Pre to Intraoperative Data Fusion Framework for Multimodal Characterization of Myocardial Scar Tissue

Antonio R Porras, Gemma Piella, Antonio Berruezo, Juan Fernández-Armenta, Alejandro F Frangi, Antonio R Porras, Gemma Piella, Antonio Berruezo, Juan Fernández-Armenta, Alejandro F Frangi

Abstract

Merging multimodal information about myocardial scar tissue can help electrophysiologists to find the most appropriate target during catheter ablation of ventricular arrhythmias. A framework is presented to analyze and combine information from delayed enhancement magnetic resonance imaging (DE-MRI) and electro-anatomical mapping data. Using this information, electrical, mechanical, and image-based characterization of the myocardium are performed. The presented framework allows the left ventricle to be segmented by DE-MRI and the scar to be characterized prior to the intervention based on image information. It allows the electro-anatomical maps obtained during the intervention from a navigation system to be merged together with the anatomy and scar information extracted from DE-MRI. It also allows for the estimation of endocardial motion and deformation to assess cardiac mechanics. Therefore, electrical, mechanical, and image-based characterization of the myocardium can be performed. The feasibility of this approach was demonstrated on three patients with ventricular tachycardia associated to ischemic cardiomyopathy by integrating images from DE-MRI and electro-anatomical maps data in a common framework for intraoperative myocardial tissue characterization. The proposed framework has the potential to guide and monitor delivery of radio frequency ablation of ventricular tachycardia. It is also helpful for research purposes, facilitating the study of the relationship between electrical and mechanical properties of the tissue, as well as with tissue viability from DE-MRI.

Keywords: Arrhythmia; DE-MRI; catheter ablation; electro-anatomical mapping system; ventricular tachycardia.

Figures

FIGURE 1.
FIGURE 1.
(a) Layered architecture of GIMIAS. The Plugin layer is on the top and plugins can interoperate through the elements at the framework layer. The Third Party layer is at the bottom, to which all modules have access. (b) Presented pipeline. Both endocardium and epicardium meshes are segmented from DE-MRI using the cardiac segmentation module. The output meshes are used by the image-based characterization module to characterize the scar based on voxel intensities. The segmented endocardium is also used, together with electro-anatomical mapping data, for electrical and mechanical characterization of the left ventricle.
FIGURE 2.
FIGURE 2.
Layers extracted from the left ventricle model segmented with the cardiac segmentation module. Tissue classification based on image intensities is color coded. Red represents dense scar tissue, green represents viable tissue (border zone) and purple represents healthy myocardium.
FIGURE 3.
FIGURE 3.
Electrical characterization of the tissue. EAM points are registered to the left ventricle endocardium. Electrical parameters derived from the recorded electrograms are interpolated on the mesh. The image shows the maximum bipolar voltage color coded. Purple color represents healthy tissue (>1.5mV) and red color represents dense scar (

FIGURE 4.

Information integrated by the framework…

FIGURE 4.

Information integrated by the framework for a 75-year-old man with VT associated with…

FIGURE 4.
Information integrated by the framework for a 75-year-old man with VT associated with IC. In the scar characterization from DE-MRI, red color represents scar core, purple represents healthy tissue and the rest of the colors represent border zones according to the signal intensity maps. The electrical information is represented by the bipolar voltage map, the unipolar voltage map and the local activation time map. Longitudinal strain calculated at end systole is shown, where negative values represent contraction and positive values indicate stretching. End-systolic strain values are represented on the endocardium at end-diastolic phase to improve visual comparison with the other results. Red spheres represent the ablation targets identified pre-operatively from DE-MRI.

FIGURE 5.

Information integrated by the framework…

FIGURE 5.

Information integrated by the framework for a 69-year-old man with VT associated to…

FIGURE 5.
Information integrated by the framework for a 69-year-old man with VT associated to IC. In the scar characterization from DE-MRI, red color represents scar core, purple represents healthy tissue and the rest of the colors represent border zone according to the signal intensity maps. The electrical information is represented by the bipolar voltage map, the unipolar voltage map and the local activation time map. Longitudinal strain calculated at end systole is shown, where negative values represent contraction and positive values indicate stretching. End-systolic strain values are represented on the endocardium at end-diastolic phase to improve visual comparison with the other results. Red spheres represent the ablation targets identified pre-operatively from DE-MRI, while grey speheres represent the ones identified intra-operatively using the electrical maps.

FIGURE 6.

Information integrated by the framework…

FIGURE 6.

Information integrated by the framework for a 82-year-old man with VT associated to…

FIGURE 6.
Information integrated by the framework for a 82-year-old man with VT associated to IC. In the scar characterization from DE-MRI, red color represents scar core, purple represents healthy tissue and the rest of the colors represent border zone according to the signal intensity maps. The electrical information is represented by the bipolar voltage map, the unipolar voltage map and the local activation time map. Longitudinal strain calculated at end systole is shown, where negative values represent contraction and positive values indicate stretching. End-systolic strain values are represented on the endocardium at end-diastolic phase to improve visual comparison with the other results. Red spheres represent the ablation targets identified pre-operatively from DE-MRI, while grey speheres represent the ones identified intra-operatively using the electrical maps.
FIGURE 4.
FIGURE 4.
Information integrated by the framework for a 75-year-old man with VT associated with IC. In the scar characterization from DE-MRI, red color represents scar core, purple represents healthy tissue and the rest of the colors represent border zones according to the signal intensity maps. The electrical information is represented by the bipolar voltage map, the unipolar voltage map and the local activation time map. Longitudinal strain calculated at end systole is shown, where negative values represent contraction and positive values indicate stretching. End-systolic strain values are represented on the endocardium at end-diastolic phase to improve visual comparison with the other results. Red spheres represent the ablation targets identified pre-operatively from DE-MRI.
FIGURE 5.
FIGURE 5.
Information integrated by the framework for a 69-year-old man with VT associated to IC. In the scar characterization from DE-MRI, red color represents scar core, purple represents healthy tissue and the rest of the colors represent border zone according to the signal intensity maps. The electrical information is represented by the bipolar voltage map, the unipolar voltage map and the local activation time map. Longitudinal strain calculated at end systole is shown, where negative values represent contraction and positive values indicate stretching. End-systolic strain values are represented on the endocardium at end-diastolic phase to improve visual comparison with the other results. Red spheres represent the ablation targets identified pre-operatively from DE-MRI, while grey speheres represent the ones identified intra-operatively using the electrical maps.
FIGURE 6.
FIGURE 6.
Information integrated by the framework for a 82-year-old man with VT associated to IC. In the scar characterization from DE-MRI, red color represents scar core, purple represents healthy tissue and the rest of the colors represent border zone according to the signal intensity maps. The electrical information is represented by the bipolar voltage map, the unipolar voltage map and the local activation time map. Longitudinal strain calculated at end systole is shown, where negative values represent contraction and positive values indicate stretching. End-systolic strain values are represented on the endocardium at end-diastolic phase to improve visual comparison with the other results. Red spheres represent the ablation targets identified pre-operatively from DE-MRI, while grey speheres represent the ones identified intra-operatively using the electrical maps.

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