O-2
Development of a 3D Modeling Tool for Procedural Planning of Ductal Stenting
Presenter
Mudit Gupta, MD, PhD, Children's Hospital of Philadelphia, Philadelphia, PA
Mudit Gupta, MD, PhD1, Csaba Pinter, PhD2, Alana Cianciulli, BS1, Hannah Dewey1, Silvani Amin1, Andras Lasso, PhD3, Michael Liam O'Byrne, M.D., FSCAI1, Andrew C. Glatz, M.D., FSCAI4 and Matthew Jolley, MD1, (1)Children's Hospital of Philadelphia, Philadelphia, PA, (2)Pixel Medical, Kingston, ON, Canada, (3)Queen's University, Kingston, ON, Canada, (4)Washington University School of Medicine, St. Louis, MO
Keywords: Congenital Heart Disease (CHD), Imaging & Physiology and Patent Ductus Arteriosus (PDA)
Background
Ductus arteriosus stenting (DAS) is an important palliative option for infants with ductal-dependent pulmonary blood flow (DD-PBF). However, assessment of patient candidacy and pre-procedural planning are complicated by complex PDA anatomy that is difficult to characterize by standard echocardiography. We aimed to develop a novel tool for 3D modeling and quantification of PDA structure using CT angiographic (CTA) images to inform interventional planning. Methods
We identified 33 infants with DD-PBF who had a CTA followed by DAS. The CTA vascular anatomy was visualized and segmented in 3D Slicer. A custom python-scripted module was built to semi-automatically extract centerlines of the vascular tree of the ductus and surrounding vessels (A). Metrics of ductal length, diameter, curvature, and tortuosity were automatically calculated (B,C), and retrospectively compared to 2D projectional angiograms (D). Results
The ductal anatomy was successfully modeled and quantified in all. 3D modeling generated a shorter total ductal length than the 2D measurements [median 14.9mm (IQR 9.8-16.5mm) vs 16.3mm (IQR 11.3-18.4mm), p<0.001] and shorter aortic ampulla to PA length [median 7.2mm (IQR 6.3-9.2mm) vs 9.2mm (IQR 7.5-11.1mm), p<0.002]. Maximum ductal diameters were similar [median 4.6mm (IQR 3.6-5.3mm) vs 4.8mm (IQR 4.0-5.4mm), p=0.76]. Conclusions
3D visualization and semi-automatic quantitative analysis of ductal structure is feasible, and may be informative for planning DAS in patients with DD-PBF. Future work is needed to determine if 3D modeling informs patient candidacy or procedural outcomes. 