Video-densitometric vascular flowrate measurement—some error considerations

Sufficient information for the accurate measurement of vessel diameter and linear-flow velocities in vascular systems is available in the electronic video signals from a standard fluoroscopic television system. When the techniques described are applied to the televised output of an image intensified medical fluoroscope, it is possible to measure vascular flow during the course of unmodified angiography. This measurement method requires only a moderate amount of special electronic measuring and timing circuits. Some of the errors to be expected from this method are presented, and the limitations of this system are discussed.     

基于高斯过程和Radon变换的视网膜血管管径测量

视网膜血管管径的异常变化与糖尿病、高血压等心脑血管疾病发展进程息息相关,眼底图像中视网膜血管信息的提取是计算机辅助分析和诊断相关疾病的重要步骤。本研究提出一种视网膜血管管径测量方法。首先对眼底图像进行图像预处理,然后基于高斯过程和Radon变换准确跟踪血管中心线和方向,最后利用二维高斯过程回归技术测量血管管径。在DRIVE和STARE这两个眼底图像数据库中进行测试。结果表明不论是对于曲率较小的近似直线型血管段、曲率较大的弯曲型血管段,还是对于管径发生变化的血管段,本文方法都能较好地检测出血管管径宽度,且标准差低、运算速度快。     

An automated method for analysis of microcirculation videos for accurate assessment of tissue perfusion

Imaging of the human microcirculation in real-time has the potential to detect injuries and illnesses that disturb the microcirculation at earlier stages and may improve the efficacy of resuscitation. Despite advanced imaging techniques to monitor the microcirculation, there are currently no tools for the near real-time analysis of the videos produced by these imaging systems. An automated system tool that can extract microvasculature information and monitor changes in tissue perfusion quantitatively might be invaluable as a diagnostic and therapeutic endpoint for resuscitation. The experimental algorithm automatically extracts microvascular network and quantitatively measures changes in the microcirculation. There are two main parts in the algorithm: video processing and vessel segmentation. Microcirculatory videos are first stabilized in a video processing step to remove motion artifacts. In the vessel segmentation process, the microvascular network is extracted using multiple level thresholding and pixel verification techniques. Threshold levels are selected using histogram information of a set of training video recordings. Pixel-by-pixel differences are calculated throughout the frames to identify active blood vessels and capillaries with flow. Sublingual microcirculatory videos are recorded from anesthetized swine at baseline and during hemorrhage using a hand-held Side-stream Dark Field (SDF) imaging device to track changes in the microvasculature during hemorrhage. Automatically segmented vessels in the recordings are analyzed visually and the functional capillary density (FCD) values calculated by the algorithm are compared for both health baseline and hemorrhagic conditions. These results were compared to independently made FCD measurements using a well-known semi-automated method. Results of the fully automated algorithm demonstrated a significant decrease of FCD values. Similar, but more variable FCD values were calculated using a commercially available software program requiring manual editing. An entirely automated system for analyzing microcirculation videos to reduce human interaction and computation time is developed. The algorithm successfully stabilizes video recordings, segments blood vessels, identifies vessels without flow and calculates FCD in a fully automated process. The automated process provides an equal or better separation between healthy and hemorrhagic FCD values compared to currently available semi-automatic techniques. The proposed method shows promise for the quantitative measurement of changes occurring in microcirculation during injury.     

Role of nitric oxide in tumor microcirculation. Blood flow, vascular permeability, and leukocyte-endothelial interactions.

