CMR-guidance of passively tracked endomyocardial biopsy in an in vivo porcine model
CMR-guidance of passively tracked endomyocardial biopsy in an in vivo porcine model
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DOI：
10.1007/s10554-018-1402-5
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发表时间：
2018-12-01
影响因子：
2.1
通讯作者：
Boenner, F.
中科院分区：
文献类型：
--
作者：
Behm, P.;Gastl, M.;Boenner, F.
心内膜心肌活检(EMB)被认为是诊断心肌炎症的金标准。EMB通常在透视下进行，没有任何特定的靶点信息。心血管磁共振(CMR)提供的特异性靶点信息可提高EMB的特异性。目的是研究CMR引导和靶向EMB在使用被动跟踪装置的临床前模型中的可行性和安全性。手术在配备了用于实时成像的介入软件平台的MRI系统上进行。进行了体外实验，以优化导鞘的可见性。在2头猪和4头急性心肌梗死后的猪身上进行了体内实验，以测试引导和靶向EMB的可行性。对于解剖实时成像，采用单次激发平衡SSFP序列。在实时成像(单次激发T2(SshT2)序列和单次激发晚期Gd增强(SshLGE)序列)下识别心肌靶点。体外实验表明，连续标记的导鞘具有最好的可见性。所有病例均在CMR引导下行EMB，无严重并发症。同样，病变靶向心内膜心肌活检在两个病例中也是可行的。活组织检查显示出合适的大小和质量。实时病变序列显示的CNR值与临床方案相似。实时成像显示病灶的信噪比(SNR/CNR)如下：sshT2-和sshLGE的SNR分别为124+/-35和67+/-51，而CNR为81+/-30和57+/-44。本研究论证了CMR引导和基本靶向的被动跟踪装置的EMB的可行性和安全性。实时序列的信噪比不亚于用于病变检测的标准序列。由于CMR可以在实时成像下发现心肌靶点，因此CMR引导可以提高EMB的诊断准确率。
Endomyocardial biopsy (EMB) is considered to be the diagnostic gold-standard in detection of myocardial-inflammation. EMB is usually conducted under fluoroscopy without any specific target information. Specific target-information provided by cardiovascular magnetic resonance (CMR) may improve specificity of EMB. The aim was to investigate feasibility and safety of CMR-guided and targeted EMB in a preclinical-model using passively-tracked devices. Procedures were performed on a MRI-System equipped with an Interventional Software-Platform for real-time imaging. Ex vivo experiments were conducted to optimize visibility of the guide-sheath. In vivo experiments were conducted in 2 pigs for technical feasibility assessment and in 4 pigs after acute myocardial infarction to test feasibility of guided and lesion targeted EMB. For anatomical real-time imaging a single-shot-balanced-SSFP-sequence was applied. Myocardial targets were identified under real-time imaging (single-shot-T2 (sshT2) and single-shot Late-Gadolinium-Enhancement (sshLGE) sequences). Ex vivo experiments demonstrated best visibility of continuously labelled guide-sheath. CMR-guided EMB was feasible in all cases without major complications. Likewise, lesion-targeting endomyocardial biopsy was feasible in two cases. Biopsies exhibited appropriate sizes and qualities. Real-time lesion sequences revealed comparable CNR values to clinical-protocols. Real-time imaging of lesions showed following signal- and contrast-to-noise ratios (SNR/CNR): SNR of sshT2- and sshLGE was 124 +/- 35 and 67 +/- 51 respectively, whereas CNR was 81 +/- 30 and 57 +/- 44. This study demonstrates feasibility and safety of CMR-guided and basically targeted EMB with passively-tracked devices. Signal-to-noise ratios of real-time sequences is non-inferior to standard sequences for lesion detection. CMR-guidance may improve diagnostic accuracy of EMB since CMR can detect myocardial-targets under real-time-imaging.