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Rogers T, Campbell-Washburn AE, Ramasawmy R, Yildirim DK, Bruce CG, Grant LP, Stine AM, Kolandaivelu A, Herzka DA, Ratnayaka K, Lederman RJ. Interventional cardiovascular magnetic resonance: state-of-the-art. J Cardiovasc Magn Reson 2023; 25:48. [PMID: 37574552 PMCID: PMC10424337 DOI: 10.1186/s12968-023-00956-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Transcatheter cardiovascular interventions increasingly rely on advanced imaging. X-ray fluoroscopy provides excellent visualization of catheters and devices, but poor visualization of anatomy. In contrast, magnetic resonance imaging (MRI) provides excellent visualization of anatomy and can generate real-time imaging with frame rates similar to X-ray fluoroscopy. Realization of MRI as a primary imaging modality for cardiovascular interventions has been slow, largely because existing guidewires, catheters and other devices create imaging artifacts and can heat dangerously. Nonetheless, numerous clinical centers have started interventional cardiovascular magnetic resonance (iCMR) programs for invasive hemodynamic studies or electrophysiology procedures to leverage the clear advantages of MRI tissue characterization, to quantify cardiac chamber function and flow, and to avoid ionizing radiation exposure. Clinical implementation of more complex cardiovascular interventions has been challenging because catheters and other tools require re-engineering for safety and conspicuity in the iCMR environment. However, recent innovations in scanner and interventional device technology, in particular availability of high performance low-field MRI scanners could be the inflection point, enabling a new generation of iCMR procedures. In this review we review these technical considerations, summarize contemporary clinical iCMR experience, and consider potential future applications.
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Affiliation(s)
- Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA.
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St NW, Suite 4B01, Washington, DC, 20011, USA.
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - D Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Laurie P Grant
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Annette M Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Aravindan Kolandaivelu
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
- Johns Hopkins Hospital, Baltimore, MD, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Kanishka Ratnayaka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA.
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Rier SC, Vreemann S, Nijhof WH, van Driel VJHM, van der Bilt IAC. Interventional cardiac magnetic resonance imaging: current applications, technology readiness level, and future perspectives. Ther Adv Cardiovasc Dis 2022; 16:17539447221119624. [PMID: 36039865 PMCID: PMC9434707 DOI: 10.1177/17539447221119624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) provides excellent temporal and spatial resolution, tissue characterization, and flow measurements. This enables major advantages when guiding cardiac invasive procedures compared with X-ray fluoroscopy or ultrasound guidance. However, clinical implementation is limited due to limited availability of technological advancements in magnetic resonance imaging (MRI) compatible equipment. A systematic review of the available literature on past and present applications of interventional MR and its technology readiness level (TRL) was performed, also suggesting future applications. METHODS A structured literature search was performed using PubMed. Search terms were focused on interventional CMR, cardiac catheterization, and other cardiac invasive procedures. All search results were screened for relevance by language, title, and abstract. TRL was adjusted for use in this article, level 1 being in a hypothetical stage and level 9 being widespread clinical translation. The papers were categorized by the type of procedure and the TRL was estimated. RESULTS Of 466 papers, 117 papers met the inclusion criteria. TRL was most frequently estimated at level 5 meaning only applicable to in vivo animal studies. Diagnostic right heart catheterization and cavotricuspid isthmus ablation had the highest TRL of 8, meaning proven feasibility and efficacy in a series of humans. CONCLUSION This article shows that interventional CMR has a potential widespread application although clinical translation is at a modest level with TRL usually at 5. Future development should be directed toward availability of MR-compatible equipment and further improvement of the CMR techniques. This could lead to increased TRL of interventional CMR providing better treatment.
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Affiliation(s)
- Sophie C Rier
- Cardiology Division, Department of Cardiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, Postbus 40551, The Hague 2504 LN, The Netherlands
| | - Suzan Vreemann
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands Siemens Healthineers Nederland B.V., Den Haag, The Netherlands
| | - Wouter H Nijhof
- Siemens Healthineers Nederland B.V., Den Haag, The Netherlands
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Yildirim DK, Bruce C, Uzun D, Rogers T, O'Brien K, Ramasawmy R, Campbell-Washburn A, Herzka DA, Lederman RJ, Kocaturk O. A 20-gauge active needle design with thin-film printed circuitry for interventional MRI at 0.55T. Magn Reson Med 2021; 86:1786-1801. [PMID: 33860962 DOI: 10.1002/mrm.28804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/05/2021] [Accepted: 03/23/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE This work aims to fabricate RF antenna components on metallic needle surfaces using biocompatible polyester tubing and conductive ink to develop an active interventional MRI needle for clinical use at 0.55 Tesla. METHODS A custom computer numeric control-based conductive ink printing method was developed. Based on electromagnetic simulation results, thin-film RF antennas were printed with conductive ink and used to fabricate a medical grade, 20-gauge (0.87 mm outer diameter), 90-mm long active interventional MRI needle. The MRI visibility performance of the active needle prototype was tested in vitro in 1 gel phantom and in vivo in 1 swine. A nearly identical active needle constructed using a 44 American Wire Gauge insulated copper wire-wound RF receiver antenna was a comparator. The RF-induced heating risk was evaluated in a gel phantom per American Society for Testing and Materials (ASTM) 2182-19. RESULTS The active needle prototype with printed RF antenna was clearly visible both in vitro and in vivo under MRI. The maximum RF-induced temperature rise of prototypes with printed RF antenna and insulated copper wire antenna after a 3.96 W/kg, 15 min. long scan were 1.64°C and 8.21°C, respectively. The increase in needle diameter was 98 µm and 264 µm for prototypes with printed RF antenna and copper wire-wound antenna, respectively. CONCLUSION The active needle prototype with conductive ink printed antenna provides distinct device visibility under MRI. Variations on the needle surface are mitigated compared to use of a 44 American Wire Gauge copper wire. RF-induced heating tests support device RF safety under MRI. The proposed method enables fabrication of small diameter active interventional MRI devices having complex geometries, something previously difficult using conventional methods.
