Laparoscopic operations are a common and popular way for abdominal procedures. They are usually performed by insufflation of carbon dioxide (CO2) into the abdominal cavity. However, insufflation of CO2 may interfere with cardiac and circulatory as well as respiratory functions. The CO2-pneumoperitoneum (PP) may cause hypercarbia and acidosis. The direct effects of CO2 and acidosis lead to decreased cardiac contractility, sensitization of the myocardium to arrhythmogenic effects of catecholamines and systemic vasodilatation. There may even be long-lasting post-operative effects on breathing control. The pneumoperitoneum may also cause several respiratory changes, e.g. decreased functional residual capacity (FRC) and vital capacity (VC), formation of atelectasis, reduced respiratory compliance and increased airway pressure. Still, arterial oxygenation is mostly maintained or even improved during PP. In view of the apparently contradictory results in respiratory mechanics and gas exchange, the present studies were performed to evaluate respiratory changes on gas exchange and ventilation-perfusion distributions during PP in a porcine model. It was demonstrated that atelectasis during anaesthesia and PP may be estimated by an increased arterial to endtidal PCO2-gradient (study I). Perfusion was redistributed away from dorsal, collapsed lung regions when PP was established. This resulted in a better ventilation-perfusion match (study II). Increasing abdominal pressure shifted blood flow more and more away from collapsed lung tissue, decreased pulmonary shunt and improved oxygenation from 8 to 16 mmHg PP, despite an increase of atelectasis formation (study III). CO2-PP enhanced the shift of blood flow towards better ventilated parts of the lung compared to Air-PP. Moreover, sodium natriumprusside worsened the ventilation-perfusion match even more and blunted the effects previously seen with carbon dioxide. CO2 should therefore be the mediator of enhancing HPV during PP. In conclusion, pneumoperitoneum with CO2 causes atelectasis with elimination of ventilation in the dependent lung regions. However, an efficient shift of blood flow away from collapsed, non-ventilated regions results in a better ventilation-perfusion matching and better oxygenation of blood than without PP. A prerequisite for the beneficial effect is the use of carbon dioxide for the abdominal inflation, since it enhances HPV.

A análise de imagens médicas auxiliada por computador permite a análise quantitativa das anormalidades e garante maior precisão diagnóstica. Esse tipo de análise é importante para medicina nuclear com Single Photon Emission Computed Tomography (SPECT), pois no grupo de dados tridimensionais de imagens, padrões sutis de anormalidades muitas vezes são importantes achados clínicos. Porém, as imagens podem sofrer interferência de artefatos de atenuação da emissão de fótons por partes moles corporais, o que reduz sua acurácia diagnóstica. Desde que se possuam parâmetros de atenuação computados em um modelo que permita a comparação com imagens de um dado paciente, a interferência dos artefatos pode ser corrigida com ganho na acurácia diagnóstica, sem a necessidade de utilização de técnicas de correção que aumentem a dose de exposição à radiação pelo paciente. A proposta desse estudo foi a criação de um atlas de cintilografia de perfusão miocárdica, que foi obtido a partir de imagens de indíviduos normais, e o desenvolvimento de um algoritmo computacional para a detecção de anormalidades perfusionais miocárdicas, através da comparação estatística dos modelos do atlas com imagens de pacientes. Métodos de corregistro de imagens de mesma modalidade e outras técnicas de processamento de imagens foram estudados e utilizados para a comparação das imagens dos pacientes com o modelo apropriado. Pela análise visual dos modelos, verificou-se a sua validade como imagem representativa de normalidade perfusional. Para avaliação da detecção, a situação dos segmentos miocárdicos (normal ou anormal) indicada pelo algoritmo de detecção foi comparada com a situação apontada no laudo obtido pela concordância de dois especialistas, de modo a se verificar as concordâncias e discordâncias da técnica em relação ao laudo e se obter a significância estatística. Com isso, verificou-se um índice de concordância positiva da técnica em relação ao laudo de aproximadamente 50%, de concordância negativa próxima a 82% e de concordância geral próxima a 68%. O teste exato de Fisher foi aplicado às tabelas de contingência, obtendo-se um valor de p bicaudal inferior a 0,0001, indicando uma probabilidade muito baixa de as concordâncias terem sido obtidas pelo acaso. Melhorias no algoritmo deverão ser implementadas e testes futuros com um padrão-ouro efetivo serão realizados para validação da técnica. / The computer-aided medical imaging analysis allows the quantitative analysis of abnormalities and enhances diagnostic accuracy. This type of analysis is important for nuclear medicine that uses Single Photon Emission Computed Tomography (SPECT), because in the group of three-dimensional data images, subtle patterns of abnormalities often are important clinical findings. However, images can suffer interference from attenuation artifacts of the emission of photons by soft parts of the body, which reduces their diagnostic accuracy. Since there are