Claudio Lamberti

Volumetric Quantification of Global and Regional Left Ventricular Function From Real-Time Three-Dimensional Echocardiographic Images

Background—Real-time 3D echocardiographic (RT3DE) data sets contain dynamic volumetric information on cardiac function. However, quantification of left ventricular (LV) function from 3D echocardiographic data is performed on cut-planes extracted from the 3D data sets and thus does not fully exploit the volumetric information. Accordingly, we developed a volumetric analysis technique aimed at quantification of global and regional LV function. Methods and Results—RT3DE images obtained in 30 patients (Philips 7500) were analyzed by use of custom software based on the level-set approach for semiautomated detection of LV endocardial surface throughout the cardiac cycle, from which global and regional LV volume (LVV)–time and wall motion (WM)–time curves were obtained. The study design included 3 protocols. In protocol 1, time curves obtained in 16 patients were compared point-by-point with MRI data (linear regression and Bland-Altman analyses). Global LVV correlated highly with MRI (r=0.98; y=0.99x+2.3) with minimal bias (1.4 mL) and narrow limits of agreement (±20 mL). WM correlated highly only in basal and midventricular segments (r=0.88; y=0.85x+0.7). In protocol 2, we tested the ability of this technique to differentiate populations with known differences in LV function by studying 9 patients with dilated cardiomyopathy and 9 normal subjects. All calculated indices of global and regional systolic and diastolic LV function were significantly different between the groups. In protocol 3, we tested the feasibility of automated detection of regional WM abnormalities in 11 patients. In each segment, abnormality was detected when regional shortening fraction was below a threshold obtained in normal subjects. The automated detection agreed with expert interpretation of 2D WM in 86% of segments. Conclusions—Volumetric analysis of RT3DE data is clinically feasible and allows fast, semiautomated, dynamic measurement of LVV and automated detection of regional WM abnormalities.

Maximum likelihood segmentation of ultrasound images with Rayleigh distribution

This study presents a geometric model and a computational algorithm for segmentation of ultrasound images. A partial differential equation (PDE)-based flow is designed in order to achieve a maximum likelihood segmentation of the target in the scene. The flow is derived as the steepest descent of an energy functional taking into account the density probability distribution of the gray levels of the image as well as smoothness constraints. To model gray level behavior of ultrasound images, the classic Rayleigh probability distribution is considered. The steady state of the flow presents a maximum likelihood segmentation of the target. A finite difference approximation of the flow is derived, and numerical experiments are provided. Results are presented on ultrasound medical images as fetal echography arid echocardiography.

Left ventricular volume estimation for real-time three-dimensional echocardiography

The application of level set techniques to echocardiographic data is presented. This method allows semiautomatic segmentation of heart chambers, which regularizes the shapes and improves edge fidelity, especially in the presence of gaps, as is common in ultrasound data. The task of the study was to reconstruct left ventricular shape and to evaluate left ventricular volume. Data were acquired with a real-time three-dimensional (3-D) echocardiographic system. The method was applied directly in the three-dimensional domain and was based on a geometric-driven scheme. The numerical scheme for solving the proposed partial differential equation is borrowed from numerical methods for conservation law. Results refer to in vitro and human in vivo acquired 3-D+time echocardiographic data. Quantitative validation was performed on in vitro balloon phantoms. Clinical application of this segmentation technique is reported for 20 patient cases providing measures of left ventricular volumes and ejection fraction.

Evaluation of differential optical flow techniques on synthesized echo images

The performance of three methods for evaluation of motion on synthesized 2-D echo image sequences with features similar to real ones are examined. The selected techniques based on the computation of optical flow are of the differential type and assume that the image brightness pattern is constant over time. They differ in the choice of the smoothing term and in the local or global treatment of the domain. The images were synthesized by simulating the process of echo formation, considering the interaction between ultrasonic fields and human tissues. Moreover, two different approaches were followed to generate the sequences: (1) a known motion field was applied to the intensity distribution of the synthesized images; (2) a known motion field was applied directly to the point scatterer distribution of the tissue. Favorable results were obtained by applying Lucas-Kanade and Horn-Schunck techniques to the sequences of the first type, while all the techniques produced large errors when applied to the other type of sequences. A discussion about the suitability of the above-mentioned techniques for evaluation of motion on real echocardiographic images is also presented together with some results.

