Quantification of the ilio-femoral arteries tortuosity and data cluster modelling for preoperative examination

Abstract

Detecting spatial tortuosity and atherosclerotic changes of the ilio-femoral arteries are crucial for planning endovascular access. The aim of this study was to find a reliable quantification procedure of arterial lumen and tortuosity to qualify patients for a suitable endovascular procedure. We conducted computed tomographic angiography in 76 patients. All ilio-femoral segments of the arterial tree were visualized using Osirix Dicom Viewer software to help qualify the patients to one of two groups: with possible or non-recommended vascular access. The same tomograms were then analyzed with image processing algorithms to perform ilio-femoral artery segmentation and quantification. We chose a set of arterial tortuosity and lumen measuring methods, such as the modified Gustafson-Kessel clustering algorithm and Support Vector Machine classifier, to automatically classify arterial-tree regions. The two 2D feature spaces were selected with the modified Gustafson-Kessel clusterization to create a combined model to assign around 2/3 cases to the access groups with high specificity (more than 88%) whereas the remaining patients were selected for re-evaluation. We concluded that the novel modification of the Gustafson-Kessel clustering algorithm is more suitable to the highly inseparable data than commonly used approaches. To identify ilio-femoral access limitations, we recommend more complex decision model. This study confirmed high usability of our chosen methodology in the quantitative examination of arteries for endovascular access planning.