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    Atherosclerotic Plaque Characterization Methods Based on Coronary Imaging
    Atherosclerotic Plaque Characterization Methods Based on Coronary Imaging
    Atherosclerotic Plaque Characterization Methods Based on Coronary Imaging
    Ebook405 pages3 hours

    Atherosclerotic Plaque Characterization Methods Based on Coronary Imaging

    By Lambros S Athanasiou, Dimitrios I Fotiadis and Lampros K Michalis

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    About this ebook

    Atherosclerotic Plaque Characterization Methods Based on Coronary Imaging provides a complete review of computer methods for atherosclerotic plaque reconstruction and characterization. The authors, with their expertise from biomedical engineering, computer science, and cardiology, offer a holistic view. The focus of the book is on the presentation of major imaging techniques, including their limitations. It includes details on the mechanical characterization and properties of plaques and appropriate constitutive models to describe the mechanical behavior of plaques.

    The authors explore the challenges of using multiple coronary imaging technologies, and provide the pros and cons of invasive vs. non-invasive techniques. Methods for plaque characterization and 3D reconstruction of coronary arteries using IVUS, OCT, and CT images are described.

    This book will help readers study new trends in image processing analysis and plaque characterization, implement automated plaque characterization methodologies, understand coronary imaging drawbacks, and comprehend 3 dimensional coronary artery and plaque reconstruction methods.

    • Describes the multimodality imaging techniques that are commonly used in the diagnosis of arterial diseases, including intravascular ultrasound, optical coherence tomography, angiography, computed tomography angiography, and magnetic resonance angiography
    • Discusses in-depth the computational methods which can be used for the detection of different plaque types
    • Explores plaque in 3D reconstruction methods and plaque modeling approaches
    LanguageEnglish
    PublisherAcademic Press
    Release dateMay 4, 2017
    ISBN9780128051139
    Atherosclerotic Plaque Characterization Methods Based on Coronary Imaging
    Author

    Lambros S Athanasiou

    Lambros S. Athanasiou received his diploma degree from the Department of Information and Communication Systems Engineering, University of the Aegean, Greece, in 2009 and the PhD degree from the Department of Materials Science and Engineering, University of Ioannina, Greece, in 2015. He is currently working as a Postdoctoral Research Fellow at the Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA. His research interests include medical image processing, biomedical engineering, decision support and medical expert systems.

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      Book preview

      Atherosclerotic Plaque Characterization Methods Based on Coronary Imaging - Lambros S Athanasiou

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      1

      Introduction

      Abstract

      This chapter presents the anatomy and physiology of the cardiovascular system and introduces the invasive and noninvasive imaging techniques that are currently used in coronary imaging. More specifically, the fundamentals of heart functionality along with the vascular system, blood circulation, and atherosclerosis are described in detail. Atherosclerosis is presented and discussed from the initial development of the disease in the intima of the arteries, to its gradual expansion to the arterial wall. All the possible treatments which today are applied and the advances that have been made in methods for preventing and treating coronary artery disease are discussed. The various imaging modalities that are widely available and allow the assessment of luminal pathology, characterization of the type of plaque, and quantification of plaque burden are presented.

      Keywords

      Cardiovascular system; heart; atherosclerosis; coronary imaging

      1.1 Anatomy and Physiology of the Cardiovascular System

      The cardiovascular system is a closed circuit and permits blood circulation through the arteries that are connected to small arterioles and even smaller capillaries (Fig. 1.1). The cardiovascular system is divided into the pulmonary circulation where blood is circulated and oxygenated through the lungs and the systemic circulation in which blood is transferred to the rest of the body providing oxygenation to the body organs. The main components of the cardiovascular system are the heart, blood vessels, and blood. The organ responsible for blood circulation is the heart. Approximately 7000 L of blood flows through the heart every day. Inside the heart, waste products, electrolytes, and dissolved gases are exchanged between the surrounding tissues and blood.

      Figure 1.1 The blood circulation system.

      1.1.1 Heart

      The heart is a muscular organ of the cardiovascular system, which keeps blood circulating through the system. It has the size of a fist: 9 cm wide and 14 cm long in an average adult, is a cone-shaped organ, and is located in the area between the lungs in the thoracic cavity, called mediastinum. Three layers of pericardial membranes enclose the heart: the fibrous pericardium (pericardial sac), the parietal pericardium, and the visceral pericardium (epicardium) (Fig. 1.2). The outer layer of the pericardial membranes (pericardial sac) is a loose-fitting sac composed of strong fibrous connective tissue. The middle layer (parietal pericardium) extends over the diaphragm and the bases of the large vessels that enter and leave the heart. Between the parietal and visceral pericardium a serous fluid exists to avoid friction due to the heart beating. The pericardial membranes enclose the cardiac muscle (myocardium), as it is shown in Fig. 1.2, which are the walls of the four chambers of the heart. The chambers are covered with a thin membrane called endocardium (Fig. 1.2).

