3D Computed Tomography Angiography Research Articles

Edema of the upper extremity on the unaffected side in unilateral breast cancer patients.

Breast cancer-related lymphedema (BCRL) occurs usually on the affected side, and its cause and pathophysiology are well known. However, the cause of edema of the upper extremity on the unaffected side is barely known. It is often considered to be chemotherapy-induced general edema, and clinical evaluation is rarely performed in these patients. This study aimed to present the clinical characteristics of unilateral breast cancer patients with edema of upper extremity on the unaffected side, and to emphasize the importance of early diagnosis and medical interventions. This study retrospectively analyzed the medical records of unilateral breast cancer patients complaining edema of upper extremity on the unaffected side, from January 2020 to May 2021. Lymphoscintigraphy was used to assist in confirming the diagnosis of lymphedema, and Doppler ultrasonography or 3D computed tomography angiography were performed to differentiate vascular problems. Fourteen patients were enrolled in the study. Seven, 3, and 4 patients had edema of both upper extremities, edema of the upper extremity on the unaffected side only, and edema of all extremities, respectively. None of the 4 patients with edema of all extremities showed abnormal findings on examination. In patients with edema in the upper extremity on the unaffected side alone, lymphatic flow dysfunction was seen in 2 patients, and deep vein thrombosis (DVT) was diagnosed in 1. In patients with edema of both upper extremities, lymphatic flow dysfunction was seen in 2 patients, and DVT was diagnosed in 3. One patient had DVT and accompanying lymphatic flow dysfunction. Lymphedema and DVT were diagnosed in a number of patients with edema of the upper extremity on the unaffected side, and lymphedema can occur without direct injury to the lymphatic flow system. Therefore, clinicians should not overlook the fact that diseases that require early diagnosis and treatment can occur in patients with edema of the unaffected upper extremity.

3-D Contrast-Enhanced Fusion Ultrasound for Accurate Volume Assessment of Vessel Lumen and Plaque in Carotid Artery Disease as Compared With Computed Tomography Angiography

ObjectiveThree-dimensional contrast-enhanced fusion ultrasound (3D-CEFUS) of atherosclerotic carotid arteries provides spatial visualisation of the vessel lumen, creating a lumenography. As in 3D computed tomography angiography (3D-CTA), 3D-CEFUS outlines the contrast-filled lumen. Plaque and vessel contours are distinguished in 3D-CEFUS, allowing plaque volume quantification as a valid estimate of carotid plaque burden. 3D-CEFUS is unproven in inter-modality studies, vindicating the assessment of 3D-CEFUS applicability and comparing 3D-CEFUS and 3D-CTA lumenography as a proof-of-concept study. MethodsUsing an ultrasound system with magnetic tracking, a linear array transducer, and SonoVue contrast agent generated 3D-CEFUS acquisitions by spatial stitching of serial 2D images. From 3D-CEFUS and 3D-CTA imaging, the atherosclerotic carotid arteries were reconstructed with lumenography in an offline software programme for lumen and plaque volume quantification. Bland-Altman analysis was used for inter-image-modality agreement. ResultsThe study included 39 carotid arteries. Mean lumen and plaque volume in 3D-CEFUS were 0.63 cm3 (SD 0.26) and 0.62 cm3 (SD 0.26), respectively. Lumen volume differences between 3D-CEFUS and 3D-CTA were non-significant, with mean difference of 0.01 cm3 (SD 0.02, p = .26) and limits of agreement range (LoA-range) of ±0.11 cm3. Mean plaque volume difference was -0.12 cm3 (SD 0.19, p = .006) with LoA-range of ±0.39 cm3. ConclusionStrong agreement in lumenography between 3D-CEFUS and 3D-CTA was found. The inter-image-modality difference in plaque volumes was substantial due to challenging vessel wall definition in 3D-CTA. 3D-CEFUS is viable in quantifying carotid plaque volume burden and can potentially monitor plaque development over time.