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Affiliation(s)
- Dursun Korel Yildirim
- Institute of Biomedical Engineering, Bogazici University, Kandilli Campus, Istanbul, Turkey.,Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Dogangun Uzun
- Institute of Biomedical Engineering, Bogazici University, Kandilli Campus, Istanbul, Turkey.,Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kendall O'Brien
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adrienne Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ozgur Kocaturk
- Institute of Biomedical Engineering, Bogazici University, Kandilli Campus, Istanbul, Turkey.,Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Kogure T, Qureshi SA. The Future of Paediatric Heart Interventions: Where Will We Be in 2030? Curr Cardiol Rep 2020; 22:158. [PMID: 33037461 PMCID: PMC7546978 DOI: 10.1007/s11886-020-01404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
Purpose of Review Cardiac catheterization therapies to treat or palliate infants, children and adults with congenital heart disease have developed rapidly worldwide in both technical innovation and device development in the previous three decades. By reviewing of current status of novel or development of devices and techniques, we will discuss what is likely to happen in paediatric heart intervention in the next decade. Recent Findings Recently, biodegradable stents and devices, transcatheter pulmonary valve implantation for the native right ventricle outflow tract and MRI-guided interventions have been progressing rapidly with good immediate to early results. These are expected to be introduced and spread in the next decade although there are still challenges to overcome. Summary The future of paediatric heart intervention is very promising with rapid development of technological progress.
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Affiliation(s)
- Tomohito Kogure
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.,Department of Cardiology, Tokyo Women's Medical University, Tokyo, 162-0054, Japan
| | - Shakeel A Qureshi
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
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Godinez F, Scott G, Padormo F, Hajnal JV, Malik SJ. Safe guidewire visualization using the modes of a PTx transmit array MR system. Magn Reson Med 2019; 83:2343-2355. [PMID: 31722119 PMCID: PMC7048617 DOI: 10.1002/mrm.28069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 02/06/2023]
Abstract
Purpose MRI‐guided cardiovascular intervention using standard metal guidewires can produce focal tissue heating caused by induced radiofrequency guidewire currents. It has been shown that safe operation is made possible by using parallel transmit radiofrequency coils driven in the null current mode, which does not induce radiofrequency currents and hence allows safe tissue visualization. We propose that the maximum current modes, usually considered unsafe, be used at very low power levels to visualize conductive wires, and we investigate pulse sequences best suited for this application. Methods Spoiled gradient echo, balanced steady‐state free precession, and turbo spin echo sequences were evaluated for their ability to visualize a conductive guidewire embedded in a gel phantom when run in maximum current modes at very low power level. Temperature at the guidewire tip was monitored for safety assessment. Results Excellent guidewire visualization could be achieved using maximum current modes excitation, with the turbo spin echo sequence giving the best image quality. Although turbo spin echo is usually considered to be a high‐power sequence, our method reduced all pulses to 1% amplitude (0.01% power), and heating was not detected. In addition, visualization of background tissue can be achieved using null current mode, also with no recorded heating at the guidewire tip even when running at 100% (reported) specific absorption rate. Conclusion Parallel transmit is a promising approach for both guidewire and tissue visualization using maximum and null current modes, respectively, for interventional cardiac MRI. Such systems can switch excitation mode instantaneously, allowing for flexible integration into interactive sequences.
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Affiliation(s)
- Felipe Godinez
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Greig Scott
- Magnetic Resonance Systems Research Laboratory, Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | | | - Joseph V Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Shaihan J Malik
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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Functionalization of endovascular devices with superparamagnetic iron oxide nanoparticles for interventional cardiovascular magnetic resonance imaging. Biomed Microdevices 2019; 21:38. [DOI: 10.1007/s10544-019-0393-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Diagnostic and interventional cardiac catheterization is routinely used in the diagnosis and treatment of congenital heart disease. There are well-established concerns regarding the risk of radiation exposure to patients and staff, particularly in children given the cumulative effects of repeat exposure. Magnetic resonance imaging (MRI) offers the advantage of being able to provide better soft tissue visualization, tissue characterization, and quantification of ventricular volumes and vascular flow. Initial work using MRI catheterization employed fusion of x-ray and MRI techniques, with x-ray fluoroscopy to guide catheter placement and subsequent MRI assessment for anatomical and hemodynamic assessment. Image overlay of 3D previously acquired MRI datasets with live fluoroscopic imaging has also been used to guide catheter procedures.Hybrid x-ray and MRI-guided catheterization paved the way for clinical application and validation of this technique in the assessment of pulmonary vascular resistance and pharmacological stress studies. Purely MRI-guided catheterization also proved possible with passive catheter tracking. First-in-man MRI-guided cardiac catheter interventions were possible due to the development of MRI-compatible guidewires, but halted due to guidewire limitations.More recent developments in passive and active catheter tracking have led to improved visualization of catheters for MRI-guided catheterization. Improvements in hardware and software have also increased image quality and scanning times with better interactive tools for the operator in the MRI catheter suite to navigate through the anatomy as required in real time. This has expanded to MRI-guided electrophysiology studies and radiofrequency ablation in humans. Animal studies show promise for the utility of MRI-guided interventional catheterization. Ongoing investment and development of MRI-compatible guidewires will pave the way for MRI-guided diagnostic and interventional catheterization coming into the mainstream.
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8
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Magnetic Resonance-Guided Passive Catheter Tracking for Endovascular Therapy. Magn Reson Imaging Clin N Am 2015; 23:591-605. [PMID: 26499277 DOI: 10.1016/j.mric.2015.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The use of MR guidance for endovascular intervention is appealing because of its lack of ionizing radiation, high-contrast visualization of vessel walls and adjacent soft tissues, multiplanar capabilities, and potential to incorporate functional information such as flow, fluid dynamics, perfusion, and cardiac motion. This review highlights state-of-the-art imaging techniques and hardware used for passive tracking of endovascular devices in interventional MR imaging, including negative contrast, passive contrast, nonproton multispectral, and direct current techniques. The advantages and disadvantages of passive tracking relative to active tracking are also summarized.
