Active device tracking and high-resolution intravascular MRI using a novel catheter-based, opposed-solenoid phased array coil

Multi-parameter Analytical Method for B1 and SNR Analysis (MAMBA): An open source RF coil design tool

In Magnetic Resonance Imaging (MRI), radio frequency (RF) coils of different forms and shapes are used to maximize signal-to-noise ratio (SNR). RF coils are designed for clinical applications and have dimensions comparable with the target body part to be imaged, and they perform best when loaded by human tissue majority of which have conductivity values higher than 0.5 S/m. However, they are not properly tuned and matched for samples having low conductivity such as solid samples with low water content. Moreover, for samples with low filling factor and low conductivity, the noise in MRI is dominated by RF coil losses. In this case, RF coil design can be optimized to improve image SNR. Here, a new software tool (Multi-parameter Analytical Method for B1 and SNR Analysis) MAMBA is presented to design and compare volume coils of birdcage, solenoid, and loop-gap design for these samples. The input parameters of the tool are the sample properties, the coil design and the hardware properties, of which a relative SNR is determined. For that, a figure of merit is calculated from the coil sensitivity, applied resonant frequency and the resistive losses of sample, coil and capacitive components. The tool was tested in an ancient Egyptian mummy head which represents an extreme case of MRI with short T2*. Two optimized birdcage coils were designed using MAMBA, constructed and compared to a commercial transmit receive head coil. Calculated relative SNR values are in good agreement with the measurements.

MR-guided Cardiac Interventions

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.

Magnetic resonance conditional paramagnetic choke for suppression of imaging artifacts during magnetic resonance imaging

Higher risk patient populations require continuous physiological monitoring and, in some cases, connected life-support systems, during magnetic resonance imaging examinations. While recently there has been a shift toward wireless technology, some of the magnetic resonance imaging devices are still connected to the outside using cabling that could interfere with the magnetic resonance imaging's radio frequency during scanning, resulting in excessive heating. We developed a passive method for radio frequency suppression on cabling that may assist in making some of these devices magnetic resonance imaging compatible. A barrel-shaped strongly paramagnetic choke was developed to suppress induced radio frequency signals which are overlaid onto physiological monitoring leads during magnetic resonance imaging. It utilized a choke placed along the signal lines, with a gadolinium solution core. The choke's magnetic susceptibility was modeled, for a given geometric design, at increasing chelate concentration levels, and measured using a vibrating sample magnetometer. Radio frequency noise suppression versus frequency was quantified with network-analyzer measurements and tested using cabling placed in the magnetic resonance imaging scanner. Temperature-elevation and image-quality reduction due to the device were measured using American Society for Testing and Materials phantoms. Prototype chokes with gadolinium solution cores exhibited increasing magnetic susceptibility, and insertion loss (S21) also showed higher attenuation as gadolinium concentration increased. Image artifacts extending <4 mm from the choke were observed during magnetic resonance imaging, which agreed well with the predicted ∼3 mm artifact from the electrochemical machining simulation. An accompanying temperature increase of <1 °C was observed in the magnetic resonance imaging phantom trial. An effective paramagnetic choke for radio frequency suppression during magnetic resonance imaging was developed and its performance demonstrated.

Interventional magnetic resonance imaging guided carotid embolectomy using a novel resonant marker catheter: demonstration of preclinical feasibility

To assess the visualization and efficacy of a wireless resonant circuit (wRC) catheter system for carotid artery occlusion and embolectomy under real-time MRI guidance in vivo, and to compare MR imaging modality with x-ray for analysis of qualitative physiological measures of blood flow at baseline and after embolectomy. The wRC catheter system was constructed using a MR compatible PEEK fiber braided catheter (Penumbra, Inc, Alameda, CA) with a single insulated longitudinal copper loop soldered to a printed circuit board embedded within the catheter wall. In concordance with IACUC protocol (AN103047), in vivo carotid artery navigation and embolectomy were performed in four farm pigs (40-45 kg) under real-time MRI at 1.5T. Industry standard clots were introduced in incremental amounts until adequate arterial occlusion was noted in a total of n=13 arteries. Baseline vasculature and restoration of blood flow were confirmed via MR and x-ray imaging, and graded by the Thrombolysis in Cerebral Infarction (TICI) scale. Wilcoxon signed-rank tests were used to analyze differences in recanalization status between DSA and MRA imaging. Successful recanalizations (TICI 2b/3) were compared to clinical rates reported in literature via binomial tests. The wRC catheter system was visible both on 5° sagittal bSSFP and coronal GRE sequence. Successful recanalization was demonstrated in 11 of 13 occluded arteries by DSA analysis and 8 of 13 by MRA. Recanalization rates based on DSA (0.85) and MRA (0.62) were not significantly different from the clinical rate of mechanical aspiration thrombectomy reported in literature. Lastly, a Wilcoxon signed rank test indicated no significant difference between TICI scores analyzed by DSA and MRA. With demonstrated compatibility and visualization under MRI, the wRC catheter system is effective for in vivo endovascular embolectomy, suggesting progress towards clinical endovascular interventional MRI.