Peri-Aneurysmal Contact as a Risk Factor for Aneurysmal Rupture in Unruptured Intracranial Aneurysms: An Overview

The occurrence and growth of unruptured intracranial aneurysms are believed to be influenced by intraluminal factors of blood flow dynamics and pathological factors of the aneurysm wall. In addition to these, the deformation and rupture of aneurysms require consideration of physical extra-luminal factors due to contact between the aneurysm and surrounding structures including brain parenchyma, cranial nerves, arteries, veins, cranial base bone and dura mater. The extra-luminal factors of aneurysms were evaluated based on the presence of peri-aneurysmal contact. Peri-aneurysmal contact, depending on the type, location, and size of aneurysms, influenced the growth pattern of the aneurysm. Recently, with the imaging of magnetic resonance cisternography, it had become possible to non-invasively assess the anatomical relationship between the outer wall of aneurysms and the surrounding structures. Fusion images overlaying 3D magnetic resonance cisternography with 3D computed tomography angiography or 3D magnetic resonance angiography detailed the anatomical relationship of peri-aneurysmal contact, position of contact sites, and depth. We depicted the anatomical construction of peri-aneurysmal contact and bleb in unruptured intracranial aneurysms using fusion images and studied the intraluminal blood flow dynamics using computational fluid dynamics. As a result, peri-aneurysmal contact was observed to be involved as an independent variable in the process of bleb formation. It was suggested that factors extra-luminal to the aneurysm, such as peri-aneurysmal contact, might have a greater impact on bleb formation than intraluminal factors like blood flow dynamics. Peri-aneurysmal contact emerged as a noteworthy extra-luminal factor, particularly associated with bleb formation, presenting a substantial risk of rupture in unruptured intracranial aneurysms. These findings underscore the importance of considering the presence and extent of peri-aneurysmal contact alongside intraluminal and wall-related factors in future evaluations. The implications of this overview extend to the development of risk assessment protocols, providing valuable insights for guiding early intervention strategies and ultimately contributing to improved patient outcomes.

The feasibility of relaxation-enhanced angiography without contrast and triggering for preprocedural planning of transcatheter aortic valve implantation.

Cardiovascular MRI is advantageous in transcatheter aortic valve implantation (TAVI) planning. This study aimed to evaluate the feasibility of comprehensive non-contrast MRI [relaxation-enhanced angiography without contrast and triggering (REACT)] combined with a three-dimensional whole-heart MRI protocol for preprocedural planning of TAVI vs. computed tomography angiography (CTA). Thirty patients with severe aortic stenosis were prospectively enrolled. The anatomical properties of the aortic root anatomy, including the perimeter and area of the virtual aortic valve annulus and coronary heights, were determined from 3D whole-heart MRI and cardiac CTA (CCTA) images, respectively. The diameters of the aorta (thoracic and abdominal aorta) and iliofemoral arteries were measured from REACT and aortic CTA (ACTA) images, respectively. A paired t-test was used to compare these two modalities. Bland-Altman plots were used to assess cardiovascular MRI and CTA measurements. Transcatheter heart valve (THV) sizing was performed based on CCTA measurements and compared with 3D whole-heart MRI measurements. The extent of annular calcification on 3D whole-heart MRI images was evaluated by a four-point grading scale and compared with CCTA data. All 30 patients completed CTA and cardiovascular MRI examinations, with the TAVI procedure being administered in 25 patients. The mean acquisition time of the comprehensive MRI protocol was 18 ± 3.2 min. There were no significant differences between ACTA and REACT data in regard to the diameters of aortic and iliofemoral arteries, including the ascending thoracic aorta (37 ± 4.6 mm vs. 37.7 ± 5.2 mm, p = 0.085), descending thoracic aorta (24.3 ± 2.8 mm vs. 24.3 ± 2.8 mm, p = 0.832), abdominal aorta (20.9 ± 2.5 mm vs. 20.8 ± 2.5 mm, p = 0.602), bilateral common iliac arteries (right: 8.36 ± 1.44 mm vs. 8.42 ± 1.27 mm, p = 0.590; left: 8.61 ± 1.71 mm vs. 8.86 ± 1.46 mm, p = 0.050), and bilateral femoral arteries (right: 6.77 ± 1.06 mm vs. 6.87 ± 1.00 mm, p = 0.157; left: 6.75 ± 1.02 mm vs. 6.90 ± 0.80 mm, p = 0.142). Both modalities showed similar aortic valve morphology and semi-quantitative valve calcification (all, p's > 0.05). Overall agreement for implanted THV was found in all 25 (100%) patients assessed with both modalities. REACT combined with 3D whole-heart MRI enables reliable measurements of aortic root anatomy, annular calcification, and aorta and iliofemoral access in patients under evaluation for TAVI.

