Article Type : Case Report
Authors : Ogura K, Bando H,, Nishikawa S, Kato Y, Obonai T and Kato Y
Keywords : Reconstruction Image Analysis; Synapse Vincent; Superficial Femoral Artery (SFA); Ankle Brachial Index (ABI); Brachial Ankle Pulse Wave Velocity (BAPWV); Peripheral Artery Disease (PAD)
Background:
Information and communication technology (ICT) has been developed remarkably
with artificial intelligence (AI) and three-dimensional reconstruction image
analysis.
Patient
and Method: The patient is an 84-year-old male with
type 2 diabetes (T2D). The computed tomography (CT) data were analyzed by the
application of SYNAPSE VINCENT system.
Results:
His ankle brachial index (ABI) showed 1.16/0.65 (right/left) with large
difference as peripheral artery disease (PAD). He showed calcification of aorta
calcification, the occlusions of left superficial femoral artery (SFA) and
right tibial artery.
Discussion:
This technique can provide detail images, which contribute much for patients
with arteriosclerotic cardiovascular disease (ASCVD).
The authors and
co-researchers have continued clinical research and practice for years [1]. The
reported areas include atherosclerotic cardiovascular disease (ASCVD), Type 2
diabetes (T2D) and radiological development [2,3]. Among them, recent focus
would be the computed tomography (CT) scan associated with artificial
intelligence (AI) assisted three-dimensional reconstruction image analysis
[4,5].
For decade, rapid
developments of information and communication technology (ICT) have been
observed in various areas. By applying AI technology, beneficial application
has been invented so far. Among them deep learning was associated with
radiological three-dimension (3-D) analysis for the magnetic resonance imaging
(MRI) and computerized tomography (CT) [5]. From historical point of view, 3-D
imaging has been initially focused to the liver and heart, and after that to
the respiratory, neurology and urological regions. In addition, orthopedics
areas were initiated for precise analysis of joints such as knee joints [6].
Thus, reconstruction 3-D imaging of CT scan has been applied in the clinical
practice [7]. Recently, our research group experienced an elderly impressive
patient with peripheral artery disease (PAD). In this article, general progress
of the case and some perspective will be described.
History and Physicals
The patient is an 84-year-old male with hypertension and
hyperuricemia for about 8 years. He has provided anti-hypertensive agents (AHA)
as amlodipine 5mg, valsartan 80mg and febuxostat 20mg for years. He has worked
for taxi driver for long, and has been stable in recent years.
His physical examination in June 2022 showed unremarkable
findings. Consciousness alert, vitals BP 132/72, pulse 64/min, SpO2
98%, head, neck, lung and heart were negative, abdomen is flat, and
neurological test intact. His stature was 173 cm and weight 54.3kg with BMI
18.1 kg/m2.
Results of basic exams
As to his laboratory
examination, he has shown stable data until now (Table 1). Remarkable
abnormalities were not observed in liver function, lipids, renal function and
complete blood count (CBC). His electrocardiogram (ECG) and chest X-ray
revealed negative findings.
He had the examination of mechanocardiogram and sphygmogram in July, 2022. As a result, ankle brachial index (ABI) showed large difference between right and left leg as 1.16 and 0.65 (Figure 1).
The data of
brachial-ankle pulse wave velocity (baPWV) revealed the large difference of
right vs left as 1797 vs1318. Due to these results, his previous history was
again taken in detail, and then he had the episode of muscle weakness in the
left leg for a month 2 years ago.
In recent medical
practice, 3-D image analysis has been developed and evaluated for their detail
diagnosis [8]. Among them, one of the supreme analyses would be SYNAPSE VINCENT
system by Fujifilm company, Tokyo, Japan. [9]. This technique has been used for
diagnostic imaging of CT, MRI and magnetic resonance angiography (MRA) for
years [10]. As the authors and collaborators have taken most advantages of this
software, and reported impressive clinical reports, SYNAPSE VINCENT has been
used for detail radiological diagnosis this time [11].
