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Winkelmann MT, Kübler J, Hoffmann R. Magnetic Resonance-guided Procedures: Consensus on Rationale, Techniques, and Outcomes. Tech Vasc Interv Radiol 2023; 26:100914. [PMID: 38071023 DOI: 10.1016/j.tvir.2023.100914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Magnetic resonance (MR) image guidance has demonstrated significant potential in the field of interventional radiology in several applications. This article covers the main points of MR-guided hepatic tumor ablation as a representative of MR-guided procedures. Patient selection and appropriate equipment utilization are essential for successful MR-guided tumor ablation. Intra-procedural planning imaging enables the visualization of the tumor and surrounding anatomical structures in most cases without the application of a contrast agent, ensuring optimal planning of the applicator tract. MRI enables real-time, multiplanar imaging, thus simultaneous observation of the applicator and target tumor is possible during targeting with adaptable slice angulations in case of challenging tumor positions. Typical ablation zone appearance during therapy monitoring with MRI enables safe assessment of the therapy result, resulting in a high primary efficacy rate. Recent advancements in ablation probes have shortened treatment times, while technical strategies address applicator visibility issues. MR-imaging immediately after the procedure is used to rule out complications and to assess technical success. Especially in smaller neoplasms, MRI-guided liver ablation demonstrates positive outcomes in terms of technical success rates, as well as promising survival and recurrence rates. Additionally, percutaneous biopsy under MR guidance offers an alternative to classic guidance modalities, providing high soft tissue contrast and thereby increasing the reliability of lesion detection, particularly in cases involving smaller lesions. Despite these advantages, the use of MR guidance in clinical routine is still limited to few indications and centers, due to by high costs, extended duration, and the need for specialized expertise. In conclusion, MRI-guided interventions could benefit from ongoing advancements in hardware, software, and devices. Such progress has the potential to expand diagnostic and treatment options in the field of interventional radiology.
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Affiliation(s)
- Moritz T Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Jens Kübler
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tuebingen, Germany
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Massarella D, Alonso-Gonzalez R. Updates in the management of congenital heart disease in adult patients. Expert Rev Cardiovasc Ther 2022; 20:719-732. [PMID: 36128784 DOI: 10.1080/14779072.2022.2125870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Adults with congenital heart disease represent a highly diverse, ever-growing population. Optimal approaches to management of problems such as arrhythmia, sudden cardiac death, heart failure, transplant, application of advanced therapies and unrepaired shunt lesions are incompletely established. Efforts to strengthen our understanding of these complex clinical challenges and inform evidence-based practices are ongoing. AREAS COVERED This narrative review summarizes evidence underpinning current approaches to congenital heart disease management while highlighting areas requiring further investigation. A search of literature published in 'Medline,' 'EMBASE,' and 'PubMed' using search terms 'congenital heart disease,' 'arrhythmia,' 'sudden cardiac death,' 'heart failure,' 'heart transplant,' 'advanced heart failure therapy,' 'ventricular assist device (VAD),' 'mechanical circulatory support (MSC),' 'intracardiac shunt' and combinations thereof was undertaken. EXPERT OPINION Application of novel technologies in the diagnosis and management of arrhythmia has and will continue to improve outcomes in this population. Sudden death remains a prevalent problem with many persistent unknowns. Heart failure is a leading cause of morbidity and mortality. Improved access to specialist care, advanced therapies and cardiac transplant is needed. The emerging field of cardio-obstetrics will continue to define state-of-the-art care for the reproductive health of women with heart disease.
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Affiliation(s)
- Danielle Massarella
- Department of Cardiology, University Health Network, Peter Munk Cardiac Centre, Toronto ACHD program, Toronto, Ontario, Canada
| | - Rafael Alonso-Gonzalez
- Department of Cardiology, University Health Network, Peter Munk Cardiac Centre, Toronto ACHD program, Toronto, Ontario, Canada
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Ismail TF, Strugnell W, Coletti C, Božić-Iven M, Weingärtner S, Hammernik K, Correia T, Küstner T. Cardiac MR: From Theory to Practice. Front Cardiovasc Med 2022; 9:826283. [PMID: 35310962 PMCID: PMC8927633 DOI: 10.3389/fcvm.2022.826283] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/17/2022] [Indexed: 01/10/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading single cause of morbidity and mortality, causing over 17. 9 million deaths worldwide per year with associated costs of over $800 billion. Improving prevention, diagnosis, and treatment of CVD is therefore a global priority. Cardiovascular magnetic resonance (CMR) has emerged as a clinically important technique for the assessment of cardiovascular anatomy, function, perfusion, and viability. However, diversity and complexity of imaging, reconstruction and analysis methods pose some limitations to the widespread use of CMR. Especially in view of recent developments in the field of machine learning that provide novel solutions to address existing problems, it is necessary to bridge the gap between the clinical and scientific communities. This review covers five essential aspects of CMR to provide a comprehensive overview ranging from CVDs to CMR pulse sequence design, acquisition protocols, motion handling, image reconstruction and quantitative analysis of the obtained data. (1) The basic MR physics of CMR is introduced. Basic pulse sequence building blocks that are commonly used in CMR imaging are presented. Sequences containing these building blocks are formed for parametric mapping and functional imaging techniques. Commonly perceived artifacts and potential countermeasures are discussed for these methods. (2) CMR methods for identifying CVDs are illustrated. Basic anatomy and functional processes are described to understand the cardiac pathologies and how they can be captured by CMR imaging. (3) The planning and conduct of a complete CMR exam which is targeted for the respective pathology is shown. Building blocks are illustrated to create an efficient and patient-centered workflow. Further strategies to cope with challenging patients are discussed. (4) Imaging acceleration and reconstruction techniques are presented that enable acquisition of spatial, temporal, and parametric dynamics of the cardiac cycle. The handling of respiratory and cardiac motion strategies as well as their integration into the reconstruction processes is showcased. (5) Recent advances on deep learning-based reconstructions for this purpose are summarized. Furthermore, an overview of novel deep learning image segmentation and analysis methods is provided with a focus on automatic, fast and reliable extraction of biomarkers and parameters of clinical relevance.
