The Evolving Role of Artificial Intelligence in Cardiac Image Analysis.

Research in artificial intelligence (AI) has progressed over the past decade. The field of cardiac imaging has seen significant developments using newly developed deep learning methods for automated image analysis and AI tools for disease detection and prognostication. This review is aimed at those without special background in AI. We review AI concepts and survey the growing contemporary applications of AI for image analysis in echocardiography, nuclear cardiology, cardiac computed tomography, cardiac magnetic resonance, and invasive angiography.

Double S-Curve Versus Cusp-Overlap Technique: Defining the Optimal Fluoroscopic Projection for TAVR With a Self-Expanding Device.

OBJECTIVES: The purpose of this study was to assess the concordance between transcatheter aortic valve implantation angles generated by the "double S-curve" and "cusp-overlap" techniques. BACKGROUND: The "double S-curve" and "cusp-overlap" methods aim to define optimal fluoroscopic projections for transcatheter aortic valve replacement (TAVR) with a self-expandable device. METHODS: The study included 100 consecutive patients undergoing TAVR with self-expanding device planned by multidetector computed tomography. TAVR was performed using the double S-curve model, as a view in which both the aortic valve annulus and delivery catheter planes are displayed perpendicularly on fluoroscopy. Optimal projection according to the cusp-overlap technique was retrospectively generated by overlapping the right and left cups on the multidetector computed tomography annular plane. The angular difference between methods was assessed in spherical 3 dimensions and on the left and right anterior oblique (RAO) and cranial and caudal (CAU) axes. RESULTS: The double S-curve and cusp-overlap methods provided views located in the same quadrant, mostly the RAO and CAU, in 92% of patients with a median 3-dimensional angular difference of 10.0° (interquartile range: 5.5° to 17.9°). The 3-dimensional deviation between the average angulation obtained by each method was not statistically significant (1.49°; p = 0.349). No significant differences in average coordinates were noted between the double S-curve and cusp-overlap methods (RAO: 14.7 ± 15.2 vs. 12.9 ± 12.5; p = 0.36; and CAU: 27.0 ± 9.4 vs. 26.9 ± 10.4; p = 0.90). TAVR using the double S-curve was associated with 98% device success, low complication rate, and absence of moderate-to-severe paravalvular leak. CONCLUSIONS: The double S-curve and cusp-overlap methods provide comparable TAVR projections, mostly RAO and CAU. TAVR using the double S-curve model is associated with a high rate of device success and low rate of procedural complications.

Characterization of statistical prior image constrained compressed sensing (PICCS): II. Application to dose reduction.

PURPOSE: The ionizing radiation imparted to patients during computed tomography exams is raising concerns. This paper studies the performance of a scheme called dose reduction using prior image constrained compressed sensing (DR-PICCS). The purpose of this study is to characterize the effects of a statistical model of x-ray detection in the DR-PICCS framework and its impact on spatial resolution. METHODS: Both numerical simulations with known ground truth and in vivo animal dataset were used in this study. In numerical simulations, a phantom was simulated with Poisson noise and with varying levels of eccentricity. Both the conventional filtered backprojection (FBP) and the PICCS algorithms were used to reconstruct images. In PICCS reconstructions, the prior image was generated using two different denoising methods: a simple Gaussian blur and a more advanced diffusion filter. Due to the lack of shift-invariance in nonlinear image reconstruction such as the one studied in this paper, the concept of local spatial resolution was used to study the sharpness of a reconstructed image. Specifically, a directional metric of image sharpness, the so-called pseudopoint spread function (pseudo-PSF), was employed to investigate local spatial resolution. RESULTS: In the numerical studies, the pseudo-PSF was reduced from twice the voxel width in the prior image down to less than 1.1 times the voxel width in DR-PICCS reconstructions when the statistical model was not included. At the same noise level, when statistical weighting was used, the pseudo-PSF width in DR-PICCS reconstructed images varied between 1.5 and 0.75 times the voxel width depending on the direction along which it was measured. However, this anisotropy was largely eliminated when the prior image was generated using diffusion filtering; the pseudo-PSF width was reduced to below one voxel width in that case. In the in vivo study, a fourfold improvement in CNR was achieved while qualitatively maintaining sharpness; images also had a qualitatively more uniform noise spatial distribution when including a statistical model. CONCLUSIONS: DR-PICCS enables to reconstruct CT images with lower noise than FBP and the loss of spatial resolution can be mitigated to a large extent. The introduction of statistical modeling in DR-PICCS may improve some noise characteristics, but it also leads to anisotropic spatial resolution properties. A denoising method, such as the directional diffusion filtering, has been demonstrated to reduce anisotropy in spatial resolution effectively when it was combined with DR-PICCS with statistical modeling.

Characterization of statistical prior image constrained compressed sensing. I. Applications to time-resolved contrast-enhanced CT.

