Background

Imaging fusion between echocardiography and fluoroscopy was recently developed. The aim of this study was to assess its feasibility and accuracy during pediatric cardiac catheterization.

Methods

Thirty-one patients (median weight, 26 kg; interquartile range [IQR], 21–37 kg) who underwent percutaneous atrial septal defect closure were prospectively included. The feasibility and accuracy of various imaging fusion modalities (live two-dimensional, live color two-dimensional, live three-dimensional and markers) with EchoNavigator software were assessed. To assess the accuracy of spatial registration of the echocardiogram on the fluoroscopic image, the occluder screw, an object that appeared on each image, was used as a reference tool, and the distance between the two when fused was measured. A distance was measured on the fusion screen between a marker positioned on the screw from the echocardiography screen and from the fluoroscopy screen (distance 1). Another distance was measured on the fusion screen between the screw visualized by three-dimensional echocardiography and by fluoroscopy (distance 2). The two distances were measured on four C-arm orientations in end-systolic and end-diastolic frames.

Results

Fusion and marker positioning were feasible in real time in all cases. On the fusion screen, median systolic and diastolic distance 1 were 0.5 mm (IQR, 0.3–1 mm) and 2 mm (IQR, 1.5–2.5 mm; P < .0001), respectively. The marker positioned from the echocardiography screen was fixed on the fusion screen and did not follow the movement of the screw. Median systolic and diastolic distance 2 were 0.5 mm (IQR, 0–0.5 mm) and 2 mm (IQR, 1.5–2.5 mm; P < .0001), respectively.

Conclusions

Echocardiographic fluoroscopic imaging fusion is feasible, safe, and accurate in children weighting >20 kg. This technique offers a new method of imaging guidance in the catheterization laboratory for complex procedures and training.

中文翻译：

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儿童经皮房间隔缺损闭合时超声心动图-荧光检查成像融合的可行性，安全性和准确性

背景

最近开发了超声心动图和荧光检查之间的影像融合。这项研究的目的是评估其在儿科心脏导管插入术中的可行性和准确性。

方法

前瞻性纳入了31例行经皮房间隔缺损封闭的患者（中位体重26公斤；四分位间距[IQR] 21-37公斤）。使用EchoNavigator软件评估了各种成像融合模式（实时二维，实时彩色二维，实时三维和标记）的可行性和准确性。为了评估超声心动图在荧光镜图像上的空间定位的准确性，使用封堵器螺钉（出现在每个图像上的物体）作为参考工具，并测量融合时两者之间的距离。在融合屏幕上测量了位于超声心动图屏幕和荧光透视屏幕上的螺钉上的标记之间的距离（距离1）。在融合屏幕上通过三维超声心动图和荧光透视图观察到的螺钉之间的另一个距离（距离2）。在收缩末期和舒张末期框架的四个C臂方向上测量两个距离。

结果

在所有情况下，融合和标记物定位都是实时可行的。在融合屏幕上，收缩期和舒张期中位距离1分别为0.5毫米（IQR，0.3-1毫米）和2毫米（IQR，1.5-2.5毫米；P  <.0001）。从超声心动图屏幕定位的标记被固定在融合屏幕上，并且不跟随螺钉的移动。中位收缩压和舒张距离2分别为0.5毫米（IQR，0-0.5毫米）和2毫米（IQR，1.5-2.5毫米；P  <.0001）。

结论

对于体重> 20 kg的儿童，超声心动图荧光检查成像融合是可行，安全和准确的。这项技术为导管检查实验室中复杂的操作步骤和培训提供了一种成像指导的新方法。