Siogkas Panagiotis K, Stefanou Kostas A, Athanasiou Lambros S, Papafaklis Michail I, Michalis Lampros K, Fotiadis Dimitrios I
Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece.
Harvard - MIT Biomedical Engineering Center, Massachusetts Institute of Technology, Cambridge, MA, USA.
Technol Health Care. 2018;26(1):187-193. doi: 10.3233/THC-170881.
Due to the incremental increase of clinical interest in the development of software that allows the 3-dimensional (3D) reconstruction and the functional assessment of the coronary vasculature, several software packages have been developed and are available today.
Taking this into consideration, we have developed an innovative suite of software modules that perform 3D reconstruction of coronary arterial segments using different coronary imaging modalities such as IntraVascular UltraSound (IVUS) and invasive coronary angiography images (ICA), Optical Coherence Tomography (OCT) and ICA images, or plain ICA images and can safely and accurately assess the hemodynamic status of the artery of interest.
The user can perform automated or manual segmentation of the IVUS or OCT images, visualize in 3D the reconstructed vessel and export it to formats, which are compatible with other Computer Aided Design (CAD) software systems. We employ finite elements to provide the capability to assess the hemodynamic functionality of the reconstructed vessels by calculating the virtual functional assessment index (vFAI), an index that corresponds and has been shown to correlate well to the actual fractional flow reserve (FFR) value.
All the modules of the proposed system have been thoroughly validated. In brief, the 3D-QCA module, compared to a successful commercial software of the same genre, presented very good correlation using several validation metrics, with a Pearson's correlation coefficient (R) for the calculated volumes, vFAI, length and minimum lumen diameter of 0.99, 0.99, 0.99 and 0.88, respectively. Moreover, the automatic lumen detection modules for IVUS and OCT presented very high accuracy compared to the annotations by medical experts with the Pearson's correlation coefficient reaching the values of 0.94 and 0.99, respectively.
In this study, we have presented a user-friendly software for the 3D reconstruction of coronary arterial segments and the accurate hemodynamic assessment of the severity of existing stenosis.
由于临床上对开发能够进行冠状动脉血管三维（3D）重建和功能评估的软件的兴趣与日俱增，目前已经开发出了几个软件包并可供使用。
考虑到这一点，我们开发了一套创新的软件模块，该模块使用不同的冠状动脉成像方式，如血管内超声（IVUS）和有创冠状动脉造影图像（ICA）、光学相干断层扫描（OCT）和ICA图像，或单纯的ICA图像，对冠状动脉节段进行3D重建，并能够安全、准确地评估感兴趣动脉的血流动力学状态。
用户可以对IVUS或OCT图像进行自动或手动分割，以3D形式可视化重建的血管，并将其导出为与其他计算机辅助设计（CAD）软件系统兼容的格式。我们采用有限元方法，通过计算虚拟功能评估指数（vFAI）来评估重建血管的血流动力学功能，该指数与实际血流储备分数（FFR）值相对应，并且已被证明具有良好的相关性。
所提出系统的所有模块均已得到充分验证。简而言之，与同一类别的成功商业软件相比，3D-QCA模块使用多种验证指标呈现出非常好的相关性，计算体积、vFAI、长度和最小管腔直径的皮尔逊相关系数（R）分别为0.99、0.99、0.99和0.88。此外，与医学专家的注释相比，IVUS和OCT的自动管腔检测模块呈现出非常高的准确性，皮尔逊相关系数分别达到0.94和0.99。
在本研究中，我们展示了一款用户友好的软件，用于冠状动脉节段的3D重建以及对现有狭窄严重程度的准确血流动力学评估。
