|
|
Marta Diez-Ferrer, Arturo Morales, Rosa Lopez Lisbona, Noelia Cubero, Cristian Tebe, Susana Padrones, et al. (2019). Ultrathin Bronchoscopy with and without Virtual Bronchoscopic Navigation: Influence of Segmentation on Diagnostic Yield . Respiration, 97(3), 252–258.
Abstract: Background: Bronchoscopy is a safe technique for diagnosing peripheral pulmonary lesions (PPLs), and virtual bronchoscopic navigation (VBN) helps guide the bronchoscope to PPLs. Objectives: We aimed to compare the diagnostic yield of VBN-guided and unguided ultrathin bronchoscopy (UTB) and explore clinical and technical factors associated with better results. We developed a diagnostic algorithm for deciding whether to use VBN to reach PPLs or choose an alternative diagnostic approach. Methods: We compared diagnostic yield between VBN-UTB (prospective cases) and unguided UTB (historical controls) and analyzed the VBN-UTB subgroup to identify clinical and technical variables that could predict the success of VBN-UTB. Results: Fifty-five cases and 110 controls were included. The overall diagnostic yield did not differ between the VBN-guided and unguided arms (47 and 40%, respectively; p = 0.354). Although the yield was slightly higher for PPLs ≤20 mm in the VBN-UTB arm, the difference was not significant (p = 0.069). No other clinical characteristics were associated with a higher yield in a subgroup analysis, but an 85% diagnostic yield was observed when segmentation was optimal and the PPL was endobronchial (vs. 30% when segmentation was suboptimal and 20% when segmentation was optimal but the PPL was extrabronchial). Conclusions: VBN-guided UTB is not superior to unguided UTB. A greater impact of VBN-guided over unguided UTB is highly dependent on both segmentation quality and an endobronchial location of the PPL. Segmentation quality should be considered before starting a procedure, when an alternative technique that may improve yield can be chosen, saving time and resources.
Keywords: Lung cancer; Peripheral lung lesion; Diagnosis; Bronchoscopy; Ultrathin bronchoscopy; Virtual bronchoscopic navigation
|
|
|
|
Marta Diez-Ferrer, Debora Gil, Cristian Tebe, & Carles Sanchez. (2018). "Positive Airway Pressure to Enhance Computed Tomography Imaging for Airway Segmentation for Virtual Bronchoscopic Navigation " . Respiration, 96(6), 525–534.
Abstract: Abstract
RATIONALE:
Virtual bronchoscopic navigation (VBN) guidance to peripheral pulmonary lesions is often limited by insufficient segmentation of the peripheral airways.
OBJECTIVES:
To test the effect of applying positive airway pressure (PAP) during CT acquisition to improve segmentation, particularly at end-expiration.
METHODS:
CT acquisitions in inspiration and expiration with 4 PAP protocols were recorded prospectively and compared to baseline inspiratory acquisitions in 20 patients. The 4 protocols explored differences between devices (flow vs. turbine), exposures (within seconds vs. 15-min) and pressure levels (10 vs. 14 cmH2O). Segmentation quality was evaluated with the number of airways and number of endpoints reached. A generalized mixed-effects model explored the estimated effect of each protocol.
MEASUREMENTS AND MAIN RESULTS:
Patient characteristics and lung function did not significantly differ between protocols. Compared to baseline inspiratory acquisitions, expiratory acquisitions after 15 min of 14 cmH2O PAP segmented 1.63-fold more airways (95% CI 1.07-2.48; p = 0.018) and reached 1.34-fold more endpoints (95% CI 1.08-1.66; p = 0.004). Inspiratory acquisitions performed immediately under 10 cmH2O PAP reached 1.20-fold (95% CI 1.09-1.33; p < 0.001) more endpoints; after 15 min the increase was 1.14-fold (95% CI 1.05-1.24; p < 0.001).
CONCLUSIONS:
CT acquisitions with PAP segment more airways and reach more endpoints than baseline inspiratory acquisitions. The improvement is particularly evident at end-expiration after 15 min of 14 cmH2O PAP. Further studies must confirm that the improvement increases diagnostic yield when using VBN to evaluate peripheral pulmonary lesions.
Keywords: Multidetector computed tomography; Bronchoscopy; Continuous positive airway pressure; Image enhancement; Virtual bronchoscopic navigation
|
|
|
|
Oriol Rodriguez-Leon.A.Carol, H.Tizon, Eduard Fernandez-Nofrerias, Josefina Mauri, Vicente del Valle, Debora Gil, et al. (2005)." Model estadístic-determinístic per la segmentació de l adventicia en imatges d ecografía intracoronaria" . Rev Societat Catalana Cardiologia, 5, 41.
|
|
|
|
Mireia Sole, Joan Blanco, Debora Gil, G. Fonseka, Richard Frodsham, Oliver Valero, et al. (2017)." Análisis 3d de la territorialidad cromosómica en células espermatogénicas: explorando la infertilidad desde un nuevo prisma" . Revista Asociación para el Estudio de la Biología de la Reproducción, 22(2), 105.
