Published ahead of print. Accessed on 5/2/2011
Circulation: Cardiovascular Imaging
X-ray Magnetic Resonance Fusion to Internal Markers and Utility in Congenital Heart Disease Catheterization
Yoav Dori1*, et al.
The Children's Hospital of Philadelphia, Philadelphia, PA & Siemens Healthcare, Malvern, PA
Corresponding author; email: doriy@email.chop.edu
Abstract
Background—X-ray magnetic resonance fusion (XMRF) allows for utilization of 3D data during cardiac catheterization. However, to date, technical requirements have limited the use of this modality in clinical practice. Here we report on a new internal marker XMRF method that we have developed and describe how we used XMRF during cardiac catheterization in congenital heart disease.
Methods and Results—XMRF was performed in a phantom and in 23 patients presenting for cardiac catheterization who also needed cardiac MRI for clinical reasons. The registration process was performed in less than 5 minutes per patient with minimal radiation (0.004 - 0.024 mSv) and without contrast. Registration error was calculated in a phantom and in 8 patients using the maximum distance between angiographic and 3D model boundaries. In the phantom the measured error in the AP projection had a mean of 1.15 mm (standard deviation 0.73). The measured error in patients had a median of 2.15 mm (IQR 1.65 - 2.56 mm). Internal markers included bones, airway, image artifact, calcifications, and the heart and vessel borders. The MRI data was used for road mapping in 17/23 (74%) cases and camera angle selection in 11/23 (48%) cases.
Conclusions—Internal markers based registration can be performed quickly, with minimal radiation, without the need for contrast, and with clinically acceptable accuracy using commercially available software. We have also demonstrated several potential uses for XMRF in routine clinical practice. This modality has the potential to reduce radiation exposure and improve catheterization outcomes.
Two video links:
http://circimaging.ahajournals.org/content/suppl/2011/04/29/CIRCIMAGING.111.963868.DC1/Video1.mov
Video showing MRI fusion with fluoro guiding cath procedure:
http://circimaging.ahajournals.org/content/suppl/2011/04/29/CIRCIMAGING.111.963868.DC1/Video2.mov
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