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Biomedical subjects

Johan H C Reiber

Publications and source records attributed to Johan H C Reiber.

At least 19 recordsLinked to original sources

Results of the first clinical study of adjunctive CAldaret (MCC-135) in patients undergoing primary percutaneous coronary intervention for ST-Elevation Myocardial Infarction: the randomized multicentre CASTEMI study.

AIMS: To examine the safety and efficacy of intravenous caldaret in patients with large acute ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS: STEMI patients (n=387) with > or =10 mm summed ST-deviation on electrocardiogram were randomized to receive a 48 h infusion of caldaret 57.5 mg [lower dose (LD)], caldaret 172.5 mg [higher dose (HD)], or placebo, starting before PCI. Both HD and LD were well tolerated. In 247 patients with pre-PCI TIMI 0/1, there was no effect of HD or LD on single photon emission computed tomography infarct size or ejection fraction assessed at Day 7 and Day 30. Subgroup analyses suggest that future work in patients with anterior MI might be warranted. CONCLUSION: This first human experience with caldaret prior to direct PCI for large STEMI shows a good safety profile. No evidence of efficacy was discerned. Subgroup analyses in anterior MI patients showed some effects in endpoints studied, however, these findings require confirmation in a further study if a drug effect is to be established.

Angioplasty, Balloon, Coronary↗

Shape differences of the brain ventricles in Alzheimer's disease.

The brain ventricles are surrounded by gray and white matter structures that are often affected in dementia in general and Alzheimer's disease (AD) in particular. Any change of volume or shape occurring in these structures must affect the volume and shape of the ventricles. It is well known that ventricular volume is significantly higher in AD patients compared to age-matched healthy subjects. However, the large overlap between the two volume distributions makes the measurement unsuitable as a biomarker of the disease. The purpose of this work was to assess whether local shape differences of the ventricles can be detected when comparing AD patients and controls. In this work, we captured the ventricle's shape and shape variations of 29 AD subjects and 25 age-matched controls, using a fully automatic shape modeling technique. By applying permutation tests on every single node of a mesh representation of the shapes, we identified local areas with significant differences. About 22% of an average surface of the ventricles presented significant difference (P < 0.05) ( approximately 14% of the left against approximately 7% of the right side). We found out that in patients with Alzheimer disease, not only the lateral horns were significantly affected, but also the areas adjacent to the anterior corpus callosum, the splenium of the corpus callosum, the amygdala, the thalamus, the tale of the caudate nuclei (especially the left one), and the head of the left caudate nucleus.

Aged↗

An integrated automated analysis method for quantifying vessel stenosis and plaque burden from carotid MRI images: combined postprocessing of MRA and vessel wall MR.

BACKGROUND AND PURPOSE: We report the evaluation of a semiautomated method for in vivo assessment of the severity of carotid atherosclerosis with minimal user interaction that combines 3-dimensional contrast-enhanced magnetic resonance angiography (CE-MRA) and vessel wall magnetic resonance imaging (MRI). METHODS: Lumen and outer-wall contours were automatically detected, and stenosis and plaque burden were estimated. The method was tested on 22 subjects (352 postcontrast, T1-weighted cross sections and 3-dimensional CE-MRA). RESULTS: We observed good correlation with expert contours: lumen and outer-wall area (r=0.96) and the degree of stenosis (r=0.97). CONCLUSIONS: The fusion of MRA and MRI reduces user interaction and improves contour detection, providing reproducible parameters to assess the severity of atherosclerosis.

Aged↗

Assessment of left ventricular dyssynchrony in patients with conduction delay and idiopathic dilated cardiomyopathy: head-to-head comparison between tissue doppler imaging and velocity-encoded magnetic resonance imaging.

