GReAT: leveraging geometric artery data to improve wall shear stress assessment

Leveraging big data for patient care is promising in many medical fields such as cardiovascular health. For example, hemodynamic biomarkers like wall shear stress could be assessed from patient-specific medical images via machine learning algorithms, bypassing the need for time-intensive computational fluid simulation. However, it is extremely challenging to amass large-enough datasets to effectively train such models. We could address this data scarcity by means of self-supervised pre-training and foundations models given large datasets of geometric artery models. In the context of coronary arteries, leveraging learned representations to improve hemodynamic biomarker assessment has not yet been well studied. In this work, we address this gap by investigating whether a large dataset (8449 shapes) consisting of geometric models of 3D blood vessels can benefit wall shear stress assessment in coronary artery models from a small-scale clinical trial (49 patients). We create a self-supervised target for the 3D blood vessels by computing the heat kernel signature, a quantity obtained via Laplacian eigenvectors, which captures the very essence of the shapes. We show how geometric representations learned from this datasets can boost segmentation of coronary arteries into regions of low, mid and high (time-averaged) wall shear stress even when trained on limited data.

Classifier-guided registration of coronary CT angiography and intravascular ultrasound

Coronary CT angiography (CCTA) and intravascular ultrasound (IVUS) provide complementary information for coronary artery disease assessment, making their registration valuable for comprehensive analysis. However, existing registration methods require manual interaction or extensive segmentations, limiting their practical application. In this work, we present a fully automatic framework for CCTA-IVUS registration using deep learning-based feature detection and a differentiable image registration module. Our approach leverages a convolutional neural network trained to identify key anatomical features from polar-transformed multiplanar reformatted CCTA or IVUS data. These detected anatomical featuers subsequently guide a differentiable registration module to optimize transformation parameters of an automatically extracted coronary artery centerline. The method does not require landmark selection or segmentations as input, while accounting for the presence of IVUS guidewire artifacts. Evaluated on 48 clinical cases with reference CCTA centerlines corresponding to IVUS pullback, our method achieved successful registration in 83.3\% of cases, with a median centerline overlap F$_1$-score of 0.982 and median cosine similarities of 0.940 and 0.944 for cross-sectional plane orientation. Our results demonstrate that automatically detected anatomical features can be leveraged for accurate registration. The fully automatic nature of the approach represents a significant step toward streamlined multimodal coronary analysis, potentially facilitating large-scale studies of coronary plaque characteristics across modalities.