Ehret Nicole, Alkassar Muhannad, Dittrich Sven, Cesnjevar Robert, Rüffer André, Uder Michael, Rompel Oliver, Hammon Matthias, Glöckler Martin
1Department of Pediatric Cardiology,University Hospital Erlangen,Friedrich-Alexander University Erlangen-Nuremberg,Erlangen,Germany.
2Department of Congenital Heart Surgery,University Hospital Erlangen,Friedrich-Alexander University Erlangen-Nuremberg,Erlangen,Germany.
Cardiol Young. 2018 May;28(5):661-667. doi: 10.1017/S1047951117002840. Epub 2018 Jan 18.
Optimal imaging is essential for catheter-based interventions in CHD. The three-dimensional models in volume-rendering technique currently in use are not standardised. This paper investigates the feasibility and impact of novel three-dimensional guidance with segmented and tessellated three-dimensional heart models in catheterisation of CHD. In addition, a nearly radiation-free two- to three-dimensional registration and a biplane overlay were used.Methods and resultsWe analysed 60 consecutive cases in which segmented tessellated three-dimensional heart models were merged with live fluoroscopy images and aligned using the tracheal bifurcation as a fiducial mark. The models were generated from previous MRI or CT by dedicated medical software. We chose the stereo-lithography format, as this promises advantage over volume-rendering-technique models regarding visualisation. Prospects, potential benefits, and accuracy of the two- to three-dimensional registration were rated separately by two paediatric interventionalists on a five-point Likert scale. Fluoroscopy time, radiation dose, and contrast dye consumption were evaluated. Over a 10-month study period, two- to three-dimensional image fusion was applied to 60 out of 354 cases. Of the 60 catheterisations, 73.3% were performed in the context of interventions. The accuracy of two- to three-dimensional registration was sufficient in all cases. Three-dimensional guidance was rated superior to conventional biplane imaging in all 60 cases. We registered significantly smaller amounts of used contrast dye (p<0.01), lower levels of radiation dose (p<0.02), and less fluoroscopy time (p<0.01) during interventions concerning the aortic arch compared with a control group.
Two- to three-dimensional image fusion can be applied successfully in most catheter-based interventions of CHD. Meshes in stereo-lithography format are accurate and base for standardised and reproducible three-dimensional models.
最佳成像对于先天性心脏病（CHD）的导管介入治疗至关重要。目前使用的容积再现技术中的三维模型尚未标准化。本文研究了在CHD导管插入术中使用分割和细分的三维心脏模型进行新型三维引导的可行性和影响。此外，还使用了近乎无辐射的二维到三维配准和双平面叠加。
方法和结果
我们分析了60例连续病例，其中分割细分的三维心脏模型与实时荧光透视图像合并，并以气管分叉作为基准标记进行对齐。这些模型由专用医学软件根据先前的MRI或CT生成。我们选择了立体光刻格式，因为在可视化方面，它比容积再现技术模型更具优势。两名儿科介入专家分别用五点李克特量表对二维到三维配准的前景、潜在益处和准确性进行了评分。评估了透视时间、辐射剂量和造影剂用量。在为期10个月的研究期间，在354例病例中的60例应用了二维到三维图像融合。在这60例导管插入术中，73.3%是在介入治疗的情况下进行的。在所有病例中，二维到三维配准的准确性都足够。在所有60例病例中，三维引导被评为优于传统双平面成像。与对照组相比，在涉及主动脉弓的介入治疗期间，我们使用的造影剂用量显著减少（p<0.01），辐射剂量水平更低（p<0.02），透视时间更短（p<0.01）。
二维到三维图像融合可以成功应用于大多数CHD的导管介入治疗。立体光刻格式的网格准确，是标准化和可重复三维模型的基础。