attenuation parameters computed in a template that allows for comparison with images of a given patient, the artifacts interference can be corrected with a gain in diagnostic accuracy, without the need of using correction techniques that increase the radiation exposure dose of the patient. The purpose of this study was to create an atlas of myocardial perfusion scintigraphy, which was obtained from images of normal individuals and the development of a computational algorithm for detection of myocardial perfusion abnormalities by statistical comparison of atlas templates with images of patients. Methods of image registration of same modality and other image processing techniques were studied and used for comparison of patient images with the appropriate template. By the visual analysis of the templates it was found its validity as a representative image of normal perfusion. For the detection evaluation, the situation of myocardial segments (normal or abnormal) indicated by the detection algorithm was compared with the situation indicated in the medical appraisal report obtained by agreement of two specialists in order to determine the agreement and disagreement of the technique regarding the medical appraisal report and obtaining the statistical significance. Thus, there was a positive agreement index of the technique regarding the medical appraisal report of approximately 50%, a negative agreement index close to 82% and a general agreement index near 68%. The Fisher exact test was applied to the contingency tables, yielding a two-sided p-value less than 0.0001, that indicates a very low probability of the agreements have been obtained by chance. Algorithm improvements should be implemented and further tests with an effective gold-standard will be conducted to validate the technique.

Made available in DSpace on 2014-10-09T12:36:04Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:59:49Z (GMT). No. of bitstreams: 0 / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Made available in DSpace on 2014-10-09T12:36:04Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:59:49Z (GMT). No. of bitstreams: 0 / O presente trabalho tem como objetivo a padronização de 68Ga, um emissor de pósitrons de meia-vida curta, usado em PET (Tomografia por Emissão de Pósitrons). A padronização do 68Ga foi realizada em um sistema de coincidência 4πβ-γ, que consiste de um detector proporcional em geometria 4π a gás fluente acoplado a um detector de cristal semicondutor HPGe, para a detecção de raios gama. A aquisição de dados foi realizada por meio de um Sistema de Coincidência por Software (SCS), desenvolvido no Laboratório de Metrologia Nuclear (Laboratório de Metrologia Nuclear - LMN) no IPEN-CNEN / SP. Os resultados finais foram obtidos a partir de um ajuste de curva multiparamétrica aplicando-se uma metodologia que leva em consideração a matriz de covariância combinando os resultados experimentais com aqueles determinados pela simulação Monte Carlo. / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Le développement de plusieurs méthodes de reconstruction quantitatives dédiées à la Tomographie par Emission Mono Photonique du petit animal a été au cœur de cette thèse. Dans cette optique, une modélisation rigoureuse par simulation Monte Carlo du processus d’acquisition du système disponible, a été mise en place et validée. La modélisation matricielle combinée à l’algorithme de reconstruction itératif OS-EM, a permis la caractérisation des performances du système. Les valeurs de sensibilité et de résolution spatiale tomographique sont respectivement de 0,027% au centre du champ de vue et de 0,87 mm. Les limitations majeures des méthodes Monte Carlo nous ont conduit à développer une génération matricielle efficace et simplifiée des effets physiques occurrents dans le sujet. Mon approche, basée sur une décomposition de la matrice système, associée à une base de données pré-calculées, a démontré un temps acceptable pour un suivi quotidien (1h), conduisant à une reconstruction d’images personnalisée. Les approximations inhérentes à l’approche mise en place ont un impact modéré sur les valeurs des coefficients de recouvrement, une correction d’environ 10% ayant été obtenue. / My thesis focuses on the development of several quantitative reconstruction methods dedicated to small animal Single Photon Emission Computed Tomography. The latter is based on modeling the acquisition process of a 4-heads pinhole SPECT system using Monte Carlo simulations.The system matrix approach, combined with the OS-EM iterative reconstruction algorithm, enabled to characterize the system performances and to compare it to the state of the art. Sensitivity of about 0,027% in the center of the field of view combined with a tomographic spatial resolution of 0,87 mm were obtained.The major drawbacks of Monte Carlo methods led us to develop an efficient and simplified modeling of the physical effects occurring in the subject. My approach based on a system matrix decomposition, associated to a scatter pre-calculated database method, demonstrated an acceptable time for a daily imaging subject follow-up (1h), leading to a personalized imaging approach. The inherent approximations of the scatter pre-calculated approach have a moderate impact on the recovery coefficients results, nevertheless a correction of about 10% was achieved.

