多模态影像及3D打印技术在经导管二尖瓣缘对缘修复术中的应用

多模态影像是指联合多种影像学成像技术不同模态的图像信息,多种学科优势互补,交叉验证,在疾病诊断和治疗中的综合成像模式。经导管二尖瓣缘对缘修复术已经发展成为外科高风险二尖瓣反流患者外科修复的一种替代方案。为了保证手术的安全性和成功率,经导管二尖瓣缘对缘修复术对多模态影像的依赖性也越来越强。该文主要对经胸超声心动图、经食道超声心动图、多层螺旋CT、心脏磁共振及二尖瓣3D打印模型在TEER中的应用进行了全面回顾。     

影像技术在动脉粥样硬化性疾病中的应用进展

随着全身血管成像技术的迅速发展,动脉粥样硬化所形成的血管狭窄和斑块能够达到可视化定性及定量评估。多模态成像可通过评估血管壁斑块的组成和代谢过程来进行心脑血管风险的预测。本文概述了当前影像技术在动脉粥样硬化性疾病中的应用进展。     

心脏脂肪沉积机制及相关影像学研究进展

心肌细胞代谢特点及心外膜脂肪组织独特解剖及生理功能可能是相关心血管疾病的基础，多模态影像技术的快速发展在临床诊断心肌脂肪代谢异常所致相关疾病中具有重要价值。现对心脏脂肪组织解剖、生理功能、相关疾病发生机制及其影像学研究进展进行综述。     

基于256CT影像数据的心脏三维实体模型重建

【摘要】 目的 建立心脏实体三维模型，探讨其对复杂心脏疾病诊治的临床意义。方法 采用荷兰飞利浦Brilliance256iCT扫描心脏区域的断层图像，将扫描所得DICOM图像导入比利时Ｍimics16.0 软件，经过图像分割、Mask指令阈值分类标注不同组织、模板成像等步骤进行心脏实体三维重建。结果 在计算机上成功重建心脏三维模型，重建模型能多结构、多角度显示心脏内部空间结构以及毗邻关系。结论 通过Brilliance256iCT影像数据可有效重建心脏三维实体模型，为复杂心脏疾病的诊断、治疗提供全新视角。     

应用超声单模态融合成像技术指导微波消融治疗原发性肝癌即时疗效评价的价值研究*

目的 研究超声单模态融合成像技术在微波消融治疗原发性肝癌(PLC)患者中的应用价值。方法 2018年3月～2019年12月我院诊治的88例PLC患者,其中44例采用超声单模态融合成像(观察组),另44例采用CT/MRI多模态融合成像(对照组)指导微波消融治疗。结果 观察组配准评估时间为(3.8±1.3)min,显著短于对照组【(5.2±1.7)min, P<0.05】,观察组和对照组融合成像成功率分别为63.6%和56.8%,无显著性差异(P>0.05);在44例观察组发现52个病灶,单模态融合成功36个病灶(69.2%),在44例对照组发现54个病灶,多模态融合成功32个病灶(59.3%),两组病灶融合成功率比较,无显著性差异(P>0.05);两组肿瘤完全消融率分别为97.7%和93.2%,无显著性差异(P>0.05);观察组消融治疗后发热、局部疼痛、胆道出血和胆漏并发症发生率分别为9.1%、20.5%、4.5%和0.0%,与对照组的13.6%、27.3%、9.1%和2.3%比,差异无统计学意义(P>0.05);随访3～20个月,观察组生存32例(72.7%),总体生存(OS)为15.1(5.0,20.0)个月,无进展生存(PFS)为12.8(4.9,20.0)个月,对照组生存32例(72.7%),OS为14.2(4.8,20.0)个月,PFS为13.3(4.7,20.2)个月(Log rank x²=0.592, P=0.442;x²=1.103,P=0.294)。结论 超声单模态融合成像与CT/MRI多模态融合成像均可用于指导微波消融治疗PLC患者,但超声单模态融合成像更为简便,经济,可提供即时影像学资料,为后续治疗提供依据。     

关于中西医结合多模态诊断模式的思考

中西医结合医学的发展有赖于诊断水平的提高。当前中西医结合诊断存在西医疾病结合中医证候、西医疾病结合中医病证、中医疾病结合中医证候的多种模式,而具体疾病、证候的诊断有赖于多维度、多模态数据的处理与融合。鉴于此,本研究结合传统中医病证诊断、现代计算机科学、现代生物学技术,对多模态中西医结合医学诊断模式进行探讨。以冠状动脉粥样硬化性心脏病诊断为例,探索中西医结合多模态诊断模式实现思路,以期有利于中西医结合医学诊断、治疗的发展。     

