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Clinical Trial
. 2012 Nov;19(11):1332-44.
doi: 10.1016/j.acra.2012.06.009. Epub 2012 Aug 11.

Centerline tracking for quantification of reverse structural remodeling of the pulmonary veins following cardiac ablation therapy

Maryam E Rettmann  1 , Mia S Gunawan, David R Holmes 3rd, Jerome F Breen, Douglas L Packer, Richard A Robb; CABANA Pilot Imaging Investigators
Collaborators, Affiliations
Clinical Trial

Centerline tracking for quantification of reverse structural remodeling of the pulmonary veins following cardiac ablation therapy

Maryam E Rettmann et al. Acad Radiol. 2012 Nov.

Abstract

Rationale and objectives: Patients with atrial fibrillation undergo structural remodeling resulting in increased pulmonary vein sizes. Studies have demonstrated that these changes are reversible following successful ablation therapy. To date, analyses of pulmonary vein structure have focused on measurements at the pulmonary vein ostia, and the full extent of reverse remodeling along the length of the pulmonary veins has not yet been fully characterized.

Materials and methods: An automated, three-dimensional method is proposed that quantifies pulmonary vein geometry starting at the ostia and extending several centimeters into the veins. A centerline is tracked along the length of the pulmonary vein, and orthogonal planes are computed along the curve. The method was validated against manual measurements on each of the four pulmonary veins for 10 subjects. The proposed methodology was used to analyze the pulmonary veins in 21 patients undergoing cardiac ablation therapy with preoperative and postoperative computed tomographic scans.

Results: Validation results demonstrated that the automated measurements closely followed the manual measurements, with an overall mean difference of 11.50 mm(2). Significant differences in cross-sectional area at the two time points were observed at all pulmonary vein ostia and extending for 2.0 cm (excluding the 0.5-cm interval) into the left inferior pulmonary vein, 3.5 cm into the left superior pulmonary vein, and 2.0 cm into the right superior pulmonary vein.

Conclusions: Quantitative analysis along the length of the pulmonary veins can be accomplished using centerline tracking and measurements from orthogonal planes along the curve. The patient study demonstrated that reverse structural remodeling following ablation therapy occurs not only at the ostia but for several centimeters extending into the pulmonary veins.

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Conflict of interest statement

Conflict of Interest Statement

Mayo Clinic and R.A. Robb have a financial interest in technology referenced in this article. Dr. D. Packer in the past 12 months has provided consulting services for Biosense Webster, Inc., CardioFocus, Cardiomedics, Cyberheart, Endosense, Johnson & Johnson Healthcare Systems, Medtronic CryoCath, OrthoMcNeill, Siemens, St. Jude Medical, Siemens AG, and Valencia Technologies. Dr. Packer received no personal compensation for these consulting activities. Dr. Packer receives research funding from the Biosense Webster, Boston Scientific, Endosense, EpiEP, EP Advocate, Medtronic CryoCath LP, Minnesota Partnership for Biotechnology and Medical Genomics/ University of Minnesota, NIH, St. Jude Medical, Siemens AcuNav, and Ther-medical (EP Limited). Royalties from Blackwell Publishing and St. Jude Medical. Mayo Clinic and Drs. D. Packer and R. Robb have a financial interest in mapping technology that may have been used at some of the 10 centers participating in this pilot research. In accordance with the Bayh-Dole Act, this technology has been licensed to St. Jude Medical, and Mayo Clinic and Drs. Packer and Robb have received annual royalties greater than $10,000, the federal threshold for significant financial interest. Mayo Clinic and Dr. R. Robb have a financial interest in Analyze-AVW technology that was used to analyze some of the heart images in this research. In accordance with the Bayh-Dole Act, this technology has been licensed to commercial entities, and both Mayo Clinic and Dr. Robb have received royalties greater than $10,000, the federal threshold for significant financial interest. In addition, Mayo Clinic holds an equity position in the company to which the AVW technology has been licensed.

Figures

Figure 1
Figure 1
Back view of left atrium illustrating measurements made along pulmonary vein using successive planes orthogonal to a centerline curve. LSPV=left superior pulmonary vein, RSPV=right superior pulmonary vein, LIPV=left inferior pulmonary vein, RIPV=right inferior pulmonary vein.
Figure 2
Figure 2
3D software for segmentation of left atrium and pulmonary veins. The pulmonary veins are separated from the left atrium using an interactive cut plane which is visualized in the 3D dislay on the top left and the location of the oblique cut plane is shown in three orthogonal planes along the bottom. The oblique image slice is also displayed in the top right panel.
Figure 3
Figure 3
Flowchart demonstrating the overall method for using a centerline curve to compute the cross-sectional area along a pulmonary vein.
Figure 4
Figure 4
Centerlines tracked for (a) left inferior, (b) left superior, (c) right inferior, and (d) right superior pulmonary veins.
Figure 5
Figure 5
(a) The centerline curve with orthogonal plane near the ostium. (b) Plane accurately cutting across pulmonary vein near ostium.
Figure 6
Figure 6
In (a), the orthogonal plane to the centerline curve near the pulmonary vein ostium is shown with (b) its associated image slice. In (c), the manually adjusted cut plane from the segmentation procedure is shown with (d) its associated image slice.
Figure 7
Figure 7
Cross-sectional area versus distance for three methods: segmentation cut plane (blue), orthogonal to centerline normal (green), and orthogonal to combined vector (magenta).
Figure 8
Figure 8
Planes orthogonal to the orientation vector at centerline points along the right superior pulmonary vein (top panel) and corresponding oblique images extracted from volume (bottom panel).
Figure 9
Figure 9
Interface used to make manual measurements of the cross-sectional area. (a) The initial plane orthogonal to the x axis. (b) The manually adjusted plane.
Figure 10
Figure 10
Back view of segmented left atrium and pulmonary veins from a patient at (a) baseline and (b) three month follow-up. LIPV (green), LSPV (red), RIPV (blue), RSPV (magenta).
Figure 11
Figure 11
Plots of manual (blue) and automatic (red) cross-sectional area measurements. Circles indicate locations of manual measurements.
Figure 12
Figure 12
(a) Average cross-sectional area plots at baseline (blue) and follow-up (green) for all 21 patients. Number of patients included in calculation shown next to each data point. (b) Mean(std) of paired differences in cross-sectional area between baseline and follow up scans. Significant differences are indicated by a red star.
See this image and copyright information in PMC

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