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Affiliation(s)
- Tevfik F. Ismail
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Cardiology Department, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Wendy Strugnell
- Queensland X-Ray, Mater Hospital Brisbane, Brisbane, QLD, Australia
| | - Chiara Coletti
- Magnetic Resonance Systems Lab, Delft University of Technology, Delft, Netherlands
| | - Maša Božić-Iven
- Magnetic Resonance Systems Lab, Delft University of Technology, Delft, Netherlands
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
| | | | - Kerstin Hammernik
- Lab for AI in Medicine, Technical University of Munich, Munich, Germany
- Department of Computing, Imperial College London, London, United Kingdom
| | - Teresa Correia
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Centre of Marine Sciences, Faro, Portugal
| | - Thomas Küstner
- Medical Image and Data Analysis (MIDAS.lab), Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
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Rier SC, Vreemann S, Nijhof WH, van Driel VJHM, van der Bilt IAC. Interventional cardiac magnetic resonance imaging: current applications, technology readiness level, and future perspectives. Ther Adv Cardiovasc Dis 2022; 16:17539447221119624. [PMID: 36039865 PMCID: PMC9434707 DOI: 10.1177/17539447221119624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) provides excellent temporal and spatial resolution, tissue characterization, and flow measurements. This enables major advantages when guiding cardiac invasive procedures compared with X-ray fluoroscopy or ultrasound guidance. However, clinical implementation is limited due to limited availability of technological advancements in magnetic resonance imaging (MRI) compatible equipment. A systematic review of the available literature on past and present applications of interventional MR and its technology readiness level (TRL) was performed, also suggesting future applications. METHODS A structured literature search was performed using PubMed. Search terms were focused on interventional CMR, cardiac catheterization, and other cardiac invasive procedures. All search results were screened for relevance by language, title, and abstract. TRL was adjusted for use in this article, level 1 being in a hypothetical stage and level 9 being widespread clinical translation. The papers were categorized by the type of procedure and the TRL was estimated. RESULTS Of 466 papers, 117 papers met the inclusion criteria. TRL was most frequently estimated at level 5 meaning only applicable to in vivo animal studies. Diagnostic right heart catheterization and cavotricuspid isthmus ablation had the highest TRL of 8, meaning proven feasibility and efficacy in a series of humans. CONCLUSION This article shows that interventional CMR has a potential widespread application although clinical translation is at a modest level with TRL usually at 5. Future development should be directed toward availability of MR-compatible equipment and further improvement of the CMR techniques. This could lead to increased TRL of interventional CMR providing better treatment.
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Affiliation(s)
- Sophie C Rier
- Cardiology Division, Department of Cardiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, Postbus 40551, The Hague 2504 LN, The Netherlands
| | - Suzan Vreemann
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands Siemens Healthineers Nederland B.V., Den Haag, The Netherlands
| | - Wouter H Nijhof
- Siemens Healthineers Nederland B.V., Den Haag, The Netherlands
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Siebermair J, Kholmovski EG, Sheffer D, Schroeder J, Jensen L, Kheirkhahan M, Baher AA, Ibrahim MM, Reiter T, Rassaf T, Wakili R, Marrouche NF, McGann CJ, Wilson BD. Saturation recovery-prepared magnetic resonance angiography for assessment of left atrial and esophageal anatomy. Br J Radiol 2021; 94:20210048. [PMID: 34111982 DOI: 10.1259/bjr.20210048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Magnetic resonance angiography (MRA) has been established as an important imaging method in cardiac ablation procedures. In pulmonary vein (PV) isolation procedures, MRA has the potential to minimize the risk of severe complications, such as atrio-esophageal fistula, by providing detailed information on esophageal position relatively to cardiac structures. However, traditional non-gated, first-pass (FP) MRA approaches have several limitations, such as long breath-holds, non-uniform signal intensity throughout the left atrium (LA), and poor esophageal visualization. The aim of this observational study was to validate a respiratory-navigated, ECG-gated (EC), saturation recovery-prepared MRA technique for simultaneous imaging of LA, LA appendage, PVs, esophagus, and adjacent anatomical structures. METHODS Before PVI, 106 consecutive patients with a history of AF underwent either conventional FP-MRA (n = 53 patients) or our new EC-MRA (n = 53 patients). Five quality scores (QS) of LA and esophagus visibility were assessed by two experienced readers. The non-parametric Mann-Whitney U-test was used to compare QS between FP-MRA and EC-MRA groups, and linear regression was applied to assess clinical contributors to image quality. RESULTS EC-MRA demonstrated significantly better image quality than FP-MRA in every quality category. Esophageal visibility using the new MRA technique was markedly better than with the conventional FP-MRA technique (median 3.5 [IQR 1] vs median 1.0, p < 0.001). In contrast to FP-MRA, overall image quality of EC-MRA was not influenced by heart rate. CONCLUSION Our ECG-gated, respiratory-navigated, saturation recovery-prepared MRA technique provides significantly better image quality and esophageal visibility than the established non-gated, breath-holding FP-MRA. Image quality of EC-MRA technique has the additional advantage of being unaffected by heart rate. ADVANCES IN KNOWLEDGE Detailed information of cardiac anatomy has the potential to minimize the risk of severe complications and improve success rates in invasive electrophysiological studies. Our novel ECG-gated, respiratory-navigated, saturation recovery-prepared MRA technique provides significantly better image quality of LA and esophageal structures than the traditional first-pass algorithm. This new MRA technique is robust to arrhythmia (tachycardic, irregular heart rates) frequently observed in AF patients.
