Fusion of Delayed Hyperenhancement MRI with Live X-ray Imaging for Guidance of Targeted Endomyocardial Injections of Therapeutic Cells
Gutirrez L, de Silva R, Raval A, Ozturk C, McVeigh E, Banu N, Lederman R
Johns Hopkins University School of Medicine, NHLBI, NIH
MRI and X-ray fluoroscopy provide complementary information for diagnosis and treatment of myocardial infarction. We fused pre-procedural delayed-hyperenhancement MRI with live X-ray to guide endomyocardial injection of iron-labeled mesenchymal stromal cells to the infarcts of 12 swine. Injections were identified on post-injection T2*-weighted MRI for in vivo<\I> quantitative measurement of registration error. Injections were also spiked with tissue dye for visualization on ex vivo<\I> TTC-stained heart slices. Fusion-predicted injection locations mapped onto DHE images compared favorably with dye staining on necropsy, and in vivo<\I> error was 3.22.6 mm (n=64). Fusion of DHE-MRI and live X-ray enables accurate, targeted endomyocardial injections.