Abdel-Kafi Saif, Sramko Marek, Omara Sharif, de Riva Marta, Cvek Jakub, Peichl Petr, Kautzner Josef, Zeppenfeld Katja
Willem Einthoven Center for Cardiac Arrhythmia research and Management, Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Praha 4, Prague, Czech Republic.
Europace. 2021 Dec 7;23(12):1989-1997. doi: 10.1093/europace/euab195.
To analyse and optimize the interobserver agreement for gross target volume (GTV) delineation on cardiac computed tomography (CCT) based on electroanatomical mapping (EAM) data acquired to guide radiotherapy for ventricular tachycardia (VT).
Electroanatomical mapping data were exported and merged with the segmented CCT using manual registration by two observers. A GTV was created by both observers for predefined left ventricular (LV) areas based on preselected endocardial EAM points indicating a two-dimensional (2D) surface area of interest. The influence of (interobserver) registration accuracy and availability of EAM data on the final GTV and 2D surface location within each LV area was evaluated. The median distance between the CCT and EAM after registration was 2.7 mm, 95th percentile 6.2 mm for observer #1 and 3.0 mm, 95th percentile 7.6 mm for observer #2 (P = 0.9). Created GTVs were significantly different (8 vs. 19 mL) with lowest GTV overlap (35%) for lateral wall target areas. Similarly, the highest shift between 2D surfaces was observed for the septal LV (6.4 mm). The optimal surface registration accuracy (2.6 mm) and interobserver agreement (Δ interobserver EAM surface registration 1.3 mm) was achieved if at least three cardiac chambers were mapped, including high-quality endocardial LV EAM.
Detailed EAM of at least three chambers allows for accurate co-registration of EAM data with CCT and high interobserver agreement to guide radiotherapy of VT. However, the substrate location should be taken in consideration when creating a treatment volume margin.
基于为指导室性心动过速（VT）放疗而获取的电解剖标测（EAM）数据，分析并优化心脏计算机断层扫描（CCT）上大体靶区（GTV）勾画的观察者间一致性。
两名观察者通过手动配准导出电解剖标测数据并与分割后的CCT进行合并。两名观察者均基于预先选择的指示感兴趣二维（2D）表面积的左心室内膜EAM点，为预定义的左心室（LV）区域创建GTV。评估（观察者间）配准准确性和EAM数据可用性对每个LV区域内最终GTV和2D表面位置的影响。观察者1配准后CCT与EAM之间的中位距离为2.7mm，第95百分位数为6.2mm；观察者2为3.0mm，第95百分位数为7.6mm（P = 0.9）。创建的GTV有显著差异（8 vs. 19mL），侧壁靶区的GTV重叠率最低（35%）。同样，在室间隔LV中观察到2D表面之间的最大偏移（6.4mm）。如果至少对三个心腔进行标测，包括高质量的左心室内膜EAM，则可实现最佳表面配准准确性（2.6mm）和观察者间一致性（观察者间EAM表面配准差异1.3mm）。
至少对三个心腔进行详细的EAM可实现EAM数据与CCT的准确共配准以及观察者间的高度一致性，以指导VT放疗。然而，在创建治疗体积边界时应考虑基质位置。
