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Kawafuji S, Yamaji H, Kayama M, Akiyama A, Miyahara M, Tomiya T, Koumoto T, Akagi T, Higashiya S, Murakami T, Kusachi S. Usefulness of three-dimensional pulmonary vein-left atrium image reconstructed from non-enhanced computed tomography for atrial fibrillation ablation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2517-2526. [PMID: 37646891 DOI: 10.1007/s10554-023-02943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
Enhanced computed tomography (CT) is unsuitable for patients with reduced renal function and/or allergy for contrast medium (CM). CT image registration into an electroanatomic system (EAMS) is essential to perform pulmonary vein isolation (PVI) safely and smoothly in patients with atrial fibrillation (AF). To create three-dimensional pulmonary vein-left atrium (3D PV-LA) images from non-enhanced CT images to register them into EAMS for AF ablation. Using a non-enhanced ECG-gated image, 3D PV-LA images were generated by our developed techniques with an EnSite image analyzing tool for patients unfit for CM use (n = 100). Segmentation between tissues was performed as follows: tissues distal from or close to PV-LA were segmented in transverse slices to clearly show the whole LA. Tissues bordering PV-LA, including the pulmonary artery, left ventricle, and right atrium, were segmented manually with great care. Practical ablation parameters were compared with those obtained from enhanced CT (n = 100). 3D PV-LA image reconstruction from non-enhanced CT imaging required a longer time than that from enhanced CT (42 ± 6 vs 14 ± 3 min). All 100 PV-LA non-enhanced CT images were successfully reconstructed and registered into the EAM system without the need for re-segmentation. Practical ablation parameters, including procedural time and AF recurrence rate, did not differ between imaging methods. This study provides clinically useful information on a detailed methodology for 3D PV-LA image reconstruction using non-enhanced CT. Non-enhanced CT 3D PV-LA images were successfully registered into the EAM system and useful for patients unsuitable for CM use.
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Affiliation(s)
- Souhei Kawafuji
- Division of Clinical Engineering, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Hirosuke Yamaji
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan.
| | - Masaaki Kayama
- Division of Clinical Engineering, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Akitaka Akiyama
- Division of Clinical Engineering, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Motoaki Miyahara
- Division of Clinical Engineering, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Takumi Tomiya
- Division of Radiation, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Takuto Koumoto
- Division of Radiation, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Takuya Akagi
- Division of Radiation, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Shunichi Higashiya
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Takashi Murakami
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Shozo Kusachi
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Shikata 2-5-1, Kita-Ku, Okayama, 700-8558, Japan
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Koktzoglou I, Huang R, Edelman RR. Quantitative time-of-flight MR angiography for simultaneous luminal and hemodynamic evaluation of the intracranial arteries. Magn Reson Med 2022; 87:150-162. [PMID: 34374455 PMCID: PMC8616782 DOI: 10.1002/mrm.28969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To report a quantitative time-of-flight (qTOF) MRA technique for simultaneous luminal and hemodynamic evaluation of the intracranial arteries. METHODS Implemented using a thin overlapping slab 3D stack-of-stars based 3-echo FLASH readout, qTOF was tested in a flow phantom and for imaging the intracranial arteries of 10 human subjects at 3 Tesla. Display of the intracranial arteries with qTOF was compared to resolution-matched and scan time-matched standard Cartesian 3D time-of-flight (TOF) MRA, whereas quantification of mean blood flow velocity with qTOF, done using a computer vision-based inter-echo image analysis procedure, was compared to 3D phase contrast MRA. Arterial-to-background contrast-to-noise ratio was measured, and intraclass correlation coefficient was used to evaluate agreement of flow velocities. RESULTS For resolution-matched protocols of similar scan time, qTOF portrayed the intracranial arteries with good morphological correlation with standard Cartesian TOF, and both techniques provided superior contrast-to-noise ratio and arterial delineation compared to phase contrast (20.6 ± 3.0 and 37.8 ± 8.7 vs. 11.5 ± 2.2, P < .001, both comparisons). With respect to phase contrast, qTOF showed excellent agreement for measuring mean flow velocity in the flow phantom (intraclass correlation coefficient = 0.981, P < .001) and good agreement in the intracranial arteries (intraclass correlation coefficient = 0.700, P < .001). Stack-of-stars data sampling used with qTOF eliminated oblique in-plane flow misregistration artifacts that were seen with standard Cartesian TOF. CONCLUSION qTOF is a new 3D MRA technique for simultaneous luminal and hemodynamic evaluation of the intracranial arteries that provides significantly greater contrast-to-noise ratio efficiency than phase contrast and eliminates misregistration artifacts from oblique in-plane blood flow that occur with standard 3D TOF.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL,Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Rong Huang
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL
| | - Robert R. Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL,Northwestern University Feinberg School of Medicine, Chicago, IL
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Peters DC, Lamy J, Sinusas AJ, Baldassarre LA. Left atrial evaluation by cardiovascular magnetic resonance: sensitive and unique biomarkers. Eur Heart J Cardiovasc Imaging 2021; 23:14-30. [PMID: 34718484 DOI: 10.1093/ehjci/jeab221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/12/2021] [Indexed: 12/12/2022] Open
Abstract
Left atrial (LA) imaging is still not routinely used for diagnosis and risk stratification, although recent studies have emphasized its importance as an imaging biomarker. Cardiovascular magnetic resonance is able to evaluate LA structure and function, metrics that serve as early indicators of disease, and provide prognostic information, e.g. regarding diastolic dysfunction, and atrial fibrillation (AF). MR angiography defines atrial anatomy, useful for planning ablation procedures, and also for characterizing atrial shapes and sizes that might predict cardiovascular events, e.g. stroke. Long-axis cine images can be evaluated to define minimum, maximum, and pre-atrial contraction LA volumes, and ejection fractions (EFs). More modern feature tracking of these cine images provides longitudinal LA strain through the cardiac cycle, and strain rates. Strain may be a more sensitive marker than EF and can predict post-operative AF, AF recurrence after ablation, outcomes in hypertrophic cardiomyopathy, stratification of diastolic dysfunction, and strain correlates with atrial fibrosis. Using high-resolution late gadolinium enhancement (LGE), the extent of fibrosis in the LA can be estimated and post-ablation scar can be evaluated. The LA LGE method is widely available, its reproducibility is good, and validations with voltage-mapping exist, although further scan-rescan studies are needed, and consensus regarding atrial segmentation is lacking. Using LGE, scar patterns after ablation in AF subjects can be reproducibly defined. Evaluation of 'pre-existent' atrial fibrosis may have roles in predicting AF recurrence after ablation, predicting new-onset AF and diastolic dysfunction in patients without AF. LA imaging biomarkers are ready to enter into diagnostic clinical practice.
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Affiliation(s)
- Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Cardiology, Yale School of Medicine, New Haven, CT, USA
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