title: Multi-phase rotational angiography of the left ventricle to assist ablations: feasibility and accuracy of novel imaging.
abstract: OBJECTIVE
  Interventional left ventricular (LV) procedures integrating static 3D anatomy visualization are subject to mismatch with dynamic catheter movements due to prominent LV motion. We aimed to evaluate the accuracy of a recently developed acquisition and post-processing protocol for low radiation dose LV multi-phase rotational angiography (4DRA) in patients.
  
  
  RESULTS
  4DRA image acquisition of the LV was performed as investigational acquisition in patients undergoing left-sided ablation (11 men; BMI = 24.7 ± 2.5 kg/m²). Iodine contrast was injected in the LA, while pacing from the RA at a cycle length of 700 ms. 4DRA acquisition and reconstruction were possible in all 11 studies. Reconstructed images were post-processed using streak artefact reduction algorithms and an interphase registration-based filtering method, increasing contrast-to-noise ratio by a factor 8.2 ± 2.1. This enabled semi-automatic segmentation, yielding LV models of five equidistant phases per cardiac cycle. For evaluation, off-line 4DRA fluoroscopy registration was performed, and the 4DRA LV contours of the different phases were compared with the contours of five corresponding phases of biplane LV angiography, acquired in identical circumstances. Of the distances between these contours, 95% were <4 mm in both incidences. Effective radiation dose for 4DRA, calculated by patient-specific Monte-Carlo simulation, was 5.1 ± 1.1 mSv.
  
  
  CONCLUSIONS
  Creation of 4DRA LV models in man is feasible at near-physiological heart rate and with clinically acceptable radiation dose. They showed high accuracy with respect to LV angiography in RAO and LAO. The presented technology not only opens perspectives for full cardiac cycle dynamic anatomical guidance during interventional procedures, but also for 3DRA without need for very rapid pacing.
authors.affiliation: Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium jean-yves.wielandts@uzleuven.be.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Wielandts
authors.affiliation: Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium Department of Electrical Engineering, ESAT/PSI, Medical Image Computing, KU Leuven, Leuven, Belgium.
authors.forename: Stijn
authors.initials: S
authors.lastname: De Buck
authors.affiliation: Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium Department of Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Michielsen
authors.affiliation: Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Ruan
authors.initials: R
authors.lastname: Louw
authors.affiliation: Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Garweg
authors.affiliation: Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium Department of Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Nuyts
authors.affiliation: Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
authors.forename: Joris
authors.initials: J
authors.lastname: Ector
authors.affiliation: Medical Imaging Research Centre, KU Leuven and UZ Leuven, Herestraat 49, Leuven, Belgium Department of Electrical Engineering, ESAT/PSI, Medical Image Computing, KU Leuven, Leuven, Belgium iMinds-Future Health Department, KU Leuven, Leuven, Belgium.
authors.forename: Frederik
authors.initials: F
authors.lastname: Maes
authors.affiliation: Hasselt University and Heart Center Hasselt, Diepenbeek, Belgium.
authors.forename: Hein
authors.initials: H
authors.lastname: Heidbuchel
mesh_terms: D000465:Algorithms; D016477:Artifacts; D006328:Cardiac Catheterization; D017115:Catheter Ablation; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000601:surgery*
chemical_list: D003287:Contrast Media
keywords: angiography; catheter ablation; imaging; tomography; ventricle