A physically based model to simulate maxillo-facial surgery from 3D CT images

Abstract Computer-based surgery simulation represents a rapidly emerging and increasingly important area of research that combines a number of disciplines for the common purpose of improving health care. Generally, the goal of computer-based surgery simulation is to enable a surgeon to experiment with different surgical procedures in an artificial environment. This paper describes an approach for elastic modelling of human tissue based on the use of embedded boundary condition techniques. Embedded boundary condition models allow to simulate the cranio-facial surgery directly on the grid of the 3D CT image of the patient. Previously simulated operations have been performed using surface models or by using a low detailed model of the tissue volume. The approach proposed here involves complete 3D modelling of the solid highly detailed structure of the object, starting from the information present in the 3D diagnostic images. Due to the huge amount of data and the computational complexity of the problem, a parallel version of the software has been implemented on the supercomputer CRAY T3E. The application of this approach for modelling the elastic deformation of human tissue in response to movement of bones is demonstrated both on the visible human data set of the National Library of Medicine and on the CT data set of real patients.

Identification of the three-element windkessel model incorporating a pressure-dependent compliance

A new one-step computational procedure is presented for estimating the parameters of the nonlinear three-element windkessel model of the arterial system incorporating a pressure-dependent compliance. The data required are pulsatile aortic pressure and flow. The basic assumptions are a steadystate periodic regime and a purely elastic compliant element. By stating two conditions, zero mean flow and zero mean power in the compliant element, peripheral and characteristic resistances are determined through simple closed form formulas as functions of mean values of the square of aortic pressure, the square of aortic flow, and the product of aortic pressure with aortic flow. The pressure across as well as the flow through the compliant element can be then obtained so allowing the calculation of volume variation and compliance as functions of pressure. The feasibility of this method is studied by applying it to both simulated and experimental data relative to different circulatory conditions and comparing the results with those obtained by an iterative parameter optimization algorithm and with the actual values when available. The conclusion is that the proposed method appears to be effective in identifying the three-element windkessel even in the case of nonlinear compliance.

Left ventricular endocardial surface detection based on real-time 3D echocardiographic data

OBJECTIVE A new computerized semi-automatic method for left ventricular (LV) chamber segmentation is presented. METHODS The LV is imaged by real-time three-dimensional echocardiography (RT3DE). The surface detection model, based on level set techniques, is applied to RT3DE data for image analysis. The modified level set partial differential equation we use is solved by applying numerical methods for conservation laws. The initial conditions are manually established on some slices of the entire volume. The solution obtained for each slice is a contour line corresponding with the boundary between LV cavity and LV endocardium. RESULTS The mathematical model has been applied to sequences of frames of human hearts (volume range: 34-109 ml) imaged by 2D and reconstructed off-line and RT3DE data. Volume estimation obtained by this new semi-automatic method shows an excellent correlation with those obtained by manual tracing (r = 0.992). Dynamic change of LV volume during the cardiac cycle is also obtained. CONCLUSION The volume estimation method is accurate; edge based segmentation, image completion and volume reconstruction can be accomplished. The visualization technique also allows to navigate into the reconstructed volume and to display any section of the volume.

