Lalys Florent, Esneault Simon, Castro Miguel, Royer Lucas, Haigron Pascal, Auffret Vincent, Tomasi Jacques
a Therenva , Rennes , France.
b INSERM , Rennes , France.
Minim Invasive Ther Allied Technol. 2019 Jun;28(3):157-164. doi: 10.1080/13645706.2018.1488734. Epub 2018 Jul 24.
Minimally invasive trans-catheter aortic valve implantation (TAVI) has emerged as a treatment of choice for high-risk patients with severe aortic stenosis. However, the planning of TAVI procedures would greatly benefit from automation to speed up, secure and guide the deployment of the prosthetic valve. We propose a hybrid approach allowing the computation of relevant anatomical measurements along with an enhanced visualization.
After an initial step of centerline detection and aorta segmentation, model-based and statistical-based methods are used in combination with 3 D active contour models to exploit the complementary aspects of these methods and automatically detect aortic leaflets and coronary ostia locations. Important anatomical measurements are then derived from these landmarks.
A validation on 50 patients showed good precision with respect to expert sizing for the ascending aorta diameter calculation (2.2 ± 2.1 mm), the annulus diameter (1.31 ± 0.75 mm), and both the right and left coronary ostia detection (1.96 ± 0.87 mm and 1.80 ± 0.74 mm, respectively). The visualization is enhanced thanks to the aorta and aortic root segmentation, the latter showing good agreement with manual expert delineation (Jaccard index: 0.96 ± 0.03).
This pipeline is promising and could greatly facilitate TAVI planning.
微创经导管主动脉瓣植入术（TAVI）已成为高危重度主动脉瓣狭窄患者的首选治疗方法。然而，TAVI手术的规划若能实现自动化，将极大地有助于加快人工瓣膜的植入速度、确保植入安全并提供植入引导。我们提出一种混合方法，可计算相关解剖测量值并增强可视化效果。
在中心线检测和主动脉分割的初始步骤之后，基于模型和基于统计的方法与3D活动轮廓模型结合使用，以利用这些方法的互补性，自动检测主动脉瓣叶和冠状动脉开口位置。然后从这些标志点得出重要的解剖测量值。
对50例患者的验证表明，在升主动脉直径计算（2.2±2.1毫米）、瓣环直径（1.31±0.75毫米）以及左右冠状动脉开口检测（分别为1.96±0.87毫米和1.80±0.74毫米）方面，与专家测量尺寸相比具有良好的精度。由于主动脉和主动脉根部的分割，可视化效果得到增强，后者与专家手动勾勒显示出良好的一致性（杰卡德指数：0.96±0.03）。
该流程很有前景，可极大地促进TAVI手术规划。
