medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-2018-3-33-48medvis-574Research ArticleСЕРДЦЕHEARTМультиспиральная компьютерная томография сердца: оптимизация протокола сканирования при проведении неинвазивного картирования сердца перед катетерной абляцией фибрилляции предсердийCardiac multispiral computed tomography: optimization of examination’s protocol for non-invasive cardaic mapping before catheter ablation of atrial fibrrillationКаштановаН. Ю.KashtanovaN. Yu.

Каштанова Наталия Юрьевна – ординатор отделения рентгенологии и магнитно-резонансных исследований

117997 Москва, ул. Большая Серпуховская, д. 27

Natalia Yu. Kashtanova – resident of Radiology Departmen

61/2–9 Shchepkina str., Moscow, 129110

nat.y.kashtanova@mail.ruГруздевИ. C.GruzdevI. S.

Груздев Иван Сергеевич – ординатор отделения рентгенологии и магнитно-резонансных исследований

Москва

Ivan S. Gruzdev – resident of Radiology Department

Moscow

КондратьевЕ. В.Kondrat’evE. V.

Кондратьев Евгений Валерьевич – кандидат медицинских наук, старший научный сотрудник отделения рентгенологии и магнитно-резонансных исследований

Москва

Evgenij V. Kondrat’ev – cand. of med. sci., senior research of Radiology Department

Moscow

АртюхинаЕ. А.ArtyukhinaЕ. A.

Артюхина Елена Александровна – доктор медицинских наук, заведующая отделением электрофизиологических рентгенэндоваскулярных методов диагностики и лечения аритмий

Москва

Elena A. Artyukhina – doct. of med. sci., Head of the Department of Electrophysiological Endovascular Methods of Diagnosis and Dreatment of Arrhythmias

Moscow

ЯшковМ. В.YashkovМ. V.

Яшков Максим Валерьевич – ординатор отделения электрофизиологических рентгенэндоваскулярных методов диагностики и лечения аритмий

Москва

Maksim V. Yashkov – resident of the Department of Electrophysiological Endovascular Methods of Diagnosis and Dreatment of Arrhythmias

Moscow

РевишвилиА. Ш.RevishviliA. Sh.

Ревишвили Амиран Шотаевич – академик РАН, профессор, доктор медицинских наук, директор

Москва

Amiran Sh. Revishvili – Academician of RAS, Professor, doct. of med. sci., Director of A.V. Vishnevsky National Medical Research Center of Surgery

Moscow

ФГБУ “НМИЦ хирургии им. А.В. Вишневского” Минздрава РоссииРоссияA.V. Vishnevsky National Medical Research Center of SurgeryRussian Federation201828062018033348Copyright © Каштанова Н.Ю., Груздев И.C., Кондратьев Е.В., Артюхина Е.А., Яшков М.В., Ревишвили А.Ш., 20182018Каштанова Н.Ю., Груздев И.C., Кондратьев Е.В., Артюхина Е.А., Яшков М.В., Ревишвили А.Ш.Kashtanova N.Y., Gruzdev I.S., Kondrat’ev E.V., Artyukhina Е.A., Yashkov М.V., Revishvili A.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.vidar.ru/jour/article/view/574Цель исследования

Цель исследования: разработать оптимальную методику сканирования для мультиспиральной компьютерной томографии (МСКТ) сердца при проведении неинвазивного картирования сердца (НКС) перед катетерной абляцией фибрилляции предсердий.

Материал и методы

Материал и методы. В исследование включено 94 случая фибрилляции предсердий (60 мужчин и 34 женщины, средний возраст 58,3 ± 10 лет, средний индекс массы тела 29,9 ± 4,8 кг/м2). Пациенты разделены на 2 группы: 1-я (n = 80) – МСКТ выполнялась по специальному протоколу для НКС со стандартным контрастированием (сингл-болюс), 2-я (n = 14) – МСКТ сердца выполнялась по модифицированной методике предболюса. Для выявления тромбов в ушке левого предсердия (ЛП) выполнялась низкодозовая отсроченная фаза контрастирования. Проанализированны индивидуальные особенности легочных вен (ЛВ), ЛП и соседних структур. Проведена оценка контрастирования камер сердца по результатам измерения средней плотности и гомогенности заполнения контрастом.