Myocardial Perfusion: Near-automated Evaluation from Contrast-enhanced MR Images Obtained at Rest and during Vasodilator Stress

PURPOSE To develop and validate a technique for near-automated definition of myocardial regions of interest suitable for perfusion evaluation during vasodilator stress cardiac magnetic resonance (MR) imaging. MATERIALS AND METHODS The institutional review board approved the study protocol, and all patients provided informed consent. Image noise density distribution was used as a basis for endocardial and epicardial border detection combined with nonrigid registration. This method was tested in 42 patients undergoing contrast material-enhanced cardiac MR imaging (at 1.5 T) at rest and during vasodilator (adenosine or regadenoson) stress, including 15 subjects with normal myocardial perfusion and 27 patients referred for coronary angiography. Contrast enhancement-time curves were near-automatically generated and were used to calculate perfusion indexes. The results were compared with results of conventional manual analysis, using quantitative coronary angiography results as a reference for stenosis greater than 50%. Statistical analyses included the Student t test, linear regression, Bland-Altman analysis, and κ statistics. RESULTS Analysis of one sequence required less than 1 minute and resulted in high-quality contrast enhancement curves both at rest and stress (mean signal-to-noise ratios, 17±7 [standard deviation] and 22±8, respectively), showing expected patterns of first-pass perfusion. Perfusion indexes accurately depicted stress-induced hyperemia (increased upslope, from 6.7 sec(-1)±2.3 to 15.6 sec(-1)±5.9; P<.0001). Measured segmental pixel intensities correlated highly with results of manual analysis (r=0.95). The derived perfusion indexes also correlated highly with (r up to 0.94) and showed the same diagnostic accuracy as manual analysis (area under the receiver operating characteristic curve, up to 0.72 vs 0.73). CONCLUSION Despite the dynamic nature of contrast-enhanced image sequences and respiratory motion, fast near-automated detection of myocardial segments and accurate quantification of tissue contrast is feasible at rest and during vasodilator stress. This technique, shown to be as accurate as conventional manual analysis, allows detection of stress-induced perfusion abnormalities.

Application of continuum theory and multi-grid methods to motion evaluation from 3D echocardiography

As the motion of the heart is a 3D phenomenon, its evaluation from sequences of 2D images causes a great loss of information on the motion itself. Our aim is therefore to process real 3D echocardiographic images and to carry out an automatic way of evaluating the movements of the cardiac structures. To estimate the optical flow, a mathematical model based on the continuum theory is used; echocardiographic images can indeed be considered a function of a conserved quantity (the acoustic impedance). Since we need to calculate the velocity vector for every point in the image and every image is built with more than 2 million voxels (128/spl times/128/spl times/128), we implement a multigrid relaxation method to accelerate the computation of an approximate solution otherwise too slow with a simple iterative solver. The experiments on simulated velocity fields have demonstrated an effective speed-up in the evaluation of motion, and the calculation on real echo images has given a realistic estimation of the 3D dynamics of the heart.

Comparative Evaluation of Different Methods to Estimate Urea Distribution Volume and Generation Rate

Eight methods to estimate urea distribution volume and generation rate from blood urea samples measured in dialysis patients are reviewed. An analytical solution has been provided for a double-pool variable volume kinetic model to allow for faster and more accurate simulation and identification. The reliable parameter estimates provided by the double-pool kinetic model starting from seven samples, were assumed as references for the estimates obtained by the remaining methods. These include three kinetic models and four methods based on urea mass-balance. In particular, the estimation techniques differ in the number of compartments where urea is assumed distributed (double- and single-pool) or in the number of blood urea samples. Among the methods based on mass-balance, two techniques neglecting the weight loss or the urea generation during dialysis, were also analysed. The results obtained during hemofiltration sessions using three samples, usually available in clinical practice at the beginning and at the end of dialysis, demonstrate that a new method based on double-pool kinetics provides, on average, the most reliable estimates. Moreover, methods belonging to a single pool view and including both weight loss and urea generation during dialysis seem to underestimate by 1÷2 liters the urea distribution volume. However, neglecting the weight loss or the urea generation can overcompensate this error, resulting in a significant overestimation of the distribution volume. Finally, it has been experimentally proved that the single-pool kinetic methods overestimate the urea production rate, while techniques based on mass balance provide more reliable values.