Jean-Yves Wielandts1, Stijn De Buck2, Koen Michielsen3, Ruan Louw4, Christophe Garweg4, Johan Nuyts3, Joris Ector4, Frederik Maes5, Hein Heidbuchel6. 1. Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium jean-yves.wielandts@uzleuven.be. 2. Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium Department of Electrical Engineering, ESAT/PSI, Medical Image Computing, KU Leuven, Leuven, Belgium. 3. Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium Department of Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium. 4. Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium. 5. Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium Department of Electrical Engineering, ESAT/PSI, Medical Image Computing, KU Leuven, Leuven, Belgium iMinds-Future Health Department, KU Leuven, Leuven, Belgium. 6. Hasselt University and Heart Center Hasselt, Diepenbeek, Belgium.
Abstract
AIMS: Interventional left ventricular (LV) procedures integrating static 3D anatomy visualization are subject to mismatch with dynamic catheter movements due to prominent LV motion. We aimed to evaluate the accuracy of a recently developed acquisition and post-processing protocol for low radiation dose LV multi-phase rotational angiography (4DRA) in patients. METHODS AND RESULTS: 4DRA image acquisition of the LV was performed as investigational acquisition in patients undergoing left-sided ablation (11 men; BMI = 24.7 ± 2.5 kg/m²). Iodine contrast was injected in the LA, while pacing from the RA at a cycle length of 700 ms. 4DRA acquisition and reconstruction were possible in all 11 studies. Reconstructed images were post-processed using streak artefact reduction algorithms and an interphase registration-based filtering method, increasing contrast-to-noise ratio by a factor 8.2 ± 2.1. This enabled semi-automatic segmentation, yielding LV models of five equidistant phases per cardiac cycle. For evaluation, off-line 4DRA fluoroscopy registration was performed, and the 4DRA LV contours of the different phases were compared with the contours of five corresponding phases of biplane LV angiography, acquired in identical circumstances. Of the distances between these contours, 95% were <4 mm in both incidences. Effective radiation dose for 4DRA, calculated by patient-specific Monte-Carlo simulation, was 5.1 ± 1.1 mSv. CONCLUSION: Creation of 4DRA LV models in man is feasible at near-physiological heart rate and with clinically acceptable radiation dose. They showed high accuracy with respect to LV angiography in RAO and LAO. The presented technology not only opens perspectives for full cardiac cycle dynamic anatomical guidance during interventional procedures, but also for 3DRA without need for very rapid pacing. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Interventional left ventricular (LV) procedures integrating static 3D anatomy visualization are subject to mismatch with dynamic catheter movements due to prominent LV motion. We aimed to evaluate the accuracy of a recently developed acquisition and post-processing protocol for low radiation dose LV multi-phase rotational angiography (4DRA) in patients. METHODS AND RESULTS: 4DRA image acquisition of the LV was performed as investigational acquisition in patients undergoing left-sided ablation (11 men; BMI = 24.7 ± 2.5 kg/m²). Iodine contrast was injected in the LA, while pacing from the RA at a cycle length of 700 ms. 4DRA acquisition and reconstruction were possible in all 11 studies. Reconstructed images were post-processed using streak artefact reduction algorithms and an interphase registration-based filtering method, increasing contrast-to-noise ratio by a factor 8.2 ± 2.1. This enabled semi-automatic segmentation, yielding LV models of five equidistant phases per cardiac cycle. For evaluation, off-line 4DRA fluoroscopy registration was performed, and the 4DRA LV contours of the different phases were compared with the contours of five corresponding phases of biplane LV angiography, acquired in identical circumstances. Of the distances between these contours, 95% were <4 mm in both incidences. Effective radiation dose for 4DRA, calculated by patient-specific Monte-Carlo simulation, was 5.1 ± 1.1 mSv. CONCLUSION: Creation of 4DRA LV models in man is feasible at near-physiological heart rate and with clinically acceptable radiation dose. They showed high accuracy with respect to LV angiography in RAO and LAO. The presented technology not only opens perspectives for full cardiac cycle dynamic anatomical guidance during interventional procedures, but also for 3DRA without need for very rapid pacing. Published on behalf of the European Society of Cardiology. All rights reserved.
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