Fused Whole-Heart Coronary and Myocardial Scar Imaging Using 3-T CMR Implications for Planning of Cardiac Resynchronization Therapy and Coronary Revascularization

JACC-CARDIOVASCULAR IMAGING

卷:3

Article

White, James A.^1,2,3,6  Fine, Nowell²  Gula, Lorne J.²  Yee, Raymond²  Al-Admawi, Mohammed²  Krahn, Andrew²  Skanes, Allan²  MacDonald, Anna²  Peters, Terry^4,5  Drangova, Maria^4,5,6 

[1] Univ Western Ontario, Cardiovasc MRI Clin Res CMCR Program, Robarts Res Inst, Imaging Res Labs,MRI Unit 3T 7T, London, ON N6A 5K8, Canada

[2] Univ Western Ontario, Div Cardiol, Dept Med, Schulich Sch Med & Dent, London, ON N6A 5K8, Canada

[3] Univ Western Ontario, Lawson Hlth Res Inst, London, ON N6A 5K8, Canada

[4] Univ Western Ontario, Dept Med Biophys, London, ON N6A 5K8, Canada

[5] Univ Western Ontario, Dept Med Imaging, London, ON N6A 5K8, Canada

[6] Heart & Stroke Fdn Ontario, Toronto, ON, Canada

关键词: cardiac magnetic resonance;    coronary imaging;    delayed enhancement;    image fusion;   

DOI  :  10.1016/j.jcmg.2010.05.014

来源: Elsevier

【 摘 要 】

OBJECTIVES The aim of this study was to demonstrate the feasibility of providing spatially matched, 3-dimensional (3D) myocardial scar and coronary imaging for the purpose of fused volumetric image display in patients undergoing cardiac resynchronization therapy (CRT) or coronary artery revascularization (CAR). BACKGROUND Clinical success in coronary vascular-based interventions is mitigated by the presence of scar in related myocardium. Pre-procedural fused volumetric imaging of both myocardial scar and coronary vasculature may benefit pre-procedural planning and patient selection in populations referred for CRT or CAR. METHODS A total of 55 studies were performed in patients referred for either CRT (n = 42) or CAR (n = 13). Coronary-enhanced and scar-enhanced imaging was performed on a 3-T cardiac magnetic resonance scanner using the same cardiac-gated, 3D, free-breathing cardiac magnetic resonance technique during and 20 minutes following slow gadolinium infusion. Matched image datasets were fused and volume-rendered to simultaneously display coronary anatomy and myocardial scar. Visual scoring of coronary artery, coronary vein, and myocardial scar image quality (score 0 to 4) was performed. The clinical impact of imaging was also scored using a physician survey. RESULTS Mean age was 57 +/- 14 years. Combined 3D coronary and scar imaging was successful in 49 studies (89%). A quality score >= 2 was obtained for 97% of proximal- and mid-coronary artery and vein segments. The mean quality score of 3D scar imaging was 2.8 +/- 1.0 and was scored as >= 2 in 86% of patients with myocardial scar. All patients with a scar quality score >= 2 achieved successful image fusion. Transmural scar was present below >= 1 planned target vessel in 9 patients (39%) planned for CRT and 8 patients (62%) planned for CAR. Physician surveys demonstrated incremental clinical impact in 67% of patients. CONCLUSIONS Three-dimensional myocardial scar and coronary imaging with fused volumetric display is clinically feasible and may be valuable for the planning of vascular-based interventions when regional myocardial scar is pertinent to therapeutic success. (J Am Coll Cardiol Img 2010;3:921-30) (C) 2010 by the American College of Cardiology Foundation

【 授权许可】

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