Microsurgical strategies for small unruptured dorsal internal carotid artery aneurysms.

This study aimed to develop microsurgical strategies based on the anatomical relationship between dorsal internal carotid artery (ICA) aneurysms, the falciform ligament (FL), and the anterior clinoid process (ACP). Between 2017 and 2022, 25 patients with unruptured dorsal ICA aneurysms (less than 4 mm in diameter) underwent microsurgical direct clipping. These cases involved the left ICA (n=17) and the right ICA (n=8), with a mean aneurysm size of 3.3 mm (range, 2.5 to 4 mm). We used computed tomography angiography (CTA) and digital subtraction angiography to elucidate the anatomical relationship between dorsal ICA aneurysms and other structures. All procedures involved an ipsilateral pterional approach with securement of the ipsilateral cervical ICA for proximal control. Among the 25 dorsal ICA aneurysms, 8 (32%) were clipped without the FL being incised. Another 5 (20%) were clipped solely after the FL was cut. For the remaining 12 cases, the aneurysms were successfully clipped following FL incision and partial ACP removal. Patients exhibited favorable postoperative recoveries with good outcomes, and postoperative CTA revealed complete aneurysm clipping without any residual remnants. Conclusions: We were able to perform clipping without removing the ACP in 13 patients (52%), and in 8 of these (32%), the clipping was carried out directly without cutting the FL. Microsurgery, coupled with proximal control of the cervical ICA, can serve as a viable alternative for patients with small dorsal ICA aneurysms, especially when endovascular treatment options are limited, and 3D CTA confirms a clear anatomical relationship with the ACP.

A deep-learning method for the end-to-end prediction of intracranial aneurysm rupture risk

It is critical to accurately predict the rupture risk of an intracranial aneurysm (IA) for timely and appropriate treatment because the fatality rate after rupture is . Existing methods relying on morphological features (e.g., height-width ratio) measured manually by neuroradiologists are labor intensive and have limited use for risk assessment. Therefore, we propose an end-to-end deep-learning method, called TransIAR net, to automatically learn the morphological features from 3D computed tomography angiography (CTA) data and accurately predict the status of IA rupture. We devise a multiscale 3D convolutional neural network (CNN) to extract the structural patterns of the IA and its neighborhood with a dual branch of shared network structures. Moreover, we learn the spatial dependence within the IA neighborhood with a transformer encoder. Our experiments demonstrated that the features learned by TransIAR are more effective and robust than handcrafted features, resulting in a improvement in the accuracy of rupture status prediction.

Enhancing the depth perception of DSA images with 2D-3D registration.

Today, cerebrovascular disease has become an important health hazard. Therefore, it is necessary to perform a more accurate and less time-consuming registration of preoperative three-dimensional (3D) images and intraoperative two-dimensional (2D) projection images which is very important for conducting cerebrovascular disease interventions. The 2D-3D registration method proposed in this study is designed to solve the problems of long registration time and large registration errors in 3D computed tomography angiography (CTA) images and 2D digital subtraction angiography (DSA) images. To make a more comprehensive and active diagnosis, treatment and surgery plan for patients with cerebrovascular diseases, we propose a weighted similarity measure function, the normalized mutual information-gradient difference (NMG), which can evaluate the 2D-3D registration results. Then, using a multi-resolution fusion optimization strategy, the multi-resolution fused regular step gradient descent optimization (MR-RSGD) method is presented to attain the optimal value of the registration results in the process of the optimization algorithm. In this study, we adopt two datasets of the brain vessels to validate and obtain similarity metric values which are 0.0037 and 0.0003, respectively. Using the registration method proposed in this study, the time taken for the experiment was calculated to be 56.55s and 50.8070s, respectively, for the two sets of data. The results show that the registration methods proposed in this study are both better than the Normalized Mutual (NM) and Normalized Mutual Information (NMI). The experimental results in this study show that in the 2D-3D registration process, to evaluate the registration results more accurately, we can use the similarity metric function containing the image gray information and spatial information. To improve the efficiency of the registration process, we can choose the algorithm with gradient optimization strategy. Our method has great potential to be applied in practical interventional treatment for intuitive 3D navigation.

Deep reinforcement learning for cerebral anterior vessel tree extraction from 3D CTA images.