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Affiliation(s)
- Johannes Siebermair
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany.,Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt Lake City, UT, USA.,Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Eugene G Kholmovski
- Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt Lake City, UT, USA.,UCAIR, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Douglas Sheffer
- Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt Lake City, UT, USA
| | - Joyce Schroeder
- UCAIR, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Leif Jensen
- UCAIR, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Mobin Kheirkhahan
- Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt Lake City, UT, USA.,Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Alex A Baher
- Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt Lake City, UT, USA
| | - Majd M Ibrahim
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
| | - Theresa Reiter
- Department of Internal Medicine, Cardiology, University Hospital Wuerzburg, Würzburg, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany.,Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany.,German Cardiovascular Research Center (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Nassir F Marrouche
- Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt Lake City, UT, USA.,Section of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Christopher J McGann
- Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt Lake City, UT, USA.,Swedish Heart and Vascular Institute, Seattle, WA, USA
| | - Brent D Wilson
- Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt Lake City, UT, USA.,Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
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Xu R, Wright GA. GPU accelerated dynamic respiratory motion model correction for MRI-guided cardiac interventions. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 136:31-43. [PMID: 27686701 DOI: 10.1016/j.cmpb.2016.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/10/2016] [Accepted: 08/09/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The use of pre-procedural magnetic resonance (MR) roadmap images for interventional guidance has limited anatomical accuracy due to intra-procedural respiratory motion of the heart. Therefore, the objective of this study is to explore the use of a rapidly updated dynamic motion model to correct for respiratory motion induced errors during MRI-guided cardiac interventions. The motivation for the proposed technique is to improve the accuracy of MRI guidance by taking advantage of the anatomical context provided by the high resolution prior images and the respiratory motion information present in a series of realtime MR images. METHODS We implemented a GPU accelerated image registration algorithm to derive the respiratory motion information and used the resulting transformation parameters to update an adaptive motion model once every heart cycle. In the subsequent heart cycle, the dynamic motion model could be used to predict the respiratory motion and provide a motion estimate to realign the prior volume with the realtime MR image. This iterative update and prediction process is then continuously repeated. RESULTS The GPU accelerated image registration algorithm could be completed in an average of 176.9 ± 14.0 ms, which is 139× faster than a CPU implementation. Thus, it was feasible to update the dynamic model once every heart cycle. The proposed dynamic model was also able to improve the registration accuracy from 86.0 ± 7.5% to 93.0 ± 3.3% in case of variable breathing patterns, as evaluated by the dice similarity coefficient of the left ventricular border overlap between the prior and realtime images. CONCLUSIONS The feasibility of a dynamic motion correction framework was demonstrated. The resulting improvements may lead to more accurate MRI-guided cardiac interventions in the future.
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Affiliation(s)
- Robert Xu
- Physical Sciences Platform and Schulich Research Centre, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, M5G 2M9, Canada.
| | - Graham A Wright
- Physical Sciences Platform and Schulich Research Centre, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, M5G 2M9, Canada
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Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking - experience with 14 cases. Eur Radiol 2016; 27:1954-1962. [PMID: 27553931 DOI: 10.1007/s00330-016-4560-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/14/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the feasibility of performing comprehensive Cardiac Magnetic resonance (CMR) guided electrophysiological (EP) interventions in a porcine model encompassing left atrial access. METHODS After introduction of two femoral sheaths 14 swine (41 ± 3.6 kg) were transferred to a 1.5 T MR scanner. A three-dimensional whole-heart sequence was acquired followed by segmentation and the visualization of all heart chambers using an image-guidance platform. Two MR conditional catheters were inserted. The interventional protocol consisted of intubation of the coronary sinus, activation mapping, transseptal left atrial access (n = 4), generation of ablation lesions and eventually ablation of the atrioventricular (AV) node. For visualization of the catheter tip active tracking was used. Catheter positions were confirmed by passive real-time imaging. RESULTS Total procedure time was 169 ± 51 minutes. The protocol could be completed in 12 swine. Two swine died from AV-ablation induced ventricular fibrillation. Catheters could be visualized and navigated under active tracking almost exclusively. The position of the catheter tips as visualized by active tracking could reliably be confirmed with passive catheter imaging. CONCLUSIONS Comprehensive CMR-guided EP interventions including left atrial access are feasible in swine using active catheter tracking. KEY POINTS • Comprehensive CMR-guided electrophysiological interventions including LA access were conducted in swine. • Active catheter-tracking allows efficient catheter navigation also in a transseptal approach. • More MR-conditional tools are needed to facilitate left atrial interventions in humans.