The present study was designed to define the role of nitric oxide (NO) in tumor microcirculation, through the direct intravital microcirculatory observations after administration of NO synthase (NOS) inhibitor and NO donor both regionally and systemically. More specifically, we tested the following hypotheses: 1) endogenous NO derived from tumor vascular endothelium and/or tumor cells increases and/or maintains tumor blood flow, decreases leukocyte-endothelial interactions, and increases vascular permeability, 2) exogenous NO can increase tumor blood flow via vessel dilatation and decrease leukocyte-endothelial interactions, and 3) NO production and tissue responses to NO are tumor dependent. To this end, a murine mammary adenocarcinoma (MCaIV) and a human colon adenocarcinoma (LS174T) were implanted in the dorsal skinfold chamber in C3H and severe combined immunodeficient mice, respectively, and observed by means of intravital fluorescence microscopy. Both regional and systemic inhibition of endogenous NO by N omega-nitro-L-arginine methyl ester (L-NAME; 100 mumol/L superfusion or 10 mg/kg intravenously) significantly decreased vessel diameter and local blood flow rate. The diameter change was dominant on the arteriolar side. Superfusion of NO donor (spermine NO, 100 mumol/L) increased tumor vessel diameter and flow rate, whereas systemic injection of spermine NO (2.62 mg/kg) had no significant effect on these parameters. Rolling and stable adhesion of leukocytes were significantly increased by intravenous injection of L-NAME. In untreated animals, both MCaIV and LS174T tumor vessels were leaky to albumin. Systemic NO inhibition significantly attenuated tumor vascular permeability of MCaIV but not of LS174T tumor. Immunohistochemical studies, using polyclonal antibodies to endothelial NOS and inducible NOS, revealed a diffuse pattern of positive labeling in both MCaIV and LS174T tumors. Nitrite and nitrate levels in tumor interstitial fluid of MCaIV but not of LS174T were significantly higher than that in normal subcutaneous interstitial fluid. These results support our hypotheses regarding the microcirculatory response to NO in tumors. Modulation of NO level in tumors is a potential strategy for altering tumor hemodynamics and thus improving oxygen, drug, gene vector, and effector cell delivery to solid tumors.     

Absolute diameter measurements of coronary arteries based on the first zero crossing of the Fourier spectrum

Current edge detection methods used to determine coronary artery dimensions from digital (DSA) images suffer a strong dependence on the system's modulation transfer function (MTF). The videodensitometric algorithms are less sensitive to MTF blurring, yet still result in an overestimation of the vessel size of 10% to 25% for blurring aperture sizes of 50% to 80% of the vessel diameter. We propose a new algorithm to measure the absolute diameter of a vessel which has a lower sensitivity to the system MTF for blurring aperture sizes up to 80% of the vessel diameter. A consequence of the similarity theorem of Fourier transform pairs is that the "width" of the Fourier transform, as characterized by the first zero crossing in frequency space, is inversely proportional to the width of the vessel profile. For an ideal (unblurred) vessel image, the width of the vessel profile is equal to the diameter of the vessel. For a blurred image this is not true. In frequency space, however, the transform of the blurred profile is simply the product of the transformed ideal profile and the system MTF. Thus, if the blurring aperture of the system is below some critical value, the first zero of the unblurred profile will still dominate the transform of the blurred profile. For vessels of circular cross section and a rectangular blurring aperture, this critical aperture size is approximately 80% of the vessel diameter. A more detailed explanation of the theory and calculations involved in this measurement, along with measurements of computer simulated and phantom vessels is presented.     

Microvascular Endothelial Cells Exhibit Optimal Aspect Ratio for Minimizing Flow Resistance

A recent analytical solution of the three-dimensional Stokes flow through a bumpy tube predicts that for a given bump area, there exists an optimal circumferential wavenumber which minimizes flow resistance. This study uses measurements of microvessel endothelial cell morphology to test whether this prediction holds in the microvasculature. Endothelial cell (EC) morphology was measured in blood perfused in situ microvessels in anesthetized mice using confocal intravital microscopy. EC borders were identified by immunofluorescently labeling the EC surface molecule ICAM-1 which is expressed on the surface but not in the EC border regions. Comparison of this theory with extensive in situ measurements of microvascular EC geometry in mouse cremaster muscle using intravital microscopy reveals that the spacing of EC nuclei in venules ranging from 27 to 106 μm in diameter indeed lies quite close to this predicted optimal configuration. Interestingly, arteriolar ECs are configured to minimize flow resistance not in the resting state, but at the dilated vessel diameter. These results raise the question of whether less organized circulatory systems, such as that found in newly formed solid tumors or in the developing embryo, may deviate from the optimal bump spacing predicted to minimize flow resistance.     

