Towards Automatic Cerebral 3D-2D CTA-DSA Registration

Abstract

Stroke remains a leading cause of morbidity and mortality worldwide, despite advances in treatment modalities. Endovascular thrombectomy (EVT), a revolutionary intervention for ischemic stroke, is limited by its reliance on 2D fluoroscopic imaging, which lacks depth and comprehensive vascular detail. We propose a novel AI-driven pipeline for 3D CTA to 2D DSA cross-modality registration, termed DeepIterReg. The proposed pipeline integrates neural network-based initialization with iterative optimization to align pre-intervention and peri-intervention data. Our approach addresses the challenges of cross-modality alignment, particularly in scenarios involving limited shared vascular structures, by leveraging synthetic data, vein-centric anchoring, and differentiable rendering techniques. We assess the efficacy of DeepIterReg through quantitative analysis of capture ranges and registration accuracy. Results indicate that our method is able to accurately register 70% of a testset of 20 patients, and is able to improve capture ranges when performing an initial pose estimation using a convolutional neural network.