Extracting the cerebral anterior vessel tree of patients with an intracranial large vessel occlusion(LVO) is relevant to investigate potential biomarkers that can contribute to treatment decision making. The purpose of our work is to develop a method that can achieve this from routinely acquired computed tomography angiography(CTA)and computed tomography perfusion(CTP)images. To this end, we regard the anterior vessel tree as a set of bifurcations and connected centerlines. The method consists of a proximal policy optimization(PPO) based deep reinforcement learning (DRL) approach for tracking centerlines, a convolutional neural network based bifurcation detector, and a breadth-first vessel tree construction approach taking the tracking and bifurcation detection results as input. We experimentally determine the added values of various components of the tracker. Both DRL vessel tracking and CNN bifurcation detection were assessed in a cross validation experiment using 115 subjects. The anterior vessel tree formation was evaluated on an independent test set of 25 subjects, and compared to interobserver variation on a small subset of images. The DRL tracking result achieves a median overlapping rate until the first error (1.8mm off the reference standard) of 100, [46, 100]% on 8032 vessels over 115 subjects. The bifurcation detector reaches an average recall and precision of 76% and 87% respectively during the vessel tree formation process. The final vessel tree formation achieves a median recall of 68% and precision of 70%, which is in line with the interobserver agreement.

Deep learning for collateral evaluation in ischemic stroke with imbalanced data.

Collateral evaluation is typically done using visual inspection of cerebral images and thus suffers from intra- and inter-rater variability. Large open databases of ischemic stroke patients are rare, limiting the use of deep learning methods in treatment decision-making. We adapted a pre-trained EfficientNet B0 network through transfer learning to improve collateral evaluation using slice-based and subject-level classification. Our method uses stacking and overlapping of 2D slices from a patient's 4D computed tomography angiography (CTA) and a majority voting scheme to determine a patient's final collateral grade based on all classified 2D MIPs. Class imbalance is handled in the evaluation process by using the focal loss with class weight to penalize the majority class. We evaluated our method using a nine-fold cross-validation performed with 83 subjects. Mean sensitivity of 0.71, specificity of 0.84, and a weighted F1 score of 0.71 in multi-class (good, intermediate, and poor) classification were obtained. Considering treatment effect, a dichotomized decision is also made for collateral scoring of a subject based on two classes (good/intermediate and poor) which achieves a sensitivity of 0.89 and specificity of 0.96 with a weighted F1 score of 0.95. An automatic and robust collateral assessment method that mitigates the issues with the small imbalanced dataset was developed. Computer-aided evaluation of collaterals can help decision-making of ischemic stroke treatment strategy in clinical settings.

Computerized Differentiation of Growth Status for Abdominal Aortic Aneurysms: A Feasibility Study.

Fast-growing abdominal aortic aneurysms (AAA) have a high rupture risk and poor outcomes if not promptly identified and treated. Our primary objective is to improve the differentiation of small AAAs' growth status (fast versus slow-growing) through a combination of patient health information, computational hemodynamics, geometric analysis, and artificial intelligence. 3D computed tomography angiography (CTA) data available for 70 patients diagnosed with AAAs with known growth status were used to conduct geometric and hemodynamic analyses. Differences among ten metrics (out of ninety metrics) were statistically significant discriminators between fast and slow-growing groups. Using a support vector machine (SVM) classifier, the area under receiving operating curve (AUROC) and total accuracy of our best predictive model for differentiation of AAAs' growth status were 0.86 and 77.50%, respectively. In summary, the proposed analytics has the potential to differentiate fast from slow-growing AAAs, helping guide resource allocation for the management of patients with AAAs.

Venous collaterals in acute ischemic stroke patients after endovascular treatments: a novel scoring system using 4D computed tomography angiography.