Dorsal skinfold chamber technique for intravital microscopy in nude mice.

For many years, observation chambers, implanted in various animal species and in man, have been used for intravital microscopy of the microcirculation in granulation tissue, preformed tissue, or of the microvascularization of tissue implants. We describe herein a skinfold chamber model for the intravital microscopic investigation of striated skin muscle in immunoincompetent, nude mice over a minimum period of 2 weeks. Using fluorescent markers for contrast enhancement of plasma (fluorescein isothiocyanate-dextran) and leukocytes (acridine orange), the presented model allows the quantitative analysis of 1) the microhemodynamic parameters microvessel diameter and red blood cell velocity in arterioles (16 to 50 mu diameter), capillaries (4 to 9 mu diameter), and post-capillary venules (19 to 60 mu diameter), 2) leukocyte/endothelium interaction in these vessel segments, 3) functional capillary density and intercapillary distance, and 4) endothelial cell integrity. These parameters can be assessed in the microcirculation of the striated muscle tissue under normal or pathological conditions, as well as in the microcirculation of transplanted xenogeneic (human) neoplastic and non-neoplastic tissue grafts.     

Structure of Microvascular Networks in the Lungs and Peculiarities of Blood Circulation in Them

Microvessels and their relationship with alveoli in the lungs of albino rats under physiological condition in the thorax were studied by intravital microscopy. The structure of a network of large microvessels 20–30 μ in diameter surrounding each alveolus along the perimeter from all sides was demonstrated. Blood flow was investigated by video.     

A review of ultrasound common carotid artery image and video segmentation techniques

The determination of the wall thickness [intima–media thickness (IMT)], the delineation of the atherosclerotic carotid plaque, the measurement of the diameter in the common carotid artery (CCA), as well as the grading of its stenosis are important for the evaluation of the atherosclerosis disease. All these measurements are also considered to be significant markers for the clinical evaluation of the risk of stroke. A number of CCA segmentation techniques have been proposed in the last few years either for the segmentation of the intima–media complex (IMC), the lumen of the CCA, or for the atherosclerotic carotid plaque from ultrasound images or videos of the CCA. The present review study proposes and discusses the methods and systems introduced so far in the literature for performing automated or semi-automated segmentation in ultrasound images or videos of the CCA. These are based on edge detection, active contours, level sets, dynamic programming, local statistics, Hough transform, statistical modeling, neural networks, and an integration of the above methods. Furthermore, the performance of these systems is evaluated and discussed based on various evaluation metrics. We finally propose the best performing method that can be used for the segmentation of the IMC and the atherosclerotic carotid plaque in ultrasound images and videos. We end the present review study with a discussion of the different image and video CCA segmentation techniques, future perspectives, and further extension of these techniques to ultrasound video segmentation and wall tracking of the CCA. Future work on the segmentation of the CCA will be focused on the development of integrated segmentation systems for the complete segmentation of the CCA as well as the segmentation and motion analysis of the plaque and or the IMC from ultrasound video sequences of the CCA. These systems will improve the evaluation, follow up, and treatment of patients affected by advanced atherosclerosis disease conditions.     

