Vegulla Ravi V, Tandon Animesh, Rathinaswamy Jebaraj, Cherian Kotturathu Mammen, Hussain Tarique, Murala John S
Department of Pediatric Cardiology, University of Texas Southwestern, Dallas, Texas, USA.
Department of Pediatric Cardiology, Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India.
Ann Pediatr Cardiol. 2022 Jul-Aug;15(4):351-357. doi: 10.4103/apc.apc_176_21. Epub 2023 Jan 6.
Preserved congenital heart specimens are an important component of training professionals working with children and adults with congenital heart disease. They are curated in few institutions worldwide and not freely accessible. This was a proof-of-concept project to explore the use of advanced cardiac imaging modalities (computed tomography [CT] and magnetic resonance imaging [MRI]) and virtual reality (VR) simulation to assess the feasibility and identify the best method of imaging curated cardiac pathology specimens.
Seven specimens in glass jars with formalin, with varied anatomic lesions, from a curated collection were imaged using MRI and high-dose CT to compare the fidelity of models created via each modality. Three-dimensional (3D) models were created and loaded into a VR headset and viewed in virtual space. Two independent physicians performed a "virtual dissection" and scored the resultant models.
The highest fidelity and tissue characterization of more delicate structures was achieved with T2 spoiled gradient-echo sequences on MRI (median score of 4 out of 5). CT (median score of 3), while excellent for external anatomy, lost some fidelity with delicate internal anatomy, even at high-radiation doses. No specimens were damaged.
We believe that heart specimens can be easily scanned with high fidelity at a relatively low cost, without causing damage, using high-dose CT and MRI. The ability to "walk through" different chambers of the heart makes the understanding of anatomy easy and intuitive. VR and 3D printing are technologies that could be easily adapted to digitize preserved heart specimens, making it globally accessible for teaching and training purposes.
保存的先天性心脏病标本是培训从事先天性心脏病儿童和成人治疗工作的专业人员的重要组成部分。全球范围内只有少数机构收藏了这些标本,且无法免费获取。这是一个概念验证项目,旨在探索使用先进的心脏成像模式(计算机断层扫描[CT]和磁共振成像[MRI])以及虚拟现实(VR)模拟来评估其可行性,并确定对保存的心脏病理标本进行成像的最佳方法。
从一批收藏的标本中选取七个装有福尔马林的玻璃罐中的标本,这些标本具有不同的解剖病变,使用MRI和高剂量CT进行成像,以比较通过每种模式创建的模型的逼真度。创建三维(3D)模型并加载到VR头显中,在虚拟空间中查看。两名独立的医生进行了“虚拟解剖”并对所得模型进行评分。
MRI上的T2扰相梯度回波序列对更精细结构实现了最高的逼真度和组织特征描述(中位数评分为4分,满分5分)。CT(中位数评分为3分)虽然对外部解剖结构很好,但对于精细的内部解剖结构,即使在高辐射剂量下也会损失一些逼真度。没有标本受损。
我们认为,使用高剂量CT和MRI可以以相对较低的成本轻松地对心脏标本进行高保真扫描,且不会造成损坏。“穿行”心脏不同腔室的能力使解剖结构的理解变得轻松直观。VR和3D打印是可以轻松适应将保存的心脏标本数字化的技术,使其能够在全球范围内用于教学和培训目的。