Ultrasound Based Multimodal Imaging System for Guiding Cardiac Ablation Therapy

描述（由申请人提供）：本项目的目标是将用于指导心脏消融治疗的声辐射力脉冲（ARFI）成像技术推向临床实践的边缘。心脏消融用于治疗房性和室性快速性心律失常。这种疗法每天使用数百次，没有直接的病变成像。我们提出的多模式系统将实现1）病变生长的真实的时间评估，2）病变连续性的视觉评估，以及3）导管的引导和放置。该系统的成功实施将缩短手术时间，减少重复手术的发生率，并限制因附带损害引起的并发症。复杂消融依赖于形成透壁和连续的聚集性病变来阻断折返性传导。不完全损伤导致手术时间延长和频繁重复手术。过量的能量输送会导致严重的发病率，导致组织内的微爆炸和附带组织损伤，并伴有潜在的致命并发症。迫切需要一种成像技术来滴定能量输送并引导消融快速性心律失常治疗。我们将使用ARFI成像来表征心脏消融病变。ARFI成像表征了弹性特性的空间分布，可用于区分消融心肌和正常心肌。将通过增强（128通道）心内回波（ICE）成像导管进行ARFI成像。本文提出的主要工作是使用ICE导管实现ARFI成像，并将该技术整合到临床的标准介入方案中。电解剖标测现在是用于在心脏中引导导管并在临床相关位置定位病变的标准工具。我们将与行业合作，开发技术，通过利用配备CARTO（tm）磁传感器的新型ICE导管，将基于ARFI图像的病变评价集成到该标准工具中，用于临床干预。该工具将实现两种技术的配准，并允许将病变评价整合到临床范例中。最后，我们将充分描述与消融相关的弹性特性的变化，并在动物模型中证明ARFI图像引导治疗可用于增强现有的临床方法，并提供提高护理质量所需的真实的时间图像反馈。我们建议开发一种多模态成像系统来指导心脏消融治疗。该系统将利用基于导管的声辐射力脉冲成像来表征病变生长。该技术将被集成到标准临床导管引导范例中，从而产生用于快速性心律失常消融治疗的完整工具。

DESCRIPTION (provided by applicant): The goal of this project is to bring to the verge of clinical practice the promising technique of acoustic radiation force impulse (ARFI) imaging for guiding cardiac ablation therapy. Cardiac ablation is used to treat atrial and ventricular tachyarrhythmias. This therapy is used hundreds of times daily with no direct lesion imaging. The multimodal system we are proposing will enable 1) real time evaluation of lesion growth, 2) visual evaluation of lesion continuity, and 3) guidance and placement of catheters. The successful implementation of this system will shorten procedure times, reduce the incidence of repeat procedures and limit complications due to collateral damage. Complex ablations rely on the creation of transmural and contiguous aggregate lesions to block reentrant conduction. Incomplete lesions result in extended procedure times and frequent repeat procedures. Excess energy delivery leads to significant morbidity causing micro-explosions within the tissue and collateral tissue damage with potentially fatal complications. There is an urgent need for an imaging technology to titrate energy delivery and guide ablation tachyarrhythmia therapy. We will use ARFI imaging to characterize cardiac ablation lesions. ARFI imaging characterizes the spatial distribution of elastic properties that can be used to differentiate ablated from normal myocardium. ARFI imaging will be implemented from an enhanced (128 channel) intracardiac echo (ICE) imaging catheter. The major work proposed here is the implementation of ARFI imaging with the ICE catheter and the integration of this technology into the standard interventional regime of the clinic. Electroanatomical mapping is now the standard tool used to guide catheters in the heart and position lesions at clinically relevant locations. Working in concert with industry, we will develop the technology to integrate ARFI image based lesion evaluation into this standard tool for clinical intervention by exploiting a new ICE catheter equipped with a CARTO(tm) magnetic sensor. This tool will enable registration of the two technologies and allow integration of lesion evaluation into the clinical paradigm. Finally, we will fully characterize the change in elastic properties associated with ablation and demonstrate in an animal model that ARFI image guided therapy can be used to augment existing clinical methods and provide the real time image feedback needed to improve the quality of care. We propose to develop a multimodality imaging system to guide cardiac ablation therapy. The system will exploit catheter based acoustic radiation force impulse imaging to characterize lesion growth. This technology will be integrated into the standard clinical catheter guidance paradigm yielding a complete tool for ablative therapy of cardiac tachyarrhythmias.