Bisplinghoff S, Hänisch C, Becker M, Radermacher K, de la Fuente M
Chair of Medical Engineering, RWTH Aachen University, Pauwelsstr. 20, 52074 , Aachen, Germany,
Int J Comput Assist Radiol Surg. 2015 Jan;10(1):11-7. doi: 10.1007/s11548-014-1063-3. Epub 2014 May 10.
Identification of viable myocardial tissue is important for patients with a low left ventricular ejection fraction, since revascularization is effective only if the affected region is viable. After cineangiographic identification of occluded coronary vessels, the myocardial viability is usually determined using cardiac MRI or SPECT. Alternatively, myocardial deformation imaging by echocardiography has been introduced that allows detection of viable myocardium directly within the catheterization laboratory. Multimodality fusion of coronary angiograms and echocardiograms was developed to match viable regions with areas affected by occluded vessels.
Identification of corresponding myocardial regions in both coronary angiograms and ultrasound scans was performed using multimodality image fusion. Geometrically correct superposition of these images was done to allow direct identification of the involved myocardial regions. An electromagnetic tracking system was used as a common base for co-registration of the images. The system was tested using a phantom test device in a cardiac catheterization laboratory.
A 2D projection error of 3.8±1.1 mm was achieved in trials using a cardiac phantom test object.
Superimposition of the occluded coronary artery and the regional myocardial viability was achieved using automated multimodality fusion of coronary angiograms and stress echocardiograms with in vitro experiments. This system is promising for integrated single step angiography and angioplasty that may reduce procedure time, cost and length of hospitalization. Further testing in vivo is needed to verify and validate the system in a clinical setting.
对于左心室射血分数低的患者，识别存活心肌组织很重要，因为只有当受影响区域存活时，血管重建才有效。在通过心血管造影术识别出闭塞的冠状动脉后，通常使用心脏磁共振成像（MRI）或单光子发射计算机断层扫描（SPECT）来确定心肌活力。另外，已经引入了超声心动图心肌变形成像，可在导管实验室直接检测存活心肌。开发了冠状动脉造影和超声心动图的多模态融合技术，以将存活区域与受闭塞血管影响的区域相匹配。
使用多模态图像融合技术在冠状动脉造影和超声扫描中识别相应的心肌区域。对这些图像进行几何校正叠加，以便直接识别受累心肌区域。使用电磁跟踪系统作为图像配准的共同基础。该系统在心脏导管实验室中使用模拟测试设备进行了测试。
在使用心脏模拟测试对象的试验中，二维投影误差为3.8±1.1毫米。
通过冠状动脉造影和负荷超声心动图的自动多模态融合以及体外实验，实现了闭塞冠状动脉与区域心肌活力的叠加。该系统有望用于集成的单步血管造影和血管成形术，这可能会减少手术时间、成本和住院时间。需要在体内进行进一步测试，以在临床环境中验证和确认该系统。
