Magnetic resonance and computed tomography imaging fusion for live guidance of percutaneous pulmonary valve implantation

摘要

Introduction Until recently, two-dimensional (2D) angiography was the mainstay of guidance for percutaneous pulmonary valve implantation (PPVI). Recent advances in fusion software have enabled direct fusion of pre-intervention imaging, magnetic resonance imaging (MRI) or computed tomography (CT) scans, to create a?reliable three-dimensional (3D) roadmap for procedural guidance. Aim To report initial two-center experience with direct 2D–3D image fusion for live guidance of PPVI with MRI- and CT-derived 3D roadmaps. Material and methods We performed a?prospective study on PPVIs guided with the new fusion imaging platform introduced in the last quarter of 2015. Results 3D guidance with an MRI- (n = 14) or CT- (n = 8) derived roadmap was utilized during 22 catheterizations for right ventricular outflow tract balloon sizing (n = 7) or PPVI (n = 15). Successful 2D–3D registration was performed in all but 1 patient. Six (27%) patients required intra-procedural readjustment of the 3D roadmap due to distortion of the anatomy after introduction of a?stiff wire. Twenty-one (95%) interventions were successful in the application of 3D imaging. Patients in the CT group received less contrast volume and had a?shorter procedural time, though the differences were not statistically significant. Those in the MRI group had significantly lower weight adjusted radiation exposure. Conclusions With intuitive segmentation and direct 2D–3D fusion of MRI or CT datasets, VesselNavigator facilitates PPVI. Our initial data show that utilization of CT-derived roadmaps may lead to less contrast exposure and shorter procedural time, whereas application of MRI datasets may lead to lower radiation exposure.