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Pushparajah K, Tzifa A, Bell A, Wong JK, Hussain T, Valverde I, Bellsham-Revell HR, Greil G, Simpson JM, Schaeffter T, Razavi R. Cardiovascular magnetic resonance catheterization derived pulmonary vascular resistance and medium-term outcomes in congenital heart disease. J Cardiovasc Magn Reson 2015; 17:28. [PMID: 25890289 PMCID: PMC4395971 DOI: 10.1186/s12968-015-0130-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 03/13/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Selection of patients with congenital heart disease for surgical septation in biventricular repair or surgical palliation in functionally single ventricles requires low pulmonary vascular resistance (PVR). Where there is uncertainty, PVR can be assessed using hybrid cardiovascular magnetic resonance (CMR) and fluoroscopic (X-Ray) guided cardiac catheterizations (XMR). CMR/XMR catheterization is a validated technique for accurate assessment of pulmonary vascular resistance. However, data concerning its application in clinical practice is lacking. METHODS PVR assessments were performed in 167 studies in 149 congenital heart disease patients by CMR/XMR catheterization. Data was collated on patient demographics, procedural data, complications and outcomes. Institutional ethics approval was obtained. RESULTS Median age was 3.6 years (6 days-67 years) and weight 13.8 kg (2.3-122 kg). One hundred and eight studies were in biventricular circulations and 59 in functionally single ventricles. Median radiation dose was 0.72 mSv. A baseline Qp:Qs ≤2.75 in biventricular circulations with left-to-right shunts predicted a PVR ≥6 WU x m(2) with 100% sensitivity and 48% specificity. Median follow up until death or last review was 4.2 years (4 days-11 years). Eighty-four patients had a surgical or catheter intervention based on CMR/XMR catheterization findings at a median of 94 days after the study. This included successful biventricular repair at resting PVR values ≤6 WU x m(2) and Fontan completion at ≤4 WU x m(2). CONCLUSION PVR measured by CMR/XMR catheterization allows accurate stratification for intervention in patients with congenital heart disease in both, biventricular and univentricular circulations.
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Affiliation(s)
- Kuberan Pushparajah
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Aphrodite Tzifa
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
| | - Aaron Bell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - James K Wong
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
| | - Tarique Hussain
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Israel Valverde
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
| | - Hannah R Bellsham-Revell
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Gerald Greil
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - John M Simpson
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Tobias Schaeffter
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
| | - Reza Razavi
- Division of Imaging Sciences, King's College London BHF Centre, NIHR Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Schächinger V, Nef H, Achenbach S, Butter C, Deisenhofer I, Eckardt L, Eggebrecht H, Kuon E, Levenson B, Linke A, Madlener K, Mudra H, Naber C, Rieber J, Rittger H, Walther T, Zeus T, Kelm M. Leitlinie zum Einrichten und Betreiben von Herzkatheterlaboren und Hybridoperationssälen/Hybridlaboren. KARDIOLOGE 2015. [DOI: 10.1007/s12181-014-0631-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pushparajah K, Tzifa A, Razavi R. Cardiac MRI catheterization: a 10-year single institution experience and review. Interv Cardiol 2014. [DOI: 10.2217/ica.14.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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White MJ, Thornton JS, Hawkes DJ, Hill DL, Kitchen N, Mancini L, McEvoy AW, Razavi R, Wilson S, Yousry T, Keevil SF. Design, Operation, and Safety of Single-Room Interventional MRI Suites: Practical Experience From Two Centers. J Magn Reson Imaging 2014; 41:34-43. [DOI: 10.1002/jmri.24577] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/10/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mark J. White
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
| | - John S. Thornton
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
| | | | | | - Neil Kitchen
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
| | - Laura Mancini
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
| | - Andrew W. McEvoy
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
| | | | - Sally Wilson
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
| | - Tarek Yousry
- National Hospital for Neurology and Neurosurgery; Queen Square, London UK
- UCL Institute of Neurology; Queen Square, London UK
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Hahn T, Kozerke S, Schwizer W, Fried M, Boesiger P, Steingoetter A. Real-time multipoint gastrointestinal 19-fluorine catheter tracking. Magn Reson Med 2013; 71:302-7. [PMID: 23400935 DOI: 10.1002/mrm.24654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 12/28/2012] [Accepted: 12/28/2012] [Indexed: 12/22/2022]
Abstract
PURPOSE To develop MR based real-time gastrointestinal 19-Fluorine (19F) catheter tracking and visualization allowing for real-time detection and feedback of 3D catheter shape and movement as well as catheter-driven adjustments of 1H imaging geometry parameters. METHODS Data were acquired on a 3T clinical system using 3D Golden Angle radial sampling. Two gastrointestinal catheters incorporating four fiducial 19F markers (65 or 50 µL marker volume) were tracked while being pulled through a gel phantom by an operator inside the MR room with velocities of 2-18 mm/s. During continuous acquisition, k-space profiles were transferred in real-time to an external computer for concurrent reconstruction of 3D 19F images and detection and visualization of marker positions. Based on αthe marker positions, automatic adjustments of 1H imaging planes to facilitate targeted anatomical scanning was implemented. RESULTS Mean tracking reliabilities were 94.5 and 83.6% (catheters 1 and 2) for temporal resolutions 185-740 ms. Reconstruction times of 196 ms were achieved. Real-time visual feedback allowed the operator to accurately control the catheter movement. Catheter-guidance for 1H imaging was reliable. CONCLUSION The presented real-time 19F MR based framework for the tracking of 19F labeled devices is applicable to combined 19F and 1H MRI guidance of gastrointestinal devices in vivo.
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Affiliation(s)
- Tobias Hahn
- Institute for Biomedical Engineering, University and ETH Zurich, Switzerland
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Ratnayaka K, Faranesh AZ, Hansen MS, Stine AM, Halabi M, Barbash IM, Schenke WH, Wright VJ, Grant LP, Kellman P, Kocaturk O, Lederman RJ. Real-time MRI-guided right heart catheterization in adults using passive catheters. Eur Heart J 2012; 34:380-9. [PMID: 22855740 DOI: 10.1093/eurheartj/ehs189] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Real-time MRI creates images with superb tissue contrast that may enable radiation-free catheterization. Simple procedures are the first step towards novel interventional procedures. We aim to perform comprehensive transfemoral diagnostic right heart catheterization in an unselected cohort of patients entirely using MRI guidance. METHODS AND RESULTS We performed X-ray and MRI-guided transfemoral right heart catheterization in consecutive patients undergoing clinical cardiac catheterization. We sampled both cavae and both pulmonary arteries. We compared success rate, time to perform key steps, and catheter visibility among X-ray and MRI procedures using air-filled or gadolinium-filled balloon-tipped catheters. Sixteen subjects (four with shunt, nine with coronary artery disease, three with other) underwent paired X-ray and MRI catheterization. Complete guidewire-free catheterization was possible in 15 of 16 under both. MRI using gadolinium-filled balloons was at least as successful as X-ray in all procedure steps, more successful than MRI using air-filled balloons, and better than both in entering the left pulmonary artery. Total catheterization time and individual procedure steps required approximately the same amount of time irrespective of image guidance modality. Catheter conspicuity was best under X-ray and next-best using gadolinium-filled MRI balloons. CONCLUSION In this early experience, comprehensive transfemoral right heart catheterization appears feasible using only MRI for imaging guidance. Gadolinium-filled balloon catheters were more conspicuous than air-filled ones. Further workflow and device enhancement are necessary for clinical adoption.
