DBP: Image Analysis for Atrial Arrhythmias · • MIT: Robust atlas-based segmentation of highly...
Transcript of DBP: Image Analysis for Atrial Arrhythmias · • MIT: Robust atlas-based segmentation of highly...
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COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
DBP: Image Analysis for Atrial Arrhythmias
Rob MacLeod, PhDSCI Institute, Dept. of Bioengineering
CVRTI, CARMAUniversity of Utah
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Driven (Crazy?) by Doctors
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The CARMA Team
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COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
CARMA = Comprehensive Arrhythmia Research and
MAnagement
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Normal Contraction Atrial Fibrillation
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What We Know About AF
Substrate Triggers
*
PulmonaryVeins
Left Atrium
**
*
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What We Do Not Know about AF: Everything Else
Mechanisms Time Course EnvironmentalFactors
Genetics
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The Million $ Mechanistic QuestionAfib begets Afib
Afib is a tissue disease
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Structure is Important
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The CARMA Mantra“AF is a heart tissue disease”
“Fibrotic Atrial Cardiac Myopathy (FACM)” Kottkamp H: J Cardiovasc Electrophysiol 2012;23:797-799
Ausma J, .... Allessie M ...J mol Cell Cardiol. 2001: 2083.
Normal Early stage Mid stage Late stage
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Effective Treatment of AF Eventually Involves Intervention
TriggeringFoci
Atrial Septum
SuperiorVena Cava
InferiorVena Cava
LeftAtrium
PulmonaryVeins
RightVentricle
LeftVentricle
RightAtrium
MappingCatheter
AblationCatheter
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CARMA Started HerePseudo-color
Normal
Low-voltageEnhanced(fibrosis?)
Pseudo-color
Normal
Low-voltageEnhanced(fibrosis?)
Electroanatomical Map
Electroanatomical Map
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Utah Scoring Scheme: 2011
Akoum et al. J Cardiovasc Electrophysiol, 22:16-22, 2011
< 5% 5-20%
20-35% > 35%
Nazem Akoum
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Fibrosis Predicts Outcome of Ablation Therapy
!
Utah I
Utah II
Utah III
Utah IV
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Utah Stages: Latest Edition
<10% 10-20%
20-30% >30%
Chris McGann
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Utah Stages: Latest Edition
Utah IUtah IIUtah III
Utah IV
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It is MRI but is it Real?
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Blue is Normal
epi
endo
Chris McGann
Amit Patel
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Green is Fibrosis
endo
epi
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Histology SummaryControl AF-mix AF-fibrosis
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Not All Lesions Can Be Effective
Epicardial
Not Effective
Potentially Effective
Likely Effective
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COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
DE-MRI Determinant of Successful Catheter
Ablation of Atrial Fibrillation (DECAAF)
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Inclusion
CARMA/SCI - Univeristy of Utah
DE-MRI Ablation Followup
AFIS
Image Processing& Analysis
Statistics Core
FTP (SCI) WWW
Collaborator
DECAAF Organization
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COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
Late Breaking Abstract at
AmericanCollege of Cardiology Meeting
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COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
Along Came NAMIC
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AF Specific Aims
SegmentationRegistration Quantification
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The CARMA AF Workflow
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Implementing the Workflow
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Corview to Slicer
Commercialization
Research
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Slicer: Intensity Correction
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Slicer: Registration
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Slicer: Scar Detection
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Slicer: Pulmonary Vein Removal
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Slicer: CARMA Workflow
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CARMA Makes Data Available!
60 Patients with multiple MRI scans
http://www.insight-journal.org/midas
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COMPREHENSIVE ARRYTHMIARESEARCH & MANAGEMENT CENTER
What Does CARMA Bring to NA-MIC?
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Access to Image Based Medicine
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Access to Data
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Real World Testing
• KCL: Left atrium segmentation for atrial fibrillation ablation, Karim, et al., Proc. SPIE Medical Imaging, 2008
• MIT: Robust atlas-based segmentation of highly variable anatomy: left atrium segmentation, Depa, et al., Statistical Atlases and Computational Models of the Heart, 2010
• GA Tech: Segmentation of the Endocardial Wall of the Left Atrium using Local Region-Based Active Contours and Statistical Shape Learning, Gholami, et al., 2010
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DisseminationCARMA
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