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Xu R, Athavale P, Krahn P, Anderson K, Barry J, Biswas L, Ramanan V, Yak N, Pop M, Wright GA. Feasibility Study of Respiratory Motion Modeling Based Correction for MRI-Guided Intracardiac Interventional Procedures. IEEE Trans Biomed Eng 2016; 62:2899-910. [PMID: 26595904 DOI: 10.1109/tbme.2015.2451517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
GOAL The purpose of this study is to improve the accuracy of interventional catheter guidance during intracardiac procedures. Specifically, the use of preprocedural magnetic resonance roadmap images for interventional guidance has limited anatomical accuracy due to intraprocedural respiratory motion of the heart. Therefore, we propose to build a novel respiratory motion model to compensate for this motion-induced error during magnetic resonance imaging (MRI)-guided procedures. METHODS We acquire 2-D real-time free-breathing images to characterize the respiratory motion, and build a smooth motion model via registration of 3-D prior roadmap images to the real-time images within a novel principal axes frame of reference. The model is subsequently used to correct the interventional catheter positions with respect to the anatomy of the heart. RESULTS We demonstrate that the proposed modeling framework can lead to smoother motion models, and potentially lead to more accurate motion estimates. Specifically, MRI-guided intracardiac ablations were performed in six preclinical animal experiments. Then, from retrospective analysis, the proposed motion modeling technique showed the potential to achieve a 27% improvement in ablation targeting accuracy. CONCLUSION The feasibility of a respiratory motion model-based correction framework has been successfully demonstrated. SIGNIFICANCE The improvement in ablation accuracy may lead to significant improvements in success rate and patient outcomes for MRI-guided intracardiac procedures.
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Schmidt EJ. Magnetic Resonance Imaging-Guided Cardiac Interventions. Magn Reson Imaging Clin N Am 2015; 23:563-77. [PMID: 26499275 DOI: 10.1016/j.mric.2015.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Performing intraoperative cardiovascular procedures inside an MR imaging scanner can potentially provide substantial advantage in clinical outcomes by reducing the risk and increasing the success rate relative to the way such procedures are performed today, in which the primary surgical guidance is provided by X-ray fluoroscopy, by electromagnetically tracked intraoperative devices, and by ultrasound. Both noninvasive and invasive cardiologists are becoming increasingly familiar with the capabilities of MR imaging for providing anatomic and physiologic information that is unequaled by other modalities. As a result, researchers began performing animal (preclinical) interventions in the cardiovascular system in the early 1990s.
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Affiliation(s)
- Ehud J Schmidt
- Radiology Department, Brigham and Women's Hospital, 221 Longwood Avenue, Room BRB 34C, Boston, MA 02115, USA.
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Closed-Bore Interventional MRI: Percutaneous Biopsies and Ablations. AJR Am J Roentgenol 2015; 205:W400-10. [DOI: 10.2214/ajr.15.14732] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Mahnkopf C, Mitlacher M, Brachmann J. [Relevance of magnetic resonance imaging for catheter ablation of atrial fibrillation]. Herzschrittmacherther Elektrophysiol 2014; 25:252-257. [PMID: 25160815 DOI: 10.1007/s00399-014-0327-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Abstract
Currently, atrial fibrillation is the most common form of arrhythmia encountered in clinical practice. Until recently the treatment approach to atrial fibrillation was limited by imprecise risk stratification models and suboptimal therapy options. At present cardiac magnetic resonance imaging (MRI) is an important noninvasive diagnostic modality which aids in the completion of complex electrophysiological and ablation interventions. Cardiac MRI and 3D imaging reconstruction are used clinically to assess the cardiac chambers as well as complex anatomical structures. Through the development of cardiac MRI it has become possible to detect areas of fibrosis in the left atrium which can be the cause of atrial fibrillation. The most recent clinical data suggest that there is a strong correlation between the amount of left atrial fibrosis and recurrent atrial fibrillation following ablation procedures and will in the future allow more individualized treatment strategies for patients with atrial fibrillation. In addition, cardiac MRI allows the direct visualization of catheter-induced lesions after ablation procedures which helps in assessing therapy success and can also assist in the early detection of procedure-related complications. Furthermore, with the implementation of cardiac MRI it appears possible to assess the stroke risk in patients with atrial fibrillation. Promising future developments will allow individualized therapy for patients with atrial fibrillation in addition to improving safety and procedure results after ablation.