OBJECTIVES: This study sought to compare tissue Doppler imaging (TDI) with velocity-encoded (VE) magnetic resonance imaging (MRI) for left ventricular (LV) dyssynchrony assessment. BACKGROUND: Cardiac resynchronization therapy (CRT) is proposed for patients with heart failure, depressed LV function, and a wide QRS complex. Selection is based mainly on electrocardiogram criteria, but recent data suggest that intraventricular dyssynchrony may be preferred for selection. An LV dyssynchrony can adequately be assessed with TDI, but this has not been compared directly with other imaging modalities. A VE MRI potentially allows direct myocardial wall motion measurements similar to TDI. METHODS: Twenty patients with heart failure, systolic LV dysfunction, and a wide QRS complex were included, as well as 10 normal individuals with normal QRS duration and LV function. The TDI and VE MRI data were acquired to study intraventricular dyssynchrony. RESULTS: Left ventricular dyssynchrony was not observed in normal individuals (mean dyssynchrony -2 +/- 15 ms on TDI; mean -5 +/- 17 ms on MRI, p = NS). In patients, mean LV dyssynchrony was 55 +/- 37 ms on TDI; 49 +/- 38 ms on MRI (p = NS). Good correlation between both modalities was observed (linear regression TDI = 0.99 x MRI - 5, n = 30, r = 0.98, p < 0.01). The MRI showed a small, nonsignificant underestimation of 5 +/- 8 ms compared with TDI. Agreement between MRI and TDI for classification according to severity of LV dyssynchrony (minimal, intermediate, and extensive) was excellent (kappa +/- SE = 0.96 +/- 0.07, p < 0.01) with 95% of patients classified identical. CONCLUSIONS: Both MRI and TDI yield comparable information on LV dyssynchrony; MRI is useful in the selection of patients for CRT.

Adult↗

SPASM: a 3D-ASM for segmentation of sparse and arbitrarily oriented cardiac MRI data.

A new technique (SPASM) based on a 3D-ASM is presented for automatic segmentation of cardiac MRI image data sets consisting of multiple planes with arbitrary orientations, and with large undersampled regions. Model landmark positions are updated in a two-stage iterative process. First, landmark positions close to intersections with images are updated. Second, the update information is propagated to the regions without image information, such that new locations for the whole set of the model landmarks are obtained. Feature point detection is performed by a fuzzy inference system, based on fuzzy C-means clustering. Model parameters were optimized on a computer cluster and the computational load distributed by grid computing. SPASM was applied to image data sets with an increasing sparsity (from 2 to 11 slices) comprising images with different orientations and stemming from different MRI acquisition protocols. Segmentation outcomes and calculated volumes were compared to manual segmentation on a dense short-axis data configuration in a 3D manner. For all data configurations, (sub-)pixel accuracy was achieved. Performance differences between data configurations were significantly different (p<0.05) for SA data sets with less than 6 slices, but not clinically relevant (volume differences<4 ml). Comparison to results from other 3D model-based methods showed that SPASM performs comparable to or better than these other methods, but SPASM uses considerably less image data. Sensitivity to initial model placement proved to be limited within a range of position perturbations of approximately 20 mm in all directions.

Algorithms↗

Is there an effect of flat-panel-based imaging systems on quantitative coronary and vascular angiography?

OBJECTIVES: To study the possible effects on quantitative coronary or vascular analyses (QCA and QVA) on images of a flat-panel-based (FP-based) system. BACKGROUND: Since a few years, more and more cardiovascular X-ray imaging systems are equipped with flat-panel detectors, replacing the conventional image intensifiers in combination with CCD cameras for the creation of the angiographic images. METHODS: To assess any differences in QCA and QVA results from these two types of digital X-ray imaging systems, we performed a quantitative comparison study on images of the Medis coronary and vascular phantom, respectively. All phantom images were acquired on both a FP-based and an image intensifier-based (II-based) imaging system with different system settings (3 different kV-levels and 4 field of view sizes). RESULTS: The QCA and QVA results showed that all the systematic and random errors for the subsets of the FP-based and II-based systems were very small and satisfy the QCA and QVA reference guidelines, though some of the subsets of the FP-based and II-based coronary and vascular phantom images demonstrate a statistically significant difference. However, given the small magnitude of these under- and overestimations under phantom conditions, these differences are considered clinically irrelevant. CONCLUSIONS: The image characteristics of the FP-based images do not have any significant influence on the results of QCA and QVA analyses. As a consequence, a further optimization of the contour detection algorithm is not necessary for FP-based images, and data from both II-based and FP-based X-ray imaging systems can be used collectively in (multicenter) clinical trials.

