Robert Manzke

Adaptive temporal resolution optimization in helical cardiac cone beam CT reconstruction

Cone beam computed tomography scanners in combination with heart rate adaptive reconstruction schemes have the potential to enable cardiac volumetric computed tomography (CT) imaging for a larger number of patients and applications. In this publication, an adaptive scheme for the automatic and patient-specific reconstruction optimization is introduced to improve the temporal resolution and image quality. The optimization method permits the automatic determination of the required amount of gated helical cone beam projection data for the reconstruction volume. It furthermore allows one to optimize subvolume reconstruction yielding an increased temporal resolution. In addition, methods for the assessment of the temporal resolution are given which enable a quantitative documentation of the reconstruction improvements. Results are presented for patient data sets acquired in low pitch helical mode using a 16-slice cone beam CT system with parallel ECG recording.

Helical cardiac cone beam reconstruction using retrospective ECG gating.

In modern computer tomography (CT) systems, the fast rotating gantry and the increased detector width enable 3D imaging of the heart. Cardiac volume CT has a high potential for non-invasive coronary angiography with high spatial resolution and short scan time. Due to the increased detector width, true cone beam reconstruction methods are needed instead of adapted 2D reconstruction schemes. In this paper, the extended cardiac reconstruction method is introduced. It integrates the idea of retrospectively gated cardiac reconstruction for helical data acquisition into a cone beam reconstruction framework. It leads to an efficient and flexible algorithmic scheme for the reconstruction of single- and multi-phase cardiac volume datasets. The method automatically adapts the number of cardiac cycles used for the reconstruction. The cone beam geometry is fully taken into account during the reconstruction process. Within this paper, results are presented on patient datasets which have been acquired using a 16-slice cone beam CT system.

Intraprocedural Volume Imaging of the Left Atrium and Pulmonary Veins with Rotational X-Ray Angiography: Implications for Catheter Ablation of Atrial Fibrillation

Introduction: The use of preprocedural CT or MR imaging to generate patient‐specific cardiac anatomy greatly facilitates catheter ablation of the left atrium and pulmonary veins (LA‐PVs) to treat atrial fibrillation (AF). This report details the accuracy and utility of an intraprocedural means to generate 3‐D volumetric renderings of the LA‐PV anatomy: contrast‐enhanced rotational X‐ray angiography (3DRA).

Automatic determination of minimal cardiac motion phases for computed tomography imaging: initial experience

Low motion phases for cardiac computed tomography reconstructions are currently detected manually in a user-dependent selection process which is often time consuming and suboptimal. The concept of motion maps was recently introduced to achieve automatic phase selection. This pilot study compared the accuracy of motion-map phase selection to that with manual iterative selection. The study included 20 patients, consisting of one group with low and one with high heart rate. The technique automatically derives a motion strength function between multiple low-resolution reconstructions through the cardiac cycle, with periods of lowest difference between neighboring phases indicating minimal cardiac motion. A high level of agreement was found for phase selection achieved with the motion map approach compared with the manual iterative selection process. The motion maps allowed automated quiescent phase detection of the cardiac cycle in 85% of cases, with best results at low heart rates and for the left coronary artery. They can also provide additional information such as the presence of breathing artifacts. Motion maps show promise as a rapid off-line tool to automatically detect quiescent cardiac phases in a variety of patients.