To establish a novel cortical venous collateral score based on four-dimensional computed tomography angiography (4D CTA) and to assess the relationship between the score and clinical outcomes in patients with acute ischemic stroke (AIS) after endovascular treatments (EVTs). This was a retrospective case-control study designed to evaluate all consecutive patients with large vessel occlusion in unilateral anterior circulation who underwent EVTs at a single institution. Two independent neuroradiologists evaluated venous collaterals using different venous collateral scores: a cortical venous collateral score based on 4D CTA (4D-VCS), the prognostic evaluation based on cortical vein score difference in stroke (PRECISE) score, and the cortical vein opacification score (COVES). Spearman correlation analysis was used to analyze the correlation of different venous collateral scoring systems with final infarct volume (FIV), modified Rankin Scale (mRS) score, and artery collateral score. Multivariate logistic regression analysis was used to identify the prognostic value of each model. The areas under the curve (AUC) of the receiver operating characteristic (ROC) curve of the 6 models were compared by the DeLong test. A total of 107 patients were enrolled in the study. The AUC of 4D-VCS was 0.92 [95% confidence interval (CI): 0.85 to 0.96; P<0.0001]. The 4D-VCS was highly correlated with FIV (r=-0.615; 95% CI: -0.737 to -0.473; P<0.001), mRS score (r=-0.706; 95% CI: -0.789 to -0.602; P<0.001), and arterial collateral score (r=0.769; 95% CI: 0.678 to 0.838; P<0.001). There were statistically significant differences between model 1 (AUC, 0.89; 95% CI: 0.81 to 0.94) and model 2 (AUC, 0.94; 95% CI: 0.88 to 0.98) (P=0.025), model 1 (AUC, 0.89; 95% CI: 0.81 to 0.94) and model 3 (AUC, 0.93; 95% CI: 0.87 to 0.97) (P=0.045), model 1 (AUC, 0.89; 95% CI: 0.81 to 0.94) and model 6 (AUC, 0.95; 95% CI: 0.89 to 0.98) (P=0.011), and model 2 (AUC, 0.94; 95% CI: 0.88 to 0.98) and model 5 (AUC, 0.89; 95% CI: 0.82 to 0.94) (P=0.032). The findings of this study suggested that 4D-VCS, a novel measurement of venous enhancement based on 4D CTA, may be accurately used to identify AIS patients with high risk of poor clinical outcome after EVTs.

Utility and Feasibility of a Low-Cost System to Simulate Clipping Strategy for Cerebral Aneurysms Using Three-Dimensional Computed Tomography Angiography with Virtual Craniotomy

To assess utility and feasibility of a low-cost system to simulate clipping strategy for cerebral aneurysms using patient-specific surgically oriented three-dimensional (3D) computed tomography angiography with virtual craniotomy. From 2017 to 2021, 53 consecutive patients scheduled for aneurysm clipping underwent preoperative planning using 3D computed tomography angiography with virtual craniotomy. The model was oriented in the surgical position to observe the anatomy through surgical corridors. Clipping was planned considering 3 parameters: shape of the clip, clip type (standard vs. fenestrated), and clipping strategy (simple vs. multiple). We used a scoring system (0-3) to assess the concordance of virtual planning with real surgery by assigning 1 point for each correctly predicted parameter. Qualitative assessment of 3D models was a secondary end point. In 51 patients, 3D images perfectly matched the real anatomy shown in surgical videos. Concordance scores of 0, 1, 2, and 3 occurred with a frequency of 5%, 14%, 38%, and 43%, respectively. Concerning the shape of the clip, clip type, and clipping strategy, the concordance occurred in 73%, 80%, and 59%, respectively. Compared with simple clipping, strategies with multiple clippings were more difficult to predict correctly. Concordance scores of 0, 1, 2, and 3 occurred with a frequency of 5.7%, 5.7%, 31.4%, and 57.1%, respectively, in simple clipping and 4.8%, 28.6%, 47.6%, and 19%, respectively, in multiple clipping. In our experience, use of 3D computed tomography angiography with virtual craniotomy is an easy and useful solution to plan clipping strategy. The surgeon's awareness of the surgical anatomy is improved. Although this method has some technical limitations, it represents a low-cost alternative if complex and expensive simulation systems are not available.

Value of 4D CT Angiography Combined with Whole Brain CT Perfusion Imaging Feature Analysis under Deep Learning in Imaging Examination of Acute Ischemic Stroke.

This study was aimed at investigating the application of deep learning 4D computed tomography angiography (CTA) combined with whole brain CT perfusion (CTP) imaging in acute ischemic stroke (AIS). A total of 46 patients with ischemic stroke were selected from the hospital as the research objects. Image quality was analyzed after the 4D CTA images were obtained by perfusion imaging. The results showed that whole brain perfusion imaging based on FCN can achieve automatic segmentation. FCN segmentation results took a short time, an average of 2-3 seconds, and the Dice similarity coefficient (DSC) and mean absolute distance (MAD) were lower than those of other algorithms. FCN segmentation distance was 17.87. The parameters of the central area, the peripheral area, and the mirror area of the perfusion map were compared, and the mean transit time (MTT) and time to peak (TTP) of the lesion were prolonged compared with the mirror area. Moreover, the peripheral CBV was increased, and the differences between the parameters were significant (P < 0.05). In conclusion, using the deep learning FCN network, 4D CTA combined with whole brain CTP imaging technology can effectively analyze the perfusion state and achieve clinically personalized treatment.