Angiography↗

Automatic vessel wall contour detection and quantification of wall thickness in in-vivo MR images of the human aorta.

PURPOSE: To develop an automated technique to trace the contours of the lumen and outer boundary of the aortic wall, and measure aortic wall thickness in axial MR images. MATERIALS AND METHODS: The algorithm uses prior knowledge of vessel wall morphology. A geometrical model (ellipse) is deformed, translated and rotated to obtain a rough approximation of the contours. Model-matching is based on image gradient measurements. To enhance edges, the images were preprocessed using gray-level stretching. Refinement is performed by means of dynamic programming. Wall thickness is computed by measuring the distance between inner and outer contour of the aortic wall. RESULTS: The algorithm has been tested on high-resolution axial MR images from 28 human subjects of the descending thoracic aorta. The results demonstrate: High correspondence between automatic and manual area measurements: lumen (r = 0.99), outer (r = 0.96), and wall thickness (r = 0.85). CONCLUSION: Though further optimization is required, our algorithm is a powerful tool to automatically draw the boundaries of the aortic wall and measure aortic wall thickness in aortic wall devoid of major lesions. J. Magn. Reson. Imaging 2006. (c) 2006 Wiley-Liss, Inc.

Aged↗

Time continuous tracking and segmentation of cardiovascular magnetic resonance images using multidimensional dynamic programming.

In this article, we propose a semiautomatic method for time-continuous contour detection in all phases of the cardiac cycle in magnetic resonance sequences. The method is based on multidimensional dynamic programming. After shape parameterization, cost hypercubes are filled with image-feature derived cost function values. Using multidimensional dynamic programming, an optimal path is sought through the sequence of hypercubes. Constraints can be imposed by setting limits to the parameter changes between subsequent hypercubes. Quantitative evaluation was performed on 20 subjects. Average border positioning error over all slices, all phases and all studies, was 1.77 +/- 0.57 mm for epicardial and 1.86 +/- 0.59 mm for endocardial contours. The average error in end-diastolic and end-systolic volumes over all studies was small: 4.24 +/- 4.62 mL and -4.36 +/- 4.26 mL, respectively. The average error in ejection fraction was 4.82 +/- 3.01%. The reported results compare favorable to the best-reported results in recent literature, underlining the potential of this method for application in daily clinical practice.

Algorithms↗

Automated contour detection in X-ray left ventricular angiograms using multiview active appearance models and dynamic programming.

This paper describes a new approach to the automated segmentation of X-ray left ventricular (LV) angiograms, based on active appearance models (AAMs) and dynamic programming. A coupling of shape and texture information between the end-diastolic (ED) and end-systolic (ES) frame was achieved by constructing a multiview AAM. Over-constraining of the model was compensated for by employing dynamic programming, integrating both intensity and motion features in the cost function. Two applications are compared: a semi-automatic method with manual model initialization, and a fully automatic algorithm. The first proved to be highly robust and accurate, demonstrating high clinical relevance. Based on experiments involving 70 patient data sets, the algorithm's success rate was 100% for ED and 99% for ES, with average unsigned border positioning errors of 0.68 mm for ED and 1.45 mm for ES. Calculated volumes were accurate and unbiased. The fully automatic algorithm, with intrinsically less user interaction was less robust, but showed a high potential, mostly due to a controlled gradient descent in updating the model parameters. The success rate of the fully automatic method was 91% for ED and 83% for ES, with average unsigned border positioning errors of 0.79 mm for ED and 1.55 mm for ES.