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Affiliation(s)
- Kanishka Ratnayaka
- Division of Intramural Research, Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538, USA
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Anderson KJT, Scott GC, Wright GA. Catheter tracking with phase information in a magnetic resonance scanner. IEEE TRANSACTIONS ON MEDICAL IMAGING 2012; 31:1173-1180. [PMID: 22186949 DOI: 10.1109/tmi.2011.2179944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this study is to describe a new active technique for accurately determining both the position and orientation of the tip of a catheter during magnetic resonance (MR)-guided percutaneous cardiovascular procedures. The technique utilizes phase information introduced into the MR signal from a small receive coil located on the distal tip of the catheter. Phase patterns around a small receive coil are rich in information that is directly related to position and orientation. This information can be collected over a large spherical volume with a diameter several times that of the receive coil. The high degree of redundancy yields the potential for an accurate and robust method of catheter tracking. A tracking algorithm is presented that performs catheter tip localization using phase images acquired in two orthogonal planes without any a priori knowledge of catheter position. Associated experimentation demonstrating feasibility is also presented.
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Affiliation(s)
- Kevan J T Anderson
- Department of Medical Biophysics, University of Toronto, Toronto, ON M5S 1A1, Canada.
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16
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Celik H, Atalar E. Reverse polarized inductive coupling to transmit and receive radiofrequency coil arrays. Magn Reson Med 2011; 67:446-56. [PMID: 21656566 DOI: 10.1002/mrm.23030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 04/25/2011] [Accepted: 05/05/2011] [Indexed: 11/07/2022]
Abstract
In this study, the reverse polarization method is implemented using transmit and receive arrays to improve the visibility of the interventional devices. Linearly polarized signal sources--inductively and receptively coupled radiofrequency coils--are used in the experimental setups to demonstrate the ability of the method to separate these sources from a forward polarized anatomy signal. Two different applications of the reverse polarization method are presented here: (a) catheter tracking and (b) fiducial marker visualization, in both of which transmit and receive arrays are used. The performance of the reverse polarization method was further tested with phantom and volunteer studies, and the results proved the feasibility of this method with transmit and receive arrays.
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Affiliation(s)
- Haydar Celik
- National Research Center for Magnetic Resonance (UMRAM), Bilkent University, Ankara, Turkey
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17
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Tzifa A, Krombach GA, Krämer N, Krüger S, Schütte A, von Walter M, Schaeffter T, Qureshi S, Krasemann T, Rosenthal E, Schwartz CA, Varma G, Buhl A, Kohlmeier A, Bücker A, Günther RW, Razavi R. Magnetic Resonance–Guided Cardiac Interventions Using Magnetic Resonance–Compatible Devices. Circ Cardiovasc Interv 2010; 3:585-92. [DOI: 10.1161/circinterventions.110.957209] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Percutaneous cardiac interventions are currently performed under x-ray guidance. Magnetic resonance imaging (MRI) has been used to guide intravascular interventions in the past, but mainly in animals. Translation of MR-guided interventions into humans has been limited by the lack of MR-compatible and safe equipment, such as MR guide wires with mechanical characteristics similar to standard guide wires. The aim of the present study was to evaluate the safety and efficacy of a newly developed MR-safe and compatible passive guide wire in aiding MR-guided cardiac interventions in a swine model and describe the 2 first-in-man solely MR-guided interventions.
Methods and Results—
In the preclinical trial, the new MR-compatible wire aided the performance of 20 interventions in 5 swine. These consisted of balloon dilation of nondiseased pulmonary and aortic valves, aortic arch, and branch pulmonary arteries. After ethics and regulatory authority approval, the 2 first-in-man MR-guided interventions were performed in a child and an adult, both with elements of valvar pulmonary stenosis. Catheter manipulations were monitored with real-time MRI sequence with interactive modification of imaging plane and slice position. Temporal resolution was 11 to 12 frames/s. Catheterization procedure times were 110 and 80 minutes, respectively. Both patients had successful relief of the valvar stenosis and no procedural complications.
Conclusions—
The described preclinical study and case reports are encouraging that with the availability of the new MR-compatible and safe guide wire, certain percutaneous cardiac interventions will become feasible to perform solely under MR guidance in the future. A clinical trial is underway in our institution.
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Affiliation(s)
- Aphrodite Tzifa
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Gabriele A. Krombach
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Nils Krämer
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Sascha Krüger
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Adrian Schütte
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Matthias von Walter
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Tobias Schaeffter
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Shakeel Qureshi
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Thomas Krasemann
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Eric Rosenthal
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Claudia A. Schwartz
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Gopal Varma
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Alexandra Buhl
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Antonia Kohlmeier
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Arno Bücker
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Rolf W. Günther
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
| | - Reza Razavi
- From King's College London BHF Centre (A.T., T.S., S.Q., G.V., R.R.), Division of Imaging Sciences, NIHR Biomedical, Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; the Pediatric Cardiology Department (A.T., S.Q., T.K., E.R., R.R.), Evelina Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom; the Department of Diagnostic Radiology (G.A.K., N.K., C.A.S., A.K., A.B., R.W.G.), University Hospital Aachen, Aachen, Germany; Philips Research
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18
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Patil S, Bieri O, Jhooti P, Scheffler K. Automatic slice positioning (ASP) for passive real-time tracking of interventional devices using projection-reconstruction imaging with echo-dephasing (PRIDE). Magn Reson Med 2010; 62:935-42. [PMID: 19585605 DOI: 10.1002/mrm.22080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A novel and fast approach for passive real-time tracking of interventional devices using paramagnetic markers, termed "projection-reconstruction imaging with echo-dephasing" (PRIDE) is presented. PRIDE is based on the acquisition of echo-dephased projections along all three physical axes. Dephasing is preferably set to 4pi within each projection ensuring that background tissues do not contribute to signal formation and thus appear heavily suppressed. However, within the close vicinity of the paramagnetic marker, local gradient fields compensate for the intrinsic dephasing to form an echo. Successful localization of the paramagnetic marker with PRIDE is demonstrated in vitro and in vivo in the presence of different types of off-resonance (air/tissue interfaces, main magnetic field inhomogeneities, etc). In order to utilize the PRIDE sequence for vascular interventional applications, it was interleaved with balanced steady-state free precession (bSSFP) to provide positional updates to the imaged slice using a dedicated real-time feedback link. Active slice positioning (ASP) with PRIDE is demonstrated in vitro, requiring approximately 20 ms for the positional update to the imaging sequence, comparable to existing active tracking methods.
