Xu Zhenzhen, Tao Bo, Liu Chuanbin, Han Dong, Zhang Jibin, Liu Junsong, Li Sulei, Li Weijie, Wang Jing, Liang Jimin, Cao Feng
School of Life Science and Technology, Xidian University, Xi'an, China.
Department of Geriatric Cardiology, Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
Quant Imaging Med Surg. 2021 Jul;11(7):3175-3189. doi: 10.21037/qims-20-702.
The precise assessment of myocardial infarction (MI) is crucial both for therapeutic interventions in old MI and the development of new and effective techniques to repair injured myocardium. A novel method was developed to assess left ventricular (LV) quantitatively infarction through three-dimensional (3D) multimodality fusion based on computed tomography angiography (CTA) and technetium-99m methoxyisobutylisonitrile (Tc-MIBI) single-photon emission computed tomography (SPECT) images. This study sought to develop a 3D quantitative method for MI for pre-clinical study and clinical application.
Three months after the MI models were established in 20 minipigs, CTA and SPECT images were acquired separately, which were then aligned automatically with the constraints of the shape and the whole heart and LV myocardium position. Infarct ratios were quantified based on the 3D fusion images. The quantitative assessment was then experimentally validated via an histology analysis using triphenyl-tetrazolium-chloride staining and subsequently applied to post-MI patients (n=8).
The location of an infarct identified by the SPECT was consistent with that identified by an heart in a 3D space. Infarct size determined by CTA-SPECT was correlated with infarct size assessed by triphenyl-tetrazolium-chloride pathology {27.6% [interquartile range (IQR) 17.1-34.7%] 24.1% (IQR 14.7-32.5%), r=0.99, P<0.01}. In clinical cases, the CTA-SPECT 3D fusion quantitative results were significantly correlated with the quantitative perfusion SPECT results (r=0.976, P<0.01).
The proposed 3D fusion quantitative assessment method provides reliable and intuitive evaluations of infarction. This novel quantification technique enables whole heart quantification for the pre-operation evaluation and post-diagnosis management of old MI patients. It could also be applied to the design of 3D-printed cardiac patches.
精确评估心肌梗死（MI）对于陈旧性心肌梗死的治疗干预以及开发修复受损心肌的新有效技术都至关重要。基于计算机断层血管造影（CTA）和锝-99m甲氧基异丁基异腈（Tc-MIBI）单光子发射计算机断层扫描（SPECT）图像，开发了一种通过三维（3D）多模态融合定量评估左心室（LV）梗死的新方法。本研究旨在开发一种用于临床前研究和临床应用的心肌梗死3D定量方法。
在20只小型猪中建立心肌梗死模型3个月后，分别采集CTA和SPECT图像，然后在心脏形状以及全心和左心室心肌位置的约束下自动对齐。基于3D融合图像对梗死比例进行定量。然后通过使用氯化三苯基四氮唑染色的组织学分析对定量评估进行实验验证，并随后应用于心肌梗死后患者（n = 8）。
SPECT识别出的梗死位置与3D空间中的心识别出的位置一致。CTA-SPECT确定的梗死大小与通过氯化三苯基四氮唑病理学评估的梗死大小相关{27.6%[四分位间距（IQR）17.1 - 34.7%]对24.1%（IQR 14.7 - 32.5%），r = 0.99，P < 0.01}。在临床病例中，CTA-SPECT 3D融合定量结果与定量灌注SPECT结果显著相关（r = 0.976，P < 0.01）。
所提出的3D融合定量评估方法为梗死提供了可靠且直观的评估。这种新的定量技术能够对陈旧性心肌梗死患者进行术前评估和诊断后管理的全心定量。它还可应用于3D打印心脏补片的设计。
