J. Fredrick Cornhill

Assessment of coronary compensatory enlargement by three-dimensional intravascular ultrasound.

Several techniques have been used to demonstrate that human arteries respond to atherosclerosis by increasing their total arterial area to prevent a decrease in blood flow. Three-dimensional reconstructions of coronary arteries can document this compensatory response accurately and specifically. Seven human coronary arteries were reconstructed using intravascular ultrasound and biplane angiography, and vessel geometries were quantified. In all seven vessels, as plaque area increased, overall vessel area increased (R = 0.986, 0.933, 0.984, 0.678, 0.763, 0.963, and 0.830), but luminal cross-sectional area did not significantly decrease. Focal compensatory enlargement was identified in each vessel, and in some cases this response appeared to occur until the vessel was 65% occluded. Luminal enlargement near the proximal ends was attributed to the natural taper of the vessel. The semi-automated, three-dimensional segmentation technique used in this study allows reproducible quantification, as there is no subjective manual tracing involved. Following the intravascular ultrasound transducer in time and space with biplane angiography allows for accurate reconstruction with or without automated pullback devices. Information on the rate of change of vessel measurements is also presented, which, when combined with visualization of accurate 3D geometry, provides a unique assessment of coronary compensatory enlargement. This reconstruction technique can be applied in a clinical environment with no major modification.

Age related development of atherosclerotic plaque stress: A population-based finite-element analysis

BackgroundIn order to identify those age-related factors in the development of coronary atherosclerosis that would affect the stability of the plaque system, we have developed idealized, finite-element, cross-sectional models of the arterial wall and associated lesions, derived from population-based data. MethodsThe physical development and morphology of coronary plaques was documented in the Pathobiological Determinants of Atherosclerosis in Youth histological study. Using this database, finite-element analysis models were created for five age groups (15–19, 20–24, 25–29 and 30–34 years) and for the 25 largest lesions. Cosmos (Structural Research, Inc., Los Angeles, California, USA) was used to create and analyze the models. ResultsThe area of greatest stress shifted from the intima opposite the lesion in the 15–19 years age group to the edge of the cap and adjacent healthy tissue in the later age groups. Increasing age had a strong positive correlation with the shoulder stress level (r = 0.95) and the per cent stenosis correlated well with shoulder stress (r = 0.99, P < 0.002). Increasing the cap stiffness from a soft cap to a fibrous cap in the 30–34 year age group model resulted in a localized increase in shoulder surface stress by 10%. A calcified cap increased this shoulder surface stress by 30%. ConclusionsThis finite-element analysis of the population-based data shows that the increase in stress appears to be closely related to the impaired load-bearing capability of the lipid pool that develops with age. The shoulder area of the lesion has been shown to be the location of most of the plaque fractures. Coronary Artery Dis 9:13–19

Quantitative comparison of immunohistochemical staining intensity in tissues fixed in formalin and Histochoice

Formaldehyde fixatives have traditionally been used to preserve tissues as they impart excellent morphological preservation. Formaldehyde fixes tissue by cross linking, a process which can reduce the antigenicity of tissue and weakens the intensity of immunohistochemical stains. Preliminary studies have shown that Histochoice tissue fixative offers equal or greater staining intensity than neutral buffered formalin (NBF). This study compares these fixatives quantitatively and presents the results in unambiguous statistical terms. Tissue samples were collected, bisected, and fixed in NBF or Histochoice. The sections were stained with a total of 21 antibodies, and color images were collected. The hue, saturation, and value were determined for each positive pixel and an ANOVA performed. Small differences in hue were noted in 8 of 21 cases. Histochoice‐fixed tissue gave a greater mean saturation than NBF with 57.1% of the antibodies tested. No significant difference in the saturation was detected in 28.6% of the cases; NBF gave higher mean saturation levels with only 14.3% of the antibodies. Histochoice‐fixed tissue was found to give lower values in 66.7% of cases than those prepared with NBF, indicating darker staining. These results show that Histochoice produces staining intensity that is comparable, and in many cases superior, to formalin.

Reuse of coronary angioplasty equipment: Technical and clinical issues

Abstract The reuse of equipment for percutaneous coronary intervention is common in countries outside the United States. However, little is known about the risks or cost savings afforded by this practice. In vitro and in vivo studies suggest that reusing balloon angioplasty catheters and related equipment is not associated with increased risk of particulate body embolization, infection, endotoxic reaction, or toxicity. However, the only prospective, nonrandomized clinical trial of catheter reuse suggests that this practice may be associated with a lower success rate in crossing lesions, longer procedure times, and higher complication rates. Cost-benefit modeling demonstrates that these factors potentially offset any cost savings afforded by catheter reuse.