Diagnostic Accuracy of Three Dimentional Digital Substraction Angiography (3D DSA) in Correlation with Computed Tomographic Angiography (CTA) and Magnetic Resonance Angiography (MRA) in Evaluation of Aneurysmal Subarachnoid Haemorrhage

Background: Subarachnoid hemorrhage is cause by ruptured aneurysms. Early diagnosis is necessary for prevention of the disease. For detection of size and location of intracranial aneurysms in aneurysmal subarachnoid haemorrhage different diagnostic tool are used. The 3D DSA imaging modalities parameters were considered as gold standard in diagnosis of aneurysms. MRA and CTA competencies in diagnosis of ruptured aneurysms were also evaluated. Objective: The aim of the study was to evaluate the sensitivity of 3D DSA, CTA and MRA in diagnosis of intracranial aneurysms in referred patients. The imaging modalities parameters of 3D DSA was considered as gold standard. Study design: It was retrospective observational study with statistical approach. Methods: The 27 consecutive patients of subarachnoid haemorrhage visited the neurology and radiology department of BKMC / MMC Mardan from August 2021 to January 2022 was included in the study. All the patients passed the inclusion criteria while those who are reluctant to undergo through CTA, MRA were excluded. The three dimensional constructed images of each patient underwent through CTA, MRA and 3D DSA were recorded. The obtained data was analyzed for the results. Results: CTA and MRA has variable sensitivity range in diagnosis of intracranial aneurysms. It varied according to the size of aneurysms. For the diagnosis of small sized aneurysms the CTA and MRA has the sensitivity of 57.1 %, while it changes to 88.8 % in diagnosis of medium sized aneurysms. For diagnosis of large sized aneurysms, the CTA and MRA has same sensitivity of 100%. Hence for the detection of small and medium sized aneurysms the sensitivity of CTA and MRA reduced to 20% as compared to the sensitivity of 3D DSA. Conclusion: It was concluded from the results that the 3D DSA is most accurate tool with higher sensitivity for diagnosis of intracranial aneurysms in patients of subarachnoid haemorrhage. The results obtained by using 3D DSA are 20% more sensitive than the results obtained by using CTA and MRA. Keywords: (SAH) Subarachnoid hemorrhage, CTA) Computed Tomographic Angiography, (MRA) Magnetic Resonance Angiography.

Detection of AAD at the level of T12 vertebrae by using three Dimensional (MDCT) Angiography in subset of Karachi Population

Objective: To determine the diameter of abdominal aorta at T12 vertebral level by the use of Multidetector Computer Tomography Angiography (MDCTA). Study Design: It is a Cross-sectional study. Place and Duration of Study: This study was executed in Ziauddin University (Hospital) Clifton campus Karachi, at Radiology Department, from March 2017 to August 2017. Materials and Methods: Total 160 individuals were enrolled, 75 (46.9%) were females and 85 (53.1%) were males who do not have any abdominal and arterial or venous problems, approach to Radiology Department, for Abdominal 3D Computed Tomography Angiography. Patients who were enrolled in current study were referred to department of Radiology for different indications like adrenal and renal pathologies altered bowel habits and abdominal aches. In current study abdominal aortic dimension (diameter) was analyzed at T12 vertebral levels in both sexes. The SPSS version used in current study was 20 for statistical analysis. Pearson correlation was applied to check the relationship between variables, Independent sample T test was applied. P-value is less than or equal to 0.05 was considered significant. Result: The results of current study revealed that the mean diameter of the abdominal aorta, measured at T12 vertebral level was 20.402±2.54 mm in total 160 individuals. It was observed that male having diameter with 21.47±2.25 and female have 19.18±2.31mm. It clearly showed that male having greater diameter with highly significant values P=0.001. it was also found that there was a high positive correlation was evident in between diameter of abdominal aorta &amp; age with highly significant difference P=0.001 and r =0.713. This correlation showed that as the age increases the thickness of abdominal aorta also increases. Conclusion: It is the first study conducted in Pakistan on detection of abdominal aortic diameter at T12 vertebral level by Multidetector computed tomography angiography. The current study showed that male having greater aortic diameter than in females it also revealed that the age have a great impact on the diameter of abdominal aorta. Keywords: Multidetector computed tomography, aorta, abdominal, heart, tunica Intima.

