U. Renneisen

Improving the applicability of myocardial densitometry and parametric imaging by extended automated densogram analysis

In clinical applications the analysis of X-ray contrast densograms acquired in regions of interest (ROIs) over the myocardium is disturbed by many complex factors. For this reason we acquire redundant densogram information for quality control before extracting densitometric parameters. In our approach, initially some stable measures of quality for densograms are used to lower the influence of poor quality densograms by a quality weighted averaging. For example a shape quality measure, Q1, is calculated using regions of optimal and minimal acceptable quality defined with respect to a prototype densogram. Not a few myocardial ROIs yield densograms that differ from single-source densograms (SSDs) due to e.g. superposition of different perfusion beds or the position of the ROI relative to the coronary sinus or stenoses. This might result in a densogram shape with oscillating or plateau behavior. For densograms of a such general shape many parameters defined in the usual way do not depend smoothly on the densogram values. The conventional definitions of some parameters (appearance time, rise time) are therefore extended for application to multi-maxima densograms as well as to SSDs. These new methods are evaluated using digitized clinical angiocardiograms and are applied to parametric imaging (pixeldensograms) in a slightly modified way. Taking into account the densogram quality, its shape and its origin results in a considerable improvement both for densitometry and parametric imaging of myocardial perfusion.

Parametric assessment of myocardial perfusion during interventional cardiac catheterization by means of X-ray densitometry — short — and long-term results

SummaryX-ray densitometric evaluation of digital subtraction angiocardiograms allows an assessment of myocardial perfusion by means of the parameter ‘MEAN RISE TIME’ (MRT), defined as the time from the onset of local myocardial contrast medium opacification to the point of maximum opacification. Best results are obtained when the response of that parameter is compared before and after stimulation of coronary flow by papaverine. A prolongation of this parameter, especially after papaverine, was indicative of an impairment of myocardial perfusion, when compared to the results obtained by TL-201 scintigraphy.In 50 patients with single vessel coronary artery disease the results of MRT pre and post papaverine before and after coronary angioplasty, as well as after 6 months were evaluated for 204 post-stenotic regions-of-interest. Before angioplasty papaverine induced a significant prolongation of post-stenotic MRT (2.3s ± 0.9s vs. 3.1s ± 0.8s; p<0.01), while after successful angioplasty post-stenotic MRT was measured significantly shorter after stimulation of coronary flow (2.6s ± 1.0s vs. 1.9s ± 0.9s; p<0.01). This indicated an improvement in myocardial perfusion. Nevertheless, 16/50 patients still presented pathological results of post-stenotic MRT after papaverine, although angioplasty was regarded successful. These patients presented a markedly higher rate of restenosis (14/16 patients after 6 months), a higher rate of dissections at the dilatation site and a higher rate of dilated vessels, supplying myocardial areas after a Q-wave myocardial infarction.Thus, these results demonstrate the additional information about the short-and long-term outcome of an angioplasty procedure by densitometric myocardial perfusion analysis.

New techniques for visualization of losses due to image compression in grayscale medical still images

To evaluate the visual influence of irreversible compression on medical images, changes of the images have to be visualized. The authors have explored alternative techniques to be used instead of the usual side-by-side comparison, where the information contained in both images is perceived in a single image, preserving the context between compression errors and image structures. Thus fast and easy comparison can be done. These techniques make use of the human ability to perceive information also in the dimensions of color, space, and time. A study was performed with JPEG-compressed coronary angiographic images. Changes in the resulting images for six compression factors from 7 to 30 were scored by an observer. The results show that medically relevant changes, using the JPEG algorithm, appear between compression ratios of 7:1 and 10:1.<<ETX>>

Determination of myocardial perfusion and coronary flow reserve by densitometric measurements: a selective classification of regions of interest

To evaluate the functional effect of a coronary artery stenosis on the dependent myocardium, digitized coronary angiograms (DCAs) were recorded. The DCAs, acquired during heart catheterization, provide information about myocardial perfusion and coronary flow reserve of areas supplied by this coronary artery. For each analysis the myocardium is separated into different regions of interest (ROIs); 16 ROIs in the distribution of the LCA and 8 ROIs for the RCA. In addition to that, the ROIs of the diseased vessels are divided into ROIs which are proximal, within and distal to the stenosis. Using a semiautomatic procedure, densograms are constructed from which the parameter rise time is calculated.<<ETX>>

Medizinische Relevanz von Bildkompressionsverlusten bei digitalen Koronarangiographien am Beispiel des JPEG-Algorithmus

Die effiziente Übertragung und Speicherung sehr großer Datenmengen spielt bei medizinischen Bilddaten speziell in der Kardiologie eine immer größere Rolle. Auch in Zukunft wird aufgrund steigender Anforderungen die Echtzeit-Datenkompression eine Schlüsselrolle bei der Lösung dieser Probleme darstellen. Mit verlustfreien DatenkompressionsAlgorithmen werden hier nur geringe Kompressionsfaktoren von etwa 2 bis 3 erreicht. Bei Verzicht auf Verlustfreiheit sind wesentlich höhere Faktoren möglich; Faktoren zwischen 20 und 30 sind bereits berichtet worden.