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Related Experiment Video

Updated: Apr 21, 2026

Echocardiography-guided Injection for Targeted and Reliable Intramyocardial Stem Cell Delivery in a Rat Model of Myocardial Infarction
06:47

Echocardiography-guided Injection for Targeted and Reliable Intramyocardial Stem Cell Delivery in a Rat Model of Myocardial Infarction

Published on: July 25, 2025

712

Multimodality infarct identification for optimal image-guided intramyocardial cell injections.

F J van Slochteren1, R van Es, S Koudstaal

  • 1Department of Cardiology, University Medical Center Utrecht, E03.511, PO Box 85500, 3508 GA, Utrecht, the Netherlands, f.j.vanslochteren@umcutrecht.nl.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|October 22, 2014
PubMed
Summary

A new 3D CartBox toolbox accurately co-registers magnetic resonance imaging (MRI) and electromechanical mapping (EMM) data. This enables precise, image-guided cell injections to the infarct border zone in cardiac regenerative therapy.

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Area of Science:

  • Cardiovascular Research
  • Medical Imaging
  • Regenerative Medicine

Background:

  • Current intramyocardial cell injections for cardiac regeneration use NOGA®XP electromechanical mapping (EMM).
  • Late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) is the gold standard for determining infarct size and location.
  • A gap exists in precisely guiding injections to infarct borders using current methods.

Purpose of the Study:

  • To describe a practical technique for co-registering LGE-MRI and EMM datasets.
  • To enable image-guided injections to the infarct border zone identified by LGE-MRI.

Main Methods:

  • LGE-MRI and EMM data were acquired in three pigs with chronic myocardial infarction.
  • An in-house developed 3D CartBox toolbox performed image registration in three steps: landmark, surface, and manual optimization.
  • The apex and coronary ostia served as registration landmarks.

Main Results:

  • Successful image registration was achieved across all datasets.
  • The mean registration error between MRI surface mesh and EMM points was 3.22 ± 1.86 mm.
  • LGE-MRI infarct areas showed only partial overlap with EMM-identified infarct areas.

Conclusions:

  • The 3D CartBox toolbox enables registration of EMM with pre-procedural LGE-MRI during catheter injections.
  • This facilitates real-time, image-guided cell injections to the LGE-MRI-defined infarct border zone.
  • The 3D CartBox standardizes injection locations in cardiac regenerative therapy.