Effect of polymethylmethacrylate particles on mature bone in the optical bone chamber

Reaction of mature bone and its vasculature to 3.33 +/- 0.19 microm polymethylmethacrylate (PMMA) particles at a concentration of 2.5 x 10(8)/cc was measured using optical bone chamber implant intravital microscopy. Twelve adult female New Zealand White rabbits were divided into six receiving Healon alone (controls) and six receiving Healon plus PMMA. The particles were introduced to the bone chamber compartment after removing its overlying optical element, which was immediately reinstalled. Reaction was monitored weekly over a 6-week period using video and photographic imaging. Bone was labeled before treatment with oxytetracycline and after treatment with alizarin complexone. Perfusing blood was labeled with fluorescein isothiocyanate dextran-70 kDa (FITC-D70). Parameters measured were net bone resorption, from black and white images, bone turnover, from color images, vascularity, and average vessel caliber. Neither bone turnover nor vessel caliber were significantly affected at the p < or = 0.050 level over time. In contrast, bone resorption was significantly greater and vascularity significantly less in the presence of PMMA. It was inferred that any differences in bone turnover were masked by resorption of new bone. It was concluded that the lack of a PMMA effect on average vessel caliber meant that the vascularity effects were not due to angiogenesis, but to vessel recruitment (or its opposite), an effect more consistent with inflammation than repair. The lack of vascularity increase in PMMA-treated compartments also suggested that increased resorption was a local phenomenon, because blood supply had not increased to provide the extra osteoclasts required for observed net bone loss.     

Retinal Vessel Detection and Measurement for Computer-aided Medical Diagnosis

Since blood vessel detection and characteristic measurement for ocular retinal images is a fundamental problem in computer-aided medical diagnosis, automated algorithms/systems for vessel detection and measurement are always demanded. To support computer-aided diagnosis, an integrated approach/solution for vessel detection and diameter measurement is presented and validated. In the proposed approach, a Dempster–Shafer (D–S)-based edge detector is developed to obtain initial vessel edge information and an accurate vascular map for a retinal image. Then, the appropriate path and the centerline of a vessel of interest are identified automatically through graph search. Once the vessel path has been identified, the diameter of the vessel will be measured accordingly by the algorithm in real time. To achieve more accurate edge detection and diameter measurement, mixed Gaussian-matched filters are designed to refine the initial detection and measures. Other important medical indices of retinal vessels can also be calculated accordingly based on detection and measurement results. The efficiency of the proposed algorithm was validated by the retinal images obtained from different public databases. Experimental results show that the vessel detection rate of the algorithm is 100 % for large vessels and 89.9 % for small vessels, and the error rate on vessel diameter measurement is less than 5 %, which are all well within the acceptable range of deviation among the human graders.     

Spatial variation of plasma flow in the oxazolone-stimulated microcirculation

INTRODUCTION: In cutaneous lymphocytic inflammation, enhanced regional blood flow is suggested by persistent erythema and warmth. Direct assessment of the microcirculation, however, has been limited by tissue edema and skin thickness. METHODS: To assess the microcirculatory adaptations to the epicutaneous antigen oxazolone, we studied the first pass kinetics and microvascular topography of the inflammatory skin microcirculation using a specially adapted epi-illumination intravital microscopy system. The fluorescence intravital videomicroscopy and streaming image acquisition of fluorescein-labeled dextran (approximately 500,000 MW) injections were used to assess changes in plasma flow. RESULTS: Direct plasma tracer injections of both the oxazolone-stimulated and control microcirculation demonstrated comparable transit times (leading edge and intensity-weighted peak times) from the carotid artery to the superficial vascular plexus (p > 0.05). In contrast to transit times, continuous infusion of the plasma tracer demonstrated a significant increase in the delivery of the fluorescein-labeled dextran to the oxazolone-stimulated microcirculation. Quantitative morphometry of intravital microscopic images demonstrated a 2.2-fold increase in the mean diameter of vessels in the superficial vascular plexus (p < 0.01). Further, fluorescence intensity mapping indicated that the increase was associated with increased perfusion of focal regions of the superficial vascular plexus (p < 0.001). CONCLUSIONS: These results indicate that the oxazolone-stimulated adaptations of the inflammatory microcirculation include both microvascular dilatation and the redistribution of plasma flow.     