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Affiliation(s)
- S Patil
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.
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19
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Saikus CE, Lederman RJ. Interventional cardiovascular magnetic resonance imaging: a new opportunity for image-guided interventions. JACC Cardiovasc Imaging 2009; 2:1321-31. [PMID: 19909937 PMCID: PMC2843404 DOI: 10.1016/j.jcmg.2009.09.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Revised: 09/10/2009] [Accepted: 09/11/2009] [Indexed: 01/12/2023]
Abstract
Cardiovascular magnetic resonance (CMR) combines excellent soft-tissue contrast, multiplanar views, and dynamic imaging of cardiac function without ionizing radiation exposure. Interventional cardiovascular magnetic resonance (iCMR) leverages these features to enhance conventional interventional procedures or to enable novel ones. Although still awaiting clinical deployment, this young field has tremendous potential. We survey promising clinical applications for iCMR. Next, we discuss the technologies that allow CMR-guided interventions and, finally, what still needs to be done to bring them to the clinic.
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Affiliation(s)
- Christina E Saikus
- Translational Medicine Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD 20892-1538, USA
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20
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Schirra CO, Weiss S, Krueger S, Pedersen SF, Razavi R, Schaeffter T, Kozerke S. Toward true 3D visualization of active catheters using compressed sensing. Magn Reson Med 2009; 62:341-7. [PMID: 19526499 DOI: 10.1002/mrm.22001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A crucial requirement in MR-guided interventions is the visualization of catheter devices in real time. However, true 3D visualization of the full length of catheters has hitherto been impossible given scan time constraints. Compressed sensing (CS) has recently been proposed as a method to accelerate MR imaging of sparse objects. Images acquired with active interventional devices exhibit a high CNR and are inherently sparse, therefore rendering CS ideally suited for accelerating data acquisition. A framework for true visualization of active catheters in 3D is proposed employing CS to gain high undersampling factors making real-time applications feasible. Constraints are introduced taking into account prior knowledge of catheter geometry and catheter motion over time to improve and accelerate image reconstruction. The potential of the method is demonstrated using computer simulations and phantom experiments and in vivo feasibility is demonstrated in a pig experiment.
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Affiliation(s)
- C O Schirra
- King's College London BHF Centre, Division of Imaging Sciences, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, London, UK.
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21
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Mekle R, Zenge MO, Ladd ME, Quick HH, Hofmann E, Scheffler K, Bilecen D. Initial in vivo studies with a polymer-based MR-compatible guide wire. J Vasc Interv Radiol 2009; 20:1384-9. [PMID: 19699660 DOI: 10.1016/j.jvir.2009.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 05/14/2009] [Accepted: 07/01/2009] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to evaluate a new polymer-based and magnetic resonance (MR) imaging-compatible guide wire for its application in MR-guided endovascular interventions, particularly for interventional peripheral MR angiography in swine experiments in vivo. A passive device tracking method tailored to the specific conditions of peripheral MR angiography was developed. Near-real-time visualization of the guide wire was accomplished in vivo in the carotid artery, aorta, heart, and iliac arteries of two domestic pigs. Results show great potential for this guide wire in aiding the realization of interventional peripheral MR angiography in humans.
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Affiliation(s)
- Ralf Mekle
- Division of MR Physics, Department of Medical Radiology, University Hospital Basel, Basel, Switzerland.
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22
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Kocaturk O, Saikus CE, Guttman MA, Faranesh AZ, Ratnayaka K, Ozturk C, McVeigh ER, Lederman RJ. Whole shaft visibility and mechanical performance for active MR catheters using copper-nitinol braided polymer tubes. J Cardiovasc Magn Reson 2009; 11:29. [PMID: 19674464 PMCID: PMC2743675 DOI: 10.1186/1532-429x-11-29] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 08/12/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catheter visualization and tracking remains a challenge in interventional MR.Active guidewires can be made conspicuous in "profile" along their whole shaft exploiting metallic core wire and hypotube components that are intrinsic to their mechanical performance. Polymer-based catheters, on the other hand, offer no conductive medium to carry radio frequency waves. We developed a new "active" catheter design for interventional MR with mechanical performance resembling braided X-ray devices. Our 75 cm long hybrid catheter shaft incorporates a wire lattice in a polymer matrix, and contains three distal loop coils in a flexible and torquable 7Fr device. We explored the impact of braid material designs on radiofrequency and mechanical performance. RESULTS The incorporation of copper wire into in a superelastic nitinol braided loopless antenna allowed good visualization of the whole shaft (70 cm) in vitro and in vivo in swine during real-time MR with 1.5 T scanner. Additional distal tip coils enhanced tip visibility. Increasing the copper:nitinol ratio in braiding configurations improved flexibility at the expense of torquability. We found a 16-wire braid of 1:1 copper:nitinol to have the optimum balance of mechanical (trackability, flexibility, torquability) and antenna (signal attenuation) properties. With this configuration, the temperature increase remained less than 2 degrees C during real-time MR within 10 cm horizontal from the isocenter. The design was conspicuous in vitro and in vivo. CONCLUSION We have engineered a new loopless antenna configuration that imparts interventional MR catheters with satisfactory mechanical and imaging characteristics. This compact loopless antenna design can be generalized to visualize the whole shaft of any general-purpose polymer catheter to perform safe interventional procedures.
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Affiliation(s)
- Ozgur Kocaturk
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christina E Saikus
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael A Guttman
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anthony Z Faranesh
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kanishka Ratnayaka
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cengizhan Ozturk
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
| | - Elliot R McVeigh
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert J Lederman
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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23
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Ratnayaka K, Faranesh AZ, Guttman MA, Kocaturk O, Saikus CE, Lederman RJ. Interventional cardiovascular magnetic resonance: still tantalizing. J Cardiovasc Magn Reson 2008; 10:62. [PMID: 19114017 PMCID: PMC2637847 DOI: 10.1186/1532-429x-10-62] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 12/29/2008] [Indexed: 12/30/2022] Open
Abstract
The often touted advantages of MR guidance remain largely unrealized for cardiovascular interventional procedures in patients. Many procedures have been simulated in animal models. We argue these opportunities for clinical interventional MR will be met in the near future. This paper reviews technical and clinical considerations and offers advice on how to implement a clinical-grade interventional cardiovascular MR (iCMR) laboratory. We caution that this reflects our personal view of the "state of the art."