Modeling Endovascular MRI Coil Coupling With Transmit RF Excitation

OBJECTIVE

To model inductive coupling of endovascular coils with transmit RF excitation for selecting coils for MRI-guided interventions.

METHODS

Independent and computationally efficient FEM models are developed for the endovascular coil, cable, transmit excitation, and imaging domain. Electromagnetic and circuit solvers are coupled to simulate net B₁ + fields and induced currents and voltages. Our models are validated using the Bloch-Siegert B₁ + mapping sequence for a series-tuned multimode coil, capable of tracking, wireless visualization, and high-resolution endovascular imaging.

RESULTS

Validation shows good agreement at 24-, 28-, and 34-μT background RF excitation within experimental limitations. Quantitative coil performance metrics agree with simulation. A parametric study demonstrates tradeoff in coil performance metrics when varying number of coil turns. Tracking, imaging, and wireless marker multimode coil features and their integration is demonstrated in a pig study.

CONCLUSION

Developed models for the multimode coil were successfully validated. Modeling for geometric optimization and coil selection serves as a precursor to time consuming and expensive experiments. Specific applications demonstrated include parametric optimization, coil selection for a cardiac intervention, and an animal imaging experiment.

SIGNIFICANCE

Our modular, adaptable, and computationally efficient modeling approach enables rapid comparison, selection, and optimization of inductively coupled coils for MRI-guided interventions.

Using a low-amplitude RF pulse at echo time (LARFET) for device localization in MRI

We describe a new method for frequency down-conversion of MR signals acquired with the radio-frequency projections method for device localization. A low-amplitude, off-center RF pulse applied simultaneously with the echo signal is utilized as the reference for frequency down-conversion. Because of the low-amplitude and large offset from the Larmor frequency, the RF pulse minimally interfered with magnetic resonance of protons. We conducted an experiment with the coil placed at different positions to verify this concept. The down-converted signal was transformed into optical signal and transmitted via fiber-optic cable to a receiver unit placed outside the scanner room. The position of the coil could then be determined by the frequency analysis of this down-converted signal and superimposed on previously acquired MR images for comparison. Because of minimal positional errors (≤ 0.8 mm), this new device localization method may be adequate for most interventional MRI applications.

Acceleration and motion-correction techniques for high-resolution intravascular MRI

PURPOSE

High-resolution intravascular (IV) MRI is susceptible to degradation from physiological motion and requires high frame-rates for true endoscopy. Traditional cardiac-gating techniques compromise efficiency by reducing the effective scan rate. Here we test whether compressed sensing (CS) reconstruction and ungated motion-compensation using projection shifting, could provide faster motion-suppressed, IVMRI.

THEORY AND METHODS

CS reconstruction is developed for undersampled Cartesian and radial imaging using a new IVMRI-specific cost function to effectively increase imaging speed. A new motion correction method is presented wherein individual IVMRI projections are shifted based on the IVMRI detector's intrinsic amplitude and phase properties. The methods are tested at 3 Tesla (T) in fruit, human vessel specimens, and a rabbit aorta in vivo. Images are compared using structural-similarity and "spokal variation" indices.

RESULTS

Although some residual artifacts persisted, CS acceleration and radial motion compensation strategies reduced motion artifact in vitro and in vivo, allowing effective accelerations of up to eight-fold at 200-300 µm resolution.

CONCLUSION

The 3T IVMRI detectors are well-suited to CS and motion correction strategies based on their intrinsic radially-sparse sensitivity profiles and high signal-to-noise ratios.

Interventional device visualization with toroidal transceiver and optically coupled current sensor for radiofrequency safety monitoring

PURPOSE

The development of catheters and guidewires that are safe from radiofrequency (RF) -induced heating and clearly visible against background tissue is a major challenge in interventional MRI. An interventional imaging approach using a toroidal transmit-receive (transceive) coil is presented. This toroidal transceiver allows controlled, low levels of RF current to flow in the catheter/guidewire for visualization, and can be used with conductive interventional devices that have a localized low-impedance tip contact.