Algorithms↗

MRI to evaluate left atrial and ventricular reverse remodeling after restrictive mitral annuloplasty in dilated cardiomyopathy.

BACKGROUND: Data on reverse remodeling of the left atrium (LA) and left ventricle (LV) after restrictive annuloplasty in patients with dilated cardiomyopathy are scarce, and follow-up studies are performed with echocardiography. METHODS AND RESULTS: Twenty patients with dilated cardiomyopathy and severe mitral regurgitation selected for restrictive mitral annuloplasty underwent serial MRI studies (within 1 week before surgery, and 2 months [n =18] and 1 year [n =13] after surgery). Early mortality was 10%; all patients were free from endocarditis and thromboembolism. New York Heart Association class improved from 3.2+/-0.4 to 1.2+/-0.9. Only 1 patient developed recurrent severe mitral regurgitation during follow-up and it was re-repaired. LA end-systolic volumes decreased significantly over time (from 165+/-48 mL to 109+/-23 mL to 111+/-28 mL; P < 0.01), as did LA end-diastolic volumes (from 92+/-32 mL to 71+/-22 mL to 75+/-17 mL; P = 0.01). LV end-diastolic volumes decreased significantly (from 244+/-56 mL to 184+/-54 mL to 195+/-67 mL; P < 0.01), whereas end-systolic volumes did not change significantly. LV ejection fraction increased significantly (from 35+/-8% to 46+/-13% to 46+/-15%; P < 0.01) and LV mass decreased significantly (from 150+/-43 grams to 132+/-39 grams to 136+/-33 grams; P = 0.02). CONCLUSIONS: Restrictive annuloplasty in patients with dilated cardiomyopathy yielded excellent clinical results associated with significant LA and LV reverse remodeling over time as demonstrated by MRI.

Adult↗

Influence of positional and angular variation of automatically planned short-axis stacks on quantification of left ventricular dimensions and function with cardiovascular magnetic resonance.

PURPOSE: To theoretically and experimentally investigate the influence of the automated cardiovascular magnetic resonance (CMR) scan planning pitfalls, namely inaccurate positioning and tilting of short-axis (SA) imaging planes, on quantification of the left ventricular (LV) dimensions and function. MATERIALS AND METHODS: Eleven healthy subjects and eight patients underwent CMR. Manually and automatically planned SA sets were acquired. To obtain the quantitative measurements of LV function, one observer performed image analysis twice. The agreement between planning methods, as well as the decomposition of the total variation into interstudy and intraobserver components was measured. RESULTS: The decomposition of the total variation showed that the interstudy factor accounts for 70-85% of the total variation, while the rest is due to the intraobserver factor. Moreover, the relative contribution of the interstudy factor remains independent from errors in slice positioning and small angular deviation of SA stacks from the optimal orientation. Good agreement between the theoretical and measured variability factors was observed. CONCLUSION: Global LV function derived from the automatically planned CMR acquisitions yield accurate quantification of the human cardiovascular system. Inaccurate positioning and tilting of SA images does not affect the quantitative measurements of LV function. The computer-aided system for automated CMR has proven clinical applicability.

Adult↗

Automatic initialization algorithm for carotid artery segmentation in CTA images.

Analysis of CT datasets is commonly time consuming because of the required manual interaction. We present a novel and fast automatic initialization algorithm to detect the carotid arteries providing a fully automated approach of the segmentation and centerline detection. First, the volume of interest (VOI) is estimated using a shoulder landmark. The carotid arteries are subsequently detected in axial slices of the VOI by applying a circular Hough transform. To select carotid arteries related signals in the Hough space, a 3-D, direction dependent hierarchical clustering is used. To allow a successful detection for a wide range of vessel diameters, a feedback architecture was introduced. The algorithm was designed and optimized using a training set of 20 patients and subsequently evaluated using 31 test datasets. The detection algorithm, including VOI estimation, correctly detects 88% of the carotid arteries. Even though not all carotid arteries have been correctly detected, the results are very promising.