Artifact analysis and reconstruction improvement in helical cardiac cone beam CT

With the introduction of cone beam (CB) scanners, cardiac volumetric computed tomography (CT) imaging has the potential to become a noninvasive imaging tool in clinical routine for the diagnosis of various heart diseases. Heart rate adaptive reconstruction schemes enable the reconstruction of high-resolution volumetric data sets of the heart. Artifacts, caused by strong heart rate variations, high heart rates and obesity, decrease the image quality and the diagnostic value of the images. The image quality suffers from streak artifacts if suboptimal scan and reconstruction parameters are chosen, demanding improved gating techniques. In this paper, an artifact analysis is carried out which addresses the artifacts due to the gating when using a three-dimensional CB cardiac reconstruction technique. An automatic and patient specific cardiac weighting technique is presented in order to improve the image quality. Based on the properties of the reconstruction algorithm, several assessment techniques are introduced which enable the quantitative determination of the cycle-to-cycle transition smoothness and phase homogeneity of the image reconstruction. Projection data of four patients were acquired using a 16-slice CBCT system in low pitch helical mode with parallel electrocardiogram recording. For each patient, image results are presented and discussed in combination with the assessment criteria.

Automatic Segmentation of Rotational X-Ray Images for Anatomic Intra-Procedural Surface Generation in Atrial Fibrillation Ablation Procedures

Since the introduction of 3-D rotational X-ray imaging, protocols for 3-D rotational coronary artery imaging have become widely available in routine clinical practice. Intra-procedural cardiac imaging in a computed tomography (CT)-like fashion has been particularly compelling due to the reduction of clinical overhead and ability to characterize anatomy at the time of intervention. We previously introduced a clinically feasible approach for imaging the left atrium and pulmonary veins (LAPVs) with short contrast bolus injections and scan times of ~ 4-10 s. The resulting data have sufficient image quality for intra-procedural use during electro-anatomic mapping (EAM) and interventional guidance in atrial fibrillation (AF) ablation procedures. In this paper, we present a novel technique to intra-procedural surface generation which integrates fully-automated segmentation of the LAPVs for guidance in AF ablation interventions. Contrast-enhanced rotational X-ray angiography (3-D RA) acquisitions in combination with filtered-back-projection-based reconstruction allows for volumetric interrogation of LAPV anatomy in near-real-time. An automatic model-based segmentation algorithm allows for fast and accurate LAPV mesh generation despite the challenges posed by image quality; relative to pre-procedural cardiac CT/MR, 3-D RA images suffer from more artifacts and reduced signal-to-noise. We validate our integrated method by comparing (1) automatic and manual segmentations of intra-procedural 3-D RA data, (2) automatic segmentations of intra-procedural 3-D RA and pre-procedural CT/MR data, and (3) intra-procedural EAM point cloud data with automatic segmentations of 3-D RA and CT/MR data. Our validation results for automatically segmented intra-procedural 3-D RA data show average segmentation errors of (1) ~ 1.3 mm compared with manual 3-D RA segmentations (2) ~ 2.3 mm compared with automatic segmentation of pre-procedural CT/MR data and (3) ~ 2.1 mm compared with registered intra-procedural EAM point clouds. The overall experiments indicate that LAPV surfaces can be automatically segmented intra-procedurally from 3-D RA data with comparable quality relative to meshes derived from pre-procedural CT/MR.

Cardiac cone‐beam CT volume reconstruction using ART

Modern computed tomography systems allow volume imaging of the heart. Up to now, approximately two-dimensional (2D) and 3D algorithms based on filtered backprojection are used for the reconstruction. These algorithms become more sensitive to artifacts when the cone angle of the x-ray beam increases as it is the current trend of computed tomography (CT) technology. In this paper, we investigate the potential of iterative reconstruction based on the algebraic reconstruction technique (ART) for helical cardiac cone-beam CT. Iterative reconstruction has the advantages that it takes the cone angle into account exactly and that it can be combined with retrospective cardiac gating fairly easily. We introduce a modified ART algorithm for cardiac CT reconstruction. We apply it to clinical cardiac data from a 16-slice CT scanner and compare the images to those obtained with a current analytical reconstruction method. In a second part, we investigate the potential of iterative reconstruction for a large area detector with 256 slices. For the clinical cases, iterative reconstruction produces excellent images of diagnostic quality. For the large area detector, iterative reconstruction produces images superior to analytical reconstruction in terms of cone-beam artifacts.

