A statistical model for quantification and prediction of cardiac remodelling: application to tetralogy of Fallot

Cardiac remodelling plays a crucial role in heart diseases. Analyzing how the heart grows and remodels over time can provide precious insights into pathological mechanisms, eventually resulting in quantitative metrics for disease evaluation and therapy planning. This study aims to quantify the regional impacts of valve regurgitation and heart growth upon the end-diastolic right ventricle (RV) in patients with tetralogy of Fallot, a severe congenital heart defect. The ultimate goal is to determine, among clinical variables, predictors for the RV shape from which a statistical model that predicts RV remodelling is built. Our approach relies on a forward model based on currents and a diffeomorphic surface registration algorithm to estimate an unbiased template. Local effects of RV regurgitation upon the RV shape were assessed with Principal Component Analysis (PCA) and cross-sectional multivariate design. A generative 3-D model of RV growth was then estimated using partial least squares (PLS) and canonical correlation analysis (CCA). Applied on a retrospective population of 49 patients, cross-effects between growth and pathology could be identified. Qualitatively, the statistical findings were found realistic by cardiologists. 10-fold cross-validation demonstrated a promising generalization and stability of the growth model. Compared to PCA regression, PLS was more compact, more precise and provided better predictions.     

Dynamic model of communicating hydrocephalus for surgery simulation

We propose a dynamic model of cerebrospinal fluid and intracranial pressure regulation. In this model, we investigate the coupling of biological parameters with a 3-D model, to improve the behavior of the brain in surgical simulators. The model was assessed by comparing the simulated ventricular enlargement with a patient case study of communicating hydrocephalus. In our model, cerebro-spinal fluid production-resorption system is coupled with a 3-D representation of the brain parenchyma. We introduce a new bi-phasic model of the brain (brain tissue and extracellular fluid) allowing for fluid exchange between the brain extracellular space and the venous system. The time evolution of ventricular pressure has been recorded on a symptomatic patient after closing the ventricular shunt. A finite element model has been built based on a computed tomography scan of this patient, and quantitative comparisons between experimental measures and simulated data are proposed.     

Personalization of a cardiac electrophysiology model using optical mapping and MRI for prediction of changes with pacing

Computer models of cardiac electrophysiology (EP) can be a very efficient tool to better understand the mechanisms of arrhythmias. Quantitative adjustment of such models to experimental data (personalization) is needed in order to test their realism and predictive power, but it remains challenging at the organ scale. In this paper, we propose a framework for the personalization of a 3-D cardiac EP model, the Mitchell-Schaeffer (MS) model, and evaluate its volumetric predictive power under various pacing scenarios. The personalization was performed on ex vivo large porcine healthy hearts using diffusion tensor MRI (DT-MRI) and optical mapping data. The MS model was simulated on a 3-D mesh incorporating local fiber orientations, built from DT-MRI. The 3-D model parameters were optimized using features such as 2-D epicardial depolarization and repolarization maps, extracted from the optical mapping. We also evaluated the sensitivity of our personalization framework to different pacing locations and showed results on its robustness. Further, we evaluated volumetric model predictions for various epi- and endocardial pacing scenarios. We demonstrated promising results with a mean personalization error around 5 ms and a mean prediction error around 10 ms (5% of the total depolarization time). Finally, we discussed the potential translation of such work to clinical data and pathological hearts.     

Toward realistic soft-tissue modeling in medical simulation

Most of today's medical simulation systems are based on geometric representations of anatomical structures that take no account of their physical nature. Representing physical phenomena and, more specifically, the realistic modeling of soft tissue will not only improve current medical simulation systems but will considerably enlarge the set of applications and the credibility of medical simulation, from neurosurgery planning to laparoscopic-surgery simulation. To achieve realistic tissue deformation, it is necessary to combine deformation accuracy with computer efficiency. On the one hand, biomechanics has studied complex mathematical models and produced a large amount of experimental data for accurately representing the deformation of soft tissue. On the other hand, computer graphics has proposed many algorithms for the real-time computation of deformable bodies, often at the cost of ignoring the physics principles. The author surveys existing models of deformation in medical simulation and analyze the impediments to combining computer-graphics representations with biomechanical models. In particular, the different geometric representations of deformable tissue are compared in relation to the tasks of real-time deformation, tissue cutting, and force-feedback interaction. Last, the author inspects the potential of medical simulation under the development of this key technology     