Thoracic surgical procedures require partial or complete airway separation and the opportunity to exclude one lung from ventilation (one-lung ventilation, OLV). OLV is commonly associated with profound pathophysiological changes that may affect the postoperative outcome. It is injurious in terms of increased mechanical stress including alveolar cell stretch and overdistension, shear forces secondary to repeated tidal collapse and reopening of alveolar units and compression of alveolar vessels. Ventilation and perfusion distribution may thus be affected during and after OLV. The present studies investigated the influence of OLV on ventilation and perfusion distribution, on the gas/tissue distribution and on the lung histomorphology in a pig model of thoracic surgery. Anaesthetised and mechanically ventilated piglets were examined. The ventilation and perfusion distribution within the lungs was assessed by single photon emission computed tomography. Computed tomography was used to establish the effects of OLV on dependent lung gas/tissue distribution. The pulmonary histopathology of pigs undergoing OLV and thoracic surgery was compared with that of two-lung ventilation (TLV) and spontaneous breathing. OLV induced hyperperfusion and significant V/Q mismatch in the ventilated lung persistent in the postoperative course. It increased cyclic tidal recruitment that was associated with a persistent increase of gas content in the ventilated lung. OLV and thoracic surgery as well resulted in alveolar damage.  In the present model of OLV and thoracic surgery, alveolar recruitment manoeuvre (ARM) and protective ventilation approach using low tidal volume preserved the ventilated lung density distribution and did not aggravate cyclic recruitment of alveoli in the ventilated lung. In conclusion, the present model established significant alveolar damage in response to OLV and thoracic surgery. Lung injury could be related to the profound pathophysiological consequences of OLV including hyperperfusion, ventilation/perfusion mismatch and increased tidal recruitment of lung tissue in the dependent, ventilated lung.  These mechanisms may contribute to the increased susceptibility for respiratory complications in patients undergoing thoracic surgery. A protective approach including sufficient ARM, application of PEEP, and the use of lower tidal volumes may prevent the ventilated lung from deleterious consequences of OLV.

La néoangiogenèse tumorale est un élément pronostique de l’évolution de nombreux cancers. L’intégrine alphaVbeta3 ainsi que la métalloprotéase matricielle 9 (MMP-9), sont des marqueurs de ce processus. Leur ciblage offre la perspective d’une information diagnostique pour la détection précoce, l’évaluation de l’agressivité de pathologies et la sélection de patients répondeurs aux nouvelles thérapies anti-angiogéniques. Dans ce contexte, notre travail s’attèle à mettre au point les techniques nécessaires à la caractérisation de radiotraceurs. Des modèles de tumeurs richement néovascularisées ont été sélectionnés : le mélanome malin et le gliome malin. Nous nous sommes dans un premier temps intéressés à la détection de l’intégrine alphaVbeta3. Un traceur technétié, le 99mTc-DTPA-bis-c(RGDfK) a servi de support à la validation de nos techniques d’analyse. Cette méthodologie d’évaluation a ensuite été adaptée à des projets collaboratifs. L’étude du 18F-ribofuranose-RGD est réalisée avec le Centre de Recherche en Cancérologie de Toulouse (INSERM UMR 1037) et l’Institut des Sciences Moléculaires (CNRS UMR 5255). Un radioligand de la MMP-9, l’111In- DOTA-F3B, fait l’objet d’un partenariat avec l’ARNA (ARN : Régulations Naturelle et Artificielle, INSERM UMR 869) et l’Institut Lumière Matière (CNRS UMR 5306). Le composé technétié a démontré une bonne affinité et spécificité pour alphaVbeta3. In vivo, chez l’animal, les radioligands technétiés et fluorés ont permis l’identification de tumeurs alphaVbeta3 positives. L’111In-DOTA-F3B a, quant à lui, permis la visualisation de tumeurs chez l’animal et sur coupes tissulaires. Ces traceurs constituent une piste intéressante pour l’imagerie de la néoangiogenèse tumorale. / Tumor neoangiogenesis is a predictive element of the evolution of numerous cancers. AlphaVbeta3 integrin and matrix metalloprotease 9 (MMP-9) are markers of tumor neoangiogenesis. Their targeting appears of great interest either for early detection, aggressiveness staging of the disease or for selection of responders to new-targeted therapies. In this context, our objective is to develop methodologies needed for radiotracers characterization. Tracers have been investigated in different tumor models for which vascularization is very important: melanoma and glioma. First of all 99mTc-DTPA-bis-c(RGDfK) has been assessed in our laboratory and helped us to develop analytical methods. These methodologies were used in different partnership, the evaluation of 18F-ribofuranose-RGD targeting alphaVbeta3 with INSERM UMR 1037 and CNRS UMR 5255, and 111In-DOTA-F3B for molecular imaging of MMP-9 with INSERM UMR 869 and CNRS UMR 5306.The technetium peptide has demonstrated good affinity and specificity for alphaVbeta3. In vivo analysis in mice showed that both tracers were able to identify some alphaVbeta3-positive tumors. 111In-DOTA-F3B allowed us to detect hMMP-9 positive tumors in mice and in tumor tissue sections. In conclusion, these tracers still require to be investigated but represent promising tracers for tumor neoangiogenesis.

