High-resolution real-time spiral MRI for guiding vascular interventions in a rabbit model at 1.5T

Current State of MRI-Guided Endovascular Arterial Interventions: A Systematic Review of Preclinical and Clinical Studies

BACKGROUND

MRI guidance of arterial endovascular interventions could be beneficial as it does not require radiation exposure, allows intrinsic blood-tissue contrast, and enables three-dimensional and functional imaging, however, clinical applications are still limited.

PURPOSE

To review the current state of MRI-guided arterial endovascular interventions and to identify the most commonly reported challenges.

STUDY TYPE

Systematic review.

POPULATION

Pubmed, Embase, Web of Science, and The Cochrane Library were systematically searched to find relevant articles. The search strategy combined synonyms for vascular pathology, endovascular therapy, and real-time MRI guidance.

FIELD STRENGTH/SEQUENCE

No field strength or sequence restrictions were applied.

ASSESSMENT

Two reviewers independently identified and reviewed the original articles and extracted relevant data.

STATISTICAL TESTS

Results of the included original articles are reported.

RESULTS

A total of 24,809 studies were identified for screening. Eighty-eight studies were assessed for eligibility, after which data were extracted from 43 articles (6 phantom, 33 animal, and 4 human studies). Reported technical success rates for animal and human studies ranged between 42% to 100%, and the average complication rate was 5.8% (animal studies) and 8.8% (human studies). Main identified challenges were related to spatial and temporal resolution as well as safety, design, and scarcity of current MRI-compatible endovascular devices.

DATA CONCLUSION

MRI guidance of endovascular arterial interventions seems feasible, however, included articles included mostly small single-center case series. Several hurdles remain to be overcome before larger trials can be undertaken. Main areas of research should focus on adequate imaging protocols with integrated tracking of dedicated endovascular devices.

Positive contrast spiral imaging for visualization of commercial nitinol guidewires with reduced heating

BACKGROUND

CMR-guidance has the potential to improve tissue visualization during cardiovascular catheterization procedures and to reduce ionizing radiation exposure, but a lack of commercially available CMR guidewires limits widespread adoption. Standard metallic guidewires are considered to be unsafe in CMR due to risks of RF-induced heating. Here, we propose the use of RF-efficient gradient echo (GRE) spiral imaging for reduced guidewire heating (low flip angle, long readout), in combination with positive contrast for guidewire visualization.

METHODS

A GRE spiral sequence with 8 interleaves was used for imaging. Positive contrast was achieved using through-slice dephasing such that the guidewire appeared bright and the background signal suppressed. Positive contrast images were interleaved with anatomical images, and real-time image processing was used to produce a color overlay of the guidewire on the anatomy. Temperature was measured with a fiber-optic probe attached to the guidewire in an acrylic gel phantom and in vivo.

RESULTS

Left heart catheterization was performed on swine using the real-time color overlay for procedural guidance with a frame rate of 6.25 frames/second. Using our standard Cartesian real-time imaging (flip angle 60°), temperature increases up to 50 °C (phantom) and 4 °C (in vivo) were observed. In comparison, spiral GRE images (8 interleaves, flip angle 10°) generated negligible heating measuring 0.37 °C (phantom) and 0.06 °C (in vivo).

CONCLUSIONS

The ability to use commercial metallic guidewires safely during CMR-guided catheterization could potentially expedite clinical translation of these methods.

Magnetic Resonance Sequences and Rapid Acquisition for MR-Guided Interventions

Interventional MR uses rapid imaging to guide diagnostic and therapeutic procedures. One of the attractions of MR-guidance is the abundance of inherent contrast mechanisms available. Dynamic procedural guidance with real-time imaging has pushed the limits of MR technology, demanding rapid acquisition and reconstruction paired with interactive control and device visualization. This article reviews the technical aspects of real-time MR sequences that enable MR-guided interventions.

Real-time distortion correction of spiral and echo planar images using the gradient system impulse response function

PURPOSE

MRI-guided interventions demand high frame rate imaging, making fast imaging techniques such as spiral imaging and echo planar imaging (EPI) appealing. In this study, we implemented a real-time distortion correction framework to enable the use of these fast acquisitions for interventional MRI.