Результаты

Результаты. Справа типичная анатомия ЛВ встречалась в 93,6%, впадение средней вены отдельным стволом – в 5,3%, отсутствие формирования крупных стволов – в 1,1%. Слева типичное впадение ЛВ отмечено в 57,4% случаев, вестибюль ЛВ – в 18,1%, общий ствол – в 24,5%. Увеличение объема ЛП определялось у 96,8% пациентов. В 6 случаях по МСКТ был заподозрен тромбоз ушка ЛП, исследование было дополнено отсроченной фазой, в 2 случаях дефекты контрастирования сохранялись; далее тромбоз подтвержден при чреспищеводной эхокардиографии. При протоколе сингл-болюс отмечалось наилучшее контрастирование левых отделов сердца (средняя плотность крови в ЛП 296 ± 84 HU, в левом желудочке (ЛЖ) 286 ± 83 HU), но неудовлетворительное контрастирование и недостаточная гомогенность правых отделов (средняя плотность крови в правом предсердии (ПП) 179 ± 97 HU, правом желудочке (ПЖ) 176±80 HU). При использовании модифицированного протокола контрастирования с предварительным болюсом контрастного средства отмечалось оптимальное контрастирование и гомогенность всех отделов сердца (средняя плотность крови в ЛП = 259 ± 31 HU, ЛЖ= 286 ± 83 HU, ПП = 270 ± 92 HU, ПЖ = 253 ± 80 HU). Это позволило построить более точные эпи-эндокардиальные модели сердца при неинвазивном картировании для анализа высокочастотной драйверной активности и выбора тактики интервеционнного лечения.

Purpose

Purpose: to develop optimal technique of cardiac multidetector computed tomography (MDCT) before noninvasive cardiac mapping before cateter ablation of atrial fibrillation.

Materials and methods

Materials and methods. 94 patients with atrial fibrillation were included in study (60 males, 34 females; mean age = 58.3 ± 10 years; mean body mass index (BMI) = 29.9 ± ± 4.8). The patients were divided into 2 groups: I – 80 patients who underwent computer tomography (CT)-protocol for noninvasive cardiac mapping with standard contrast enhancement (single-bolus protocol); II – 14 patients who underwent CT with modified contrast enhancement technique with preliminary contrast injection (prebolus). To detect thrombotic masses in the left auricle the low-dose delayed phase was performed. The analysis of individual features of pulmonary veins, left atrium and adjacent structures was performed. Contrast enhancement of heart chambers was assessed by mean attenuation and homogeneity measurement.

Results and discussion

Results and discussion. The typical anatomy of the right pulmonary veins was in 93.6% of cases; right middle pulmonary vein in 5.3%; right segmental veins in 1.1%. The typical anatomy at the left side was in 57.4% of cases; common vestibulum of the left pulmonary veins in 18.1%; common left trunk in 24.5%. Volume enlargement of the left atrium (LA) was in 96.8% of patients. In 6 cases left auricle thrombosis was suspected, low-dose delayed phase was performed. In 2 cases filling defects in left auricle persisted, thrombosis was proved by transesophageal echocardiography. With the single-bolus injection protocol the contrast enhancement of left heart chambers was best (mean attenuation of blood in LA = 296 ± 84 HU, in left ventricle (LV) = 286 ± 83 HU), but the contrast enhancement and homogeneity of the chambers were insufficient (mean attenuation of blood in right atrium (RA) = 179 ± 97 HU, in right ventricle (RV) = 176 ± 80 HU). With prebolus protocol the contrast enhancement and homogeneity of all chambers were optimal (mean attenuation of blood in LA = 259 ± 31 HU, in LV = 286 ± 83 HU, in RA = 270 ± 92 HU, in RV = 253 ± 80 HU). This allowed making more accurate epi-endocardial heart models in the noninvasive cardiac mapping and operation planning.

Conclusion

Conclusion. MDCT with standard contrast enhancement protocol provides detailed information about anatomy and size of pulmonary veins, the left atrium volume, the presence of intracardiac masses (including thrombotic masses), the anatomy of adjacent structures. The modified contrast enhancement technique with preliminary contrast injection (prebolus) allows to receive optimal contrast enhancement of all heart chambers and to make high accurate epi-endocardial models of both the right and left sides of the heart in case of noninvasive cardiac mapping.

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The authors declare that there are no conflicts of interest present.