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Affiliation(s)
- Kanishka Ratnayaka
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Cardiology Division, Children's National Medical Center, Washington, DC, USA
| | - Anthony Z Faranesh
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael A Guttman
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ozgur Kocaturk
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christina E Saikus
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert J Lederman
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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24
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Settecase F, Sussman MS, Wilson MW, Hetts S, Arenson RL, Malba V, Bernhardt AF, Kucharczyk W, Roberts TPL. Magnetically-assisted remote control (MARC) steering of endovascular catheters for interventional MRI: a model for deflection and design implications. Med Phys 2007; 34:3135-42. [PMID: 17879774 PMCID: PMC3980585 DOI: 10.1118/1.2750963] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Current applied to wire coils wound at the tip of an endovascular catheter can be used to remotely steer a catheter under magnetic resonance imaging guidance. In this study, we derive and validate an equation that characterizes the relationship between deflection and a number of physical factors: theta/sin(gamma-theta) = nIABL/EI(A) where theta is the deflection angle, n is the number of solenoidal turns, I is the current, A is the cross-sectional area of the catheter tip, B is the magnetic resonance (MR) scanner main magnetic field, L is the unconstrained catheter length, E is Young's Modulus for the catheter material, and I(A) is the area moment of inertia, and y is the initial angle between the catheter tip and B. Solenoids of 50, 100, or 150 turns were wound on 1.8 F and 5 F catheters. Varying currents were applied remotely using a DC power supply in the MRI control room. The distal catheter tip was suspended within a phantom at varying lengths. Images were obtained with a 1.5 T or a 3 T MR scanner using "real-time" MR pulse sequences. Deflection angles were measured on acquired images. Catheter bending stiffess was determined using a tensile testing apparatus and a stereomicroscope. Predicted relationships between deflection and various physical factors were observed (R2 = 0.98-0.99). The derived equation provides a framework for modeling of the behavior of the specialized catheter tip. Each physical factor studied has implications for catheter design and device implementation.
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Affiliation(s)
- Fabio Settecase
- Department of Medical Imaging and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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25
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Koktzoglou I, Li D, Dharmakumar R. Dephased FLAPS for improved visualization of susceptibility-shifted passive devices for real-time interventional MRI. Phys Med Biol 2007; 52:N277-86. [PMID: 17664566 DOI: 10.1088/0031-9155/52/13/n01] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Recently, balanced steady-state free precession (SSFP) magnetic resonance imaging at small flip angles (i.e. FLAPS imaging) has been shown to preferentially enhance the visibility of spins residing near susceptibility-shifted media by exploiting the unique spectral response of SSFP signals. Nevertheless, the use of FLAPS imaging to visualize passive, susceptibility-shifted devices within thick slices is complicated by partial volume effects that reduce the conspicuity of the devices. In this work, dephased FLAPS (dFLAPS), a variation of the FLAPS method with dephasing gradients applied in the slice direction, is presented as a method for improving the contrast of susceptibility-shifted interventional devices in thick-slice magnetic resonance images by suppressing signal from on-resonant spins. In comparison to FLAPS imaging, results demonstrate that dFLAPS imaging of thick, projection-like slices improves the contrast of susceptibility-shifted devices relative to background signal with no increase in acquisition time.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, Northwestern University, Suite 700, 448 E. Ontario St, Chicago, IL 60611, USA.
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Saborowski O, Saeed M. An overview on the advances in cardiovascular interventional MR imaging. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2007; 20:117-27. [PMID: 17487451 DOI: 10.1007/s10334-007-0074-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 03/19/2007] [Accepted: 03/20/2007] [Indexed: 10/23/2022]
Abstract
Interventional cardiovascular magnetic resonance imaging (iCMR) represents a new discipline whose systematic development will foster minimally invasive interventional procedures without radiation exposure. New generations of open, wide and short bore MR scanners and real time sequences made cardiovascular intervention possible. MR compatible endovascular catheters and guide-wires are needed for delivery of devices such as stents or atrial septal defect (ASD) closures. Catheter tracking is based on active and passive approaches. Currently performed MR-guided procedures are used to monitor, navigate and track endovascular catheters and to deliver local therapeutic agents to targets, such as infarcted myocardium and vascular walls. Heating of endovascular MR catheters, guide-wires and devices during imaging still presents high safety risks. MR contrast media improve the capabilities of MR imaging by enhancing blood signal, pathologic targets (such as myocardial infarctions and atherosclerotic plaques), endovascular catheters and by tracking injected therapeutic agents. Labeling injected soluble therapeutic agents, genes or cells with MR contrast media enables interventionalists to ensure the administration of the drugs in the target and to trace their distribution in the targets. The future clinical use of this iCMR technique requires (1) high spatial and temporal resolution imaging, (2) special catheters and devices and (3) effective therapeutic agents, genes or cells. These conditions are available at a low scale at the present time and need to be developed in the near future. Such progress will lead to improved patient care and minimize invasiveness.
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Affiliation(s)
- Olaf Saborowski
- Department of Radiology, University of California San Francisco, 513 Parnassus Avenue, HSW 207B, San Francisco, CA 94143-0628, USA
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Hegde S, Miquel ME, Boubertakh R, Gilderdale D, Muthurangu V, Keevil SF, Young I, Hill DLG, Razavi RS. Interactive MR imaging and tracking of catheters with multiple tuned fiducial markers. J Vasc Interv Radiol 2006; 17:1175-9. [PMID: 16868171 DOI: 10.1097/01.rvi.0000228466.09982.8b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The lack of magnetic resonance (MR) safe catheters and guide wires remains an important obstacle to widespread clinical use of MR-guided endovascular procedures. The authors looked at the feasibility of using multiple tuned fiducial markers (TFM) and novel imaging sequences to track catheters reliably under MR and to evaluate the safety of such markers in terms of heating. MATERIALS AND METHODS The visualization and tracking of a catheter with six quadrature tuned fiducial coils was carried out in a special designed in-vitro setup within a 1.5-T MR imager simulating an MR-guided endovascular intervention. The fiducial markers were also tested for heating. RESULTS The excellent signal contrast between the fiducial and the background when using novel interleaved real time and interactive sequences allowed for rapid and reliable identification of the fiducial markers and therefore the catheter. No significant heating of the marker was noted. CONCLUSIONS The authors have shown that catheters with multiple tuned fiducial markers are superior to passive catheter designs in terms of visualization and do not carry the risk of heating that is commonly associated with active catheters.