A spherical representation for recognition of free-form surfaces

Introduces a new surface representation for recognizing curved objects. The authors approach begins by representing an object by a discrete mesh of points built from range data or from a geometric model of the object. The mesh is computed from the data by deforming a standard shaped mesh, for example, an ellipsoid, until it fits the surface of the object. The authors define local regularity constraints that the mesh must satisfy. The authors then define a canonical mapping between the mesh describing the object and a standard spherical mesh. A surface curvature index that is pose-invariant is stored at every node of the mesh. The authors use this object representation for recognition by comparing the spherical model of a reference object with the model extracted from a new observed scene. The authors show how the similarity between reference model and observed data can be evaluated and they show how the pose of the reference object in the observed scene can be easily computed using this representation. The authors present results on real range images which show that this approach to modelling and recognizing 3D objects has three main advantages: (1) it is applicable to complex curved surfaces that cannot be handled by conventional techniques; (2) it reduces the recognition problem to the computation of similarity between spherical distributions; in particular, the recognition algorithm does not require any combinatorial search; and (3) even though it is based on a spherical mapping, the approach can handle occlusions and partial views     

Virtual reality applied to hepatic surgery simulation: the next revolution

It has previously been shown that zones of higher electric field form close to the loading end of the gel during denaturing polyacrylamide gel electrophoresis. Here we show that the field can reach up to three times its normal mean value a few cm in front of the loading wells when 44.5 mM Tris-44.5 mM boric acid-1 mM EDTA is used as the gel buffer. We also demonstrate that this electric field gradient is mostly due to the difference in ion transference numbers at the gel/buffer interface caused by the high viscosity of the urea solution contained in the gel. This field gradient leads to increased band widths and forces us to redefine both the electrophoretic mobility and the mean field intensity. We discuss some methods that can be used to minimize the effects of this gradient.     

Regional appearance modeling based on the clustering of intensity profiles

Model-based image segmentation is a popular approach for the segmentation of anatomical structures from medical images because it includes prior knowledge about the shape and appearance of structures of interest. This paper focuses on the formulation of a novel appearance prior that can cope with large variability between subjects, for instance due to the presence of pathologies. Instead of relying on Principal Component Analysis such as in Statistical Appearance Models, our approach relies on a multimodal intensity profile atlas from which a point may be assigned to several profile modes consisting of a mean profile and its covariance matrix. These profile modes are first estimated without any intra-subject registration through a boosted EM classification based on spectral clustering. Then, they are projected on a reference mesh whose role is to store the appearance information in a common geometric representation. We show that this prior leads to better performance than the classical monomodal Principal Component Analysis approach while relying on fewer profile modes.     

An electromechanical model of the heart for image analysis and simulation

This paper presents a new three-dimensional electromechanical model of the two cardiac ventricles designed both for the simulation of their electrical and mechanical activity, and for the segmentation of time series of medical images. First, we present the volumetric biomechanical models built. Then the transmembrane potential propagation is simulated, based on FitzHugh-Nagumo reaction-diffusion equations. The myocardium contraction is modeled through a constitutive law including an electromechanical coupling. Simulation of a cardiac cycle, with boundary conditions representing blood pressure and volume constraints, leads to the correct estimation of global and local parameters of the cardiac function. This model enables the introduction of pathologies and the simulation of electrophysiology interventions. Moreover, it can be used for cardiac image analysis. A new proactive deformable model of the heart is introduced to segment the two ventricles in time series of cardiac images. Preliminary results indicate that this proactive model, which integrates a priori knowledge on the cardiac anatomy and on its dynamical behavior, can improve the accuracy and robustness of the extraction of functional parameters from cardiac images even in the presence of noisy or sparse data. Such a model also allows the simulation of cardiovascular pathologies in order to test therapy strategies and to plan interventions.     

Robust nonrigid registration to capture brain shift from intraoperative MRI

We present a new algorithm to register 3-D preoperative magnetic resonance (MR) images to intraoperative MR images of the brain which have undergone brain shift. This algorithm relies on a robust estimation of the deformation from a sparse noisy set of measured displacements. We propose a new framework to compute the displacement field in an iterative process, allowing the solution to gradually move from an approximation formulation (minimizing the sum of a regularization term and a data error term) to an interpolation formulation (least square minimization of the data error term). An outlier rejection step is introduced in this gradual registration process using a weighted least trimmed squares approach, aiming at improving the robustness of the algorithm. We use a patient-specific model discretized with the finite element method in order to ensure a realistic mechanical behavior of the brain tissue. To meet the clinical time constraint, we parallelized the slowest step of the algorithm so that we can perform a full 3-D image registration in 35 s (including the image update time) on a heterogeneous cluster of 15 personal computers. The algorithm has been tested on six cases of brain tumor resection, presenting a brain shift of up to 14 mm. The results show a good ability to recover large displacements, and a limited decrease of accuracy near the tumor resection cavity.