Kristin McLeod

Benchmarking framework for myocardial tracking and deformation algorithms: An open access database

In this paper we present a benchmarking framework for the validation of cardiac motion analysis algorithms. The reported methods are the response to an open challenge that was issued to the medical imaging community through a MICCAI workshop. The database included magnetic resonance (MR) and 3D ultrasound (3DUS) datasets from a dynamic phantom and 15 healthy volunteers. Participants processed 3D tagged MR datasets (3DTAG), cine steady state free precession MR datasets (SSFP) and 3DUS datasets, amounting to 1158 image volumes. Ground-truth for motion tracking was based on 12 landmarks (4 walls at 3 ventricular levels). They were manually tracked by two observers in the 3DTAG data over the whole cardiac cycle, using an in-house application with 4D visualization capabilities. The median of the inter-observer variability was computed for the phantom dataset (0.77 mm) and for the volunteer datasets (0.84 mm). The ground-truth was registered to 3DUS coordinates using a point based similarity transform. Four institutions responded to the challenge by providing motion estimates for the data: Fraunhofer MEVIS (MEVIS), Bremen, Germany; Imperial College London - University College London (IUCL), UK; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Inria-Asclepios project (INRIA), France. Details on the implementation and evaluation of the four methodologies are presented in this manuscript. The manually tracked landmarks were used to evaluate tracking accuracy of all methodologies. For 3DTAG, median values were computed over all time frames for the phantom dataset (MEVIS=1.20mm, IUCL=0.73 mm, UPF=1.10mm, INRIA=1.09 mm) and for the volunteer datasets (MEVIS=1.33 mm, IUCL=1.52 mm, UPF=1.09 mm, INRIA=1.32 mm). For 3DUS, median values were computed at end diastole and end systole for the phantom dataset (MEVIS=4.40 mm, UPF=3.48 mm, INRIA=4.78 mm) and for the volunteer datasets (MEVIS=3.51 mm, UPF=3.71 mm, INRIA=4.07 mm). For SSFP, median values were computed at end diastole and end systole for the phantom dataset(UPF=6.18 mm, INRIA=3.93 mm) and for the volunteer datasets (UPF=3.09 mm, INRIA=4.78 mm). Finally, strain curves were generated and qualitatively compared. Good agreement was found between the different modalities and methodologies, except for radial strain that showed a high variability in cases of lower image quality.

An incompressible log-domain demons algorithm for tracking heart tissue

We describe an application of the previously proposed iLogDemons algorithm to the STACOM motion-tracking challenge data. The iLogDemons algorithm is a consistent and efficient framework for tracking left-ventricle heart tissue using an elastic incompressible non-linear registration algorithm based on the LogDemons algorithm. This method has shown promising results when applied to previous data-sets. Along with having the advantages of the LogDemons algorithm such as computing deformations that are invertible with smooth inverse, the method has the added advantage of allowing physiological constraints to be added to the deformation model. The registration is entirely performed in the log-domain with the incompressibility constraint strongly ensured and applied directly in the demons minimisation space. Strong incompressibility is ensured by constraining the stationary velocity fields that parameterise the transformations to be divergence-free in the myocardium. The method is applied to a data-set of 15 volunteers and one phantom, each with echocardiography, cine-MR and tagged-MR images. We are able to obtain reasonable results for each modality and good results for echocardiography images with respect to quality of the registration and computed strain curves.

A statistical shape modelling framework to extract 3D shape biomarkers from medical imaging data: assessing arch morphology of repaired coarctation of the aorta

BackgroundMedical image analysis in clinical practice is commonly carried out on 2D image data, without fully exploiting the detailed 3D anatomical information that is provided by modern non-invasive medical imaging techniques. In this paper, a statistical shape analysis method is presented, which enables the extraction of 3D anatomical shape features from cardiovascular magnetic resonance (CMR) image data, with no need for manual landmarking. The method was applied to repaired aortic coarctation arches that present complex shapes, with the aim of capturing shape features as biomarkers of potential functional relevance. The method is presented from the user-perspective and is evaluated by comparing results with traditional morphometric measurements.MethodsSteps required to set up the statistical shape modelling analyses, from pre-processing of the CMR images to parameter setting and strategies to account for size differences and outliers, are described in detail. The anatomical mean shape of 20 aortic arches post-aortic coarctation repair (CoA) was computed based on surface models reconstructed from CMR data. By analysing transformations that deform the mean shape towards each of the individual patient’s anatomy, shape patterns related to differences in body surface area (BSA) and ejection fraction (EF) were extracted. The resulting shape vectors, describing shape features in 3D, were compared with traditionally measured 2D and 3D morphometric parameters.ResultsThe computed 3D mean shape was close to population mean values of geometric shape descriptors and visually integrated characteristic shape features associated with our population of CoA shapes. After removing size effects due to differences in body surface area (BSA) between patients, distinct 3D shape features of the aortic arch correlated significantly with EF (r = 0.521, p = .022) and were well in agreement with trends as shown by traditional shape descriptors.ConclusionsThe suggested method has the potential to discover previously unknown 3D shape biomarkers from medical imaging data. Thus, it could contribute to improving diagnosis and risk stratification in complex cardiac disease.