|
|
|
|
Oriol Rodriguez-Leon, Josefina Mauri, Eduard Fernandez-Nofrerias, Antonio Tovar, Vicente del Valle, Aura Hernandez-Sabate, et al. (2004)." Utilizacion de la estructura de los campos vectoriales para la deteccion de la Adventicia en imagenes de Ecografia Intracoronaria" . Revista Española de Cardiología, 57(2), 100.
|
|
|
|
Oriol Rodriguez-Leon, Debora Gil, & Eduard Fernandez-Nofrerias. (2006)." Analisis en los cambios en el nivel de gris en las secuencias angiograficas mediante descriptores estadisticos para determinar la perfusion miocardica" . Revista Española de Cardiología, 59 Supl 2-166(2), 128.
|
|
|
|
Ferran Poveda, Debora Gil, Enric Marti, Albert Andaluz, Manel Ballester, & Francesc Carreras Costa. (2013). "Helical structure of the cardiac ventricular anatomy assessed by Diffusion Tensor Magnetic Resonance Imaging multi-resolution tractography " . Revista Española de Cardiología, 66(10), 782–790.
Abstract: Deep understanding of myocardial structure linking morphology and function of the heart would unravel crucial knowledge for medical and surgical clinical procedures and studies. Several conceptual models of myocardial fiber organization have been proposed but the lack of an automatic and objective methodology prevented an agreement. We sought to deepen in this knowledge through advanced computer graphic representations of the myocardial fiber architecture by diffusion tensor magnetic resonance imaging (DT-MRI).
We performed automatic tractography reconstruction of unsegmented DT-MRI canine heart datasets coming from the public database of the Johns Hopkins University. Full scale tractographies have been build with 200 seeds and are composed by streamlines computed on the vectorial field of primary eigenvectors given at the diffusion tensor volumes. Also, we introduced a novel multi-scale visualization technique in order to obtain a simplified tractography. This methodology allowed to keep the main geometric features of the fiber tracts, making easier to decipher the main properties of the architectural organization of the heart.
On the analysis of the output from our tractographic representations we found exact correlation with low-level details of myocardial architecture, but also with the more abstract conceptualization of a continuous helical ventricular myocardial fiber array.
Objective analysis of myocardial architecture by an automated method, including the entire myocardium and using several 3D levels of complexity, reveals a continuous helical myocardial fiber arrangement of both right and left ventricles, supporting the anatomical model of the helical ventricular myocardial band described by Torrent-Guasp.
Keywords: Heart;Diffusion magnetic resonance imaging;Diffusion tractography;Helical heart;Myocardial ventricular band.
|
|
|
|
Jaume Garcia, Debora Gil, Sandra Pujades, & Francesc Carreras. (2008). "Valoracion de la Funcion del Ventriculo Izquierdo mediante Modelos Regionales Hiperparametricos " . Revista Española de Cardiologia, 61(3), 79.
Abstract: La mayoría de la enfermedades cardiovasculares afectan a las propiedades contráctiles de la banda ventricular helicoidal. Esto se refleja en una variación del comportamiento normal de la función ventricular. Parámetros locales tales como los strains, o la deformación experimentada por el tejido, son indicadores capaces de detectar anomalías funcionales en territorios específicos. A menudo, dichos parámetros son considerados de forma separada. En este trabajo presentamos un marco computacional (el Dominio Paramétrico Normalizado, DPN) que permite integrarlos en hiperparámetros funcionales y estudiar sus rangos de normalidad. Dichos rangos permiten valorar de forma objetiva la función regional de cualquier nuevo paciente. Para ello, consideramos secuencias de resonancia magnética etiquetada a nivel basal, medio y apical. Los hiperparámetros se obtienen a partir del movimiento intramural del VI estimado mediante el método Harmonic Phase Flow. El DPN se define a partir de en una parametrización del Ventrículo Izquierdo (VI) en sus coordenadas radiales y circunferencial basada en criterios anatómicos. El paso de los hiperparámetros al DPN hace posible la comparación entre distintos pacientes. Los rangos de normalidad se definen mediante análisis estadístico de valores de voluntarios sanos en 45 regiones del DPN a lo largo de 9 fases sistólicas. Se ha usado un conjunto de 19 (14 H; E: 30.7±7.5) voluntarios sanos para crear los patrones de normalidad y se han validado usando 2 controles sanos y 3 pacientes afectados de contractilidad global reducida. Para los controles los resultados regionales se han ajustado dentro de la normalidad, mientras que para los pacientes se han obtenido valores anormales en las zonas descritas, localizando y cuantificando así el diagnóstico empírico.
|
|
|
|
Oriol Rodriguez-Leon, Josefina Mauri, Eduard Fernandez-Nofrerias, Antonio Tovar, Vicente del Valle, Aura Hernandez-Sabate, et al. (2004)." Utilización de la Estructura de los Campos Vectoriales para la Detección de la Adventicia en Imágenes de Ecografía Intracoronaria" . Revista Internacional de Enfermedades Cardiovasculares Revista Española de Cardiología, 57(2), 100.
|
|
|
|
Oriol Rodriguez-Leon, Josefina Mauri, Eduard Fernandez-Nofrerias, M.Gomez, Antonio Tovar, L.Cano, et al. (2002)." Ecografia Intracoronaria: Segmentacio Automatica de area de la llum" . Revista Societat Catalana de Cardiologia, 4(4), 42.
|
|
