基于经食管三维超声的3D打印模型评价左心耳解剖  

Morphology evaluation of left atrial appendage by transesophageal echocardiographic three-dimensional printed model

作　　者：加丹 宋宏宁[1] 张兰[1] 陈金玲[1] 王益佳[1] 胡波[1] 谭团团[1] 周青[1] 

机构地区：[1]武汉大学人民医院超声科,湖北武汉430060

出　　处：《中国医学影像技术》2017年第3期349-354,共6页Chinese Journal of Medical Imaging Technology

基　　金：中央高校基本科研业务重点重大培育专项基金(302410500246)

摘　　要：目的探讨经食管三维超声心动图(3D-TEE)作为左心耳(LAA)三维(3D)打印数据源的可行性及超声3D打印模型的准确性,并评价3D打印模型对特殊解剖形态LAA封堵手术的指导价值。方法回顾性分析18例因心房颤动接受LAA封堵术的患者资料,包括LAA的3D-TEE和CT容积图像数据。对3D-TEE数据进行后处理,并使用弹性材料制作LAA的3D打印模型。采用3D打印模型评价LAA解剖分型与分叶分型,测量LAA开口的最大径、最小径及深度,并与3D-TEE及CT容积图像结果进行对比。在封堵困难的特殊形态LAA模型上进行封堵器释放试验。结果对18例患者均成功进行超声数据后处理并获取LAA 3D打印模型。应用3D打印模型与CT容积图像对LAA进行解剖分型及分叶分型的一致性均较高,Kappa值分别为0.92和0.83。且3D打印模型对LAA开口最大径、最小径及深度的测量值与3D-TEE测量值差异均无统计学意义(P均>0.05)。18例中2例为特殊形态LAA,均通过3D打印模型进行封堵伞释放模拟出术中封堵过程。结论基于3D-TEE的LAA 3D打印技术具有较高的可行性及准确性,有助于指导特殊形态LAA的个性化封堵。Objective To evaluate the feasibility and accuracy of three-dimensional（3D）printed left atrial appendage（LAA）models based on 3D transesophageal echocardiography（3D-TEE）data and the application value for treating special anatomic LAA.Methods Data of 18 patients of atrial fibrillation who were underwent LAA occlusion were retrospectively analyzed,including 3D-TEE and CT volume data of the patients.The 3D-TEE data of the LAA were post-processed and a flexible material was used to print the LAA model by 3D printer.The morphological classification and lobulated classifications of LAAs were assessed by the 3D printed models.The measurements of long axis,short axis and depth of LAAs were also performed.And the measurement and classification results were compared with those based on 3D-TEE and CT volume images.A occluder release test was performed on the 3D printed models for patients with challenging LAA morphology.Results For all 18 patients,3D-TEE full volume data of the LAA were successfully reprocessed and printed as 3D LAA models.The consistency of morphological classifications and lobulated classifications of LAAs based on 3D printed models and cardiac CT were 0.92 and 0.83,respectively.No significant differences of LAA ostium dimensions（long axis and short axis）and depth were found between the measurement results based on 3D printed models and 3D-TEE（all P〉0.05）.A simulation of LAA occlusion rehearsal was successfully performed on 3D models of two challenging cases.Conclusion The echocardiographic 3D printing technique has high feasibility and accuracy,and can be promising for personalized planning in cases of transcatheter special morphological LAA occlusion.

关 键 词：打印 三维 超声心动描记术 经食管 成像 三维 心耳 封堵 

分 类 号：R541.75[医药卫生—心血管疾病] R540.45[医药卫生—内科学]