Abstract
BackgroundThis study aimed to assess the error of different registration techniques and imaging modalities for fusion imaging of the aorta in a standardized setting using a anthropomorphic body phantom.Materials and methodsA phantom with the 3D printed vasculature of a patient suffering from an infrarenal aortic aneurysm was constructed. Pulsatile flow was generated via an external pump. CTA/MRA of the phantom was performed, and a virtual 3D vascular model was computed. Subsequently, fusion imaging was performed employing 3D-3D and 2D-3D registration techniques. Accuracy of the registration was evaluated from 7 right/left anterior oblique c-arm angulations using the agreement of centerlines and landmarks between the phantom vessels and the virtual 3D virtual vascular model. Differences between imaging modalities were assessed in a head-to-head comparison based on centerline deviation. Statistics included the comparison of means ± standard deviations, student’s t-test, Bland-Altman analysis, and intraclass correlation coefficient for intra- and inter-reader analysis.Results3D-3D registration was superior to 2D-3D registration, with the highest mean centerline deviation being 1.67 ± 0.24 mm compared to 4.47 ± 0.92 mm. The highest absolute deviation was 3.25 mm for 3D-3D and 6.25 mm for 2D-3D registration. Differences for all angulations between registration techniques reached statistical significance. A decrease in registration accuracy was observed for c-arm angulations beyond 30° right anterior oblique/left anterior oblique. All landmarks (100%) were correctly positioned using 3D-3D registration compared to 81% using 2D-3D registration. Differences in accuracy between CT and MRI were acceptably small. Intra- and inter-reader reliability was excellent.ConclusionIn the realm of registration techniques, the 3D-3D method proved more accurate than did the 2D-3D method. Based on our data, the use of 2D-3D registration for interventions with high registration quality requirements (e.g., fenestrated aortic repair procedures) cannot be fully recommended. Regarding imaging modalities, CTA and MRA can be used equivalently.
Highlights
Endovascular therapy for vascular pathologies has become an established technique on par with surgical therapy in many vascular territories (Feezor et al 2007; Indes et al 2013; Mandawat et al 2012)
3D-3D registration was superior to 2D-3D registration, with the highest mean centerline deviation being 1.67 ± 0.24 mm compared to 4.47 ± 0.92 mm
A decrease in registration accuracy was observed for c-arm angulations beyond 30° right anterior oblique/left anterior oblique
Summary
Endovascular therapy for vascular pathologies has become an established technique on par with surgical therapy in many vascular territories (Feezor et al 2007; Indes et al 2013; Mandawat et al 2012). Fusion imaging (FI) is becoming more established as an add-on technique for significantly reducing CM doses and radiation exposure in various endovascular procedures (Stahlberg et al 2019; Goudeketting et al 2018; Sailer et al 2015; Swerdlow et al 2019; Goudeketting et al 2017). The two established registration methods (2-dimensional-3-dimensional (2D-3D) registration; 3D-3D registration) differ in the resulting accuracy, and in the technical complexity of the registration and the required radiation doses. Literature that systematically evaluates the accuracy of image registration techniques is scarce (Schulz et al 2019). This study aimed to assess the error of different registration techniques and imaging modalities for fusion imaging of the aorta in a standardized setting using a anthropomorphic body phantom
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