title: Contrast-enhanced C-arm CT evaluation of radiofrequency ablation lesions in the left ventricle.
abstract: OBJECTIVE
  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.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Bioengineering, Stanford University, Palo Alto, California 94304, USA. egirard@stanford.edu
authors.forename: Erin E
authors.initials: EE
authors.lastname: Girard
authors.forename: Amin
authors.initials: A
authors.lastname: Al-Ahmad
authors.forename: Jarrett
authors.initials: J
authors.lastname: Rosenberg
authors.forename: Richard
authors.initials: R
authors.lastname: Luong
authors.forename: Teri
authors.initials: T
authors.lastname: Moore
authors.forename: Günter
authors.initials: G
authors.lastname: Lauritsch
authors.forename: Jan
authors.initials: J
authors.lastname: Boese
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fahrig
mesh_terms: D000818:Animals; D017115:Catheter Ablation; D003287:Contrast Media; D004867:Equipment Design; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D007472:Iohexol; D009336:Necrosis; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D012044:Regression Analysis; D013552:Swine; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*
chemical_list: D003287:Contrast Media; D007472:Iohexol