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Affiliation(s)
- Sanjeet Hegde
- Division of Imaging Sciences, King's College London School of Medicine, Guy's Campus, London SE1 9RT, UK
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Mekle R, Hofmann E, Scheffler K, Bilecen D. A polymer-based MR-compatible guidewire: a study to explore new prospects for interventional peripheral magnetic resonance angiography (ipMRA). J Magn Reson Imaging 2006; 23:145-55. [PMID: 16374877 DOI: 10.1002/jmri.20486] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To introduce a newly developed polymer-based and magnetic resonance (MR)-compatible guidewire and to explore its capabilities with respect to interventional peripheral magnetic resonance angiography (ipMRA) in a flow phantom. MATERIALS AND METHODS The guidewire is based on a polyetheretherketone (PEEK) polymer core, and small iron particles are embedded in its coating. A passive device tracking technique was designed utilizing a susceptibility artifact induced by the wire in images acquired with a balanced steady-state free precession (b-SSFP) sequence using small flip angles. The position of the guidewire tip was determined from image intensity maxima and overlayed onto a roadmap in near real-time. Guidewire tracking and balloon angioplasty of an artificial stenosis were attempted in two configurations of a flow phantom. RESULTS Successful passive guidewire tracking was performed for all phantom configurations. Robustness and accuracy of the tracking technique were sufficient for phantom studies. A balloon catheter was placed into the stenosis using the guidewire under complete MR guidance, and subsequent balloon angioplasty yielded improved flow conditions. CONCLUSION The new guidewire is well-suited for clinical application due to an absence of the risk of core fracture and its atraumatic flexible tip. It opens novel prospects for the realization of ipMRA in humans that need to be explored in further studies.
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Affiliation(s)
- Ralf Mekle
- MR-Physics, University of Basel/University Hospital, Basel, Switzerland.
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Affiliation(s)
- Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1538, USA.
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Krueger JJ, Ewert P, Yilmaz S, Gelernter D, Peters B, Pietzner K, Bornstedt A, Schnackenburg B, Abdul-Khaliq H, Fleck E, Nagel E, Berger F, Kuehne T. Magnetic resonance imaging-guided balloon angioplasty of coarctation of the aorta: a pilot study. Circulation 2006; 113:1093-100. [PMID: 16490822 DOI: 10.1161/circulationaha.105.578112] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND MRI guidance of percutaneous transluminal balloon angioplasty (PTA) of aortic coarctation (CoA) would be desirable for continuous visualization of anatomy and to eliminate x-ray exposure. The aim of this study was (1) to determine the suitability of MRI-controlled PTA using the iron oxide-based contrast medium Resovist (ferucarbotran) for catheter visualization and (2) to subsequently apply this technique in a pilot study with patients with CoA. METHODS AND RESULTS The MRI contrast-to-noise ratio and artifact behavior of Resovist-treated balloon catheters was optimized in in vitro and animal experiments (pigs). In 5 patients, anatomy of the CoA was evaluated before and after intervention with high-resolution respiratory-navigated 3D MRI and multiphase cine MRI. Position monitoring of Resovist-treated catheters was realized with interactive real-time MRI. Aortic pressures were continuously recorded. Conventional catheterization was performed before and after MRI to confirm interventional success. During MRI, catheters filled with 25 micromol of iron particles per milliliter of Resovist produced good signal contrast between catheters and their background anatomy but no image distortion due to susceptibility artifacts. All MRI procedures were performed successfully in the patient study. There was excellent agreement between the diameters of CoA and pressure gradients as measured during MRI and conventional catheterization. In 4 patients, PTA resulted in substantial widening of the CoA and a decrease in pressure gradients. In 1 patient, PTA was ineffective. CONCLUSIONS The MRI method described represents a potential alternative to conventional x-ray fluoroscopy for catheter-based treatment of patients with CoA.
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Affiliation(s)
- Julia J Krueger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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Miquel ME, Rhode KS, Acher PL, Macdougall ND, Blackall J, Gaston RP, Hegde S, Morris SL, Beaney R, Deehan C, Popert R, Keevil SF. Using combined x-ray and MR imaging for prostate I-125 post-implant dosimetry: phantom validation and preliminary patient work. Phys Med Biol 2006; 51:1129-37. [PMID: 16481682 DOI: 10.1088/0031-9155/51/5/005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Post-implantation dosimetry is an important element of permanent prostate brachytherapy. This process relies on accurate localization of implanted seeds relative to the surrounding organs. Localization is commonly achieved using CT images, which provide suboptimal prostate delineation. On MR images, conversely, prostate visualization is excellent but seed localization is imprecise due to distortion and susceptibility artefacts. This paper presents a method based on fused MR and x-ray images acquired consecutively in a combined x-ray and MRI interventional suite. The method does not rely on any explicit registration step but on a combination of system calibration and tracking. A purpose-built phantom was imaged using MRI and x-rays, and the images were successfully registered. The same protocol was applied to three patients where combining soft tissue information from MRI with stereoscopic seed identification from x-ray imaging facilitated post-implant dosimetry. This technique has the potential to improve on dosimetry using either CT or MR alone.
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Affiliation(s)
- M E Miquel
- Division of Imaging Sciences, King's College London, London, SE1 9RT, UK
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Abstract
Magnetic resonance imaging (MRI), which provides superior soft-tissue imaging and no known harmful effects, has the potential as an alternative modality to guide various medical interventions. This review will focus on MR-guided endovascular interventions and present its current state and future outlook. In the first technical part, enabling technologies such as developments in fast imaging, catheter devices, and visualization techniques are examined. This is followed by a clinical survey that includes proof-of-concept procedures in animals and initial experience in human subjects. In preclinical experiments, MRI has already proven to be valuable. For example, MRI has been used to guide and track targeted cell delivery into or around myocardial infarctions, to guide atrial septal puncture, and to guide the connection of portal and systemic venous circulations. Several investigational MR-guided procedures have already been reported in patients, such as MR-guided cardiac catheterization, invasive imaging of peripheral artery atheromata, selective intraarterial MR angiography, and preliminary angioplasty and stent placement. In addition, MR-assisted transjugular intrahepatic portosystemic shunt procedures in patients have been shown in a novel hybrid double-doughnut x-ray/MRI system. Numerous additional investigational human MR-guided endovascular procedures are now underway in several medical centers around the world. There are also significant hurdles: availability of clinical-grade devices, device-related safety issues, challenges to patient monitoring, and acoustic noise during imaging. The potential of endovascular interventional MRI is great because as a single modality, it combines 3-dimensional anatomic imaging, device localization, hemodynamics, tissue composition, and function.