Mechanical behavior of pressurized in vitro prearteriolar vessels determined with a video system

The muscular resistance arteries of the mesentery and brain serve two different control functions in the cardiovascular system. The former are representative vessels of vascular beds that influence total peripheral resistance and blood pressure; the latter are a good model of vessels in beds that demonstrate blood flow autoregulation. Our purpose was to develop a versatile myographic system appropriate for the in vitro study of 75–250 μm diameter vessels and to explore different physiological properties of cerebral and mesenteric arteries. In this paper the system is described in detail, examples of its use in determining the dynamic responses of the vessels to electrical stimulation are provided, and certain measures indicative of the extent of myogenic behavior are characterized. Cylindrical artery segments about 3-mm long were dissected from Wistar-Kyoto rats and mounted in a chamber filled with physiological saline solution maintained at 37°C. The same solution was perfused via a syringe into one end of the vessel through a microcannula. The other end was then occluded so that experiments could be made over a wide range of transmural pressures without flow. The vessel was viewed through a microscope coupled with a TV camera, and the video output signal of a selected scan line was processed by an electronic dimension analyzing system. This permitted simultaneous digital presentation and analog voltage outputs of the vessel wall thicknesses and lumen diameter. We further incorporated servo control of the syringe using a motor drive. In this way, vessel tests could be carried out at constant pressure or constant diameter, and vessel responses could be obtained following either pressure or diameter command signals. Using the methods presented in this study, small vessels can be maintained under conditions that approximate their in vivo state more closely than other in vitro techniques using ring segments on wires. We also find that the opto-electronic instrumentation is ideally suited for studying the dynamic vessel properties that underlie the control of vascular smooth muscle.     

Noise in stenosis measurement using digital subtraction angiography

This paper examines statistical errors in the measurement of arterial stenoses by digital videodensitometry. Images of vessel phantoms were acquired using digital subtraction angiographic techniques with low concentrations of an iodine contrast medium and low levels of x-ray exposure. Effects of the spatial and temporal averaging of image information on signal-to-noise ratios in the stenosis measurement were of primary interest. The influences of iodine concentration, x-ray scatter, veiling glare, x-ray energy spectrum, x-ray exposure, and detective quantum efficiency of the system were also included in the theoretical analysis. The agreement between theoretical calculation and experimental measurement of a simulated vessel was verified using measured values of the imaging system parameters. With a 14.2 mg/ml iodine concentration, using 20 mR per image at the entrance to a 13-cm water phantom, and averaging over a 6-mm length of a vessel 6.2 mm in diameter, the standard deviation in a measurement of a vessel's relative cross-sectional area was about 0.05. The extension of these results to practical applications in vivo is discussed.     

Automatic endotracheal tube position confirmation system based on image classification--a preliminary assessment

Endotracheal intubation is a complex medical procedure in which a ventilating tube is inserted into the human trachea. Improper positioning carries potentially fatal consequences and therefore confirmation of correct positioning is mandatory. This paper introduces a novel system for endotracheal tube position confirmation. The proposed system comprises a miniature complementary metal oxide silicon sensor (CMOS) attached to the tip of a semi rigid stylet and connected to a digital signal processor (DSP) with an integrated video acquisition component. Video signals are acquired and processed by a confirmation algorithm implemented on the processor. The confirmation approach is based on video image classification, i.e., identifying desired expected anatomical structures (upper trachea and main bifurcation of the trachea) and undesired structures (esophagus). The desired and undesired images are indicators of correct or incorrect endotracheal tube positioning. The proposed methodology is comprised of a continuous and probabilistic image representation scheme using Gaussian mixture models (GMMs), estimated using a greedy algorithm. A multi-dimensional feature space, which consists of several textural-based features, is utilized to represent the images. The performance of the proposed algorithm was evaluated using two datasets: a dataset of 1600 images extracted from 10 videos recorded during intubations on dead cows, and a dataset of 358 images extracted from 8 videos recorded during intubations performed on human subjects. Each one of the video images was classified by a medical expert into one of three categories: upper tracheal intubation, correct (carina) intubation and esophageal intubation. The results, obtained using a leave-one-case-out method, show that the system correctly classified 1530 out of 1600 (95.6%) of the cow intubations images, and 351 out of the 358 human images (98.0%). Misclassification of an image of the esophagus as carina or upper-trachea, which is potentially fatal, was extremely rare (only one case when in the animal dataset and no cases when in the human intubation dataset). The classification results of the cow intubations dataset compare favorably with a state-of-the-art classification method tested on the same dataset.     

