Javier Oliván Bescós

CoViCAD: Comprehensive Visualization of Coronary Artery Disease

We present novel, comprehensive visualization techniques for the diagnosis of patients with coronary artery disease using segmented cardiac MRI data. We extent an accepted medical visualization technique called the bulls eye plot by removing discontinuities, preserving the volumetric nature of the left ventricular wall and adding anatomical context. The resulting volumetric bulls eye plot can be used for the assessment of transmurality. We link these visualizations to a 3D view that presents viability information in a detailed anatomical context. We combine multiple MRI scans (whole heart anatomical data, late enhancement data) and multiple segmentations (polygonal heart model, late enhancement contours, coronary artery tree). By selectively combining different rendering techniques we obtain comprehensive yet intuitive visualizations of the various data sources.

Exploration of 4D MRI Blood Flow using Stylistic Visualization

Insight into the dynamics of blood-flow considerably improves the understanding of the complex cardiovascular system and its pathologies. Advances in MRI technology enable acquisition of 4D blood-flow data, providing quantitative blood-flow velocities over time. The currently typical slice-by-slice analysis requires a full mental reconstruction of the unsteady blood-flow field, which is a tedious and highly challenging task, even for skilled physicians. We endeavor to alleviate this task by means of comprehensive visualization and interaction techniques. In this paper we present a framework for pre-clinical cardiovascular research, providing tools to both interactively explore the 4D blood-flow data and depict the essential blood-flow characteristics. The framework encompasses a variety of visualization styles, comprising illustrative techniques as well as improved methods from the established field of flow visualization. Each of the incorporated styles, including exploded planar reformats, flow-direction highlights, and arrow-trails, locally captures the blood-flow dynamics and may be initiated by an interactively probed vessel cross-section. Additionally, we present the results of an evaluation with domain experts, measuring the value of each of the visualization styles and related rendering parameters.

Lines of Curvature for Polyp Detection in Virtual Colonoscopy

Computer-aided diagnosis (CAD) is a helpful addition to laborious visual inspection for preselection of suspected colonic polyps in virtual colonoscopy. Most of the previous work on automatic polyp detection makes use of indicators based on the scalar curvature of the colon wall and can result in many false-positive detections. Our work tries to reduce the number of false-positive detections in the preselection of polyp candidates. Polyp surface shape can be characterized and visualized using lines of curvature. In this paper, we describe techniques for generating and rendering lines of curvature on surfaces and we show that these lines can be used as part of a polyp detection approach. We have adapted existing approaches on explicit triangular surface meshes, and developed a new algorithm on implicit surfaces embedded in 3D volume data. The visualization of shaded colonic surfaces can be enhanced by rendering the derived lines of curvature on these surfaces. Features strongly correlated with true-positive detections were calculated on lines of curvature and used for the polyp candidate selection. We studied the performance of these features on 5 data sets that included 331 pre-detected candidates, of which 50 sites were true polyps. The winding angle had a significant discriminating power for true-positive detections, which was demonstrated by a Wilcoxon rank sum test with p<0.001. The median winding angle and inter-quartile range (IQR) for true polyps were 7.817 and 6.770-9.288 compared to 2.954 and 1.995-3.749 for false-positive detections

Interactive Virtual Probing of 4D MRI Blood-Flow

Better understanding of hemodynamics conceivably leads to improved diagnosis and prognosis of cardiovascular diseases. Therefore, an elaborate analysis of the blood-flow in heart and thoracic arteries is essential. Contemporary MRI techniques enable acquisition of quantitative time-resolved flow information, resulting in 4D velocity fields that capture the blood-flow behavior. Visual exploration of these fields provides comprehensive insight into the unsteady blood-flow behavior, and precedes a quantitative analysis of additional blood-flow parameters. The complete inspection requires accurate segmentation of anatomical structures, encompassing a time-consuming and hard-to-automate process, especially for malformed morphologies. We present a way to avoid the laborious segmentation process in case of qualitative inspection, by introducing an interactive virtual probe. This probe is positioned semi-automatically within the blood-flow field, and serves as a navigational object for visual exploration. The difficult task of determining position and orientation along the view-direction is automated by a fitting approach, aligning the probe with the orientations of the velocity field. The aligned probe provides an interactive seeding basis for various flow visualization approaches. We demonstrate illustration-inspired particles, integral lines and integral surfaces, conveying distinct characteristics of the unsteady blood-flow. Lastly, we present the results of an evaluation with domain experts, valuing the practical use of our probe and flow visualization techniques.

