Tian Jing, Smith Mark F, Chinnadurai Ponraj, Dilsizian Vasken, Turgeman Aharon, Abbo Aharon, Gajera Kalpitkumar, Xu Chenyang, Plotnick Daniel, Peters Robert, Saba Magdi, Shorofsky Stephen, Dickfeld Timm
University of Maryland School of Medicine, Baltimore, MD, USA.
J Cardiovasc Electrophysiol. 2009 Jun;20(6):567-604. doi: 10.1111/j.1540-8167.2008.01377.x.
Integration of 3D PET with Voltage Map for VT Ablation. Background: Image integration has the potential to display three-dimensional (3D) scar anatomy and facilitate substrate characterization for ventricular tachycardia (VT) ablation. However, the current generation of clinical mapping systems cannot display 3D left ventricle (LV) anatomy with embedded 3D scar reconstructions or allow display of border zone and high-resolution anatomic scar features. Objective: This study reports the first clinical experience with a mapping system allowing an integrated display of 3D LV anatomy with detailed 2D/3D scar and border zone reconstruction. Methods: Ten patients scheduled for VT ablation underwent contrast-enhanced computed tomography (CT) and Rubidium-82 perfusion/F-18 Fluorodeoxyglucose metabolic Positron Emission Tomography (PET) imaging to reconstruct 3D LV and scar anatomy. LV and scar models were co-registered using a 3D mapping system and analyzed with a 17-segment model. Metabolic thresholding was used to reconstruct the 3D border zone. Real-time display of CT images was performed during ablation. Results: Co-registration (error 4.3 +/- 0.7 mm) allowed simultaneous visualization of 3D LV anatomy and embedded scar and guided additional voltage mapping. Segments containing homogenous or partial scar correlated in 94.4% and 85.7% between voltage maps and 3D PET scar reconstructions, respectively. Voltage-defined scar and normal myocardium had relative FDG uptakes of 40 +/- 13% and 89 +/- 30% (P < 0.05). The 3D border zone correlated best with a 46% metabolic threshold. Real-time display of registered high-resolution CT images allowed the simultaneous characterization of scar-related anatomic changes. Conclusion: Integration of PET/CT reconstruction allows simultaneous 3D display of myocardial scar and border zone embedded into the LV anatomy as well as the display of detailed scar anatomy. Multimodality imaging may enable a new image-guided approach to substrate-guided VT ablation.
用于室性心动过速消融的三维正电子发射断层显像（PET）与电压图的整合。背景：图像整合有潜力显示三维（3D）瘢痕解剖结构，并有助于对室性心动过速（VT）消融的基质进行特征描述。然而，当前一代的临床标测系统无法显示带有嵌入式3D瘢痕重建的三维左心室（LV）解剖结构，也不允许显示边界区和高分辨率解剖瘢痕特征。目的：本研究报告了使用一种标测系统的首次临床经验，该系统可整合显示三维左心室解剖结构以及详细的二维/三维瘢痕和边界区重建。方法：计划进行室性心动过速消融的10例患者接受了对比增强计算机断层扫描（CT）和铷 - 82灌注/F - 18氟脱氧葡萄糖代谢正电子发射断层显像（PET）成像，以重建三维左心室和瘢痕解剖结构。使用三维标测系统对左心室和瘢痕模型进行配准，并采用17节段模型进行分析。代谢阈值法用于重建三维边界区。在消融过程中实时显示CT图像。结果：配准（误差4.3±0.7毫米）允许同时可视化三维左心室解剖结构和嵌入式瘢痕，并指导额外的电压标测。电压图与三维PET瘢痕重建之间，包含均匀或部分瘢痕的节段分别有94.4%和85.7%的相关性。电压定义的瘢痕和正常心肌的相对氟脱氧葡萄糖摄取分别为40±13%和89±30%（P<0.05）。三维边界区与46%的代谢阈值相关性最佳。配准的高分辨率CT图像的实时显示允许同时表征与瘢痕相关的解剖变化。结论：PET/CT重建的整合允许同时三维显示嵌入左心室解剖结构中的心肌瘢痕和边界区，以及详细的瘢痕解剖结构。多模态成像可能实现一种新的图像引导方法用于基质引导的室性心动过速消融。
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