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


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.
Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Maryam E
ME
Rettmann
Mia S
MS
Gunawan
David R
DR
Holmes
Jerome F
JF
Breen
Douglas L
DL
Packer
Richard A
RA
Robb
D000465:Algorithms; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D010363:Pattern Recognition, Automated / Q000379:methods*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery*; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*