Robust border enhancement and detection for measurement of fetal nuchal translucency in ultrasound images

Ultrasonic measurement of nuchal translucency (NT) thickness in the first trimester of pregnancy has recently been proposed as the most useful marker in early screening for fetal chromosomal abnormalities. However, manual tracing of the two echogenic lines in the image, using on-screen calipers, is hampered by weak edges, together with noise and other artifacts, leading to variable results and inefficiency. Our semi-automatic method of fetal NT thickness measurement uses a coherence-enhancing diffusion filter to enhance the border and reduce noise, followed by detection of the NT by minimization of a cost function, that combines intensity, edge strength and continuity, using dynamic programming. This method has been validated by determining the correlation between manual and semi-automatic measurements.     

Continuous recording of blood vessel diameter in vitro during perfusion with regulated pressure patterns

A system is described for continuously measuring blood vessel diameter during perfusion with constant pressure or with fluctuating pressure of preselected patterns. An electromechanical modulator controls the inflow of the perfusion solution, keeping the actual pressure in the blood vessel at a preselected value via a feed-back circuit. The outer diameter of the vessel can be simultaneously and continuously recorded at several chosen positions with the aid of a multichannel video angiometer. The whole set-up is suitable for small vessels of a diameter reaching down to 0.5 mm.     

GoPro Hero Cameras for Creation of a Three-Dimensional,Educational, Neurointerventional Video

Neurointerventional education relies on an apprenticeship model, with the trainee observing and participating in procedures with the guidance of a mentor. While educational videos are becoming prevalent in surgical cases, there is a dearth of comparable educational material for trainees in neurointerventional programs. We sought to create a high-quality, three-dimensional video of a routine diagnostic cerebral angiogram for use as an educational tool. A diagnostic cerebral angiogram was recorded using two GoPro HERO 3+ cameras with the Dual HERO System to capture the proceduralist’s hands during the case. This video was edited with recordings from the video monitors to create a real-time three-dimensional video of both the actions of the neurointerventionalist and the resulting wire/catheter movements. The final edited video, in either two or three dimensions, can serve as another instructional tool for the training of residents and/or fellows. Additional videos can be created in a similar fashion of more complicated neurointerventional cases. The GoPro HERO 3+ camera and Dual HERO System can be used to create educational videos of neurointerventional procedures.     

Improving fluoroscopic image quality with continuously variable zoom magnification

Coning down is commonly used during fluoroscopy to increase image contrast by reducing scatter. However, the resulting image fills only part of a video display whose resolution is limited by line rate and bandwidth. Optical or electron-optical zooming can be used to magnify the collimated image so that it fills a larger fraction of the viewable area of the video frame to make more effective use of the available video-display capacity. Modulation-transfer functions (MTFs) were measured for various zoom factors achieved using a zoom lens and the image-intensifier (II) electronic magnification mode. Significant and continuing improvement in total system MTF was observed up to zoom magnifications of greater than 3.3. For larger zoom factors, the resolution limit becomes dominated by the intrinsic resolving power of the II and by geometric unsharpness rather than by the line rate of the video system. When the MTF at infinite zoom factor, obtained by extrapolation, was divided into the measured MTFs, the resultant MTFz's were shown to scale predictably with zoom factor. Only a slight improvement in MTF was obtained using the II's electronic magnification mode compared to the same magnification using a zoom lens. It is concluded that, if improved image quality is the motivation for the use of coning down in fluoroscopy, then zooming to use fully the available video frame is warranted.