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Novel registration-based framework for CT angiography in lower legs
Roman Peter1, Milos Malinsky, Petr Ourednicek
1Department of Biomedical Engineering, Brno University of Technology, Brno, Czech Republic. peter.roman@mayo.edu
Insights
This study introduces a novel framework to accurately visualize lower extremity blood vessels in computed tomography angiography (CTA) by correcting patient motion. This improves diagnosis and treatment decisions for peripheral arterial occlusive disease (PAOD).
Area of Science:
- Medical Imaging
- Radiology
- Vascular Imaging
Background:
- Accurate visualization of contrast-enhanced blood vessels in lower extremities via computed tomography angiography (CTA) is crucial for diagnosing peripheral arterial occlusive disease (PAOD).
- Patient motion during CTA examinations complicates the precise masking of non-contrasted tissues, hindering accurate diagnosis and treatment planning.
- Eliminating artifacts from bones, calcifications, and soft tissues in lower leg CTA (knees to toes) remains a significant challenge.
Purpose of the Study:
- To propose and evaluate a novel registration-based framework for detecting and correcting patient motion in lower leg CTA.
- To enhance the precision of non-contrasted tissue masking for improved CTA subtraction imaging.
- To assess the clinical utility of the proposed framework compared to existing commercial tools.
Main Methods:
- Development of a registration-based framework incorporating two alternative registration cores for motion detection and correction.
- Application of the framework to CTA pre-contrast and post-contrast acquisitions in lower extremities.
- Comparison of resulting CTA subtraction images with Advanced Vessel Analysis, a clinical reference tool.
- Visual evaluation of CTA subtraction images from 55 PAOD patients by four expert observers using predefined criteria.
Main Results:
- The proposed framework demonstrated valuable improvements in CTA examination of the lower legs.
- The registration-based approach effectively detected and corrected motion artifacts occurring between and during CTA acquisitions.
- Expert evaluation indicated the robustness and clinical relevance of the generated CTA subtraction images.
Conclusions:
- The novel registration-based framework offers significant advancements for lower leg CTA.
- Improved motion correction leads to more accurate subtraction imaging, aiding PAOD diagnosis and treatment.
- The proposed method shows promise as a valuable tool in clinical vascular imaging practices.
Abstract:
Proper subtraction and visualization of contrast-enhanced blood vessels in lower extremities using computed tomography angiography (CTA) is based on precise masking of all non-contrasted structures in the area, and it is the main prerequisite for correct diagnosis and decision on treatment for peripheral arterial occlusive disease (PAOD). Because of possible motion of patients during the CTA examination, precise elimination of non-contrasted tissues, including bones, calcifications, and soft tissue, is still very challenging for lower legs, that is, from knees to toes. We propose novel registration-based framework for detection and correction of the motion in lower legs, which typically occurs between and during CTA pre-contrast and post-contrast acquisitions. Within the framework, two registration cores are proposed as alternatives, and resulting CTA subtraction images are compared with Advanced Vessel Analysis considered one of the reference commercial tools among clinical applications for CTA of lower extremities. The CTA subtraction images of 55 patients examined for PAOD are evaluated visually by four expert observers on the Philips Extended Brilliance Workspace using four criteria assessing the overall robustness of tested methods. According to the complex evaluation, the proposed framework enabled valuable improvements of CTA examination of lower legs.
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