Mr. Nicholas J. Pham Profile

Nicholas J. Pham

at Canon Stroke and Vascular Research Center

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Proceedings Article | 28 February 2020 Presentation + Paper

Co-registration of infarct core location with angiography during mechanical thrombectomy procedures for treatment progression monitoring

Nicholas Pham, Ryan Rava, Mohammad Mahdi Shiraz Bhurwani, Alexander Podgorsak, Kenneth Snyder, Elad Levy, Jason Davies, Adnan Siddiqui, Ciprian Ionita

Proceedings Volume 11317, 113170E (2020) https://doi.org/10.1117/12.2549039

KEYWORDS: Angiography, Image registration, Targeting Task Performance metric, Tissues, Arteries, Image segmentation, Brain, Blood circulation, Computed tomography, Blood

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Purpose: The standard workflow for patients affected by acute ischemic stroke (AIS) due to large vessel occlusions (LVO) includes diagnosis using CT-perfusion (CTP) followed by image-guided mechanical thrombectomy (MT). The CTP is used to establish the ischemic tissue location and size; however, during the MT procedure this information is not currently available in the angiographic suites. We developed a method to co-register the infarct location with the angiograms in order to monitor the reperfusion of the tissue affected by the ischemia. Materials and Methods: We used the complex tortuosity of the cerebral vasculature as its own fiducial system to co-register the CTP data with the angiographic sequences acquired during MT. A carotid segment was used to create a complete set of projections for different 3D transformations which included: rotation and translation. The 3D transformation which minimized the difference between the projected data and the angiogram section containing the carotid was selected and applied to co-register the infarct core from CTP onto the angiographic sequences. Angiographic parametric imaging was performed and average mean transit time (MTT), time to peak (TTP), cerebral blood volume (CBV) and cerebral blood flow (CBF) measurements were monitored in the infarct core pre-and post-thrombectomy. We then tested coregistration accuracy using phantoms as a ground truth to evaluate registration accuracy. Results: Using the proposed method we were able to monitor flow changes in the infarct core during MT. Changes of parameters between 50% and 100% were observed following the MT. Co-registration performance analysis yielded a 0.69 average DICE coefficient score for the entire image and a 0.82 average DICE coefficient for the Circle of Willis. Conclusions: CTP data can be used to improve guidance during MT for patients with AIS using infarct core co-registration with angiographic sequences.

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