3D打印技术在心脏结构性疾病中的应用

3D打印技术近年来逐渐应用于医学研究中,为许多疾病的治疗带来希望。尤其是在心脏结构性疾病中的应用,从协助诊断到指导治疗,以及心脏结构性疾病发病机制的研究,意义越来越突出。3D打印的过程包括成像数据的采集、图像数据的处理、模型打印3个步骤。现对3D打印技术在心脏结构性疾病中的应用作以下论述。     

老年听力损失的影像研究进展

近年来,随着人口老龄化的加速,越来越多的人正在或即将遭受年龄相关性听力损失带来的困扰,这对人们的工作和生活造成了极大不便。因此,精准快速诊断老年人群听力损失相关疾病的重要性不言而喻。以电子计算机断层扫描、磁共振多模态成像和分子影像为主的影像技术的构建和发展,正为老年人群听力损失相关疾病的诊断和疗效预测提供着重要客观依据。本文对年龄相关性听力损失方面的影像学研究进展进行了综述。     

流体力学影像技术分析心脏血流状态

流体力学影像技术用于研究血液在心脏与血管中的运动规律,主要包括计算机模拟、粒子图像测速、核磁共振成像和血流向量成像等.血流向量成像较其他技术具有安全无创、操作简单、耗时少等优势,尤其在定量分析心腔内流场与涡流大小方面有一定优势.     

心血管磁共振分子影像研究现状与进展

在心血管影像发展中, 磁共振多模态成像技术具备在体评估心肌组织学特征的优势, 有较高的临床应用价值, 其"一站式"成像在心血管疾病诊断、鉴别诊断以及预后判断和危险分层中发挥了重要作用, 其在分子影像学领域也在不断发展。该文从动脉粥样硬化、心肌梗死、干细胞疗法3个方面介绍磁共振分子探针及其成像技术的应用。     

Korrelative Bildgebung in der Kardiologie

Technical progress has engendered a broad spectrum of methods to image cardiac structure, function, and metabolism. Frequently, the imaging tools available provide complementary information. Therefore, methods to integrate image information from different modalities into one common coordinate system are increasingly receiving attention also in cardiology. Currently available technology includes software-based image fusion as well as hardware-based registration of datasets. The latter capitalizes on so-called hybrid cameras combining detectors of different modalities in one gantry. Hardware-based image fusion is, to date, anatomically more accurate than the software-based methodology. However, the anatomic accuracy of both approaches is still far from perfect. This is, in particular, due to artifacts caused by respiratory movements also affecting the heart. The clinical potential of correlative imaging of the heart includes an improvement of accuracy in diagnosing hemodynamically significant coronary artery disease using single-photon emission computed tomography (SPECT). This is due to the possibility to correct myocardial scintigraphy for attenuation artifacts using registered X-ray computerized tomographic (CT) images. The visualization of coronary anatomy and myocardial perfusion in one imaging session using hybrid systems combining CT with positron emission tomography (PET) or SPECT is also an interesting option. Nevertheless, larger clinical trials investigating its usefulness are still missing. The possibility to match structure with radioactivity concentration is essential for approaches to image the molecular composition of atherosclerotic plaques and their stability.     

Cardiac Imaging in Carcinoid Heart Disease

Carcinoid disease is caused by neuroendocrine tumors, most often located in the gut, and leads in approximately 20% of cases to specific, severe heart disease, most prominently affecting right-sided valves. If cardiac disease occurs, it determines the patient’s prognosis more than local growth of the tumor. Surgical treatment of carcinoid-induced valve disease has been found to improve survival in observational studies. Cardiac imaging is crucial for both diagnosis and management of carcinoid heart disease; in the past, imaging was accomplished largely by echocardiography, but more recently, imaging for carcinoid heart disease has increasingly become multimodal and warrants awareness of the particular diagnostic challenges of this disease. This paper reviews the pathophysiology and manifestations of carcinoid heart disease in light of the different imaging modalities.     