METHODS

Toroidal transceivers were built, and phantom experiments were performed to quantify transmit power levels required for device visibility and to detect heating hazards. Imaging experiments in a pig cadaver tested the extendibility to higher field strength and nonphantom settings. A photonically powered optically coupled toroidal current sensor for monitoring induced RF currents was built, calibrated, and tested using an independent image-based current estimation method.

RESULTS

Results indicate that high signal-to-noise ratio visualization is achievable using milliwatts of transmit power-power levels orders of magnitude lower than levels that induce measurable heating in phantom tests. Agreement between image-based current estimates and RF current sensor measurements validates sensor accuracy.

CONCLUSION

The toroidal transceiver, integrated with power and current sensing, could offer a promising platform for safe and effective interventional device visualization.

Wireless MR tracking of interventional devices using phase-field dithering and projection reconstruction

PURPOSE

Device tracking is crucial for interventional MRI (iMRI) because conventional device materials do not contribute to the MR signal, may cause susceptibility artifacts and are generally invisible if moved out of the scan plane. A robust method for wireless tracking and dynamic guidance of interventional devices equipped with wirelessly connected resonant circuits (wRC) is presented.

METHODS

The proposed method uses weak spatially-selective excitation pulses with very low flip angle (0.3°), a Hadamard multiplexed tracking scheme and employs phase-field dithering to obtain the 3D position of a wRC. RF induced heating experiments (ASTM protocol) and balloon angioplasties of the iliac artery were conducted in a perfused vascular phantom and three Thiel soft-embalmed human cadavers.

RESULTS

Device tip tracking was interleaved with various user-selectable fast pulse sequences receiving a geometry update from the tracking kernel in less than 30ms. Integrating phase-field dithering significantly improved our tracking robustness for catheters with small diameters (4-6 French). The volume root mean square distance error was 2.81mm (standard deviation: 1.31mm). No significant RF induced heating (<0.6°C) was detected during heating experiments.

CONCLUSION

This tip tracking approach provides flexible, fast and robust feedback loop, intuitive iMRI scanner interaction, does not constrain the physician and delivers very low specific absorption rates. Devices with wRC can be exchanged during a procedure without modifications to the iMRI setup or the pulse sequence. A drawback of our current implementation is that position information is available for a single tracking coil only. This was satisfactory for balloon angioplasties of the iliac artery, but further studies are required for complex navigation and catheter shapes before animal trials and clinical application.

Endoluminal MR-guided ultrasonic applicator embedding cylindrical phased-array transducers and opposed-solenoid detection coil

PURPOSE

MR-guided high-intensity contact ultrasound (HICU) was suggested as an alternative therapy for esophageal and rectal cancer. To offer high-quality MR guidance, two prototypes of receive-only opposed-solenoid coil were integrated with 64-element cylindrical phased-array ultrasound transducers (rectal/esophageal).

METHODS

The design of integrated coils took into account the transducer geometry (360° acoustic window within endoluminal space). The rectal coil was sealed on a plastic support and placed reversibly on the transducer head. The esophageal coil was fully embedded within the transducer head, resulting in one indivisible device. Comparison of integrated versus external coils was performed on a clinical 1.5T scanner.

RESULTS

The integrated coils showed higher sensitivity compared with the standard extracorporeal coil with factors of up to 7.5 (rectal applicator) and 3.3 (esophageal applicator). High-resolution MR images for both anatomy (voxel 0.4 × 0.4 × 5 mm(3)) and thermometry (voxel 0.75 × 0.75 × 8 mm(3), 2 s/image) were acquired in vivo with the rectal endoscopic device. The temperature feedback loop accurately controlled multiple control points over the region of interest.

CONCLUSION

This study showed significant improvement of MR data quality using endoluminal integrated coils versus standard external coil. Inframillimeter spatial resolution and accurate feedback control of MR-guided HICU thermotherapy were achieved.

Magneto-inductive catheter receiver for magnetic resonance imaging

A catheter-based RF receiver for internal magnetic resonance imaging is demonstrated. The device consists of a double-sided thin-film circuit, wrapped around a hollow catheter and sealed in place with heat-shrink tubing. Signals are detected using a resonant LC circuit at the catheter tip and transmitted along the catheter using an array of coupled LC circuits arranged as a magneto-inductive waveguide, a form of low frequency metamaterial. Coupling to a conventional RF system is accomplished using a demountable inductive transducer. Protection against external B 1 and E fields is obtained by using figure-of-eight elements with an electrical length shorter than that of an immersed dipole. The system is primarily designed for biliary imaging, can pass the biopsy channel of a side-opening duodenoscope, and is guidewire-compatible, potentially allowing clinicians to implement MR image guided procedures without changing their standard practice. Decoupling against B 1 and E fields is verified, and in vitro (1)H magnetic resonance imaging with submillimeter resolution is demonstrated at 1.5 T using phantoms.