Morphometric Examinations of Internal Carotid Arteries of Patients with Hypertension and Patients with Type 2 Diabetes Mellitus: A Radio Anatomic Study Based on Computed Tomography Angiography Findings.

The aim of this study is to examine the relationship between the morphological features of A.carotis interna (ICA) and symptoms affecting cerebral blood circulation including type 2 diabetes mellitus (T2DM) and hypertension (HT). In this study, retrospective morphometric analysis of ICA measurements from 100 patients (45-60 years old) was performed on Computed Tomographic Angiography (CTA) images. The images were divided into four groups: patients with HT (group 1), patients with T2DM (group 2), patients with HT and T2DM (group 3), and healthy control group (group 4). Length and diameter measurements of the cervical, petrous, cavernous and terminal segments of the ICA were made by using 3D CTA images and recorded. The measurements of the male and female patients were compared by Mann Whitney-U test and the the groups were compared by using Kruskall Wallis H test. It was found that, there were statistically significant differences between male and female patients in terms of right and left petrous, cavernous and terminal segments of the ICA in Group 1, right and left cervical left cavernous in Group 3, left cervical, right and left petrous, cavernous and right cavernous in Group 4 (p 0.05). According to the Kruskall Wallis H test analysis results, it was determined that there was no statistically significant difference between the patients in 4 groups for all segment measurements (p 0.05). As a result; It was determined that ICA was more affected by hypertension than diabetes. In addition, we think that being knowledgeable of morphometric measurements of ICA will guide the radio-anatomical evaluations and increase the level of microanatomical knowledge in surgical treatment.

ImageTBAD: A 3D Computed Tomography Angiography Image Dataset for Automatic Segmentation of Type-B Aortic Dissection.

Type-B Aortic Dissection (TBAD) is one of the most serious cardiovascular events characterized by a growing yearly incidence, and the severity of disease prognosis. Currently, computed tomography angiography (CTA) has been widely adopted for the diagnosis and prognosis of TBAD. Accurate segmentation of true lumen (TL), false lumen (FL), and false lumen thrombus (FLT) in CTA are crucial for the precise quantification of anatomical features. However, existing works only focus on only TL and FL without considering FLT. In this paper, we propose ImageTBAD, the first 3D computed tomography angiography (CTA) image dataset of TBAD with annotation of TL, FL, and FLT. The proposed dataset contains 100 TBAD CTA images, which is of decent size compared with existing medical imaging datasets. As FLT can appear almost anywhere along the aorta with irregular shapes, segmentation of FLT presents a wide class of segmentation problems where targets exist in a variety of positions with irregular shapes. We further propose a baseline method for automatic segmentation of TBAD. Results show that the baseline method can achieve comparable results with existing works on aorta and TL segmentation. However, the segmentation accuracy of FLT is only 52%, which leaves large room for improvement and also shows the challenge of our dataset. To facilitate further research on this challenging problem, our dataset and codes are released to the public (Dataset, 2020).

Coarse-to-fine multiplanar D-SEA UNet for automatic 3D carotid segmentation in CTA images.

Carotid artery atherosclerotic stenosis accounts for 18-25% of ischemic stroke. In the evaluation of carotid atherosclerotic lesions, the automatic, accurate and rapid segmentation of the carotid artery is a priority issue that needs to be addressed urgently. However, the carotid artery area occupies a small target in computed tomography angiography (CTA) images, which affect the segmentation accuracy. We proposed a coarse-to-fine segmentation pipeline with the Multiplanar D-SEA UNet to achieve fully automatic carotid artery segmentation on the entire 3D CTA images, and compared with other four neural networks (3D-UNet, RA-UNet, Isensee-UNet, Multiplanar-UNet) by assessing Dice, Jaccard similarity coefficient, sensitivity, area under the curve and average hausdorff distance. Our proposed method can achieve a mean Dice score of 91.51% on the 68 neck CTA scans from Beijing Hospital, which remarkably outperforms state-of-the-art 3D image segmentation methods. And the C2F segmentation pipeline can effectively improve segmentation accuracy while avoiding resolution loss. The proposed segmentation method can realize the fully automatic segmentation of the carotid artery and has robust performance with segmentation accuracy, which can be applied into plaque exfoliation and interventional surgery services. In addition, our method is easy to extend to other medical segmentation tasks with appropriate parameter settings.