The patient received CT scan of lower arteries in Sept, 2022, which was held in plain and a contrast-enhanced procedure using iopamidol. From these data, 3-D reconstruction analysis was performed. As a result, the diagnosis would be in the following: a) several strong calcification lesions were detected in the lower aorta and in the bifurcation of the aorta (Figure 2a, b) the occlusion of left superficial femoral artery (SFA) was found at the middle portion level of left thigh, which can be observed from multiple angle (Figure 2b and c) occlusion was found in the left anterior tibial artery and in the right three branches (Figure 2c).
Figure 1: The results of mechanocardiogram and sphygmogram.
Historically speaking,
great development has been found for diagnostic imaging systems. Among these
technologies, high-precision 3D images were initiated in 2008 from tomographic
data of CT and MRI as SYNAPSE VINCENT [10]. It started in the organs of liver
and heart, and it expanded for head, respiratory and urinary systems [12]. It
also included orthopedic region in 2018 from knee joints analyses [13].
Recently, this technology has been widely applied for diagnostic imaging and
also surgical procedure in actual medical practice. Such judgement and
treatment were formerly depended on manual skill, operation and experience.
However, AI technology has changed the world of operation room (OR) in recent
decade.
Concerning the expanding
the applied organs, the Ministry of Health, Labour and Welfare, Japan formerly
had named “image-supported navigation in hepatectomy” during the early period
of 3D image visualization technologies. After that, SYNAPSE VINCENT has been
applied for preoperative liver functional evaluation using vascular fusion and
scintigraphy [14]. Furthermore, it became beneficial method of embolization
area prediction related to the transcatheter arterial chemoembolization for
surgical treatment planning for liver diseases [15] and also the treatment of
hepatocellular carcinoma (HCC) [16].
In the current patient with PAD, bilateral occluded arteries in the lower extremities were found. As to his previous history, unremarkable findings were detected from lipids, renal and diabetic aspects (Table 1). Those images were presented in detail by the application of SYNAPSE VINCENT [10]. Before recognizing large difference of bilateral ABI data, the case nor medical staffs did not notice the presence of PAD (Figure 1). By image reconstruction of aorta, multiple calcifications were detected, which may suggest the development of arteriosclerosis of large vessels (Figure 2a). For the occlusion of left SFA, collateral artery may contribute maintaining the blood flow (Figure 2b). Several aspects of rotating angles enable to observe detail changes of SFA. Further, the lesions were clearly captured in clear images by optimizing the processing of image reconstruction, where such technique will contribute further development of radiological diagnosing and treatment (Figure 2c).
Figure 2:
Reconstruction imaging using SYNAPSE VINCENT system
2a:
The calcification lesions exist in the bifurcation of the aorta.
2b:
The occlusion of left femoral artery was found.
2c: The occlusion of bilateral anterior tibial arteries was noted.
Similar latest report is
found, where a 70-year-old man with left SFA occlusion received further
evaluation [17]. The method was the motion imaging with intravoxel incoherent
way, which showed the improvement of lower limb perfusion after endovascular
treatment for lower extremity arterial disease. The changes in ABI before and
after treatment were 0.46 and 1.06, which revealed remarkable improvement. In
recent years, the development and enhancement of various computers have been
observed. Furthermore, radiological techniques of medical imaging have become
more useful with related improved software. Consequently, clinicians can be
more easily accessible for diagnosis and treatment of vascular diseases. Until
now, several evolutional novel methodologies have found for visualizing of
blood flow in vascular diseases with time-varying blood flow structures and
quantification [18]. The combined procedure would be beneficial, such as
computational fluid dynamics (CFD) method and also 3-D, time-resolved,
phase-contrast MRI method (4D-flow MRI).
Some limitations are
present in this report. Current case has been treated for hypertension, and was
proved to have PAD this time. Other ASCVD legion may exist for future
evaluation.
In summary, the
reconstruction image analysis method and its application for blood vessels were
described. By the application of SYNAPSE VINCENT, detail images of vascular
abnormalities can be obtained for lower extremity and lumbosacral region [19].
Our clinical group will follow up the case and continue various trials for
novel combination of radiological diagnostic procedures.
Conflicts of Interest: None.
Funding:
None.