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首页> 外文期刊>Advances in Interventional Cardiology: Postepy w Kardiologii Interwencyjnej >3D image fusion for live guidance of stent implantation in aortic coarctation – magnetic resonance imaging and computed tomography image overlay enhances interventional technique
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3D image fusion for live guidance of stent implantation in aortic coarctation – magnetic resonance imaging and computed tomography image overlay enhances interventional technique

机译：3D图像融合可实时指导主动脉缩窄中的支架植入–磁共振成像和计算机断层扫描图像叠加可增强介入技术

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Non-invasive three-dimensional (3D) imaging belongs in routine practice in diagnosis and treatment planning of many congenital and acquired cardiovascular defects. Improvements in the development of fusion imaging software have led to the introduction of 3D reconstructed images for guidance of various transcatheter therapies, with three-dimensional rotational angiography (3DRA) being the most popular tool [1, 2]. A recently available 3D roadmap based on pre-registered computed tomography (CT) or magnetic resonance imaging (MRI) data sets promises reduction in contrast and radiation exposure along with shorter procedural times [3, 4]. We present our initial experience of this application with 3D image fusion (“merging”) for live guidance of stent implantation in coarctation of the aorta (CoA), using MRI applied with the HeartNavigator prototype (Philips Healthcare, Best, The Netherlands) and CT with the commercially available VesselNavigator (Philips Healthcare). A 12-year-old boy presented to the outpatient clinic with arterial hypertension and intermittent headache already receiving ?-blocker therapy. Brachiocephalic hypertension was detectable with a gradient of 47–56 mm Hg between the arms and legs, and a reduced femoral pulse quality was present. Echocardiography showed normal biventricular function and left ventricular hypertrophy. The descending aorta showed a reduced pressure profile and diastolic “run-off” with no clearly detectable gradient. An MRI scan, performed with acquisition of a 3D whole heart sequence, demonstrated subatretic CoA distal to the left subclavian artery (LSA) with increased collateral flow. The aortic arch measured 10 × 12.5 mm, CoA diameter was 5 × 5 mm and the descending aorta distal to the narrowing was 17 × 19 mm. Interventional therapy was performed under conscious sedation via femoral artery access. The three-dimensional whole heart sequence was uploaded to the workstation (HeartNavigator prototype, Philips), automatically segmented and manually corrected (Figure 1 A). For accurate fusion with live fluoroscopy the roadmap was manually aligned with two angiographies (10–15 ml) performed at a minimum 30° difference in angulation from the anterior-posterior projection (Figure 1 B). Initial hemodynamic measurements confirmed significant stenosis with a systolic pressure gradient of 50 mm Hg.
机译：非侵入性三维（3D）成像属于许多先天性和后天性心血管缺陷的诊断和治疗计划中的常规实践。融合成像软件开发的改进已导致引入3D重建图像以指导各种经导管疗法，其中三维旋转血管造影（3DRA）是最受欢迎的工具[1、2]。基于预先注册的计算机断层扫描（CT）或磁共振成像（MRI）数据集的最新可用3D路线图有望降低对比度和放射线，并缩短手术时间[3，4]。我们介绍了将3D图像融合（“合并”）用于在主动脉缩窄（CoA）时进行支架植入的实时指导的3D图像融合（“合并”）应用的初步经验，以及将MRI与HeartNavigator原型（Philips Healthcare，Best，荷兰）一起应用的MRI使用市售的VesselNavigator（Philips Healthcare）。一名12岁男孩因已经接受了β受体阻滞剂治疗而患有高血压和间歇性头痛，被送到门诊就诊。臂和腿之间的梯度为47-56 mm Hg，可检测到头臂性高血压，并且股动脉搏动质量降低。超声心动图显示双室功能正常，左心室肥大。降主动脉显示出降低的压力分布和舒张期“流失”，没有明显可检测到的梯度。通过采集3D全心序列进行的MRI扫描显示，左锁骨下动脉（LSA）远端的大动脉下CoA伴有侧支血流增加。主动脉弓尺寸为10×12.5毫米，CoA直径为5×5毫米，缩窄远侧的降主动脉为17×19毫米。通过股动脉通路在有意识的镇静作用下进行介入治疗。三维全心序列被上传到工作站（HeartNavigator原型，Philips），自动分段并手动校正（图1 A）。为了用实时荧光透视术准确融合，将路线图与两个血管造影术（10-15 ml）手动对齐，并与前后投影的角度至少相差30°（图1 B）。最初的血液动力学测量结果证实狭窄程度明显，收缩压梯度为50 mm Hg。

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