Analysis of anatomical variations of the lingular artery of the left upper lobe using 3D computed tomography angiography and bronchography.

BackgroundThoracic surgeons must be familiar with the anatomy of the pulmonary artery during segmentectomy and segmentectomy. But pulmonary arteries have numerous variations and aberrant branching patterns. The purpose of the present study was to analyze the anatomical variations and frequencies of the lingular artery of the left upper lobe (LUL) using 3D computed tomography angiography and bronchography (3D-CTAB).MethodsWe retrospectively studied 166 patients having undergone lobectomy or segmentectomy from January to December 2020 at Fujian Medical University Cancer Hospital’s Department of Thoracic Surgery. All patients underwent 3D reconstruction using 3D-CTAB before surgery.ResultsThe lingular segment was supplied by 1 artery in 45.18% of cases, 2 arteries in 46.39% of cases, and 3 arteries in 8.43% of cases. The branching patterns of the lingular artery included 119 (71.68%) cases with interlobar origin, 35 (21.08%) cases with interlobar and mediastinal origin, and 13 (7.83%) cases with mediastinal origin. The interlobar lingular artery include superior lingular artery (A4) and inferior lingular artery (A5). The interlobar lingular artery type was A4a, A4b, A5 in 7.23% of cases; A4 and A4b+5 in 3.01% of cases; and A4b and A4a+5 in 4.82% of cases. The mediastinal lingular artery was divided into the following 5 types: ‘A4’, ‘A4b’, ‘A4b+5’, ‘A4b+5a’, and ‘A4+5’. The most common type was A4 (12.05%, 20/166) in 166 patients. The interlobar lingular artery had the following 5 patterns of variation: ‘A4+5’, ‘A4, A5’, ‘A4a, A4b, A5’, ‘A4a, A4b+5’, and ‘A4b, A4a+5’. The single interlobar lingular artery (A4+5) was the most common type in 38.55% of cases. In 24.10% of cases, A5 came from A8 or A8+9. Besides In 8.43% of cases, the origin of A5 was close to A8 or A8+9.ConclusionsWe identified the left various lingular artery branching patterns with 3D-CTAB in patients and defined the frequency of anatomic variations. 3D-CTAB is useful for finding these variations.

B-PO05-076 REPRODUCIBILITY OF LEFT ATRIAL ENDO AND EPICARDIAL WALL EXTRACTION FROM CTA

LA wall thickness (LAWT) is a major determinant of lesion transmurality in AF ablation. Computed tomography angiography (CTA) provides sub-millimetric resolution allowing reliable 3D LAWT segmentation. To analyze the intra and inter-user reproducibility of 3D CTA LAWT segmentations. Three observers with different levels of expertise performed, using ADAS 3D, complete LAWT segmentation of CTA (0.5x0.5x0.6mm) once for thirty patients and twice for ten. The endocardial layer was generated by a semi-automatic threshold-based segmentation. The epicardial, by manual contouring of key transverse slices followed by automatic interpolation. Finally, the user adjusted the 3D reconstructions. LAWT, presented as a discretized color map, was generated assigning at each point of the endocardium the distance to the epicardium. Reproducibility was calculated as the point to surface distance between different analyses of the same patient. Pulmonary veins, LAA and mitral annulus were excluded from analysis. Endocardial segmentations were closer than 1mm in 99.38%±0.86 of the vertices for intra and 95.12%±5.07 for inter-user variability, with a mean distance between meshes of 0.17mm±0.08 and 0.30mm±0.18, respectively. For the epicardium, mean distances between meshes were 0.54mm±0.17 for intra and 0.72mm±0.16 for inter-observer, and closer than 1 mm in 82.38%±9.89 of points for intra and 77.68%±7.16 for inter-user analyses. Reproducibility improved significantly (p<0.05) with user expertise. Obtaining reliable CTA-derived 3D LAWT maps by means of endo and epicardial segmentation of the LA wall is feasible with high reproducibility.