Intra-operative volume imaging of the left atrium and pulmonary veins with rotational x-ray angiography

Complex electrophysiology (EP) procedures, such as catheter-based ablation in the left atrium and pulmonary veins (LAPV) for treatment of atrial fibrillation, require knowledge of heart chamber anatomy. Electroanatomical mapping (EAM) is typically used to define cardiac structures by combining electromagnetic spatial catheter localization with surface models which interpolate the anatomy between EAM point locations in 3D. Recently, the incorporation of pre-operative volumetric CT or MR data sets has allowed for more detailed maps of LAPV anatomy to be used intra-operatively. Preoperative data sets are however a rough guide since they can be acquired several days to weeks prior to EP intervention. Due to positional and physiological changes, the intra-operative cardiac anatomy can be different from that depicted in the pre-operative data. We present a novel application of contrast-enhanced rotational X-ray imaging for CT-like reconstruction of 3D LAPV anatomy during the intervention itself. We perform two selective contrast-enhanced rotational acquisitions and reconstruct CT-like volumes with 3D filtered back projection. Two volumes depicting the left and right portions of the LAPV are registered and fused. The combined data sets are then visualized and segmented intra-procedurally to provide anatomical data and surface models for intervention guidance. Our results from animal and human experiments indicate that the anatomical information from intra-operative CT-like reconstructions compares favorably with pre-acquired CT data and can be of sufficient quality for intra-operative guidance.

Helical cardiac cone beam CT reconstruction with large area detectors: a simulation study

Retrospectively gated cardiac volume CT imaging has become feasible with the introduction of heart rate adaptive cardiac CT reconstruction algorithms. The development in detector technology and the rapid introduction of multi-row detectors has demanded reconstruction schemes which account for the cone geometry. With the extended cardiac reconstruction (ECR) framework, the idea of approximate helical cone beam CT has been extended to be used with retrospective gating, enabling heart rate adaptive cardiac cone beam reconstruction. In this contribution, the ECR technique is evaluated for systems with an increased number of detector rows, which leads to larger cone angles. A simulation study has been carried out based on a 4D cardiac phantom consisting of a thorax model and a dynamic heart insert. Images have been reconstructed for different detector set-ups. Reconstruction assessment functions have been calculated for the detector set-ups employing different rotation times, relative pitches and heart rates. With the increased volume coverage of large area detector systems, low-pitch scans become feasible without resulting in extensive scan times, inhibiting single breath hold acquisitions. ECR delivers promising image results when being applied to systems with larger cone angles.

Myocardial Perfusion Reserve Assessed by T2-Prepared Steady-State Free Precession Blood Oxygen Level–Dependent Magnetic Resonance Imaging in Comparison to Fractional Flow Reserve

Background—Blood oxygen level–dependent (BOLD) cardiac magnetic resonance imaging (CMR) has been shown to be able to detect myocardial perfusion differences. However, validation of BOLD CMR against fractional flow reserve (FFR) is lacking. The aim of our study was to analyze the potential diagnostic accuracy of BOLD CMR in comparison to invasively measured FFR, which served as gold standard for a hemodynamic significant coronary lesion. Methods and Results—BOLD image was performed at rest and during adenosine infusion in a 1.5-T CMR scanner. Thirty-six patients were analyzed for relative BOLD signal intensity increase according to the 16-segment model. Invasive FFR measurements were performed in the 3 major coronary arteries during adenosine infusion in all patients. An FFR⩽0.8 was regarded to indicate a significant coronary lesion. Relative BOLD signal intensity increase was significantly lower in myocardial segments supplied by coronary arteries with an FFR⩽0.8 compared with segments with an FFR>0.8 (1.1±0.2 versus 1.5±0.2; P<0.0001). Sensitivity and specificity yielded 88.2% and 89.5%, respectively. Conclusions—CMR BOLD imaging reliably detects hemodynamic significant coronary artery disease and is, thus, an alternative to contrast–enhanced perfusion studies.