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Characterization of Gadolinium Contrast Enhancement of Radiofrequency Ablation Lesions in Predicting Edema and Chronic Lesion Size.
Circ Arrhythm Electrophysiol. 2017 Nov; 10(11)CA

Abstract

BACKGROUND

Magnetic resonance imaging (MRI) has been used to acutely visualize radiofrequency ablation lesions, but its accuracy in predicting chronic lesion size is unknown. The main goal of this study was to characterize different areas of enhancement in late gadolinium enhancement MRI done immediately after ablation to predict acute edema and chronic lesion size.

METHODS AND RESULTS

In a canine model (n=10), ventricular radiofrequency lesions were created using ThermoCool SmartTouch (Biosense Webster) catheter. All animals underwent MRI (late gadolinium enhancement and T2-weighted edema imaging) immediately after ablation and after 1, 2, 4, and 8 weeks. Edema, microvascular obstruction, and enhanced volumes were identified in MRI and normalized to chronic histological volume. Immediately after contrast administration, the microvascular obstruction region was 3.2±1.1 times larger than the chronic lesion volume in acute MRI. Even 60 minutes after contrast administration, edema was 8.7±3.31 times and the enhanced area 6.14±2.74 times the chronic lesion volume. Exponential fit to the microvascular obstruction volume was found to be the best predictor of chronic lesion volume at 26.14 minutes (95% prediction interval, 24.35-28.11 minutes) after contrast injection. The edema volume in late gadolinium enhancement correlated well with edema volume in T2-weighted MRI with an R2 of 0.99.

CONCLUSION

Microvascular obstruction region on acute late gadolinium enhancement images acquired 26.1 minutes after contrast administration can accurately predict the chronic lesion volume. We also show that T1-weighted MRI images acquired immediately after contrast injection accurately shows edema resulting from radiofrequency ablation.

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Authors+Show Affiliations

Ghafoori E
From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City.
Kholmovski EG
From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City.
Thomas S
From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City.
Silvernagel J
From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City.
Angel N
From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City.
Hu N
From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City.
Dosdall DJ
From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City.
MacLeod R
From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City.
Ranjan R
From the Department of Bioengineering (E.G., J.S., N.A., D.J.D., R.M., R.R.), Cardiovascular Medicine (E.G., J.S., N.A., R.R.), UCAIR, Department of Radiology and Imaging Sciences (E.G.K.), Department of Medicine (S.T., N.H., R.R.), and Department of Surgery (D.J.D.), University of Utah, Salt Lake City. ravi.ranjan@hsc.utah.edu.

MeSH

AnimalsBiopsyCatheter AblationCicatrixContrast MediaCoronary CirculationDogsEdema, CardiacHeart VentriclesMagnetic Resonance ImagingMeglumineMicrocirculationModels, AnimalOrganometallic CompoundsPredictive Value of TestsTime Factors

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29079664

Citation

Ghafoori, Elyar, et al. "Characterization of Gadolinium Contrast Enhancement of Radiofrequency Ablation Lesions in Predicting Edema and Chronic Lesion Size." Circulation. Arrhythmia and Electrophysiology, vol. 10, no. 11, 2017.
Ghafoori E, Kholmovski EG, Thomas S, et al. Characterization of Gadolinium Contrast Enhancement of Radiofrequency Ablation Lesions in Predicting Edema and Chronic Lesion Size. Circ Arrhythm Electrophysiol. 2017;10(11).
Ghafoori, E., Kholmovski, E. G., Thomas, S., Silvernagel, J., Angel, N., Hu, N., Dosdall, D. J., MacLeod, R., & Ranjan, R. (2017). Characterization of Gadolinium Contrast Enhancement of Radiofrequency Ablation Lesions in Predicting Edema and Chronic Lesion Size. Circulation. Arrhythmia and Electrophysiology, 10(11). https://doi.org/10.1161/CIRCEP.117.005599
Ghafoori E, et al. Characterization of Gadolinium Contrast Enhancement of Radiofrequency Ablation Lesions in Predicting Edema and Chronic Lesion Size. Circ Arrhythm Electrophysiol. 2017;10(11) PubMed PMID: 29079664.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterization of Gadolinium Contrast Enhancement of Radiofrequency Ablation Lesions in Predicting Edema and Chronic Lesion Size. AU - Ghafoori,Elyar, AU - Kholmovski,Eugene G, AU - Thomas,Sam, AU - Silvernagel,Josh, AU - Angel,Nathan, AU - Hu,Nan, AU - Dosdall,Derek J, AU - MacLeod,Rob, AU - Ranjan,Ravi, PY - 2017/07/03/received PY - 2017/09/06/accepted PY - 2017/10/29/entrez PY - 2017/10/29/pubmed PY - 2017/11/8/medline KW - animals KW - catheter ablation KW - edema KW - gadolinium KW - magnetic resonance imaging JF - Circulation. Arrhythmia and electrophysiology JO - Circ Arrhythm Electrophysiol VL - 10 IS - 11 N2 - BACKGROUND: Magnetic resonance imaging (MRI) has been used to acutely visualize radiofrequency ablation lesions, but its accuracy in predicting chronic lesion size is unknown. The main goal of this study was to characterize different areas of enhancement in late gadolinium enhancement MRI done immediately after ablation to predict acute edema and chronic lesion size. METHODS AND RESULTS: In a canine model (n=10), ventricular radiofrequency lesions were created using ThermoCool SmartTouch (Biosense Webster) catheter. All animals underwent MRI (late gadolinium enhancement and T2-weighted edema imaging) immediately after ablation and after 1, 2, 4, and 8 weeks. Edema, microvascular obstruction, and enhanced volumes were identified in MRI and normalized to chronic histological volume. Immediately after contrast administration, the microvascular obstruction region was 3.2±1.1 times larger than the chronic lesion volume in acute MRI. Even 60 minutes after contrast administration, edema was 8.7±3.31 times and the enhanced area 6.14±2.74 times the chronic lesion volume. Exponential fit to the microvascular obstruction volume was found to be the best predictor of chronic lesion volume at 26.14 minutes (95% prediction interval, 24.35-28.11 minutes) after contrast injection. The edema volume in late gadolinium enhancement correlated well with edema volume in T2-weighted MRI with an R2 of 0.99. CONCLUSION: Microvascular obstruction region on acute late gadolinium enhancement images acquired 26.1 minutes after contrast administration can accurately predict the chronic lesion volume. We also show that T1-weighted MRI images acquired immediately after contrast injection accurately shows edema resulting from radiofrequency ablation. SN - 1941-3084 UR - https://www.unboundmedicine.com/medline/citation/29079664/Characterization_of_Gadolinium_Contrast_Enhancement_of_Radiofrequency_Ablation_Lesions_in_Predicting_Edema_and_Chronic_Lesion_Size_ DB - PRIME DP - Unbound Medicine ER -