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Affiliation(s)
- Christan Mahnkopf
- Klinikum Coburg, II. Medizinische Klinik, Klinik für Kardiologie, Angiologie, Pneumologie, Ketschendorferstraße 33, 96450, Coburg, Deutschland,
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Xu R, Athavale P, Nachman A, Wright GA. Multiscale Registration of Real-Time and Prior MRI Data for Image-Guided Cardiac Interventions. IEEE Trans Biomed Eng 2014; 61:2621-32. [DOI: 10.1109/tbme.2014.2324998] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hsing J, Peters DC, Knowles BR, Manning WJ, Josephson ME. Cardiovascular magnetic resonance imaging of scar development following pulmonary vein isolation: a prospective study. PLoS One 2014; 9:e104844. [PMID: 25251403 PMCID: PMC4174508 DOI: 10.1371/journal.pone.0104844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/17/2014] [Indexed: 11/30/2022] Open
Abstract
Aims Cardiovascular magnetic resonance (MR) provides non-invasive assessment of early (24-hour) edema and injury following pulmonary vein isolation (by ablation) and subsequent scar formation. We hypothesize that 24-hours after ablation, cardiovascular MR would demonstrate a pattern of edema and injury due to ablation and the severity would correlate with subsequent scar. Methods Fifteen atrial fibrillation patients underwent cardiovascular MR prior to pulmonary vein isolation, 24-hours post (N = 11) and 30-days post (N = 7) ablation, with T2-weighted (T2W) and late gadolinium enhancement (LGE) imaging. Left atrial wall thickness, edema enhancement ratio and LGE enhancement were assessed at each time point. Volumes of LGE and edema enhancement were measured, and the circumferential presence of injury was assessed at 24-hours, including comparison with LGE enhancement at 30 days. Results Left atrial wall thickness was increased 24-hours post-ablation (10.7±4.1 mm vs. 7.0±1.8 mm pre-PVI, p<0.05). T2W enhancement at 24-hours showed increased edema enhancement ratio (1.5±0.4 for post-ablation, vs. 0.9±0.2 pre-ablation, p<0.001). Edema and LGE volumes at 24-hours were correlated with 30-day LGE volume (R = 0.76, p = 0.04, and R = 0.74, p = 0.09, respectively). Using a 16 segment model for assessment, 24-hour T2W had sensitivity, specificity, and accuracy of 82%, 63%, and 79% respectively, for predicting 30-day LGE. 24-hour LGE had sensitivity, specificity, and accuracy of 91%, 47%, and 84%. Conclusions Increased left atrial wall thickening and edema were characterized on cardiovascular MR early post-ablation, and found to correlate with 30-day LGE scar.
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Affiliation(s)
- Jeff Hsing
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dana C. Peters
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Yale Medical School, New Haven, Connecticut, United States of America
- * E-mail:
| | - Benjamin R. Knowles
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Warren J. Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark E. Josephson
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
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Eitel C, Hindricks G, Grothoff M, Gutberlet M, Sommer P. Catheter Ablation Guided by Real-Time MRI. Curr Cardiol Rep 2014; 16:511. [DOI: 10.1007/s11886-014-0511-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Grothoff M, Piorkowski C, Eitel C, Gaspar T, Lehmkuhl L, Lücke C, Hoffmann J, Hildebrand L, Wedan S, Lloyd T, Sunnarborg D, Schnackenburg B, Hindricks G, Sommer P, Gutberlet M. MR Imaging–guided Electrophysiological Ablation Studies in Humans with Passive Catheter Tracking: Initial Results. Radiology 2014; 271:695-702. [DOI: 10.1148/radiol.13122671] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Roujol S, Basha TA, Tan A, Khanna V, Chan RH, Moghari MH, Rayatzadeh H, Shaw JL, Josephson ME, Nezafat R. Improved multimodality data fusion of late gadolinium enhancement MRI to left ventricular voltage maps in ventricular tachycardia ablation. IEEE Trans Biomed Eng 2012; 60:1308-17. [PMID: 23247842 DOI: 10.1109/tbme.2012.2233738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electroanatomical voltage mapping (EAVM) is commonly performed prior to catheter ablation of scar-related ventricular tachycardia (VT) to locate the arrhythmic substrate and to guide the ablation procedure. EAVM is used to locate the position of the ablation catheter and to provide a 3-D reconstruction of left-ventricular anatomy and scar. However, EAVM measurements only represent the endocardial scar with no transmural or epicardial information. Furthermore, EAVM is a time-consuming procedure, with a high operator dependence and has low sampling density, i.e., spatial resolution. Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) allows noninvasive assessment of scar morphology that can depict 3-D scar architecture. Despite the potential use of LGE as a roadmap for VT ablation for identification of arrhythmogenic substrate, its utility has been very limited. To allow for identification of VT substrate, a correlation is needed between the substrates identified by EAVM as the gold standard and LGE-MRI scar characteristics. To do so, a system must be developed to fuse the datasets from these modalities. In this study, a registration pipeline for the fusion of LGE-MRI and EAVM data is presented. A novel surface registration algorithm is proposed, integrating the matching of global scar areas as an additional constraint in the registration process. A preparatory landmark registration is initially performed to expedite the convergence of the algorithm. Numerical simulations were performed to evaluate the accuracy of the registration in the presence of errors in identifying landmarks in EAVM or LGE-MRI datasets as well as additional errors due to respiratory or cardiac motion. Subsequently, the accuracy of the proposed fusion system was evaluated in a cohort of ten patients undergoing VT ablation where both EAVM and LGE-MRI data were available. Compared to landmark registration and surface registration, the presented method achieved significant improvement in registration error. The proposed data fusion system allows the fusion of EAVM and LGE-MRI data in VT ablation with registration errors less than 3.5 mm.
