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Updated: Apr 21, 2026
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Echocardiography-guided Injection for Targeted and Reliable Intramyocardial Stem Cell Delivery in a Rat Model of Myocardial Infarction
Published on: July 25, 2025
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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.
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.
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.
