Name: improved registration of 3d ct angiography with x-ray fluoroscopy for image fusion during transcatheter aortic valve implantation
Uploaded: 2018-06-03T15:00:00
Description: Watch this Scientific Journal Video about Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation at JoVE.com

作者想感谢 Ulm 大学翻译成像 MoMAN 中心的支持。

该研究议定书符合《1975赫尔辛基宣言》的道德准则, 这反映在该机构道德委员会通过的先验批准中。这项研究中包括的所有个人参与者都获得书面知情同意 (CSI--Ulm, clinicaltrials.gov NCT02162069)。
1. CT 检查
<ol><li>用80毫升的碘造影剂在4.0 毫升/秒的流速下进行心脏 CT 血管造影, 然后用70毫升0.9% 盐水溶液冲洗丸。</li>
	<li>采集 caudally 从股动脉向锁骨下动脉扩展的数据: 矩阵为 ...

<ol>
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M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fusion+of+CT+Angiography+or+MR+Angiography+with+Unenhanced+CBCT+and+Fluoroscopy+Guidance+in+Endovascular+Treatments+of+Aorto-Iliac+Steno-Occlusion:+Technical+Note+on+a+Preliminary+Experience.">Fusion of CT Angiography or MR Angiography with Unenhanced CBCT and Fluoroscopy Guidance in Endovascular Treatments of Aorto-Iliac Steno-Occlusion: Technical Note on a Preliminary Experience.</a> CardioVascular and Interventional Radiology. 39 (1), 111-116 (2015).</li><li>Sailer, A. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=CTA+with+Fluoroscopy+Image+Fusion+Guidance+in+Endovascular+Complex+Aortic+Aneurysm+Repair.">CTA with Fluoroscopy Image Fusion Guidance in Endovascular Complex Aortic Aneurysm Repair.</a> European Journal of Vascular and Endovascular Surgery. 47 (4), 349-356 (2014).</li><li>McNally, M. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three+Dimensional+Fusion+CT+Decreases+Radiation+Exposure,+Procedure+Time+and+Contrast+Use+during+Fenestrated+Endovascular+Aortic+Repair.">Three Dimensional Fusion CT Decreases Radiation Exposure, Procedure Time and Contrast Use during Fenestrated Endovascular Aortic Repair.</a> Journal of Vascular Surgery. 61 (2), 309-316 (2015).</li><li>Krishnaswamy, A., Tuzcu, E. M., Kapadia, S. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Integration+of+MDCT+and+fluoroscopy+using+C-arm+computed+tomography+to+guide+structural+cardiac+interventions+in+the+cardiac+catheterization+laboratory.">Integration of MDCT and fluoroscopy using C-arm computed tomography to guide structural cardiac interventions in the cardiac catheterization laboratory.</a> Catheterization and Cardiovascular Interventions. 85 (1), 139-147 (2015).</li><li>Movassaghi, B., Rasche, V., Grass, M., Viergever, M. A., Niessen, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+quantitative+analysis+of+3-D+coronary+modeling+from+two+or+more+projection+images.">A quantitative analysis of 3-D coronary modeling from two or more projection images.</a> IEEE Transactions on Medical Imaging. 23 (12), 1517-1531 (2004).</li><li>Vernikouskaya, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Image-guidance+for+transcatheter+aortic+valve+implantation+(TAVI)+and+cerebral+embolic+protection.">Image-guidance for transcatheter aortic valve implantation (TAVI) and cerebral embolic protection.</a> International Journal of Cardiology. 249, 90-95 (2017).</li><li>Ramlawi, B., Anaya-Ayala, J. E., Reardon, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcatheter+Aortic+Valve+Replacement+(TAVR):+Access+Planning+and+Strategies.">Transcatheter Aortic Valve Replacement (TAVR): Access Planning and Strategies.</a> Methodist DeBakey Cardiovascular Journal. 8 (2), 22-25 (2012).</li><li>W&#246;hrle, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transfemoral+Aortic+Valve+Implantation+with+the+New+Edwards+Sapien+3+Valve+for+Treatment+of+Severe+Aortic+Stenosis-Impact+of+Valve+Size+in+a+Single+Center+Experience.">Transfemoral Aortic Valve Implantation with the New Edwards Sapien 3 Valve for Treatment of Severe Aortic Stenosis-Impact of Valve Size in a Single Center Experience.</a> PLOS ONE. 11 (3), e0151247 (2016).</li><li>Seeger, J., Gonska, B., Otto, M., Rottbauer, W., W&#246;hrle, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cerebral+Embolic+Protection+During+Transcatheter+Aortic+Valve+Replacement+Significantly+Reduces+Death+and+Stroke+Compared+With+Unprotected+Procedures.">Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement Significantly Reduces Death and Stroke Compared With Unprotected Procedures.</a> JACC: Cardiovascular Interventions. 10 (22), 2297-2303 (2017).</li><li>Seeger, J., Gonska, B., Rodewald, C., Rottbauer, W., W&#246;hrle, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+suture+mediated+femoral+access+site+closure+with+the+Prostar+XL+compared+to+the+ProGlide+system+on+outcome+in+transfemoral+aortic+valve+implantation.">Impact of suture mediated femoral access site closure with the Prostar XL compared to the ProGlide system on outcome in transfemoral aortic valve implantation.</a> International Journal of Cardiology. 223, 564-567 (2016).</li><li>Vernikouskaya, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient-specific+registration+of+3D+CT+angiography+(CTA)+with+X-ray+fluoroscopy+for+image+fusion+during+transcatheter+aortic+valve+implantation+(TAVI)+increases+performance+of+the+procedure.">Patient-specific registration of 3D CT angiography (CTA) with X-ray fluoroscopy for image fusion during transcatheter aortic valve implantation (TAVI) increases performance of the procedure.</a> Clinical Research in Cardiology. , (2018).</li><li>Eng, M. H., Kim, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fluoroscopy+and+CT+fusion+overlay-greater+than+the+sum+of+their+parts.">Fluoroscopy and CT fusion overlay-greater than the sum of their parts.</a> Catheterization and Cardiovascular Interventions. 85 (1), 148-149 (2015).</li><li>John, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=System+to+guide+transcatheter+aortic+valve+implantations+based+on+interventional+C-arm+CT+imaging.">System to guide transcatheter aortic valve implantations based on interventional C-arm CT imaging.</a> Medical Image Computing and Computer-Assisted Intervention. 13 (Pt 1), 375-382 (2010).</li><li>Lu, Y., Sun, Y., Liao, R., Ong, S. 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本研究的主要重点是探讨如果不修改临床建立的 TAVI 工作流的可行性。当预介入 CTA 数据和 XR 透视的联合注册的金标准使用专用 aortograms8时, 我们建议使用多个近似注册, 并在飞行改进中提供精确的3D 模型叠加在整个干预过程中。
不断的手工注册细化需要额外训练有素的工作人员, 以协助介入小组从控制室。由于相关的用户交互影响临床建立的介入工作流程, ...