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Affiliation(s)
- Sebastien Roujol
- Department of Medicine-Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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17
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Ganesan AN, Selvanayagam JB, Mahajan R, Grover S, Nayyar S, Brooks AG, Finnie J, Sunnarborg D, Lloyd T, Chakrabarty A, Abed HS, Sanders P. Mapping and Ablation of the Pulmonary Veins and Cavo-Tricuspid Isthmus With a Magnetic Resonance Imaging–Compatible Externally Irrigated Ablation Catheter and Integrated Electrophysiology System. Circ Arrhythm Electrophysiol 2012; 5:1136-42. [DOI: 10.1161/circep.112.974436] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anand N. Ganesan
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
| | - Joseph B. Selvanayagam
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
| | - Rajiv Mahajan
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
| | - Suchi Grover
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
| | - Sachin Nayyar
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
| | - Anthony G. Brooks
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
| | - John Finnie
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
| | - Daniel Sunnarborg
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
| | - Thomas Lloyd
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
| | - Adhiraj Chakrabarty
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
| | - Hany S. Abed
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
| | - Prashanthan Sanders
- From the Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (A.N.G., R.M., S.N., A.G.B., H.S.A., P.S.); Discipline of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, Australia (J.B.S., S.G., A.C.); SA Pathology, Adelaide, Australia (J.F.); and Imricor Medical Systems, Burnsville, MN (D.S., T.L.)
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18
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Mahnkopf C, Halbfass P, Turschner O, Brachmann J. [Use of cardiac MRI in the field of electrophysiology. Present status and future aspects]. Herzschrittmacherther Elektrophysiol 2012; 23:275-80. [PMID: 23132745 DOI: 10.1007/s00399-012-0238-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/01/2012] [Indexed: 01/15/2023]
Abstract
In recent years, ablation therapy has become the first-line treatment of modern electrophysiology in patients with cardiac arrhythmias. Today, cardiac magnetic resonance imaging (cMRI) is an important supportive imaging technique in the implementation of complex electrophysiological investigations and ablation therapy. In clinical routine, cMRI is used not only to generate accurate three-dimensional (3D) models of cavities of the heart but also for visualization of complex anatomical structures. The development of cMRI makes it possible to detect the underlying substrate of complex arrhythmias such as myocardial scar in patients with ventricular tachycardia or the structural remodeling of the left atrium in patients with atrial fibrillation. The opportunity of fusion of the different imaging modalities (e.g., fluoroscopy, cMRI) has become essential for the planning and the implementation of a safe ablation therapy. The possibility of direct visualization of induced lesions using cMRI after and in the long term after ablation can predict the success of therapy and detects potential complications. The continuous research in the field of cMRI and the development of MRI-compatible pacing and ablation catheters provided the basics for performing electrophysiological treatment in humans directly inside the MRI. The implementation of ablation using exact visualization of the anatomical substrate, precise catheter navigation and real-time visualization of lesions in cMRI promises to improve success rates and the safety of complex ablation treatment and may revolutionize electrophysiology in the future.
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Affiliation(s)
- Christan Mahnkopf
- II. Medizinische Klinik, Klinik für Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, Ketschendorferstr. 33, 96450, Coburg, Deutschland.
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19
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VT ablation in heart failure. Herzschrittmacherther Elektrophysiol 2012; 23:38-44. [PMID: 22410757 DOI: 10.1007/s00399-012-0171-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
Abstract
Ventricular tachycardias (VT), shocks, and clusters of shock are ominous signs in patients with implantable cardioverter-defibrillators and herald an increased risk of hospitalization and mortality. VT clusters have been associated with aggravation of heart failure (19%), acute coronary events (14%), and electrolyte imbalance (10%). Yet, any association of potential causative factors and aggravation of VT is vague. Maybe, in patients with any substrate for re-entry, progressive aggravation of ventricular dysrhythmias is to be expected. The high recurrence rate of electrical storm despite antiarrhythmic drug therapy supports this view. The optimal timing of VT ablation is unknown, but current convention is to perform VT ablation after shock clusters or incessant VT has occurred. Preemptive VT ablation before VT has occurred is rarely performed (only in 15% of active centers) and the majority of centers never perform VT ablation even after the first shock. Such practice is within guidelines that recommend VT ablation only in ICD patients with recurrent or incessant VT. However, there is strong data in support of preemptive VT ablation.
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20
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Mahnkopf C, Halbfass P, Holzmann S, Turschner O, Simon H, Brachmann J. [Interventional electrophysiology in cardiac MRI : what is the current status?]. Herz 2012; 37:146-52. [PMID: 22382137 DOI: 10.1007/s00059-012-3590-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The ablation of simple and complex cardiac arrhythmias has become a first-line therapy in interventional cardiology and is mainly guided by conventional fluoroscopy. Cardiac magnetic resonance imaging (cMRI) allows exact three-dimensional (3D) visualization of complex anatomical structures and serves in the planning and implementation of ablation procedures. Post-procedural lesion visualization using cMRI can assess the success of ablation therapy and may distinguish potential complications. Performing ablation directly in the MRI scanner, with the option of anatomical substrate imagining, exact catheter navigation and real-time lesion visualization, holds the promise of improving success rates and safety in the interventional therapy of simple and complex arrhythmias.
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Affiliation(s)
- C Mahnkopf
- II. Medizinische Klinik, Klinik für Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, Ketschendorferstrasse 33, Coburg, Germany.
