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Contrast-Enhanced C-Arm CT Evaluation of Radiofrequency Ablation Lesions in the Left Ventricle

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Bibliographic Details
Title: Contrast-Enhanced C-Arm CT Evaluation of Radiofrequency Ablation Lesions in the Left Ventricle
Authors: Richard Luong, Rebecca Fahrig, Teri Moore, Jan Dr. Boese, Jarrett Rosenberg, Günter Lauritsch, Erin Girard, Amin A. Al-Ahmad
Source: JACC: Cardiovascular Imaging. 4:259-268
Publisher Information: Elsevier BV, 2011.
Publication Year: 2011
Subject Terms: Time Factors, Swine, Heart Ventricles, Iohexol, imaging, Contrast Media, computed tomography, Equipment Design, arrhythmia, electrophysiology, Necrosis, 03 medical and health sciences, 0302 clinical medicine, Radiology Nuclear Medicine and imaging, Predictive Value of Tests, catheter ablation, Catheter Ablation, Animals, Radiographic Image Interpretation, Computer-Assisted, Regression Analysis, Female, Cardiology and Cardiovascular Medicine, Tomography, X-Ray Computed, C-arm computed tomography
Description: The purpose of this study was to evaluate use of cardiac C-arm computed tomography (CT) in the assessment of the dimensions and temporal characteristics of radiofrequency ablation (RFA) lesions. This imaging modality uses a standard C-arm fluoroscopy system rotating around the patient, providing CT-like images during the RFA procedure.Both cardiac magnetic resonance (CMR) and CT can be used to assess myocardial necrotic tissue. Several studies have reported visualizing cardiac RFA lesions with CMR; however, obtaining CMR images during interventional procedures is not common practice. Direct visualization of RFA lesions using C-arm CT during the procedure may improve outcomes and circumvent complications associated with cardiac ablation procedures.RFA lesions were created on the endocardial surface of the left ventricle of 9 swine using a 7-F RFA catheter. An electrocardiographically gated C-arm CT imaging protocol was used to acquire projection images during iodine contrast injection and after the injection every 5 min for up to 30 min, with no additional contrast. Reconstructed images were analyzed offline. The mean and SD of the signal intensity of the lesion and normal myocardium were measured in all images in each time series. Lesion dimensions and area were measured and compared in pathologic specimens and C-arm CT images.All ablation lesions (n = 29) were visualized and lesion dimensions, as measured on C-arm CT, correlated well with postmortem tissue measurements (linear dimensions: concordance correlation = 0.87; area: concordance correlation = 0.90. Lesions were visualized as a perfusion defect on first-pass C-arm CT images with a signal intensity of 95 HU lower than that of normal myocardium (95% confidence interval: -111 HU to -79 HU). Images acquired at 1 and 5 min exhibited an enhancing ring surrounding the perfusion defect in 24 lesions (83%).RFA lesion size, including transmurality, can be assessed using electrocardiographically gated cardiac C-arm CT in the interventional suite. Visualization of RFA lesions using cardiac C-arm CT may facilitate the assessment of adequate lesion delivery and provide valuable feedback during cardiac ablation procedures.
Document Type: Article
Language: English
ISSN: 1936-878X
DOI: 10.1016/j.jcmg.2010.11.019
Access URL: https://pubmed.ncbi.nlm.nih.gov/21414574
https://europepmc.org/abstract/MED/21414574
https://www.jacc.org/doi/10.1016/j.jcmg.2010.11.019
https://imaging.onlinejacc.org/content/jimg/4/3/259.full.pdf
http://imaging.onlinejacc.org/content/jimg/4/3/259.full.pdf
https://pubmed.ncbi.nlm.nih.gov/21414574/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3090077
Rights: Elsevier Non-Commercial
Accession Number: edsair.doi.dedup.....fb4c5da37cfd5203a4606b457279a348
Database: OpenAIRE
Description
Abstract:The purpose of this study was to evaluate use of cardiac C-arm computed tomography (CT) in the assessment of the dimensions and temporal characteristics of radiofrequency ablation (RFA) lesions. This imaging modality uses a standard C-arm fluoroscopy system rotating around the patient, providing CT-like images during the RFA procedure.Both cardiac magnetic resonance (CMR) and CT can be used to assess myocardial necrotic tissue. Several studies have reported visualizing cardiac RFA lesions with CMR; however, obtaining CMR images during interventional procedures is not common practice. Direct visualization of RFA lesions using C-arm CT during the procedure may improve outcomes and circumvent complications associated with cardiac ablation procedures.RFA lesions were created on the endocardial surface of the left ventricle of 9 swine using a 7-F RFA catheter. An electrocardiographically gated C-arm CT imaging protocol was used to acquire projection images during iodine contrast injection and after the injection every 5 min for up to 30 min, with no additional contrast. Reconstructed images were analyzed offline. The mean and SD of the signal intensity of the lesion and normal myocardium were measured in all images in each time series. Lesion dimensions and area were measured and compared in pathologic specimens and C-arm CT images.All ablation lesions (n = 29) were visualized and lesion dimensions, as measured on C-arm CT, correlated well with postmortem tissue measurements (linear dimensions: concordance correlation = 0.87; area: concordance correlation = 0.90. Lesions were visualized as a perfusion defect on first-pass C-arm CT images with a signal intensity of 95 HU lower than that of normal myocardium (95% confidence interval: -111 HU to -79 HU). Images acquired at 1 and 5 min exhibited an enhancing ring surrounding the perfusion defect in 24 lesions (83%).RFA lesion size, including transmurality, can be assessed using electrocardiographically gated cardiac C-arm CT in the interventional suite. Visualization of RFA lesions using cardiac C-arm CT may facilitate the assessment of adequate lesion delivery and provide valuable feedback during cardiac ablation procedures.
ISSN:1936878X
DOI:10.1016/j.jcmg.2010.11.019