Integrated imaging portfolio for the entire cardiology treatment process | |
Acuson SC2000 Prime ultrasound system enables real-time 3D heart imaging for reliable diagnosis of mitral insufficiency | |
Sensitive patient groups benefit from unique dual-source CT scanners for cardiac CT imaging | |
Heart MRI supports the treatment decision by revealing hypoperfusion and viability of the heart muscle |
Siemens Healthineers is helping cardiology customers optimize medical imaging at every stage of cardiology treatment as part of a comprehensive workflow. One focus at this year’s Congress of the European Society of Cardiology (ESC) is the trend toward more minimally invasive interventions, especially in more complex cases. Medical imaging in diagnostics, therapy and follow-up is essential in the case of minimally invasive interventions. Many heart patients today have already reached an advanced age by the time they are diagnosed with a structural or coronary heart disease, and this crucially influences the potential treatment options. For these sensitive patient groups, for example, open heart surgery is no longer an option given the overall risks of general anesthesia and rehabilitation, and existing chronic diseases like diabetes or heart failure. For these complex cases, lower-impact procedures that can be performed minimally invasively represent an important treatment approach.
Structural heart diseases are triggered often by age-related, anatomical,
morphological or functional changes in the heart. Mitral valve dysfunction is one of
the most commonly occurring structural heart diseases affecting the elderly. The
most common functional disorder of the mitral valve prevents it from closing properly. This causes blood to flow back into the left atrium, a process known as
regurgitation, which leads to impairment of the heart’s pump function. To avoid this,
the mitral valve must be repaired, or replaced if repair is no longer an option. This is
where medical imaging plays a key role in diagnosis, risk assessment, and also
choice of treatment.
Precise diagnosis with transesophageal echocardiography (TEE)
TEE enables real-time images of the heart. A transesophageal probe is fed into the
patient’s esophagus. The probe generates images using high-frequency ultrasound
waves. It was for this task that Siemens Healthineers developed the Acuson
SC2000 Prime, combining two state-of-the-art technologies: the ultrasound system
can produce 3D TEE full-volume color Doppler images of the heart and blood flow,
and the integrated eSie Valves analysis software supports precise measurements of
the individual heart valves in just seconds. This makes it easier to choose the
medical implants available for use. 3D ultrasound images also enable the extent of
mitral valve regurgitation and the structure and measurement data of the heart as a
whole to be analyzed. Based on this information, an interdisciplinary heart team
decides whether surgical or minimally invasive intervention is the most appropriate
treatment approach.
Previous 3D TEE methods required stitching, the fusion of multiple heartbeats, to
form a complete image of heart function and blood flow. This approach could
potentially lead to misleading results, especially in patients with cardiac arrhythmias.
Now, with the TEE ultrasound probe in the Acuson SC2000 Prime, 3D images of the
heart can be recorded in real time with no need for stitching. “It really makes a
difference when you can see complete anatomy and blood flow at high volume rates
with Siemens real-time 3D TEE. It enables you to perform valve procedures with
more accuracy and more confidence, potentially improving patient safety and
outcomes. It is truly a step forward in technology,” says cardiology Professor
Stéphane Lafitte, Hôpital Cardiologique CHU in Bordeaux, France.
Complex coronary heart diseases such as chronic total occlusions (CTO) also
necessitate imaging-supported diagnosis to facilitate the choice between the
surgical option of a bypass operation and a minimally invasive percutaneous
coronary intervention (PCI). Computed tomography can be used ahead of the
intervention to evaluate the affected segments of the coronary vessels.
Treatment planning for vessel occlusions via cardiac CT and MRI
The unique dual-source CT scanners from Siemens Healthineers make it possible to
perform CT imaging with particularly low doses of radiation and contrast medium.
The high rotational speed of the Somatom Force and the resulting temporal
resolution of only 66 milliseconds for a complete cardiac dataset make it
unnecessary for patients to hold their breath or to take medications like beta
blockers to regulate their heartbeat. The dual-source CTs from Siemens
Healthineers also greatly reduce the volume of iodine contrast media that has to be
injected, since that can prove an additional burden on the kidneys in older patients
with renal failure in particular. The software syngo.CT Coronary Analysis can rule
out coronary heart disease in less than a minute after the scan or, if there is
narrowing of the arteries, this can be quantified and characterized. In this way,
precise diagnostics can help avoid unnecessary intervention or, if intervention is
needed, it can be planned precisely in advance.
Visualization of the heart using an MRI, to evaluate circulation in the heart muscle or
the relevance of a stenosis, can also provide valuable information for further
treatment. The Cardio Dot Engine software automatically locates the axes of the
heart to ensure a swift, uncomplicated workflow. This simplifies the examinations
and supports reproducible results. The MyoMaps MRI application can help identify
an accumulation of tissue fluid in the heart muscle, a possible consequence of the
stenosis, and represent it in color. This is particularly helpful in the case of heart
diseases that involve minimal tissue lesions that are distributed across the entire
heart. Heart muscle tissue at risk from hypoperfusion can be identified using an MR
perfusion examination and the syngo.MR Perfusion evaluation software. The
information gathered from the heart MRI provides the basis for decision on further
treatment.
Imaging in the catheterization laboratory for direct control during treatment
Minimally invasive therapy is used for both mitral valve replacement and to treat
coronary stenoses in the cardiac catheterization laboratory. The increasing
complexity of the interventions necessitates precise visualization of the anatomy and
the implanted mitral valves or coronary stents, which places particular demands on
the imaging systems.
The benefit of real-time 3D ultrasound imaging provided by the Acuson SC2000
Prime comes into play with minimally invasive mitral valve therapy, since its fullvolume
color Doppler function enables the placement of the implant to be checked
immediately, while the patient is still on the operating table. For coronary artery
treatment, software applications like Clearstent and Clearstent Live, which are
available for all Artis C-arm systems from Siemens Healthineers, help visualize the
stents both during and after implementation. Imaging can provide static images or,
with Clearstent Live, real-time images that also make it possible to observe the
opening of the stent and check how it is placed. This uses a software algorithm that
aims to compensate for heart movements virtually by aligning the X-ray images
using the visible stent markers. “Clearstent allows us to see stents that are poorly
expanded, stent fractures, and other situations that we might not even be able to
identify without stent enhancement, but which are important for making clinical
decisions,” says Prof. Stephan Achenbach, Chairman of Cardiology at Erlangen
University Hospital, Germany, describing his experiences with Clearstent.
Other imaging modalities can be used both for mitral valve procedures and for
coronary interventions, depending on the progress of treatment. This also applies to
follow-up, which is meant to ensure a lasting, positive result for the patient. For
example, using the syngo.CT Coronary Analysis software if a patient develops
further chest pain can rapidly help diagnose further narrowing of the arteries.
Siemens Healthineers adopts an innovative approach to make the best use of the
wealth of opportunities available in the area of intraoperative imaging. For example,
images from pre-procedural CT and MRI examinations can be overlaid on the
images generated in the cardiac catheterization laboratory. That supports the
intervention process by providing additional clinical information from the CT or MRI
images, making it possible to reduce the dose accordingly.
Source & Image source :Siemens Healthineers