图像融合 (IF) 是将在不同时间获取的数据集叠加在一起的过程, 并将不同模式的观点转化为单个参考框架1。XR 是用于干预指导的最常用的成像方式。虽然, 提供高的时间和空间分辨率, XR 有低维度 (2D 预测), 缺乏解剖学细节。3D 从例如中派生的器官形状模型通过相关的解剖软组织结构, 将高质量的预介入 CTA 数据叠加到活透视图像上, 可增强 XR。前提步骤为 IF 是联合注册的不同成像方式。
通常情况下, 与 XR 透视的前3D 图像数据集的联合注册涉及以下技术之一2: a) 基于图像的 3 d-3 d 在术前3D 数据集的注册与术中的非/对比增强总站数据集3,4,5,6, 或 b) 直接基于图像的 2 d-3 d 注册, 其中两个造影图像最小的30°角间距7,8用于共同注册。
随着最近在商用 XR 系统上引入融合包, 如果可以更方便地提供广泛的应用。通过使用这些系统, 我们以前已经表明, 通过直接基于图像的2维-3 d 注册支持股经导管主动脉瓣植入 (TAVI)8, 在技术上可行和安全地覆盖主动脉根模型。在不损害整体 CA 或 XR 剂量的情况下, 如果证明自己在 TAVI 过程中具有很高的价值, 则可以在常规 XR 透视图像中添加3D 解剖细节, 特别是在脑保护装置的部署过程中。但是, 联合注册所使用的 aortograms 的额外购置需要额外的 CA 和 XR 剂量。因此, 如果不需要任何额外的 aortograms, 一个优化的工作流程提供了准确的, 是非常可取的。
在这里, 我们提出了一种改进的联合注册预介入 CTA 与实时 XR 不需要任何额外的 CA 或 C 臂 CT 扫描, 如果。股骨访问 TAVI 是按照其他地方的描述执行的9,10,11。简单地, 两股动脉被访问: 一为指导的对侧穿刺, 其次是放置一个辫子导管通过6F 鞘, 以允许动脉造影在安置的瓣膜假体;第二个位置的阀门输送系统和随后的气球成形术和设备放置。在我院进行适当穿刺的血管造影确认, 作为对穿刺高度 (股骨分叉以上) 定位的护理标准, 并在接触相关的情况下估计覆盖支架的位置。并发症12。为捕获栓塞碎片, 在主弓通过前插入 TAVI 后, 引入了双滤脑保护系统。
我们使用动脉在股动脉穿刺期间例行执行, 以建立初步的联合登记。在进行过程中, 联合注册的飞行细化是在持续的程序中使用在主动脉根部的辫子导管的位置, supraaortal 血管内的双滤脑栓塞保护系统和aortograms 在瓣膜假体植入前进行, 从而确保在干预过程中任何时间点的精确模型叠加。

