observed.
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