PURPOSE: Prior image constrained compressed sensing (PICCS) is an image reconstruction framework that takes advantage of a prior image to improve the image quality of CT reconstructions. An interesting question that remains to be investigated is whether or not the introduction of a statistical model of the photon detection in the PICCS reconstruction framework can improve the performance of the algorithm when dealing with high noise projection datasets. The goal of the research presented in this paper is to characterize the noise properties of images reconstructed using PICCS with and without statistical modeling. This paper investigates these properties in the clinical context of time-resolved contrast-enhanced CT. METHODS: Both numerical phantom studies and an Institutional Review Board approved human subject study were used in this research. The conventional filtered backprojection (FBP), and PICCS with and without the statistical model were applied to each dataset. The prior image used in PICCS was generated by averaging over FBP reconstructions from different time frames of the time-resolved CT exam, thus reducing the noise level. Numerical studies were used to evaluate if the noise characteristics are altered for varying levels of noise, as well as for different object shapes. The dataset acquired in vivo was used to verify that the conclusions reached from numerical studies translate adequately to a clinical case. The results were analyzed using a variety of qualitative and quantitative metrics such as the universal image quality index, spatial maps of the noise standard deviations, the noise uniformity, the noise power spectrum, and the model-observer detectability. RESULTS: The noise characteristics of PICCS were shown to depend on the noise level contained in the data, the level of eccentricity of the object, and whether or not the statistical model was applied. Most differences in the characteristics were observed in the regime of low incident x-ray fluence. No substantial difference was observed between PICCS with and without statistics in the high fluence domain. Objects with a semi-major axis ratio below 0.85 were more accurately reconstructed with lower noise using the statistical implementation. Above that range, for mostly circular objects, the PICCS implementation without the statistical model yielded more accurate images and a lower noise level. At all levels of eccentricity, the noise spatial distribution was more uniform and the model-observer detectability was greater for PICCS with the statistical model. The human subject study was consistent with the results obtained using numerical simulations. CONCLUSIONS: For mildly eccentric objects in the low noise regime, PICCS without the noise model yielded equal or better noise level and image quality than the statistical formulation. However, in a vast majority of cases, images reconstructed using statistical PICCS have a noise power spectrum that facilitated the detection of model lesions. The inclusion of a statistical model in the PICCS framework does not always result in improved noise characteristics.

Noise spatial nonuniformity and the impact of statistical image reconstruction in CT myocardial perfusion imaging.

PURPOSE: To achieve high temporal resolution in CT myocardial perfusion imaging (MPI), images are often reconstructed using filtered backprojection (FBP) algorithms from data acquired within a short-scan angular range. However, the variation in the central angle from one time frame to the next in gated short scans has been shown to create detrimental partial scan artifacts when performing quantitative MPI measurements. This study has two main purposes. (1) To demonstrate the existence of a distinct detrimental effect in short-scan FBP, i.e., the introduction of a nonuniform spatial image noise distribution; this nonuniformity can lead to unexpectedly high image noise and streaking artifacts, which may affect CT MPI quantification. (2) To demonstrate that statistical image reconstruction (SIR) algorithms can be a potential solution to address the nonuniform spatial noise distribution problem and can also lead to radiation dose reduction in the context of CT MPI. METHODS: Projection datasets from a numerically simulated perfusion phantom and an in vivo animal myocardial perfusion CT scan were used in this study. In the numerical phantom, multiple realizations of Poisson noise were added to projection data at each time frame to investigate the spatial distribution of noise. Images from all datasets were reconstructed using both FBP and SIR reconstruction algorithms. To quantify the spatial distribution of noise, the mean and standard deviation were measured in several regions of interest (ROIs) and analyzed across time frames. In the in vivo study, two low-dose scans at tube currents of 25 and 50 mA were reconstructed using FBP and SIR. Quantitative perfusion metrics, namely, the normalized upslope (NUS), myocardial blood volume (MBV), and first moment transit time (FMT), were measured for two ROIs and compared to reference values obtained from a high-dose scan performed at 500 mA. RESULTS: Images reconstructed using FBP showed a highly nonuniform spatial distribution of noise. This spatial nonuniformity led to large fluctuations in the temporal direction. In the numerical phantom study, the level of noise was shown to vary by as much as 87% within a given image, and as much as 110% between different time frames for a ROI far from isocenter. The spatially nonuniform noise pattern was shown to correlate with the source trajectory and the object structure. In contrast, images reconstructed using SIR showed a highly uniform spatial distribution of noise, leading to smaller unexpected noise fluctuations in the temporal direction when a short scan angular range was used. In the numerical phantom study, the noise varied by less than 37% within a given image, and by less than 20% between different time frames. Also, the noise standard deviation in SIR images was on average half of that of FBP images. In the in vivo studies, the deviation observed between quantitative perfusion metrics measured from low-dose scans and high-dose scans was mitigated when SIR was used instead of FBP to reconstruct images. CONCLUSIONS: (1) Images reconstructed using FBP suffered from nonuniform spatial noise levels. This nonuniformity is another manifestation of the detrimental effects caused by short-scan reconstruction in CT MPI. (2) Images reconstructed using SIR had a much lower and more uniform noise level and thus can be used as a potential solution to address the FBP nonuniformity. (3) Given the improvement in the accuracy of the perfusion metrics when using SIR, it may be desirable to use a statistical reconstruction framework to perform low-dose dynamic CT MPI.