Visualization of Myocardial Perfusion Derived from Coronary Anatomy

Visually assessing the effect of the coronary artery anatomy on the perfusion of the heart muscle in patients with coronary artery disease remains a challenging task. We explore the feasibility of visualizing this effect on perfusion using a numerical approach. We perform a computational simulation of the way blood is perfused throughout the myocardium purely based on information from a three-dimensional anatomical tomographic scan. The results are subsequently visualized using both three-dimensional visualizations and bullpsilas eye plots, partially inspired by approaches currently common in medical practice. Our approach results in a comprehensive visualization of the coronary anatomy that compares well to visualizations commonly used for other scanning technologies. We demonstrate techniques giving detailed insight in blood supply, coronary territories and feeding coronary arteries of a selected region. We demonstrate the advantages of our approach through visualizations that show information which commonly cannot be directly observed in scanning data, such as a separate visualization of the supply from each coronary artery. We thus show that the results of a computational simulation can be effectively visualized and facilitate visually correlating these results to for example perfusion data.

Accuracy and precision of vessel area assessment: Manual versus automatic lumen delineation based on full‐width at half‐maximum

To evaluate the accuracy and precision of manual and automatic blood vessel diameter measurements, a quantitative comparison was conducted, using both phantom and clinical 3D magnetic resonance angiography (MRA) data. Since diameters are often manually measured, which likely is influenced by operator dependency, automatic lumen delineation, based on the full‐width at half‐maximum (FWHM), could improve these measurements.

Fast and accurate Gaussian derivatives based on B-splines

Gaussian derivatives are often used as differential operators to analyze the structure in images. In this paper, we will analyze the accuracy and computational cost of the most common implementations for differentiation and interpolation of Gaussian-blurred multi-dimensional data. We show that - for the computation of multiple Gaussian derivatives - the method based on B-splines obtains a higher accuracy than the truncated Gaussian at equal computational cost.

Patient-Specific Mappings between Myocardial and Coronary Anatomy

The segmentation of the myocardium based on the 17-segment model as recommended by the American Heart Association is widely used in medical practice. The patient-specific coronary anatomy does not play a role in this model. Due to large variations in coronary anatomy among patients, this can result in an inaccurate mapping between myocardial segments and coronary arteries. We present two approaches to include the patient-specific coronary anatomy in this mapping. The first approach adapts the 17-segment model to fit the patient. The second approach generates a less constrained mapping that does not necessarily conform to this model. Both approaches are based on a Voronoi diagram computation of the primary coronary arteries using geodesic distances along the epicardium in three-dimensional space. We demonstrate both our approaches with several patients and show how our first approach can also be used to fit volume data to the 17-segment model. Our technique gives detailed insight into the coronary anatomy in a single diagram. Based on the feedback provided by clinical experts we conclude that it has the potential to provide a more accurate relation between deficiencies in the myocardium and the supplying coronary arteries.

Non Contrast-Enhanced MRA versus Ultrasound blood vessel assessment to determine the choice of hemodialysis vascular access

Purpose The aim of this work was to establish the relationship between traditional blood vessel mapping for vascular access (VA) creation by B-mode ultrasound (US) and novel non contrast-enhanced magnetic resonance angiography (NCE-MRA), and to study the potential influence of the diameter assessment technique on the choice of hemodialysis vascular access. Methods A total of 27 end-stage renal-disease patients were included. They received routine US and a NCE-MRA examination of the upper extremity. Diameters were measured manually on US and semi-automatically on NCE-MRA. These measurements were statistically compared for the arteries and veins and for each measurement location. Furthermore, sensitivity and specificity of both modalities to predict VA location was investigated by comparison with an experienced surgeon. This analysis gave insight into the potential influence of vessel mapping modality on decision-making. Results Comparison of NCE-MRA with US for the arteries and veins, demonstrated a bias of 9% (limits −33%-78%) and 38% (limits −36%-198%), respectively. Statistically significant differences between the modalities on the individual locations were mainly found for the venous locations. The sensitivity and specificity for US to predict VA location was 1.0 and 0.74, respectively, while for NCE-MRA this was 0.88 and 0.39, respectively. Conclusions The results obtained indicate that extreme caution should be exercised when replacing one diameter measurement modality with the other. A further need exists to improve both vessel mapping protocols to obtain a geometric description of the upper extremity vasculature regardless of acquisition modality.

Unbiased Vessel-Diameter Quantification based on the FWHM Criterion

The full-width at half-max (FWHM) criterion is often used for both manual and automatic quantification of the vessel diameter in medical images. The FWHMcriterion is easy to understand and it can be implemented with low computational cost. However, it is well known that the FWHM criterion can give an over- and underestimation of the vessel diameter. In this paper, we propose a simple and original method to create an unbiased estimation of the vessel diameter based on the FWHM criterion and we compared the robustness to noise of several edge detectors. The quantitative results of our experiments show that the proposed method is more accurate and precise than other (more complex) edge detectors, even for small vessels.