Algorithms↗

Fully automatic shape modelling using growing cell.

In this paper, we present a new framework for shape modelling and analysis: we suggest to look at the problem from a pattern recognition point of view, and claim that under this prospective several advantages are achieved. The modelling of a surface with a point distribution model is seen as an unsupervised clustering problem, and tackled by using growing cell structures. The adaptation of a model to new shapes is studied as a classification task, and provides a straightforward solution to the point correspondence problem in active shape modelling. The method is illustrated and tested in 3D synthetic datasets and applied to the modelling of brain ventricles in an elderly population.

Cerebral Ventricles↗

Towards quantitative analysis of coronary CTA.

The current high spatial and temporal resolution, multi-slice imaging capability, and ECG-gated reconstruction of multi-slice computed tomography (MSCT) allows the non-invasive 3D imaging of opacified coronary arteries. MSCT coronary angiography studies are currently carried out by the visual inspection of the degree of stenosis and it has been shown that the assessment with sensitivities and specificities of 90% and higher can be achieved. To increase the reproducibility of the analysis, we present a method that performs the quantitative analysis of coronary artery diseases with limited user interaction: only the positioning of one or two seed points is required. The method allows the segmentation of the entire left or right coronary tree by the positioning of a single seed point, and an extensive evaluation of a particular vessel segment by placing a proximal and distal seed point. The presented method consists of: (1) the segmentation of the coronary vessels, (2) the extraction of the vessel centerline, (3) the reformatting of the image volume, (4) a combination of longitudinal and transversal contour detection, and (5) the quantification of vessel morphological parameters. The method is illustrated in this paper by the segmentation of the left and right coronary trees and by the analysis of a coronary artery segment. The sensitivity of the positioning of the seed points is studied by varying the position of the proximal and distal seed points with a standard deviation of 6 and 8 mm (along the vessel's course) respectively. It is shown that only close to the individual seed points the vessel centerlines deviate and that for more than 80% of the centerlines the paths coincide. Since the quantification depends on the determination of the centerline, no user variability is expected as long as the seed points are positioned reasonably far away from the vessel lesion. The major bottleneck of MSCT imaging of the coronary arteries is the potential lack of image quality due to limitations in the spatial and temporal resolution, irregular or high heart beat, respiratory effects, and variations of the distribution of the contrast agent: the number of rejected vessel segments in diagnostic studies is currently still too high for implementation in routine clinical practice. Also for the automated quantitative analysis of the coronary arteries high image quality is required. However, based upon the trend in technological development of MSCT scanners, there is no doubt that the quantitative analysis of MSCT coronary angiography will benefit from these technological advances in the near future.

Coronary Angiography↗

Computer-aided diagnosis via model-based shape analysis: automated classification of wall motion abnormalities in echocardiograms.

RATIONALE AND OBJECTIVE: Shape analysis of endocardial contour sequences from echocardiograms can provide classification of wall motion abnormalities (WMA). MATERIALS AND METHODS: We previously reported on active appearance motion models (AAMM) for automated detection of endocardial contours in sequences of echocardiograms. The shape analysis of AAMM renders eigenvariations of shape/motion, including typical normal and pathologic endocardial contraction patterns. A set of stress echocardiograms (single-beat four-chamber and two-chamber sequences with expert-verified endocardial contours) of 129 infarct patients was split randomly into training (n = 65) and testing (n = 64) sets. AAMMs were generated from the training set and AAMM shape coefficients (ASCs) were extracted for all sequences and statistically related to regional/global visual wall motion scoring (VWMS) and volumetric parameters. RESULTS: Linear regression showed clear correlations between ASCs and VWMS. Discriminant analysis showed good prediction by ASCs of both segmental (74% correctness) and global WMA (90% correctness). Volumetric parameters correlated poorly to regional VWMS. CONCLUSION: 1) ASCs show promising accuracy for automated WMA classification. 2) VWMS and endocardial border motion are closely related; with accurate automated border detection, automated WMA classification should be feasible. 3) ASC shape analysis allows contour set evaluation by direct comparison to clinical parameters.