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21
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Tao Q, Milles J, VAN Huls VAN Taxis C, Lamb HJ, Reiber JHC, Zeppenfeld K, VAN DER Geest RJ. Toward magnetic resonance-guided electroanatomical voltage mapping for catheter ablation of scar-related ventricular tachycardia: a comparison of registration methods. J Cardiovasc Electrophysiol 2011; 23:74-80. [PMID: 21914023 DOI: 10.1111/j.1540-8167.2011.02167.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Integration of preprocedural delayed enhanced magnetic resonance imaging (DE-MRI) with electroanatomical voltage mapping (EAVM) may provide additional high-resolution substrate information for catheter ablation of scar-related ventricular tachycardias (VT). Accurate and fast image integration of DE-MRI with EAVM is desirable for MR-guided ablation. METHODS AND RESULTS Twenty-six VT patients with large transmural scar underwent catheter ablation and preprocedural DE-MRI. With different registration models and EAVM input, 3 image integration methods were evaluated and compared to the commercial registration module CartoMerge. The performance was evaluated both in terms of distance measure that describes surface matching, and correlation measure that describes actual scar correspondence. Compared to CartoMerge, the method that uses the translation-and-rotation model and high-density EAVM input resulted in a registration error of 4.32±0.69 mm as compared to 4.84 ± 1.07 (P <0.05); the method that uses the translation model and high-density EAVM input resulted in a registration error of 4.60 ± 0.65 mm (P = NS); and the method that uses the translation model and a single anatomical landmark input resulted in a registration error of 6.58 ± 1.63 mm (P < 0.05). No significant difference in scar correlation was observed between all 3 methods and CartoMerge (P = NS). CONCLUSIONS During VT ablation procedures, accurate integration of EAVM and DE-MRI can be achieved using a translation registration model and a single anatomical landmark. This model allows for image integration in minimal mapping time and is likely to reduce fluoroscopy time and increase procedure efficacy.
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Affiliation(s)
- Qian Tao
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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22
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Pennell DJ, Firmin DN, Kilner PJ, Manning WJ, Mohiaddin RH, Prasad SK. Review of journal of cardiovascular magnetic resonance 2010. J Cardiovasc Magn Reson 2011; 13:48. [PMID: 21914185 PMCID: PMC3182946 DOI: 10.1186/1532-429x-13-48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/13/2011] [Indexed: 12/15/2022] Open
Abstract
There were 75 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2010, which is a 34% increase in the number of articles since 2009. The quality of the submissions continues to increase, and the editors were delighted with the recent announcement of the JCMR Impact Factor of 4.33 which showed a 90% increase since last year. Our acceptance rate is approximately 30%, but has been falling as the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. Last year for the first time, the Editors summarized the papers for the readership into broad areas of interest or theme, which we felt would be useful to practitioners of cardiovascular magnetic resonance (CMR) so that you could review areas of interest from the previous year in a single article in relation to each other and other recent JCMR articles 1. This experiment proved very popular with a very high rate of downloading, and therefore we intend to continue this review annually. The papers are presented in themes and comparison is drawn with previously published JCMR papers to identify the continuity of thought and publication in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
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Affiliation(s)
- Dudley J Pennell
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - David N Firmin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Philip J Kilner
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Warren J Manning
- Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Raad H Mohiaddin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
| | - Sanjay K Prasad
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ, UK
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23
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Figtree GA, Lønborg J, Grieve SM, Ward MR, Bhindi R. Cardiac magnetic resonance imaging for the interventional cardiologist. JACC Cardiovasc Interv 2011; 4:137-48. [PMID: 21349451 DOI: 10.1016/j.jcin.2010.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 09/10/2010] [Accepted: 09/17/2010] [Indexed: 01/04/2023]
Abstract
Cardiac magnetic resonance imaging is a noninvasive technique for assessing heart structure and function without the need for ionizing radiation. Its ability to precisely outline regions of myocardial ischemia and infarction gives it an important role in guiding interventional cardiologists in revascularization. Its ability to characterize and precisely quantify abnormal regurgitant flow volumes or abnormal shunts also makes it a valuable tool for many noncoronary interventions. This review will discuss the evidence for cardiac magnetic resonance in guiding complex therapies in the catheter laboratory, as well as practical issues that need to be addressed to allow the application of this powerful tool to an increasing number of our patients.
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Affiliation(s)
- Gemma A Figtree
- North Shore Heart Research Group, Kolling Institute, University of Sydney, Sydney, Australia
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24
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Guerra JM, Rodríguez-Font E, Alonso-Martín C, Viñolas X. Integration of late-enhanced MRI and electroanatomical mapping for substrate ablation of poorly tolerated ventricular tachycardia. Europace 2010; 12:1793-5. [PMID: 20974752 DOI: 10.1093/europace/euq381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe the case of a patient with a poorly tolerated ventricular tachycardia (VT) in which a substrate ablation was performed. The ablation was guided by the integrated images of the scar obtained by MRI and electro-anatomical mapping. This combined technique can make substrate ablation more accurate and may have a role in the ablation of unmappable VT.
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Affiliation(s)
- Jose M Guerra
- Electrophysiology Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 167, 08025 Barcelona, Spain.