New Directives in Cardiac Imaging: Imaging the Adult With Congenital Heart Disease

Advances in pediatric surgical and interventional techniques and medical care over the past 50 years have revolutionized the care of children with congenital heart disease. Survival to adulthood is now expected and, as such, there is a growing population of adults which is exceeding the pediatric population with congenital heart disease. Noninvasive cardiac imaging with modalities such as echocardiography, computed tomography, and cardiac magnetic resonance imaging are integral to the care of adults with congenital heart disease. These modalities are used for diagnosis, surveillance for complications late after surgery and catheter-based interventions, and in decision-making for medical, interventional, and surgical therapies. In this review we will discuss noninvasive imaging modalities used to assess congenital cardiac lesions, imaging strategies for select congenital lesions, and comment on the future of cardiac imaging in congenital heart disease.     

Advances in Cardiac SPECT and PET Imaging: Overcoming the Challenges to Reduce Radiation Exposure and Improve Accuracy

Nuclear cardiology came of age in the 1970s and subsequently has expanded so that more than 9 million single-photon emission computed tomography (SPECT) studies are performed annually in North America. Coronary artery disease management has demanded a reliable technique that will detect, risk stratify, and assist with revascularization decisions. Using cardiac SPECT and positron-emission tomography (PET), researchers and clinicians have sought to achieve excellence in coronary artery disease diagnosis and risk stratification, and strive to achieve higher standards in these areas. Developments in other cardiac imaging modalities, however, such as cardiac computed tomography, cardiac magnetic resonance, and echocardiography, have raised expectations in terms of diagnostic accuracy and achieving high quality images with little or no ionizing radiation exposure. The challenge facing nuclear cardiology as it embarks upon a fifth decade of clinical use is whether high quality images can be obtained at lower radiation exposures. In this review we consider current practice in SPECT and PET perfusion imaging. We discuss emerging advances in techniques, technologies, and radiotracers that focus specifically on improvements in image quality that enhance diagnostic accuracy while reducing radiation exposure. We provide a perspective as to the future roles of cardiac SPECT and PET in ischemic heart disease, and consider emerging novel applications beyond perfusion imaging. Although for a number of years nuclear cardiology has shone brightly as a leading light for the imaging of ischemic heart disease, its half-life has not yet been reached. Instead, even with the pressure to reduce radiation exposure, the future continues to look bright for cardiac SPECT and PET.     

Dynamic three-dimensional echocardiographic imaging of congenital heart defects in infants and children by computer-controlled tomographic parallel slicing using a single integrated ultrasound instrument

Three-dimensional cardiac reconstruction generated from transesophageal interrogation can be performed using an integrated unit that captures, processes, and postprocesses tomographic parallel slices of the heart. This probe was used for infants and young children in the transthoracic position to evaluate the feasibility of producing three-dimensional cardiac images with capability for real-time dynamic display. Twenty-two infants and children (range 1 day-3.5 years) underwent image acquisition using a 16 mm 5 MHz 64 element probe placed over the precordium. Two infants were also imaged from the subcostal position. Data was obtained and stored over a single cardiac cycle after acceptable cardiac and respiratory gating intervals were met. The transducer was advanced in 0.5-1 mm increments over the cardiac structures using identical acquisition criteria. The images were reconstructed from the stored digital cubic format and could be oriented in any desired plane. In 9 of the 22 infants the images obtained were of optimal quality. The images obtained displayed normal cardiac structures emphasizing depth relationships as well as visualization of planes not generally demonstrated by two-dimensional imaging. Several lesions were also depicted in a unique fashion using this technique. Though the method employed was limited by movement artifact and reconstruction time, the quality of the three-dimensional display was excellent and enhanced by real-time demonstration. The transthoracic approach was successful in capturing sufficient data to create three-dimensional images, which may have further application in more accurate diagnosis of complex cardiac abnormalities and generation of planes of view which could duplicate surgical visualization of a lesion. Further assessment of the technique in infants with congenital heart disease is warranted.     

4D fetal echocardiography—An update

With the introduction of the electronic 4‐dimensional and spatial‐temporal image Correlation (e‐STIC), it is now possible to obtain large volume datasets of the fetal heart that are virtually free of artifact. This allows the examiner to use a number of imaging modalities when recording the volumes that include two‐dimensional real time, power and color Doppler, and B‐flow images. Once the volumes are obtained, manipulation of the volume dataset allows the examiner to recreate views of the fetal heart that enable examination of cardiac anatomy. The value of this technology is that a volume of the fetal heart can be obtained, irrespective of the position of the fetus in utero, and manipulated to render images for interpretation and diagnosis. This article presents a summary of the various imaging techniques and provides clinical examples of its application used for prenatal diagnosis of congenital heart defects and abnormal cardiac function.     

