Digital retrospective motion-mode display and processing of electron beam cine-computed tomography and other cross-sectional cardiac imaging techniques

Electron beam computed tomography is unparalleled in its ability to consistently produce high quality dynamic images of the human heart. Its use in quantification of left ventricular dynamics is well established in both clinical and research applications. However, the image analysis tools supplied with the scanners offer a limited number of analysis options. They are based on embedded computer systems which have not been significantly upgraded since the scanner was introduced over a decade ago in spite of the explosive improvements in available computer power which have occured during this period. To address these shortcomings, a workstation-based ventricular analysis system has been developed at our institution. This system, which has been in use for over five years, is based on current workstation technology and therefore has benefited from the periodic upgrades in processor performance available to these systems. The dynamic image segmentation component of this system is an interactively supervised, semi-automatic surface identification and tracking system. It characterizes the endocardial and epicardial surfaces of the left ventricle as two concentric 4D hyper-space polyhedrons. Each of these polyhedrons have nearly ten thousand vertices which are deposited into a relational database. The right ventricle is also processed in a similar manner. This database is queried by other custom components which extract ventricular function parameters such as regional ejection fraction and wall stress. The interactive tool which supervises dynamic image segmentation has been enhanced with a temporal domain display. The operator interactively chooses the spatial location of the endpoints of a line segment while the corresponding space/time image is displayed. These images, with content resembling M-Mode echocardiography, benefit form electron beam computed tomography's high spatial and contrast resolution. The segmented surfaces are displayed along with the imagery. These displays give the operator valuable feedback pertaining to the contiguity of the extracted surfaces. As with M-Mode echocardiography, the velocity of moving structures can be easily visualized and measured. However, many views inaccessible to standard transthoracic echocardiography are easily generated. These features have augmented the interpretability of cine electron beam computed tomography and have prompted the recent cloning of this system into an 'omni-directional M-Mode display' system for use in digital post-processing of echocardiographic parasternal short axis tomograms. This enhances the functional assessment in orthogonal views of the left ventricle, accounting for shape changes particularly in the asymmetric post-infarction ventricle. Conclusions: A new tool has been developed for analysis and visualization of cine electron beam computed tomography. It has been found to be very useful in verifying the consistency of myocardial surface definition with a semi-automated segmentation tool. By drawing on M-Mode echocardiography experience, electron beam tomography's interpretability has been enhanced. Use of this feature, in conjunction with the existing image processing tools, will enhance the presentations of data on regional systolic and diastolic functions to clinicians in a format that is familiar to most cardiologists. Additionally, this tool reinforces the advantages of electron beam tomography as a single imaging modality for the assessment of left and right ventricular size, shape, and regional functions.