Spatio-Temporal Tensor Decomposition of a Polyaffine Motion Model for a Better Analysis of Pathological Left Ventricular Dynamics

Given that heart disease can cause abnormal motion dynamics over the cardiac cycle, understanding and quantifying cardiac motion can provide insight for clinicians to aid with diagnosis, therapy planning, and determining prognosis. The goal of this paper is to extract population-specific motion patterns from 3D displacements in order to identify the mean motion in a population, and to describe pathology-specific motion patterns in terms of the spatial and temporal components. Since there are common motion patterns observed in patients with the same condition, extracting these can lead towards a better understanding of the disease. Quantifying cardiac motion at a population level is not a simple task since images can vary widely in terms of image quality, size, resolution, and pose. To overcome this, we analyze the parameters obtained from a cardiac-specific Polyaffine motion-tracking algorithm, which are aligned both spatially and temporally to a common reference space. Once all parameters are aligned, different subjects can be compared and analyzed in the space of Polyaffine transformations by projecting the transformations to a reduced order subspace in which dominant motion patterns in each population can be extracted. Using tensor decomposition, the spatial and temporal aspects can be decoupled in order to study the components individually. The proposed method was validated on healthy volunteers and Tetralogy of Fallot patients according to known spatial and temporal behavior for each population. A key advantage of this method is the ability to regenerate motion sequences from the models, which can be visualized in terms of the full motion.

How successful is successful? Aortic arch shape after successful aortic coarctation repair correlates with left ventricular function

Objectives: Even after successful aortic coarctation repair, there remains a significant incidence of late systemic hypertension and other morbidities. Independently of residual obstruction, aortic arch morphology alone may affect cardiac function and outcome. We sought to uncover the relationship of arch 3‐dimensional shape features with functional data obtained from cardiac magnetic resonance scans. Methods: Three‐dimensional aortic arch shape models of 53 patients (mean age, 22.3 ± 5.6 years) 12 to 38 years after aortic coarctation repair were reconstructed from cardiac magnetic resonance data. A novel validated statistical shape analysis method computed a 3‐dimensional mean anatomic shape of all aortic arches and calculated deformation vectors of the mean shape toward each patients arch anatomy. From these deformations, 3‐dimensional shape features most related to left ventricular ejection fraction, indexed left ventricular end‐diastolic volume, indexed left ventricular mass, and resting systolic blood pressure were extracted from the deformation vectors via partial least‐squares regression. Results: Distinct arch shape features correlated significantly with left ventricular ejection fraction (r = 0.42, P = .024), indexed left ventricular end‐diastolic volume (r = 0.65, P < .001), and indexed left ventricular mass (r = 0.44, P = .014). Lower left ventricular ejection fraction, larger indexed left ventricular end‐diastolic volume, and increased indexed left ventricular mass were identified with an aortic arch shape that has an elongated ascending aorta with a high arch height‐to‐width ratio, a relatively short proximal transverse arch, and a relatively dilated descending aorta. High blood pressure seemed to be linked to gothic arch shape features, but this did not achieve statistical significance. Conclusions: Independently of hemodynamically important arch obstruction or residual aortic coarctation, specific aortic arch shape features late after successful aortic coarctation repair seem to be associated with worse left ventricular function. Analyzing 3‐dimensional shape information via statistical shape modeling can be an adjunct to long‐term risk assessment in patients after aortic coarctation repair.

Group-wise construction of reduced models for understanding and characterization of pulmonary blood flows from medical images

3D computational fluid dynamics (CFD) in patient-specific geometries provides complementary insights to clinical imaging, to better understand how heart disease, and the side effects of treating heart disease, affect and are affected by hemodynamics. This information can be useful in treatment planning for designing artificial devices that are subject to stress and pressure from blood flow. Yet, these simulations remain relatively costly within a clinical context. The aim of this work is to reduce the complexity of patient-specific simulations by combining image analysis, computational fluid dynamics and model order reduction techniques. The proposed method makes use of a reference geometry estimated as an average of the population, within an efficient statistical framework based on the currents representation of shapes. Snapshots of blood flow simulations performed in the reference geometry are used to build a POD (Proper Orthogonal Decomposition) basis, which can then be mapped on new patients to perform reduced order blood flow simulations with patient specific boundary conditions. This approach is applied to a data-set of 17 tetralogy of Fallot patients to simulate blood flow through the pulmonary artery under normal (healthy or synthetic valves with almost no backflow) and pathological (leaky or absent valve with backflow) conditions to better understand the impact of regurgitated blood on pressure and velocity at the outflow tracts. The model reduction approach is further tested by performing patient simulations under exercise and varying degrees of pathophysiological conditions based on reduction of reference solutions (rest and medium backflow conditions respectively).