Knowledge-based 3D segmentation of the brain in MR images for quantitative multiple sclerosis lesion tracking

Brain segmentation in magnetic resonance (MR) images is an important step in quantitative analysis applications, including the characterization of multiple sclerosis (MS) lesions over time. Our approach is based on a priori knowledge of the intensity and three-dimensional (3D) spatial relationships of structures in MR images of the head. Optimal thresholding and connected-components analysis are used to generate a starting point for segmentation. A 3D radial search is then performed to locate probable locations of the intra-cranial cavity (ICC). Missing portions of the ICC surface are interpolated in order to exclude connected structures. Partial volume effects and inter-slice intensity variations in the image are accounted for automatically. Several studies were conducted to validate the segmentation. Accuracy was tested by calculating the segmented volume and comparing to known volumes of a standard MR phantom. Reliability was tested by comparing calculated volumes of individual segmentation results from multiple images of the same subject. The segmentation results were also compared to manual tracings. The average error in volume measurements for the phantom was 1.5% and the average coefficient of variation of brain volume measurements of the same subject was 1.2%. Since the new algorithm requires minimal user interaction, variability introduced by manual tracing and interactive threshold or region selection was eliminated. Overall, the new algorithm was shown to produce a more accurate and reliable brain segmentation than existing manual and semi-automated techniques.

Multifunction extension of simplex optimization method for mutual information-based registration of ultrasound volumes

Mutual information has been demonstrated to be an accurate and reliable criterion function to perform registration of medical data. Due to speckle noise, ultrasound volumes do not provide a smooth mutual information function. Consequently the optimization technique used must be robust enough to avoid local maxima and converge on the desired global maximum eventually. While the well-known downhill simplex optimization uses a single criterion function, our extension to multi-function optimization uses three criterion functions, namely mutual information computed at three levels of intensity quantization and hence three degrees of noise suppression. Registration was performed with rigid as well as simple non-rigid transformation modes for real-time 3D ultrasound datasets of the left ventricle. Pairs of frames corresponding to the most stationary end- diastolic cardiac phase were chosen, and an initial misalignment was artificially introduced between them. The multi-function simplex optimization reduced the failure rate by a factor of two in comparison to the standard simplex optimization, while the average accuracy for the successful cases was unchanged. A more robust registration resulted form the parallel use of criterion functions. The additional computational cost was negligible, as each of the three implementations of the mutual information used the same joint histogram and required no extra spatial transformation.

Mutual information-based registration of cardiac ultrasound volumes

Real-time volume ultrasound imaging of the heart is a new trend, and the registration of acquired volume framesets is clinically important. This registration may be accomplished by processing a selected pair of volume frames having identical cardiac phase (preferably end diastolic) from two framesets. The registration solves for the optimal rigid transformation between selected volumes through maximization of mutual information, a voxel similarity measure. The accuracy of registration was estimated through retrieval of an artificially introduced misalignment. Two volume frames, belonging to the same frameset and separated in time by 250 ms, were selected. The secondary volume was translated by seven voxels along each axis and rotated by seven degrees about each axis relative to the primary prior to registration. The translational mismatch upon registration was within one voxel and the rotational mismatch less than two degrees. Reduction of the speckle noise by spatio-temporal averaging followed by intensity binning was a key step in successful application of mutual information approach to ultrasound imaging. The application of our method to nine framesets arising from four different patients demonstrates the feasibility of using of mutual information for automatic registration of cardiac ultrasound data.

Technical and economic feasibility of reusing disposable perfusion cannulas

OBJECTIVE(S) The reuse of disposable devices is a potential source of significant cost savings to hospitals. Venous and arterial perfusion cannulas under new and reused conditions were selected to identify the clinical, safety, technical, logistic, and economic issues that must be addressed to realize these savings. METHODS Single- and dual-stage venous and arterial cannulas from two manufacturers were tested when new, after initial clinical use, and after a single clinical use plus up to nine simulated reuses. Reuse was simulated by end-to-end bending, coupling and uncoupling of the connectors, and by two 1-hour soaks in plasma at 4 degrees and 40 degrees C, respectively. Cannulas were decontaminated and then processed by a peracetic acid-based liquid chemical sterilization system after each use/reuse. Sterilization was validated by eliminating Bacillus subtilis spores from the cannulas on each of five consecutive cycles. Cannulas were tested for physical changes, functional integrity, biocompatibility, and in vivo performance in sheep. A cost analysis was also performed. RESULTS Sterilization was successfully achieved. Mechanical changes were less than 20% on all variables studied and were undetectable by experienced cardiac surgeons in selective evaluation. No clinically important differences were found between new and reused cannulas, even after nine simulated reuses. Reusing cannulas four times would reduce the cost per procedure from

A fast and accurate method for registration of MR images of the head

53 to

Quantification of coronary arterial plaque volume using 3D reconstructions formed by fusing intravascular ultrasound and biplane angiography

19 (64%). CONCLUSIONS Preliminary data suggest that the perfusion cannulas tested can be safely and efficaciously used five times. Limited reuse of these disposable cannulas is technically feasible and cost-effective. Cannula reuse would result in a small incremental savings; however, with more expensive devices and higher-volume sterilization procedures, the savings could be considerably greater. This program provides a model for evaluation of other single-use medical devices for reuse.