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Proceedings Paper

Targeted endomyocardial injections of therapeutic cells using x-ray fused with MRI guidance
Author(s): Luis F. Gutiérrez; Ranil de Silva; Elliot R. McVeigh; Cengizhan Ozturk; Robert J. Lederman
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Paper Abstract

The utility of X-ray fused with MRI (XFM) using external fiducial markers to perform targeted endomyocardial injections in infarcted hearts of swine was tested. Endomyocardial injections of feridex-labeled mesenchymal stromal cells (Fe-MSC) were performed in the previously infarcted hearts of 12 Yucatan miniswine (33-67 kg). Animals had pre-injection cardiac MRI, XFM-guided endomyocardial injection of Fe-MSC suspension spiked with tissue dye, and post-injection MRI. 24 hours later, after euthanasia, the hearts were excised, sliced and stained with TTC. During the injection procedure, operators were provided with 3D surfaces of endocardium, epicardium, myocardial wall thickness and infarct registered with live XF images to facilitate device navigation and choice of injection location. 130 injections were performed in hearts where diastolic wall thickness ranged from 2.6 to 17.7 mm. Visual inspection of the pattern of dye staining on TTC stained heart slices correlated (r=0.98) with XFM-derived injection locations mapped onto delayed hyperenhancement MRI and the susceptibility artifacts seen on the post-injection T2*-weighted gradient echo MRI. The in vivo target registration error was 3.17±2.61 mm (n=64) and 75% of injections were within 4 mm of the predicted location. 3D to 2D registration of XF and MR images using external fiducial markers enables accurate targeted endomyocardial injection in a swine model of myocardial infarction. The present data suggest that the safety and efficacy of this approach for performing targeted endomyocardial delivery should be evaluated further clinically.

Paper Details

Date Published: 13 March 2006
PDF: 10 pages
Proc. SPIE 6141, Medical Imaging 2006: Visualization, Image-Guided Procedures, and Display, 614113 (13 March 2006); doi: 10.1117/12.654279
Show Author Affiliations
Luis F. Gutiérrez, National Institutes of Health (United States)
Johns Hopkins Univ. (United States)
Ranil de Silva, National Institutes of Health (United States)
Elliot R. McVeigh, National Institutes of Health (United States)
Johns Hopkins Univ. (United States)
Cengizhan Ozturk, National Institutes of Health (United States)
Robert J. Lederman, National Institutes of Health (United States)


Published in SPIE Proceedings Vol. 6141:
Medical Imaging 2006: Visualization, Image-Guided Procedures, and Display
Kevin R. Cleary; Robert L. Galloway, Jr., Editor(s)

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