Therenva, 35000, Rennes, France.
Department of Cardiothoracic and Vascular Surgery, CHU Rennes, 35033, Rennes, France.
Int J Comput Assist Radiol Surg. 2018 Jul;13(7):997-1007. doi: 10.1007/s11548-018-1731-9. Epub 2018 Mar 16.
Interventional endovascular treatment has become the first line of management in the treatment of peripheral artery disease (PAD). However, contrast and radiation exposure continue to limit the feasibility of these procedures. This paper presents a novel hybrid image fusion system for endovascular intervention of PAD. We present two different roadmapping methods from intra- and pre-interventional imaging that can be used either simultaneously or independently, constituting the navigation system.
The navigation system is decomposed into several steps that can be entirely integrated within the procedure workflow without modifying it to benefit from the roadmapping. First, a 2D panorama of the entire peripheral artery system is automatically created based on a sequence of stepping fluoroscopic images acquired during the intra-interventional diagnosis phase. During the interventional phase, the live image can be synchronized on the panorama to form the basis of the image fusion system. Two types of augmented information are then integrated. First, an angiography panorama is proposed to avoid contrast media re-injection. Information exploiting the pre-interventional computed tomography angiography (CTA) is also brought to the surgeon by means of semiautomatic 3D/2D registration on the 2D panorama. Each step of the workflow was independently validated.
Experiments for both the 2D panorama creation and the synchronization processes showed very accurate results (errors of 1.24 and [Formula: see text] mm, respectively), similarly to the registration on the 3D CTA (errors of [Formula: see text] mm), with minimal user interaction and very low computation time. First results of an on-going clinical study highlighted its major clinical added value on intraoperative parameters.
No image fusion system has been proposed yet for endovascular procedures of PAD in lower extremities. More globally, such a navigation system, combining image fusion from different 2D and 3D image sources, is novel in the field of endovascular procedures.
介入血管内治疗已成为外周动脉疾病（PAD）治疗的首选方法。然而，对比剂和辐射暴露仍然限制了这些手术的可行性。本文提出了一种用于 PAD 血管内介入的新型混合图像融合系统。我们提出了两种来自于介入前和介入内成像的不同的配准方法，它们可以同时或独立使用，构成导航系统。
导航系统分解为几个步骤，可以完全集成在程序工作流程中，而无需修改它以从配准中受益。首先，根据介入诊断阶段期间获取的一系列步进荧光透视图像，自动创建整个外周动脉系统的 2D 全景图。在介入阶段，可以将实时图像同步到全景图上，形成图像融合系统的基础。然后集成两种类型的增强信息。首先，提出血管造影全景图以避免对比剂再注射。还通过在 2D 全景图上进行半自动 3D/2D 配准，将利用介入前计算机断层血管造影（CTA）的信息带给外科医生。工作流程的每个步骤都进行了独立验证。
2D 全景图创建和同步过程的实验都显示出非常准确的结果（误差分别为 1.24 和 [Formula: see text]mm），与 3D CTA 上的配准（误差为 [Formula: see text]mm）类似，用户交互最少，计算时间非常短。正在进行的临床研究的初步结果强调了其在术中参数方面的主要临床附加值。
目前还没有提出用于下肢 PAD 血管内手术的图像融合系统。更广泛地说，这种结合来自不同 2D 和 3D 图像源的图像融合的导航系统在血管内手术领域是新颖的。
