The carotid atheromatous plaque: a multi-disciplinary ...
Transcript of The carotid atheromatous plaque: a multi-disciplinary ...
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The carotid atheromatous plaque: a multi-disciplinary approach towards optimal management of symptomatic
and asymptomatic subjects
Spyretta Golemati, PhD
Lecturer in Biomedical Engineering, Medical School, National Kapodistrian University of Athens
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09-SYN-1054 Carotid Atheromatosis
Concept and objectives
Concept Multi-disciplinary approach
Clinical features Biochemical features Imaging features Mechanical features
Objectives To produce new knowledge
Optimal management of patients Academic excellence
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09-SYN-1054 Carotid Atheromatosis
Project overview Carotid
Clinical data Biological material Imaging data
Analysis of ultrasound images Texture analysis Motion analysis
Computerised model
Information system
Data collection
Data analysis
Interpretation
Analysis of biological material
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09-SYN-1054 Carotid Atheromatosis
Participants
Participant 1 Laboratory of Biomedical Engineering, ICCS – NTUA 2 Vascular Surgery/Radiology/Diagnostic Cytology Depts, Medical
School, UOA (‘Attikon’ Hospital) 3 VIDAVO 4 DIGIMED 5 Medical Imaging & Computer Vision Group, Ecole Centrale, Paris
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09-SYN-1054 Carotid Atheromatosis
Questions
Why carotid atherosclerosis? What could be improved in patient
management? What tools could be used?
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09-SYN-1054 Carotid Atheromatosis
Carotid atherosclerosis
Carotid artery
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09-SYN-1054 Carotid Atheromatosis
Carotid atherosclerosis
Carotid artery disease
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09-SYN-1054 Carotid Atheromatosis
Carotid atherosclerosis
Symptoms Strokes, ischaemic attacks, amaurosis fugax
Incidence 260/100 000 population in Greece
Cost € 38 billion in EU
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09-SYN-1054 Carotid Atheromatosis
Diagnosis: ultrasound imaging
Colour Doppler B-mode
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09-SYN-1054 Carotid Atheromatosis
Therapy
Medical treatment (e.g. statins) Surgical intervention
Stenting Endarterectomy
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Therapeutic decision
DS > 70% DS < 70% DS > 50% DS < 50% Symptomatic - - surgery no surgery Asymptomatic surgery no surgery - -
DS: degree of stenosis
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Improve decision making
Better identification of patients for surgical intervention Some patients are offered unnecessary
interventions Some patients are not offered necessary
interventions
Increased patient safety
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09-SYN-1054 Carotid Atheromatosis
Examples of carotid image sequences
Young normal Elderly normal Atheromatic plaque –
Elderly
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09-SYN-1054 Carotid Atheromatosis
Ultrasound image analysis
Texture analysis Motion analysis Automatic segmentation
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Texture analysis
Asymptomatic Symptomatic
Systole
Diastole
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Texture analysis
Histogram-based features Gray-scale median (GSM)
Statistical features Model-based methods Multiscale features
wavelet transforms rigdelet/curvelet transforms ~ 80% classification
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Texture analysis
Clinical significance Characterise the underlying material distribution Discriminate between stable and unstable cases
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Motion analysis
Characterise mechanical strains Radial, longitudinal directions
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Motion analysis
Weighted-least-squares optical flow (Lucas&Kanade) Affine block motion model Adaptive block matching Block matching Optical flow (Horn&Schunck)
accuracy
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Motion analysis
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Motion analysis
Displacement maps
radi
al
long
itudi
nal
disp
lace
men
t (m
m)
1st cardiac cycle 2nd cardiac cycle 3rd cardiac cycle
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Motion analysis
Displacement maps
radi
al
longitu
dinal
disp
lace
men
t (m
m)
1st cardiac cycle 2nd cardiac cycle 3rd cardiac cycle
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Motion analysis
Strain maps
radi
al
long
itudi
nal
cardiac systole cardiac diastole
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09-SYN-1054 Carotid Atheromatosis
Motion analysis
Clinical significance Elasticity (mechanical) features Functional information
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Automatic segmentation Transverse section Longitudinal section
Hough transform (HT)
HT-initialized snakes
WT-initialized snakes
young elderly
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Automatic segmentation
Clinical significance Automate the procedures
Diameter estimation Wall thickness Degree of stenosis
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‘Carotid atheromatosis’
Ultrasound-image-based features +
Biochemical markers +
Clinical information
Identify novel combined indices of disease
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Conclusion
Improve management of carotid atherosclerosis Re-evaluate the role of ultrasound imaging Consider in combination with other imaging
modalities, e.g. CT, MRI