Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany.
Catheter Cardiovasc Interv. 2013 Sep 1;82(3):436-42. doi: 10.1002/ccd.24646. Epub 2013 Mar 18.
Modern fluoroscopic angiography systems permit rendering of three-dimensional volumetric data sets using rotational angiography (3D-RA). Along with magnetic resonance imaging (MRI) or multi-detector-row computed tomography (MDCT) data sets, they can be fused with live fluoroscopy images for roadmapping during therapeutic procedures, but the value of multimodality fused data sets has not been clarified.
In a pediatric cardiac catheterization laboratory, we analyzed 78 interventional cardiovascular procedures in which 3D models of 3D-RA, MRI, or MDCT were used for 3D-guidance. Accuracy of 2D-3D registration as well as overall procedural benefit was independently rated by two pediatric interventionalists. Fluoroscopy time, radiation dose, and contrast dye consumption were evaluated and, grouping a subgroup analysis, the parameters were compared between patients who underwent stenting of aortic coarctation with and without 3D-roadmapping.
3D-guiding was used in 78 cases, 75 of these cases were with accurate 2D-3D registration. 3D-roadmapping was rated superior to conventional biplane imaging in 74 cases. 3D-guidance was used in 64 cases to define the ideal C-arm angulation and in 60 cases for accurate device positioning. Median dose-area product in the total investigation was 706.3 μGym(2) (104.8-7249.7 μGym(2) ), 3.3 ml/kg (0.9-13.7 ml/kg) of contrast dye was used, and total fluoroscopy time was 14.5 min (2.9-68.1 min). Fluoroscopy time for 3D-guided stenting of aortic coarctation is significantly lower (8.35 versus 10.2 min; P = 0.04).
3D-image fusion with live fluoroscopy can be applied successfully in catheter-based interventions of congenital heart disease. 3D-guidance facilitates catheter manipulations and interventions, allows preselection of ideal projection angles, reduces fluoroscopic time and the number of control angiographies.
现代荧光透视血管造影系统允许使用旋转血管造影（3D-RA）生成三维容积数据集。结合磁共振成像（MRI）或多排探测器计算机断层扫描（MDCT）数据集，它们可以与实时荧光透视图像融合，以便在治疗过程中进行路径规划，但多模态融合数据集的价值尚未明确。
在儿科心脏导管实验室中，我们分析了 78 例介入性心血管手术，其中使用 3D-RA、MRI 或 MDCT 的 3D 模型进行 3D 引导。两名儿科介入医师独立评估 2D-3D 配准的准确性和整体手术获益。评估了荧光透视时间、辐射剂量和造影剂消耗，并进行亚组分析，比较了主动脉缩窄支架置入术患者与无 3D 路径图患者的参数。
78 例患者中使用了 3D 引导，其中 75 例患者的 2D-3D 配准准确。74 例患者认为 3D 路径图优于传统的双平面成像。64 例患者使用 3D 引导确定理想的 C 臂角度，60 例患者使用 3D 引导进行精确的器械定位。整个研究的剂量面积乘积中位数为 706.3 μGym(2)（104.8-7249.7 μGym(2)），使用造影剂 3.3 ml/kg（0.9-13.7 ml/kg），总荧光透视时间为 14.5 分钟（2.9-68.1 分钟）。3D 引导主动脉缩窄支架置入术的荧光透视时间明显缩短（8.35 分钟比 10.2 分钟；P=0.04）。
实时荧光透视与 3D 图像融合可成功应用于先天性心脏病的导管介入治疗。3D 引导有助于导管操作和介入，允许预选理想的投影角度，减少荧光透视时间和造影次数。
