AutoFOX: An automated cross-modal 3D fusion framework of coronary X-ray angiography and OCT

Coronary artery disease (CAD) is the leading cause of death globally. The 3D fusion of coronary X-ray angiography (XA) and optical coherence tomography (OCT) provides complementary information to appreciate coronary anatomy and plaque morphology. This significantly improve CAD diagnosis and prognosis by enabling precise hemodynamic and computational physiology assessments. The challenges of fusion lie in the potential misalignment caused by the foreshortening effect in XA and non-uniform acquisition of OCT pullback. Moreover, the need for reconstructions of major bifurcations is technically demanding. This paper proposed an automated 3D fusion framework AutoFOX, which consists of deep learning model TransCAN for 3D vessel alignment. The 3D vessel contours are processed as sequential data, whose features are extracted and integrated with bifurcation information to enhance alignment via a multi-task fashion. TransCAN shows the highest alignment accuracy among all methods with a mean alignment error of 0.99 +/- 0.81 mm along the vascular sequence, and only 0.82 +/- 0.69 mm at key anatomical positions. The proposed AutoFOX framework uniquely employs an advanced side branch lumen reconstruction algorithm to enhance the assessment of bifurcation lesions. A multi-center dataset is utilized for independent external validation, using the paired 3D coronary computer tomography angiography (CTA) as the reference standard. Novel morphological metrics are proposed to evaluate the fusion accuracy. Our experiments show that the fusion model generated by AutoFOX exhibits high morphological consistency with CTA. AutoFOX framework enables automatic and comprehensive assessment of CAD, especially for the accurate assessment of bifurcation stenosis, which is of clinical value to guiding procedure and optimization.