Cardiac Volume↗

Left ventricular volume estimation in cardiac three-dimensional ultrasound: a semiautomatic border detection approach.

RATIONALE AND OBJECTIVES: We propose a semiautomatic endocardial border detection method for three-dimensional (3D) time series of cardiac ultrasound (US) data based on pattern matching and dynamic programming, operating on two-dimensional (2D) slices of the 3D plus time data, for the estimation of full cycle left ventricular volume, with minimal user interaction. MATERIALS AND METHODS: The presented method is generally applicable to 3D US data and evaluated on data acquired with the Fast Rotating Ultrasound (FRU-) Transducer, developed by Erasmus Medical Center (Rotterdam, the Netherlands), a conventional phased-array transducer, rotating at very high speed around its image axis. The detection is based on endocardial edge pattern matching using dynamic programming, which is constrained by a 3D plus time shape model. It is applied to an automatically selected subset of 2D images of the original data set, for typically 10 equidistant rotation angles and 16 cardiac phases (160 images). Initialization requires the drawing of four contours per patient manually. We evaluated this method on 14 patients against MRI end-diastole and end-systole volumes. Initialization requires the drawing of four contours per patient manually. We evaluated this method on 14 patients against MRI end-diastolic (ED) and end-systolic (ES) volumes. RESULTS: The semiautomatic border detection approach shows good correlations with MRI ED/ES volumes (r = 0.938) and low interobserver variability (y = 1.005x - 16.7, r = 0.943) over full-cycle volume estimations. It shows a high consistency in tracking the user-defined initial borders over space and time. CONCLUSIONS: We show that the ease of the acquisition using the FRU-transducer and the semiautomatic endocardial border detection method together can provide a way to quickly estimate the left ventricular volume over the full cardiac cycle using little user interaction.

Algorithms↗

Atrioventricular conduction in mammalian species: hemodynamic and electrical scaling.

OBJECTIVES: The purpose of this study was to investigate scaling of the duration of late diastolic left ventricular (LV) filling in relation to AV conduction time (delay) (PR interval on the ECG) in mammals. BACKGROUND: From mouse to whale, AV delay increases 10-fold, whereas body mass increases one million-fold. The apparent "mismatch" results from scaling of AV delay versus body and heart mass. METHODS: We measured (1) mitral orifice diameter in 138 postmortem hearts of 48 mammalian species weighing between 17 g and 250 kg and (2) transmitral diastolic flow using magnetic resonance imaging (MRI) recordings of 10 healthy human individuals. (3) We visually inspected early and late diastolic LV filling. (4) We developed two physical models to explain scaling of late diastolic LV filling time. RESULTS: (1) Diameter of the mitral orifice proportionally relates to heart length (third root of heart mass). (2) Atrial contraction starts at a fixed instant (+/- 80%) of the (normalized) cardiac cycle and contributes 31% +/- 5% to LV filling. (3) MRI shows that during diastole, the left atrium (LA) and LV form a single space. (4) The physical models relate the duration of late diastolic LV filling directly to heart length, the third root of heart mass. CONCLUSIONS: (1) Late diastolic (LV) filling time scales with heart length (third root of heart mass). (2) No "mismatch" exists between AV delay and heart size. (3) Knowledge of the actual starting time of atrial contraction may contribute to better treatment of patients with heart failure. (4) The findings suggest that in evolution of mammalian species, hemodynamics commands electrical behavior of the heart.

Animals↗