L’hypoxo-ischémie (HI) cérébrale néonatale représente une des principales causes de mortalité et de morbidité chez les nouveau-nés. Sa physiopathologie implique différents processus délétères menant vers la perte neuronale et responsables de séquelles neuro-cognitives. L'hypothermie thérapeutique est le seul traitement actuel mais est insuffisant. Cette étude a caractérisé et comparé l’effet de deux types de cellules issues du sang de cordon humain, les cellules mononuclées (HUCBCs) et les progéniteurs endothéliaux tardifs (ECFCs) sur l’amélioration des scores neuro-comportementaux mais aussi à l’échelle moléculaire et fonctionnelle dans le modèle d’hypoxo-ischémie néonatale à court (7 jours après l’épisode ischémique) et long terme (12 semaines après l’épisode ischémique).L’injection intrapéritonéale d'ECFCs ou de HUCBCs, 2 jours après HI, améliore les capacités de motricité et de mémorisation précoce et tardive des animaux à l’âge adulte, et diminue les comportements anxieux. Ces résultats sont associés à une augmentation de la densité capillaire en temps précoce et tardif. L’imagerie de perfusion cérébrale SPECT/CT a objectivé une restauration complète de la perfusion cérébrale de l’hémisphère lésé à l’âge adulte par les deux types cellulaires. Ces observations tardives sont associées à un effet protecteur précoce de ces cellules sur l’augmentation de la survie neuronale et la diminution de l’astrogliose réactionnelle ou encore sur la composante inflammatoire par diminution de l’activation microgliale pro-inflammatoire au niveau striatal. Les résultats de cette étude ouvrent ainsi de nouvelles perspectives pour l’usage des ECFCs dans le traitement de l’HI néonatale. / Neonatal hypoxic-ischemic encephalopathy (NHIE) is a dramatic perinatal complication, associated with poor neurological prognosis despite neuroprotection by therapeutic hypothermia, in the absence of an available curative therapy. We evaluated and compared ready-to-use human umbilical cord blood cells (HUCBCs) and bankable but allogeneic endothelial progenitors (ECFCs) as cell therapy candidate for NHIE. We compared benefits of HUCBC and ECFC transplantation 48 hours after injury in male rat NHIE model, based on the Rice-Vannucci approach. Based on behavioral tests, immune-histological assessment and metabolic imaging of brain perfusion using SPECT, HUCBC or ECFC administration provided equally early and sustained functional benefits, up to 8 weeks after injury. These results were associated with total normalization of injured hemisphere cerebral blood flow assessed by SPECT/CT imaging. In conclusion, even if ECFCs represent an efficient candidate, HUCBCs’ autologous criteria and easier availability make them the ideal candidate for hypoxic-ischemic cell therapy.