Time-resolved cardiac interventional cone-beam CT reconstruction from fully truncated projections using the prior image constrained compressed sensing (PICCS) algorithm.

C-arm cone-beam CT could replace preoperative multi-detector CT scans in the cardiac interventional setting. However, cardiac gating results in view angle undersampling and the small size of the detector results in projection data truncation. These problems are incompatible with conventional tomographic reconstruction algorithms. In this paper, the prior image constrained compressed sensing (PICCS) reconstruction method was adapted to solve these issues. The performance of the proposed method was compared to that of FDK, FDK with extrapolated projection data (E-FDK), and total variation-based compressed sensing. A canine projection dataset acquired using a clinical C-arm imaging system supplied realistic cardiac motion and anatomy for this evaluation. Three different levels of truncation were simulated. The relative root mean squared error and the universal image quality index were used to quantify the reconstruction accuracy. Three main conclusions were reached. (1) The adapted version of the PICCS algorithm offered the highest image quality and reconstruction accuracy. (2) No meaningful variation in performance was observed when the amount of truncation was changed. (3) This study showed evidence that accurate interior tomography with an undersampled acquisition is possible for realistic objects if a prior image with minimal artifacts is available.

Interior tomography in x-ray differential phase contrast CT imaging.

Differential phase contrast computed tomography (DPC-CT) is an x-ray imaging method that uses the wave properties of imaging photons as the contrast mechanism. It has been demonstrated that DPC images can be obtained using a conventional x-ray tube and a Talbot-Lau-type interferometer. Due to the limited size of the gratings, current data acquisition systems only offer a limited field of view, and thus are prone to data truncation. As a result, the reconstructed DPC-CT image may suffer from image artifacts and increased inaccuracy in the reconstructed image values. In this paper, we demonstrate that a small region of interest (ROI) within a large object can be accurately and stably reconstructed using fully truncated projection datasets provided that a priori information on electron density is known for a small region inside the ROI. The method reconstructs an image iteratively to satisfy a group of physical conditions by using a projection onto convex set (POCS) approach. In this work, this POCS algorithm is validated using both numerical simulations and physical phantom experimental data. In both cases, the root mean square error is reduced by an order of magnitude with respect to the truncated analytic reconstructions. Truncation artifacts observed in the latter reconstructions are eliminated using the POCS algorithm.

Prior image constrained compressed sensing: implementation and performance evaluation.

PURPOSE: Prior image constrained compressed sensing (PICCS) is an image reconstruction framework which incorporates an often available prior image into the compressed sensing objective function. The images are reconstructed using an optimization procedure. In this paper, several alternative unconstrained minimization methods are used to implement PICCS. The purpose is to study and compare the performance of each implementation, as well as to evaluate the performance of the PICCS objective function with respect to image quality. METHODS: Six different minimization methods are investigated with respect to convergence speed and reconstruction accuracy. These minimization methods include the steepest descent (SD) method and the conjugate gradient (CG) method. These algorithms require a line search to be performed. Thus, for each minimization algorithm, two line searching algorithms are evaluated: a backtracking (BT) line search and a fast Newton-Raphson (NR) line search. The relative root mean square error is used to evaluate the reconstruction accuracy. The algorithm that offers the best convergence speed is used to study the performance of PICCS with respect to the prior image parameter α and the data consistency parameter λ. PICCS is studied in terms of reconstruction accuracy, low-contrast spatial resolution, and noise characteristics. A numerical phantom was simulated and an animal model was scanned using a multirow detector computed tomography (CT) scanner to yield the projection datasets used in this study. RESULTS: For λ within a broad range, the CG method with Fletcher-Reeves formula and NR line search offers the fastest convergence for an equal level of reconstruction accuracy. Using this minimization method, the reconstruction accuracy of PICCS was studied with respect to variations in α and λ. When the number of view angles is varied between 107, 80, 64, 40, 20, and 16, the relative root mean square error reaches a minimum value for α ≈ 0.5. For values of α near the optimal value, the spatial resolution of the reconstructed image remains relatively constant and the noise texture is very similar to that of the prior image, which was reconstructed using the filtered backprojection (FBP) algorithm. CONCLUSIONS: Regarding the performance of the minimization methods, the nonlinear CG method with NR line search yields the best convergence speed. Regarding the performance of the PICCS image reconstruction, three main conclusions can be reached. (1) The performance of PICCS is optimal when the weighting parameter of the prior image parameter is selected to be near α = 0.5. (2) The spatial resolution measured for static objects in images reconstructed using PICCS from undersampled datasets is not degraded with respect to the fully-sampled reconstruction for α near its optimal value. (3) The noise texture of PICCS reconstructions is similar to that of the prior image, which was reconstructed using the conventional FBP method.