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25
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Vergara GR, Vijayakumar S, Kholmovski EG, Blauer JJE, Guttman MA, Gloschat C, Payne G, Vij K, Akoum NW, Daccarett M, McGann CJ, Macleod RS, Marrouche NF. Real-time magnetic resonance imaging-guided radiofrequency atrial ablation and visualization of lesion formation at 3 Tesla. Heart Rhythm 2010; 8:295-303. [PMID: 21034854 DOI: 10.1016/j.hrthm.2010.10.032] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 10/22/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) allows visualization of location and extent of radiofrequency (RF) ablation lesion, myocardial scar formation, and real-time (RT) assessment of lesion formation. In this study, we report a novel 3-Tesla RT -RI based porcine RF ablation model and visualization of lesion formation in the atrium during RF energy delivery. OBJECTIVE The purpose of this study was to develop a 3-Tesla RT MRI-based catheter ablation and lesion visualization system. METHODS RF energy was delivered to six pigs under RT MRI guidance. A novel MRI-compatible mapping and ablation catheter was used. Under RT MRI, this catheter was safely guided and positioned within either the left or right atrium. Unipolar and bipolar electrograms were recorded. The catheter tip-tissue interface was visualized with a T1-weighted gradient echo sequence. RF energy was then delivered in a power-controlled fashion. Myocardial changes and lesion formation were visualized with a T2-weighted (T2W) half Fourier acquisition with single-shot turbo spin echo (HASTE) sequence during ablation. RESULTS RT visualization of lesion formation was achieved in 30% of the ablations performed. In the other cases, either the lesion was formed outside the imaged region (25%) or the lesion was not created (45%) presumably due to poor tissue-catheter tip contact. The presence of lesions was confirmed by late gadolinium enhancement MRI and macroscopic tissue examination. CONCLUSION MRI-compatible catheters can be navigated and RF energy safely delivered under 3-Tesla RT MRI guidance. Recording electrograms during RT imaging also is feasible. RT visualization of lesion as it forms during RF energy delivery is possible and was demonstrated using T2W HASTE imaging.
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Affiliation(s)
- Gaston R Vergara
- Comprehensive Arrhythmia Research and Management Center, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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26
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Saybasili H, Faranesh AZ, Saikus CE, Ozturk C, Lederman RJ, Guttman MA. Interventional MRI using multiple 3D angiography roadmaps with real-time imaging. J Magn Reson Imaging 2010; 31:1015-9. [PMID: 20373448 DOI: 10.1002/jmri.22097] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To enhance real-time magnetic resonance (MR)-guided catheter navigation by overlaying colorized multiphase MR angiography (MRA) and cholangiopancreatography (MRCP) roadmaps in an anatomic context. MATERIALS AND METHODS Time-resolved MRA and respiratory-gated MRCP were acquired prior to real-time imaging in a pig model. MRA and MRCP data were loaded into a custom real-time MRI reconstruction and visualization workstation where they were displayed as maximum intensity projections (MIPs) in distinct colors. The MIPs were rendered in 3D together with real-time multislice imaging data using alpha blending. Interactive rotation allowed different views of the combined data. RESULTS Fused display of the previously acquired MIP angiography data with real-time imaging added anatomical context during endovascular interventions in swine. The use of multiple MIPs rendered in different colors facilitated differentiation of vascular structures, improving visual feedback during device navigation. CONCLUSION Interventional real-time MRI may be enhanced by combining with previously acquired multiphase angiograms. Rendered as 3D MIPs together with 2D slice data, this technique provided useful anatomical context that enhanced MRI-guided interventional applications.
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Affiliation(s)
- Haris Saybasili
- Translational Medicine Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1061, USA.
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27
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Pennell DJ, Firmin DN, Kilner PJ, Manning WJ, Mohiaddin RH, Neubauer S, Prasad SK. Review of Journal of Cardiovascular Magnetic Resonance 2009. J Cardiovasc Magn Reson 2010; 12:15. [PMID: 20302618 PMCID: PMC2847562 DOI: 10.1186/1532-429x-12-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 03/19/2010] [Indexed: 11/10/2022] Open
Abstract
There were 56 articles published in the Journal of Cardiovascular Magnetic Resonance in 2009. The editors were impressed with the high quality of the submissions, of which our acceptance rate was about 40%. In accordance with open-access publishing, the articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. We have therefore chosen to briefly summarise the papers in this article for quick reference for our readers in broad areas of interest, which we feel will be useful to practitioners of cardiovascular magnetic resonance (CMR). In some cases where it is considered useful, the articles are also put into the wider context with a short narrative and recent CMR references. It has been a privilege to serve as the Editor of the JCMR this past year. I hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality manuscripts to JCMR for publication.
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Affiliation(s)
- DJ Pennell
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - DN Firmin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - PJ Kilner
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - WJ Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center 330 Brookline Avenue, Boston, MA 02215 USA. Harvard Medical School, 25 Shattuck Street Boston, MA 02115 USA
| | - RH Mohiaddin
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
| | - S Neubauer
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - SK Prasad
- CMR Unit Royal Brompton Hospital, Sydney Street, London SW3 6NP UK. National Heart and Lung Institute, Imperial College, Exhibition Road, London, SW7 2AZ UK
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28
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Affiliation(s)
- Dudley J. Pennell
- From the Cardiovascular MR Unit, Royal Brompton Hospital, London, UK and Imperial College, London, UK
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29
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Ratnayaka K, Lederman RJ. Interventional cardiovascular MR—The next stage in pediatric cardiology. PROGRESS IN PEDIATRIC CARDIOLOGY 2010. [DOI: 10.1016/j.ppedcard.2009.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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