L'apnée obstructive du sommeil (AOS) est un problème de santé important, affectant jusqu’à 38% de la population générale et augmentant en prévalence avec l’âge. L'AOS mène à une hypoxémie intermittente, une fragmentation du sommeil et des changements de flot sanguin qui peuvent provoquer des dommages vasculaires et neuronaux. Récemment, des anomalies de flot sanguin cérébral (FSC) mesurées à l’éveil ont été observées chez les adultes présentant de l’AOS sévère. On ne sait toutefois pas si ces anomalies s’accentuent avec le temps et si le traitement de l'AOS (généralement la pression positive continue - PPC) peut diminuer ces anomalies chez les personnes âgées. Ainsi, ce projet de maîtrise vise à déterminer si le traitement par PPC d’une durée de 18 mois chez les personnes apnéiques de plus de 55 ans normalise le FSC mesuré en tomographie d'émission monophotonique. De plus, ce projet vise à investiguer les effets à moyen-terme de l'AOS non traitée relativement à un groupe contrôle. Nous avons émis l’hypothèse que les sujets avec de l'AOS traitée par PPC auront des augmentations de FSC dans des régions précédemment hypoperfusées alors que les individus avec l'AOS non traitée auront des diminutions de FSC à travers le temps dans des régions sensibles à l’AOS. Nous avons évalué 12 participants contrôles et 23 participants nouvellement diagnostiqués avec de l’AOS. Ces-derniers ont été référés à une clinique d’AOS et 13 d’entre eux ont suivi un traitement par PPC. Pour l’analyse de l’imagerie par émission monophotonique, nous avons utilisé une méthode basée sur le voxel ainsi qu’une méthode d’extraction pour mesurer les changements à travers le temps dans chacun des groupes. Nous avons observé une augmentation du FSC chez le groupe traité au niveau du gyrus temporal inférieur gauche. De plus, nous avons observé des diminutions de FSC chez le groupe non traité au niveau de l’hippocampe gauche, du gyrus parahippocampal droit et du pôle temporal supérieur gauche. Aucun changement n’a été observé chez le groupe contrôle. Les diminutions de FSC observées dans le groupe non traité pourraient être causées par les conséquences de l’AOS, notamment par une combinaison de diminution du calibre vasculaire et une perte cellulaire. En éliminant ces mécanismes pathologiques, le traitement par PPC permettrait une revascularisation et une prolifération cellulaire. Puisque les régions cérébrales affectées par l’AOS dans ce projet sont associées au déclin cognitif, d’autres études sont nécessaires pour clarifier le lien entre l’AOS, son traitement et la démence. / Obstructive sleep apnea (OSA) is an important health problem, affecting up to 38% of the general population and increasing in prevalence with age. OSA causes blood flow changes leading to vascular and neuronal damage. Indeed, decreases in regional cerebral blood flow (rCBF) have been observed in OSA. The treatment of OSA is continuous positive airway pressure (CPAP). CPAP treatment has been associated with increases in rCBF. However, studies evaluating rCBF in OSA were predominantly composed of middle-aged people. Therefore, we don’t know if these results could be generalized to the aging population. Thus, this master's project aims to determine whether an 18-month CPAP treatment for apneic individuals older than 55 years normalizes the rCBF measured in single-photon emission computed tomography. In addition, this project aims to investigate the longitudinal effects of untreated OSA relative to a control group. We hypothesized that treated subjects will have rCBF increases in previously hypoperfused regions while individuals with untreated OSA will have decreased rCBF over time in OSA-sensible regions. We evaluated 12 control participants and 23 newly diagnosed participants with OSA. The latter were referred to an OSA clinic and 13 of them followed a CPAP treatment. For the analysis of single photon emission imaging, we used a voxel-based method and an extraction method to measure changes over time in each of the groups. We observed an increased rCBF in the treated group in the left inferior temporal gyrus. In addition, we observed decreased rCBF in the untreated group in the left hippocampus, the right parahippocampal gyrus, and left superior temporal pole. No change was observed in the control group. The decreased rCBF seen in the untreated group could be caused by the consequences of OSA, including a combination of decreased blood vessels caliber and cell loss. By eliminating these pathological mechanisms, CPAP treatment would allow revascularization and cell proliferation. Since brain regions affected by OSA in this project are associated with cognitive decline, further studies are needed to clarify the link between OSA, its treatment, and dementia.