METHODS

Distortions caused by gradient waveform inaccuracies were corrected using the gradient impulse response function (GIRF), which was measured by standard equipment and saved as a calibration file on the host computer. This file was used at runtime to calculate the predicted k-space trajectories for image reconstruction. Additionally, the off-resonance reconstruction frequency was modified in real time to interactively deblur spiral images.

RESULTS

Real-time distortion correction for arbitrary image orientations was achieved in phantoms and healthy human volunteers. The GIRF-predicted k-space trajectories matched measured k-space trajectories closely for spiral imaging. Spiral and EPI image distortion was visibly improved using the GIRF-predicted trajectories. The GIRF calibration file showed no systematic drift in 4 months and was demonstrated to correct distortions after 30 min of continuous scanning despite gradient heating. Interactive off-resonance reconstruction was used to sharpen anatomical boundaries during continuous imaging.

CONCLUSIONS

This real-time distortion correction framework will enable the use of these high frame rate imaging methods for MRI-guided interventions. Magn Reson Med 75:2278-2285, 2016. © 2015 Wiley Periodicals, Inc.

Reduced k-space acquisition to accelerate MR imaging of moving interventional instruments: a phantom study

PURPOSE

The goal of this study was to investigate the impact of reduced k-space sampling rates on the visualization of a moving MR-compatible puncture needle and to demonstrate the feasibility of keyhole imaging in interventional magnetic resonance imaging (MRI).

MATERIAL AND METHODS

All experiments were performed in an open 1.0 Tesla MRI. MR images of a moving puncture needle were taken with different keyhole sampling rates from 15-100%, in 10% increments. The needle was submerged in a water-filled basin and was imaged in motion with a T1-weighted gradient-echo sequence with an initial acquisition rate of 1.4 s per image. An apparatus operated by a compressor unit enabled needle rotation and ensured reproducible needle movements. The median forward velocity of the needle tip was 2 cm/s. To evaluate the depiction of the needle, artifact diameter of the needle, contrast-to-noise ratio (CNR), and needle tip profiles (delineation) were measured.

RESULTS

The needle position was determined with an longitudinal error of 3 mm and a transverse error of 0.8 mm with respect to the needle's orientation and the theoretically calculated trajectory. No significant correlation was found between the CNR and velocity. A reduction of k-space update rates caused neither a significant reduction of CNR nor a significant increase in artifact diameter or blurring of the needle profile.

CONCLUSION

The application of keyhole imaging with update rates of greater than 15% is sufficient for the MR guidance of interventions with an signal-to-noise ratio >9 of the surrounding tissue and a target accuracy of >1 mm. Keyhole imaging can increase temporal resolution while ensuring unimpaired spatial resolution and image quality of the depicted instrument.

MRI/linac integration

PURPOSE/OBJECTIVES

In radiotherapy the healthy tissue involvement still poses serious dose limitations. This results in sub-optimal tumour dose and complications. Daily image guided radiotherapy (IGRT) is the key development in radiation oncology to solve this problem. MRI yields superb soft-tissue visualization and provides several imaging modalities for identification of movements, function and physiology. Integrating MRI functionality with an accelerator can make these capacities available for high precision, real time IGRT.

DESIGN AND RESULTS

The system being built at the University Medical Center Utrecht is a 1.5T MRI scanner, with diagnostic imaging functionality and quality, integrated with a 6MV radiotherapy accelerator. The realization of a prototype of this hybrid system is a joint effort between the Radiotherapy Department of the University of Utrecht, the Netherlands, Elekta, Crawley, U.K., and Philips Research, Hamburg, Germany. Basically, the design is a 1.5 T Philips Achieva MRI scanner with a Magnex closed bore magnet surrounded by a single energy (6 MV) Elekta accelerator. Monte Carlo simulations are used to investigate the radiation beam properties of the hybrid system, dosimetry equipment and for the construction of patient specific dose deposition kernels in the presence of a magnetic field. The latter are used to evaluate the IMRT capability of the integrated MRI linac.

CONCLUSIONS

A prototype hybrid MRI/linac for on-line MRI guidance of radiotherapy (MRIgRT) is under construction. The aim of the system is to deliver the radiation dose with mm precision based on diagnostic quality MR images.