Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
JACC Cardiovasc Imaging. 2014 Dec;7(12):1239-48. doi: 10.1016/j.jcmg.2014.09.002. Epub 2014 Nov 5.
The aim of this study was to develop a 3-dimensional (3D) fusion tool kit to integrate left ventricular (LV) venous anatomy on fluoroscopy venograms with LV epicardial surface on single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) for guiding cardiac resynchronization therapy (CRT) LV lead placement.
LV lead position is important for CRT response. For LV lead placement into viable regions with late activation, it is important to visualize both LV venous anatomy and myocardium.
Major LV veins were manually identified on fluoroscopic venograms and automatically reconstructed into a 3D anatomy. 3D LV epicardial surface was extracted from SPECT MPI. SPECT-vein fusion that consisted of geometric alignment, landmark-based registration, and vessel-surface overlay was developed to fuse the 3D venous anatomy with the epicardial surface. The accuracy of this tool was evaluated using computed tomography (CT) venograms. LV epicardial surfaces and veins were manually identified on the CT images and registered with the SPECT image by an independent operator. The locations of the fluoroscopic and CT veins on the SPECT epicardial surfaces were compared using absolute distances on SPECT short-axis slice and the 17-segment model.
Ten CRT patients were enrolled. The distance between the corresponding fluoroscopic and CT veins on the short-axis epicardial surfaces was 4.6 ± 3.6 mm (range 0 to 16.9 mm). The presence of the corresponding fluoroscopic and CT veins in the 17-segment model agreed well with a kappa value of 0.87 (95% confidence interval: 0.82 to 0.93). The tool kit was used to guide LV lead placement in a catheter laboratory and showed clinical feasibility and benefit to the patient.
A tool kit has been developed to reconstruct 3D LV venous anatomy from dual-view fluoroscopic venograms and to fuse it with LV epicardial surface on SPECT MPI. It is technically accurate for guiding LV lead placement by the 17-segment model and is feasible for clinical use in the catheterization laboratory.
本研究旨在开发一种 3 维（3D）融合工具包，以将左心室（LV）静脉解剖结构整合到荧光透视静脉造影中，并将 LV 心外膜表面整合到单光子发射计算机断层扫描（SPECT）心肌灌注成像（MPI）中，以指导心脏再同步治疗（CRT）LV 导联的放置。
LV 导联的位置对于 CRT 反应很重要。对于将 LV 导联放置到有晚期激活的存活区域，重要的是要同时可视化 LV 静脉解剖结构和心肌。
在荧光透视静脉造影中手动识别主要的 LV 静脉，并将其自动重建为 3D 解剖结构。从 SPECT MPI 中提取 3D LV 心外膜表面。开发了 SPECT-静脉融合技术，包括几何对齐、基于标志物的配准和血管表面叠加，以将 3D 静脉解剖结构与心外膜表面融合。通过独立操作者在 CT 静脉造影上手动识别 LV 心外膜表面和静脉，并将其与 SPECT 图像进行注册，来评估该工具的准确性。在 SPECT 短轴切片和 17 节段模型上使用绝对距离比较 SPECT 心外膜表面上荧光透视和 CT 静脉的位置。
共纳入 10 例 CRT 患者。在短轴心外膜表面上，相应的荧光透视和 CT 静脉之间的距离为 4.6±3.6mm（范围 0 至 16.9mm）。在 17 节段模型中，存在相应的荧光透视和 CT 静脉，kappa 值为 0.87（95%置信区间：0.82 至 0.93）。该工具套件已用于指导导管实验室中的 LV 导联放置，并显示出临床可行性和对患者的益处。
已经开发出一种工具包，用于从双视图荧光透视静脉造影中重建 3D LV 静脉解剖结构，并将其与 SPECT MPI 上的 LV 心外膜表面融合。它通过 17 节段模型引导 LV 导联放置的技术准确性高，并且在导管实验室中具有临床应用的可行性。
