Haak Alexander, Ren Ben, Mulder Harriët W, Vegas-Sánchez-Ferrero Gonzalo, van Burken Gerard, van der Steen Antonius F W, van Stralen Marijn, Pluim Josien P W, van Walsum Theo, Bosch Johannes G
Department of Biomedical Engineering of the Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Ultrasound Med Biol. 2015 Jul;41(7):1991-2000. doi: 10.1016/j.ultrasmedbio.2015.03.011. Epub 2015 Apr 8.
Minimally invasive interventions in the heart such as in electrophysiology are becoming more and more important in clinical practice. Currently, preoperative computed tomography angiography (CTA) is used to provide anatomic information during electrophysiology interventions, but this does not provide real-time feedback and burdens the patient with additional radiation and side effects of the contrast agent. Three-dimensional transesophageal echocardiography (TEE) is an excellent modality for visualization of anatomic structures and instruments in real time, but some cavities, especially the left atrium, suffer from the limited coverage of the 3-D TEE volumes. This leads to difficulty in segmenting the left atrium. We propose replacing or complementing pre-operative CTA imaging with wide-view TEE. We tested this proposal on 20 patients for which TEE image volumes covering the left atrium and CTA images were acquired. The TEE images were manually registered, and wide-view volumes were generated. Five heart cavities in single-view and wide-view TEE were segmented and compared with atlas based-segmentations derived from the CTA images. We found that the segmentation accuracy (Dice coefficients) improved relative to segmentation of single-view images by 5, 15 and 9 percentage points for the left atrium, right atrium and aorta, respectively. Average anatomic coverage was improved by 2, 29, 62 and 49 percentage points for the right ventricle, left atrium, right atrium and aorta, respectively. This finding confirms that wide-view 3-D TEE can be useful in supporting electrophysiology interventions.
诸如电生理学领域的心脏微创干预在临床实践中变得越来越重要。目前，术前计算机断层扫描血管造影（CTA）用于在电生理干预期间提供解剖学信息，但这无法提供实时反馈，且会让患者承受额外的辐射以及造影剂的副作用。三维经食管超声心动图（TEE）是实时可视化解剖结构和器械的极佳方式，但某些腔室，尤其是左心房，存在三维TEE容积覆盖范围有限的问题。这导致左心房分割困难。我们提议用宽视野TEE取代术前CTA成像或作为其补充。我们对20例患者进行了测试，获取了覆盖左心房的TEE图像容积和CTA图像。对TEE图像进行手动配准，并生成宽视野容积。对单视野和宽视野TEE中的五个心脏腔室进行分割，并与源自CTA图像的基于图谱的分割进行比较。我们发现，相对于单视野图像的分割，左心房、右心房和主动脉的分割准确率（骰子系数）分别提高了5、15和9个百分点。右心室、左心房、右心房和主动脉的平均解剖覆盖范围分别提高了2、29、62和49个百分点。这一发现证实宽视野三维TEE在支持电生理干预方面可能有用。