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			<td height="21" style="height:21px;width:247px;">Philips Allura FD10&#160;&#160;</td>
			<td style="width:149px;">Philips Healthcare</td>
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			<td style="width:201px;">x-ray system</td>
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			<td height="43" style="height:43px;width:247px;">EP Navigator Release 5.2.10</td>
			<td style="width:149px;">Philips Healthcare</td>
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			<td height="39" style="height:39px;width:247px;">Iomeron 350</td>
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			<td>x-ray contrast agent</td>
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			<td height="40" style="height:41px;width:247px;">Sentinel&#160; double-filter cerebral protection system</td>
			<td style="width:149px;">Claret Medical, Inc.</td>
			<td style="width:136px;"></td>
			<td style="width:201px;">double-filter cerebral protection system&#160;</td>
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			<td height="27" style="height:27px;width:247px;">Matlab R2013</td>
			<td style="width:149px;">MathWorks</td>
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			<td>statistical analysis</td>
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improved registration of 3d ct angiography with x-ray fluoroscopy for image fusion during transcatheter aortic valve implantation

3D 解剖模型的融合, 从高保真的前介入计算机断层成像 (CTA) 和 x 射线 (XR) 透视, 以促进解剖学指导是巨大的兴趣, 复杂的心脏干预, 如 TAVI 程序大脑保护。基于额外的术中非/对比增强锥束计算机断层扫描 (总站) 或两个单独的 aortograms, 引入了 CTA 和 XR 的联合注册。随着辐射暴露和/或造影剂 (CA) 剂量的增加, 对患者有潜在的附加风险。在这里, 我们提出了一种改进的联合注册方法, 利用动脉的髂动脉, 例行执行在股骨穿刺和鞘介绍。在正在进行的过程中, 联合注册的即时细化使精确的联合注册无需任何额外的造影, 从而减少了 CA、XR 剂量和程序时间, 同时提高了操作员的信心和程序安全。

我们在 TAVI 期间引入了一种新的图像融合联合注册方法, 它允许在整个 TAVI 过程中将病人特定的解剖模型叠加到实时 XR 图像中, 而无需任何额外的 aortograms。
一些介入步骤将受益于 IF: (1) 引导穿刺的股动脉以上的股骨分岔在鞘侧 (图 5A);(2) 即使在非常曲折的剖析完全基于解剖叠加 (图 5B</stro...

Watch this Scientific Journal Video about Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation at JoVE.com

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation

经导管主动脉瓣植入术中 X 线透视 3D CT 血管造影的改进与影像融合

本研究的目的是在股导管主动脉瓣植入术 (TAVI) 中, 改进与实时 x 射线 (XR) 透视相结合的图像融合 (IF) 的联合注册。

The fusion of 3D anatomical models derived from high-fidelity pre-interventional computed tomography angiography (CTA), and x-ray (XR) fluoroscopy to ...

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