      Figure 1.2 Layers of the heart's wall: the fibrous pericardium (pericardial sac), the parietal pericardium and the visceral pericardium (epicardium), and the membranes enclosing the heart (myocardium and endocardium).

      The upper chambers of the heart are divided into left and right chambers which are called atria. Their role is to receive blood returning to the heart through veins and arteries and send it to the two lower chambers, called ventricles. Ventricles are also divided into left and right in correspondence with chambers. Both atrium and ventricles are separate pumps, functioning in parallel: atrium fills with blood and drains it into the ventricles simultaneously. Then ventricles send it back to the body. The left and right ventricle and the left and right atrium are separated by a wall structure that is called septum. Septum keeps blood from the right side of the heart mixing with blood from the left and vice versa. Atrioventricular valves prevent blood to flow backward from the ventricles to the atria. The atrioventricular valve consists of the mitral valve on the left and the tricuspid valve on the right (Fig. 1.3).

      Figure 1.3 Cross section of the heart depicting the four chambers and the major vessels, valves, and the blood flow direction.

      Two large veins supply blood to the right atrium: one coming from the body and the other from the head. The first vein coming from the body is called inferior vena cava and the second vein coming from the head is called the superior vena cava (Fig. 1.3). The tricuspid valve lies between the right ventricle and atrium allowing blood to move only from the right atrium into the right ventricle, preventing the backflow of blood. The wall of the right ventricle is thinner than the wall of the left ventricle as it pumps blood to the lungs. When the right ventricle contracts, the tricuspid valve is closing passively as the blood pressure in the right ventricle increases. Blood can only exit through the pulmonary arteries when the pulmonary valve opens. This pulmonary valve allows blood to leave the right ventricle preventing the backflow of blood. When the right ventricle contracts, blood is pumped into the left pulmonary artery and then into the lungs. Within the lungs, blood is exposed to air and is oxygenated. Then blood is returned to the left atrium through the pulmonary veins, and when the atrioventricular valve opens it moves passively into the left ventricle. When the left ventricle contracts, blood is pumped through the semilunar valve into the aorta. Through the circulation system, blood reaches each cell of the body and will deliver O2, collect CO2, and deliver hormones, nutrients, and metabolic waste products before returning to the heart through the vena cava. Four pulmonary veins, two from each lung, supply the left atrium with blood. Then blood flows to the left atrium and then to the left ventricle through the atrioventricular valve (mitral valve) (Fig. 1.3). The mitral valve prevents the backflow of blood from the ventricle into the left atrium. When the mitral valve closes, the aortic valves open and blood is directed to the aorta. When the ventricle relaxes, the aortic valve closes preventing the backflow of blood into the ventricle. The first two aortic branches are the right and left coronary arteries that supply blood to the heart.

      1.1.2 The Cardiac Cycle

      The cardiac cycle includes two phases: diastole and systole (Fig. 1.4). In the diastole phase, blood returns to the heart from the superior and interior vena cava and flows into the right atrium. The pressure in the right atrium increases as blood flows into it. When the pressure of the right atrium exceeds the pressure of the right ventricle, the tricuspid valve opens passively allowing blood to flow into the right ventricle. At the same time, the oxygenated blood returning from the lungs flows into the left atrium. As left atrial pressure increases, the mitral valve opens and blood flows into the left ventricle.

      Figure 1.4 The cardiac cycle.

      In the systole phase, blood is forced to flow from the two atria into their respective ventricles as the atrial muscles contract due to the depolarization of the atria. There is a period called isovolumetric contraction during which the ventricles contract but the pulmonary and aortic valves are closed as the ventricles do not have enough force to open them. The atrioventricular valves also remain closed during the isovolumetric contraction period. The semilunar valves open when the ventricular muscle contracts and generates blood pressure within the ventricle higher than within the arterial tree. When the heart muscle relaxes the diastole phase begins again.

      1.1.3 Vascular System

      The human blood vessels transmit blood to every organ of the body. The size of vessels is decreased as they move away from the heart. The large arteries become smaller arteries called arterioles which become even smaller, called capillaries. On the contrary, the size of vessels is increased as they move toward the heart and the small venules become veins. The vascular system consists of arteries, arterioles, capillaries, venules, and veins (Fig. 1.5).

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