Las enfermedades cardiovasculares (ECVs) son la principal causa de mortalidad en el mundo Occidental. El interés de prevenir y tratar las ECVs ha desencadenado un rápido desarrollo de los sistemas de adquisición de imágenes médicas. Por este motivo, la cantidad de datos de imagen recolectados en las instituciones de salud se ha incrementado considerablemente. Este hecho ha aumentado la necesidad de herramientas automatizadas para dar soporte al diagnóstico, mediante una interpretación de imagen confiable y reproducible. La tarea de interpretación requiere traducir los datos crudos de imagen en parámetros cuantitativos, los cuales son considerados relevantes para clasificar la condición cardiaca de un paciente. Para realizar tal tarea, los métodos basados en modelos estadísticos de forma han recibido favoritismo dada la naturaleza tridimensional (o 3D+t) de las imágenes cardiovasculares. Deformando el modelo estadístico de forma a la imagen de un paciente, el corazón puede analizarse de manera integral. Actualmente, el campo de las imágenes cardiovasculares esta constituido por diferentes modalidades. Cada modalidad explota diferentes fenómenos físicos, lo cual nos permite observar el órgano cardiaco desde diferentes ángulos. El personal clínico recopila todas estas piezas de información y las ensambla mentalmente en un modelo integral. Este modelo integral incluye información anatómica y funcional que muestra un cuadro completo del corazón del paciente. Es de alto interés transformar este modelo mental en un modelo computacional capaz de integrar la información de manera global. La generación de un modelo como tal no es simplemente un reto de visualización. Requiere una metodología capaz de extraer los parámetros cuantitativos relevantes basados en los mismos principios técnicos. Esto nos asegura que las mediciones se pueden comparar directamente. Tal metodología debe ser capaz de: 1) segmentar con precisión las cavidades cardiacas a partir de datos multimodales, 2) proporcionar un marco de referencia único para integrar múltiples fuentes de información, y 3) asistir la clasificación de la condición cardiaca del paciente. Esta tesis se basa en que los modelos estadísticos de forma, y en particular los Modelos Activos de Forma, son un método robusto y preciso con el potencial de incluir todos estos requerimientos. Para procesar múltiples modalidades de imagen, separamos la información estadística de forma de la información de apariencia. Obtenemos la información estadística de forma a partir de una modalidad de alta resolución y aprendemos la apariencia simulando la física de adquisición de otras modalidades. Las contribuciones de esta tesis pueden ser resumidas así: 1) un método genérico para construir automáticamente modelos de intensidad para los Modelos Activos de Forma simulando la física de adquisición de la modalidad en cuestión, 2) la primera extensión de un simulador de Resonancia Magnética Nuclear diseñado para producir estudios cardiacos realistas, y 3) un método novedoso para el entrenamiento automático de modelos de intensidad y de fiabilidad aplicado a estudios cardiacos de Resonancia Magnética Nuclear. Cada una de estas contribuciones representa un artículo publicado o enviado a una revista técnica internacional. / Cardiovascular diseases (CVDs) are the major cause of death in the Western world. The desire to prevent and treat CVDs has triggered a rapid development of medical imaging systems. As a consequence, the amount of imaging data collected in health care institutions has increased considerably. This fact has raised the need for automated analysis tools to support diagnosis with reliable and reproducible image interpretation. The interpretation task requires to translate raw imaging data into quantitative parameters, which are considered relevant to classify the patient’s cardiac condition. To achieve this task, statistical shape model approaches have found favoritism given the 3D (or 3D+t) nature of cardiovascular imaging datasets. By deforming the statistical shape model to image data from a patient, the heart can be analyzed in a more holistic way. Currently, the field of cardiovascular imaging is constituted by different modalities. Each modality exploits distinct physical phenomena, which allows us to observe the cardiac organ from different angles. Clinicians collect all these pieces of information to form an integrated mental model. The mental model includes anatomical and functional information to display a full picture of the patient’s heart. It is highly desirable to transform this mental model into a computational model able to integrate the information in a comprehensive manner. Generating such a model is not simply a visualization challenge. It requires having a methodology able to extract relevant quantitative parameters by applying the same principle. This assures that the measurements are directly comparable. Such a methodology should be able to: 1) accurately segment the cardiac cavities from multimodal datasets, 2) provide a unified frame of reference to integrate multiple information sources, and 3) aid the classification of a patient’s cardiac condition. This thesis builds upon the idea that statistical shape models, in particular Active Shape Models, are a robust and accurate approach with the potential to incorporate all these requirements. In order to handle multiple image modalities, we separate the statistical shape information from the appearance information. We obtain the statistical shape information from a high resolution modality and include the appearance information by simulating the physics of acquisition of other modalities. The contributions of this thesis can be summarized as: 1) a generic method to automatically construct intensity models for Active Shape Models based on simulating the physics of acquisition of the given imaging modality, 2) the first extension of a Magnetic Resonance Imaging (MRI) simulator tailored to produce realistic cardiac images, and 3) a novel automatic intensity model and reliability training strategy applied to cardiac MRI studies. Each of these contributions represents an article published or submitted to a peer-review archival journal.