Cardiac shear-wave elastography using a transesophageal transducer: application to the mapping of thermal lesions in ultrasound transesophageal cardiac ablation
Cardiac shear-wave elastography using a transesophageal transducer: application to the mapping of thermal lesions in ultrasound transesophageal cardiac ablation
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DOI：
10.1088/0031-9155/60/20/7829
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发表时间：
2015-10-21
影响因子：
3.5
通讯作者：
Pernot, Mathieu
中科院分区：
文献类型：
--
作者：
Kwiecinski, Wojciech;Bessiere, Francis;Pernot, Mathieu
心律紊乱，如心房颤动或室性心动过速，可以通过基于导管的热消融治疗。然而，基于射频或冷冻消融的临床上可用的系统遭受有限的能量穿透和缺乏损伤的范围监测。超声引导经食管器械最近已成功用于在体内心脏的目标区域进行高强度聚焦超声（HIFU）消融。在本研究中，我们研究了在同一经食管器械上进行双重治疗和成像方法的可行性。我们证明，在体内，定量心脏剪切波弹性成像（SWE）可以与设备进行，我们显示在离体样本，经食管SWE可以映射的程度的HIFU insure.First，SWE验证与经食管内窥镜在一只羊体内。在心动周期（n = 11）和标测（n = 7）期间评估了正常心房和心室组织的硬度。其次，使用治疗成像经食管器械在离体鸡胸样品（n = 3）中进行了HIFU消融，然后在心房（左，n = 2）和心室（左n = 1，右n = 1）猪心脏组织中进行了HIFU消融。SWE提供了消融前后组织的硬度图。在心动周期中，心房的硬度从0.5 +/- 0.1 kPa变化到6.0 +/- 0.3 kPa，心室的硬度从1.3 +/-0.3 kPa变化到13.5 +/- 9.1 kPa。在消融后进行的所有SWE标测图上均可见热损伤。鸡胸中消融区的剪切模量增加至16.3 +/- 5.5 kPa（消融前为4.4 +/- 1.6 kPa），心房中增加至30.3 +/- 10.3 kPa（消融前为12.2 +/- 4.3 kPa），心室中增加至73.8 +/- 13.9 kPa（消融前为21.2 +/- 3.3 kPa）。在大体病理学上，病变的大小范围为0.1至1.5 cm（2）的成像平面面积。弹性估计的病变深度和宽度的中位数分别为0.2 mm（第一四分位数Q1：-0.8 mm;第三四分位数Q3：2.6 mm），均方误差（MSE）为5.1 mm（2），中位数为0.2 mm（Q1：-2.7 mm; Q3：2.7 mm），与大体病理学的MSE为11.1 mm（2）。我们已经证明了使用双重治疗和成像经食管设备进行HIFU热消融监测的可行性。在同一个经食管系统上结合HIFU、超声成像和SWE可能会产生一种新的临床器械，用于更安全和可控地治疗各种心律失常。
Heart rhythm disorders, such as atrial fibrillation or ventricular tachycardia can be treated by catheter-based thermal ablation. However, clinically available systems based on radio-frequency or cryothermal ablation suffer from limited energy penetration and the lack of lesion's extent monitoring. An ultrasound-guided transesophageal device has recently successfully been used to perform High-Intensity Focused Ultrasound (HIFU) ablation in targeted regions of the heart in vivo. In this study we investigate the feasibility of a dual therapy and imaging approach on the same transesophageal device. We demonstrate in vivo that quantitative cardiac shear-wave elastography (SWE) can be performed with the device and we show on ex vivo samples that transesophageal SWE can map the extent of the HIFU lesions.First, SWE was validated with the transesophageal endoscope in one sheep in vivo. The stiffness of normal atrial and ventricular tissues has been assessed during the cardiac cycle (n = 11) and mapped (n = 7). Second, HIFU ablation has been performed with the therapy-imaging transesophageal device in ex vivo chicken breast samples (n = 3), then atrial (left, n = 2) and ventricular (left n = 1, right n = 1) porcine heart tissues. SWE provided stiffness maps of the tissues before and after ablation. Areas of the lesions were obtained by tissue color change with gross pathology and compared to SWE.During the cardiac cycle stiffness varied from 0.5 +/- 0.1 kPa to 6.0 +/- 0.3 kPa in the atrium and from 1.3 +/- 0.3 kPa to 13.5 +/- 9.1 kPa in the ventricles. The thermal lesions were visible on all SWE maps performed after ablation. Shear modulus of the ablated zones increased to 16.3 +/- 5.5 kPa (versus 4.4 +/- 1.6 kPa before ablation) in the chicken breast, to 30.3 +/- 10.3 kPa (versus 12.2 +/- 4.3 kPa) in the atria and to 73.8 +/- 13.9 kPa (versus 21.2 +/- 3.3 kPa) in the ventricles. On gross pathology, the size of the lesions ranged from 0.1 to 1.5 cm(2) in the imaging plane area. Elasticity-estimated depths and widths of the lesions differed respectively with a median of 0.2 mm (first quartile Q1: -0.8 mm; third quartile Q3: 2.6 mm) for a mean squared error (MSE) of 5.1 mm(2) and a median of 0.2 mm (Q1: -2.7 mm; Q3: 2.7 mm) for a MSE of 11.1 mm(2) from gross pathology.We have demonstrated the feasibility of the HIFU thermal ablation monitoring using a dual therapy and imaging transesophageal device. The combination of HIFU, ultrasound imaging and SWE on the same transesophageal system could lead to a new clinical device for a safer and controlled treatment of a wide variety of cardiac arrhythmias.