Digital subtraction angiography in infants and children with congenital heart disease

Digital subtraction angiography was used as the sole imaging technique in 95 infants and children aged 13 hours to 16 years undergoing cardiac catheterisation for the investigation of congenital heart disease. Injections of diluted contrast medium were made selectively at central sites, and the images were obtained using continuous image intensification fluoroscopy at either 32.25 nC/kg/s (125 microR /s) or 129 nC/kg/s (500 microR /s). In all cases images adequate for diagnosis and management were obtained with appreciably less contrast medium and a lower radiation dose than in a comparable group of patients using conventional biplane cineangiography. Thus digital subtraction angiography is a viable alternative to biplane cineangiography for children with congenital heart disease.     

Digital subtraction angiography in infants and children with congenital heart disease.

Digital subtraction angiography was used as the sole imaging technique in 95 infants and children aged 13 hours to 16 years undergoing cardiac catheterisation for the investigation of congenital heart disease. Injections of diluted contrast medium were made selectively at central sites, and the images were obtained using continuous image intensification fluoroscopy at either 32.25 nC/kg/s (125 microR /s) or 129 nC/kg/s (500 microR /s). In all cases images adequate for diagnosis and management were obtained with appreciably less contrast medium and a lower radiation dose than in a comparable group of patients using conventional biplane cineangiography. Thus digital subtraction angiography is a viable alternative to biplane cineangiography for children with congenital heart disease.     

Evaluation of congenital heart disease in adults

Improvements in the diagnosis and surgical treatment of congenital heart disease during infancy and childhood have resulted in an outstanding increase in the prevalence of these entities during adulthood. Congenital heart disease in the adult represents a new diagnostic challenge to the consultant cardiologist, unfamiliar with the anatomical and functional complexities of cardiac malformations. Assessment of adult congenital heart disease with imaging techniques can be as accurate as in children. However, these techniques cannot substitute for a detailed clinical assessment. Physical examination, electrocardiography and chest x-rays remain the three main pillars of bedside diagnosis. Transthoracic echocardiography is undoubtedly the imaging technique which provides most information, and in many situations no additional studies are needed. Nevertheless, ultrasound imaging properties in adults are not as favorable as in children, and prior surgical procedures further impair image quality. Despite recent advances in ultrasound technologies such as harmonic or contrast imaging, other diagnostic procedures are sometimes required. Fortunately, transesophageal echocardiography and magnetic resonance imaging are easily performed in the adult, and do not require anaesthetic support, in contrast to pediatric patients. These techniques, together with nuclear cardiology and cardiac catheterization, complete the second tier of diagnostic techniques for congenital heart disease. To avoid unnecessary repetition of diagnostic procedures, the attending cardiologist should choose the sequence of diagnostic techniques carefully; although the information this yields is often redundant, it is also frequently complementary. This article aims to compare the diagnostic utility of different imaging techniques in adult patients with congenital heart disease, both with and without prior surgical repair.     

Three-dimensional cardiac magnetic resonance imaging

Evaluation of time-varying cardiac structure and function is challenging because of the three-dimensional (3-D) anatomy and time-varying (4-D) behavior of the heart. Historically, contrast angiography has served as the cornerstone of cardiac diagnosis because of its excellent spatial and temporal resolution. However, magnetic resonance (MR) imaging is now increasingly applied because of the wide variety of available MR imaging and data acquisition techniques, including spin-echo, gradient-echo, wall motion techniques, 1H 31P spectroscopy, and, most recently, echo-planar imaging. Planar 2-D MR imaging is used to characterize many aspects of cardiac structure and function, including anatomic relationships, valvular heart disease, ischemic heart disease, and congenital abnormalities, among others. The development of imaging display and data postprocessing analysis techniques have paralleled the growth of these image and data acquisition schemes and, increasingly, an emphasis has been placed on defining structure and function in 3-D, or even 4-D. Three-dimensional reconstructions of the heart have commonly relied on conventional planar MR image acquisition techniques; a 3-D volume of data is then created from stacked 2-D images. Surface reconstruction and graphical rendering techniques are used to generate representations of the heart that depict 3-D and 4-D cardiac structure and function. These techniques have been used both clinically and experimentally in a variety of settings, including ischemic heart disease, MR coronary angiography, and congenital heart disease.