Quantitative Analysis of 3D Anatomy to Inform Planning of Ductal Arteriosus Stenting.

Background: Ductus arteriosus stenting (DAS) is used to palliate infants with ductal-dependent pulmonary blood flow (DD-PBF), however patent ductus arteriosus (PDA) anatomy can be complex and heterogenous.

Aims: We developed custom, open-source software to model and quantify PDA anatomy.

Methods: We retrospectively identified 33 neonates with DD-PBF with a CTA before DAS. A novel custom workflow was implemented in 3D Slicer and SlicerHeart to semi-automatically extract centerlines of the course of the PDA and surrounding vessels. 3D ductal length, diameter, curvature and tortuosity were automatically calculated (3D automatic) and compared to manually adjusted 3D measurements (3D semi-automatic), and manual measurements of PDA dimensions in 2D projectional angiograms before and after stent angioplasty.

Results: Ductal anatomy was successfully modeled and quantified in all subjects. 3D automatic and semi-automatic measurements of straight-line aortic to pulmonary artery length were not significantly different than 2D measurements. Semi-automatic 3D measurements were similar to 2D measurements of the total length. Minimum and maximum ductal diameters were not significantly different by 3D automatic and 2D measurements, however semi-automatic 3D diameters were significantly larger. Inter-reader reliability of ductal length and diameter was higher with manual adjustment of 3D centerlines compared to standard measurement of 2D angiograms. These differences were consistent across PGE doses between CTA and DAS.

Conclusions: Automatic PDA modeling is feasible and efficient, enabling reproducible quantification of ductal anatomy for procedural planning of DAS in patients with DD-PBF. Further development is needed as well as investigation of whether 3D modeling-derived measurements influence procedural duration or outcome.