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Affiliation(s)
- Cengizhan Ozturk
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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Muthurangu V, Atkinson D, Sermesant M, Miquel ME, Hegde S, Johnson R, Andriantsimiavona R, Taylor AM, Baker E, Tulloh R, Hill D, Razavi RS. Measurement of total pulmonary arterial compliance using invasive pressure monitoring and MR flow quantification during MR-guided cardiac catheterization. Am J Physiol Heart Circ Physiol 2005; 289:H1301-6. [PMID: 15879483 DOI: 10.1152/ajpheart.00957.2004] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pulmonary hypertensive disease is assessed by quantification of pulmonary vascular resistance. Pulmonary total arterial compliance is also an indicator of pulmonary hypertensive disease. However, because of difficulties in measuring compliance, it is rarely used. We describe a method of measuring pulmonary arterial compliance utilizing magnetic resonance (MR) flow data and invasive pressure measurements. Seventeen patients with suspected pulmonary hypertension or congenital heart disease requiring preoperative assessment underwent MR-guided cardiac catheterization. Invasive manometry was used to measure pulmonary arterial pressure, and phase-contrast MR was used to measure flow at baseline and at 20 ppm nitric oxide (NO). Total arterial compliance was calculated using the pulse pressure method (parameter optimization of the 2-element windkessel model) and the ratio of stroke volume to pulse pressure. There was good agreement between the two estimates of compliance ( r = 0.98, P < 0.001). However, there was a systematic bias between the ratio of stroke volume to pulse pressure and the pulse pressure method (bias = 61%, upper level of agreement = 84%, lower level of agreement = 38%). In response to 20 ppm NO, there was a statistically significant fall in resistance, systolic pressure, and pulse pressure. In seven patients, total arterial compliance increased >10% in response to 20 ppm NO. As a population, the increase did not reach statistical significance. There was an inverse relation between compliance and resistance ( r = 0.89, P < 0.001) and between compliance and mean pulmonary arterial pressure ( r = 0.72, P < 0.001). We have demonstrated the feasibility of quantifying total arterial compliance using an MR method.
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Affiliation(s)
- Vivek Muthurangu
- Cardiac MR Research Group, Division of Imaging Sciences, King's College London, UK
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Kuehne T, Yilmaz S, Schulze-Neick I, Wellnhofer E, Ewert P, Nagel E, Lange P. Magnetic resonance imaging guided catheterisation for assessment of pulmonary vascular resistance: in vivo validation and clinical application in patients with pulmonary hypertension. Heart 2005; 91:1064-9. [PMID: 16020598 PMCID: PMC1769055 DOI: 10.1136/hrt.2004.038265] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2004] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To validate in vivo a magnetic resonance imaging (MRI) method for measurement of pulmonary vascular resistance (PVR) and subsequently to apply this technique to patients with pulmonary hypertension (PHT). METHODS AND RESULTS PVR was assessed from velocity encoded cine MRI derived pulmonary artery (PA) flow volumes and simultaneously determined invasive PA pressures. For pressure measurements flow directed catheters were guided under magnetic resonance fluoroscopy at 1.5 T into the PA. In preliminary validation studies (eight swine) PVR was determined with the thermodilution technique and compared with PVR obtained by MRI (0.9 (0.5) v 1.1 (0.3) Wood units.m2, p = 0.7). Bland-Altman test showed agreement between both methods. Inter-examination variability was high for thermodilution (6.2 (2.2)%) but low for MRI measurements (2.1 (0.3)%). After validation, the MRI method was applied in 10 patients with PHT and five controls. In patients with PHT PVR was measured at baseline and during inhalation of nitric oxide. Compared with the control group, PVR was significantly increased in the PHT group (1.2 (0.8) v 13.1 (5.6) Wood units.m2, p < 0.001) but decreased significantly to 10.3 (4.6) Wood units.m2 during inhalation of nitric oxide (p < 0.05). Inter-examination variability of MRI derived PVR measurements was 2.6 (0.6)%. In all experiments (in vivo and clinical) flow directed catheters were guided successfully into the PA under MRI control. CONCLUSIONS Guidance of flow directed catheters into the PA is feasible under MRI control. PVR can be determined with high measurement precision with the proposed MRI technique, which is a promising tool to assess PVR in the clinical setting.
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Affiliation(s)
- T Kuehne
- Department of Congenital Heart Diseases and Paediatric Cardiology, German Heart Institute, Berlin, Germany.
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Abstract
The motivations for developing MR-guided minimally invasive therapy include its excellent soft tissue contrast, tomographic imaging in any direction (as opposed to projection imaging as in fluoroscopy), the absence of ionizing radiation,the abundance of contrast mechanisms (including bright blood pulse sequences that lead to excellent vessel conspicuity without exogenous contrast agent injection), the ability to obtain physiologic information such as perfusion, and an overall excellent safety profile. The main pulse sequences used today for interventional MR imaging are T1/T2-weighted FISP and TrueFISP, T2-weighted turbo spin-echo, and T1-weighted FLASH. The specific clinical question, the underlying pathophysiology,and the procedure to be performed dictate which sequence is used. Each of these sequences has been written to acquire data in conventional rectilinear trajectories, radial k-space paths, or even spirals. In many ways, the questions being researched in interventional MR imaging have been dictated by the primary issues in greatest need of resolution or that most directly facilitate new clinical development. A decade ago, research focused on exploration of new scan strategies for contrast and temporal resolution. Advancements in the last decade have made it possible to acquire and display greater than 10 images per second in realtime with millimeter resolution in all three directions. This temporal and spatial resolution is considered high enough to guide most interventions. With this capability, other research has focused on instrument tracking. The field has gone from the capability to track a single coil and superimpose it on a previously acquired roadmap to systems that follow, adapt, and provide high-resolution images due to the advent of multichannel receiver systems, improved graphics, higher processor speeds, and increases in speed and quantity of memory. Hence, instruments can be reliably identified and tracked and the information can be used to update pulse sequence parameters in real time, thereby opening new opportunities for interventional MR imaging that extend from biopsy and thermal therapy to image-guided vascular and cardiac procedures. Today, we see such issues as RF heating of wires used for device localization and the noise generated by rapid switching of MR gradients being significant obstacles yet to overcome to allow the full strength of MR-guided interventions to be realized clinically. It is anticipated that these topics will emerge as critical concepts in the next decade of interventional MR imaging research.
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Affiliation(s)
- Jamal J Derakhshan
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
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