A Non-parametric Statistical Shape Model for Assessment of the Surgically Repaired Aortic Arch in Coarctation of the Aorta: How Normal is Abnormal?

Coarctation of the Aorta CoA is a cardiac defect that requires surgical intervention aiming to restore an unobstructed aortic arch shape. Many patients suffer from complications post-repair, which are commonly associated with arch shape abnormalities. Determining the degree of shape abnormality could improve risk stratification in recommended screening procedures. Yet, traditional morphometry struggles to capture the highly complex arch geometries. Therefore, we use a non-parametric Statistical Shape Model based on mathematical currents to fully account for 3D global and regional shape features. By computing a template aorta of a population of healthy subjects and analysing its transformations towards CoA arch shape models using Partial Least Squares regression techniques, we derived a shape vector as a measure of subject-specific shape abnormality. Results were compared to a shape ranking by clinical experts. Our study suggests Statistical Shape Modelling to be a promising diagnostic tool for improved screening of complex cardiac defects.

Looks Do Matter! Aortic Arch Shape After Hypoplastic Left Heart Syndrome Palliation Correlates With Cavopulmonary Outcomes

BACKGROUND Aortic arch reconstruction after hypoplastic left heart syndrome (HLHS) palliation can vary widely in shape and dimensions between patients. Arch morphology alone may affect cardiac function and outcome. We sought to uncover the relationship of arch three-dimensional shape features with functional and short-term outcome data after total cavopulmonary connection (TCPC). METHODS Aortic arch shape models of 37 patients with HLHS (age, 2.89 ± 0.99 years) were reconstructed from magnetic resonance data before TCPC completion. A novel, validated statistical shape analysis method was used to compute a three-dimensional anatomic mean shape from the cohort and calculate the deformation vectors of the mean shape toward each patients specific anatomy. From these deformations, three-dimensional shape features most related to ventricular ejection fraction, indexed end-diastolic volume, and superior cavopulmonary pressure were extracted by partial least-square regression analysis. Shape patterns relating to intensive care unit and hospital lengths of stay after TCPC were assessed. RESULTS Distinct deformation patterns, which result in an acutely mismatched aortic root and ascending aorta, and a gothic-like transverse arch, correlated with increased indexed end-diastolic volume and higher superior cavopulmonary pressure but not with ejection fraction. Specific arch morphology with pronounced transverse arch and descending aorta mismatch also correlated with longer intensive care unit and hospital lengths of stay after TCPC completion. CONCLUSIONS Independent of hemodynamically important arch obstruction, altered aortic morphology in HLHS patients appears to have important associations with higher superior cavopulmonary pressure and with short-term outcomes after TCPC completion as highlighted by statistical shape analysis, which could act as adjunct to risk assessment in HLHS.

Spatio-Temporal Dimension Reduction of Cardiac Motion for Group-Wise Analysis and Statistical Testing

Given the observed abnormal motion dynamics of patients with heart conditions, quantifying cardiac motion in both normal and pathological cases can provide useful insights for therapy planning. In order to be able to analyse the motion over multiple subjects in a robust manner, it is desirable to represent the motion by a low number of parameters. We propose a reduced order cardiac motion model, reduced in space through a polyaffine model, and reduced in time by statistical model order reduction. The method is applied to a data-set of synthetic cases with known ground truth to validate the accuracy of the left ventricular motion tracking, and to validate a patient-specific reduced-order motion model. Population-based statistics are computed on a set of 15 healthy volunteers to obtain separate spatial and temporal bases. Results demonstrate that the reduced model can efficiently detect abnormal motion patterns and even allowed to retrospectively reveal abnormal unnoticed motion within the control subjects.

Regional analysis of left ventricle function using a cardiac-specific polyaffine motion model

Given the complex dynamics of cardiac motion, understanding the motion for both normal and pathological cases can aid in understanding how different pathological conditions effect, and are affected by cardiac motion. Naturally, different regions of the left ventricle of the heart move in different ways depending on the location, with significantly different dynamics between the septal and free wall, and basal and apical regions. Therefore, studying the motion at a regional level can provide further information towards identifying abnormal regions for example. The 4D left ventricular motion of a given case was characterised by a low number of parameters at a region level using a cardiac specific polyaffine motion model. The motion was then studied at a regional level by analysing the computed affine transformation matrix of each region. This was used to examine the regional evolution of normal and pathological subjects over the cardiac cycle. The method was tested on 15 healthy volunteers with 4D ground truth landmarks and 5 pathological patients, all candidates for Cardiac Resynchronisation Therapy. Visually significant differences between normal and pathological subjects in terms of synchrony between the regions were obtained, which enables us to distinguish between healthy and unhealthy subjects. The results indicate that the method may be promising for analysing cardiac function.