Engineering novel detectors and sensors for MRI

Increasing detection sensitivity and image contrast have always been major topics of research in MRI. In this perspective, we summarize two engineering approaches to make detectors and sensors that have potential to extend the capability of MRI. The first approach is to integrate miniaturized detectors with a wireless powered parametric amplifier to enhance the detection sensitivity of remotely coupled detectors. The second approach is to microfabricate contrast agents with encoded multispectral frequency shifts, whose properties can be specified and fine-tuned by geometry. These two complementary approaches will benefit from the rapid development in nanotechnology and microfabrication which should enable new opportunities for MRI.

Prospective motion correction using tracking coils

Intracavity imaging coils provide higher signal-to-noise than surface coils and have the potential to provide higher spatial resolution in shorter acquisition times. However, images from these coils suffer from physiologically induced motion artifacts, as both the anatomy and the coils move during image acquisition. We developed prospective motion-correction techniques for intracavity imaging using an array of tracking coils. The system had <50 ms latency between tracking and imaging, so that the images from the intracavity coil were acquired in a frame of reference defined by the tracking array rather than by the system's gradient coils. Two-dimensional gradient-recalled and three-dimensional electrocardiogram-gated inversion-recovery-fast-gradient-echo sequences were tested with prospective motion correction using ex vivo hearts placed on a moving platform simulating both respiratory and cardiac motion. Human abdominal tests were subsequently conducted. The tracking array provided a positional accuracy of 0.7 ± 0.5 mm, 0.6 ± 0.4 mm, and 0.1 ± 0.1 mm along the X, Y, and Z directions at a rate of 20 frames-per-second. The ex vivo and human experiments showed significant image quality improvements for both in-plane and through-plane motion correction, which although not performed in intracavity imaging, demonstrates the feasibility of implementing such a motion-correction system in a future design of combined tracking and intracavity coil.

Initial feasibility testing of limited field of view magnetic resonance thermometry using a local cardiac radiofrequency coil

The visualization of lesion formation in real time is one potential benefit of carrying out radiofrequency ablation under magnetic resonance (MR) guidance in the treatment of atrial fibrillation. MR thermometry has the potential to detect such lesions. However, performing MR thermometry during cardiac radiofrequency ablation requires high temporal and spatial resolution and a high signal-to-noise ratio. In this study, a local MR coil (2-cm diameter) was developed to investigate the feasibility of performing limited field of view MR thermometry with high accuracy and speed. The local MR coil allowed high-resolution (1 × 1 × 3 mm(3)) image acquisitions in 76.3 ms with a field of view 64 × 32 mm(2) during an open-chest animal experiment. This represents a 4-fold image acquisition acceleration and an 18-fold field of view reduction compared to that achieved using external MR coils. The signal sensitivity achieved using the local coil was over 20 times greater than that achievable using external coils with the same scan parameters. The local coil configuration provided fewer artifacts and sharper and more stable images. These results demonstrate that MR thermometry can be performed in the heart wall and that lesion formation can be observed during radiofrequency ablation procedures in a canine model.

Implanted, inductively-coupled, radiofrequency coils fabricated on flexible polymeric material: application to in vivo rat brain MRI at 7 T

Combined with high-field MRI scanners, small implanted coils allow for high resolution imaging with locally improved SNR, as compared to external coils. Small flexible implantable coils dedicated to in vivo MRI of the rat brain at 7 T were developed. Based on the Multi-turn Transmission Line Resonator design, they were fabricated with a Teflon substrate using copper micromolding process and a specific metal-polymer adhesion treatment. The implanted coils were made biocompatible by PolyDimethylSiloxane (PDMS) encapsulation. The use of low loss tangent material achieves low dielectric losses within the substrate and the use of the PDMS layer reduces the parasitic coupling with the surrounding media. An implanted coil was implemented in a 7 T MRI system using inductive coupling and a dedicated external pick-up coil for signal transmission. In vivo images of the rat brain acquired with in plane resolution of (150 μm)(2) thanks to the implanted coil revealed high SNR near the coil, allowing for the visualization of fine cerebral structures.

Catheter tracking with phase information in a magnetic resonance scanner

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.

MR imaging-guided cardiovascular interventions in young children

Diagnostic cardiac catheterization procedures in children have been largely replaced by magnetic resonance (MR) imaging studies. However, when invasive catheterization is required, MR imaging has a significant role to play, when combined with invasive pressure measurements. Beyond the established reduction to the radiation dose involved, solely MR image-guided or MR image-assisted catheterization procedures can accurately address clinical questions, such as estimation of pulmonary vascular resistance and cardiac output response to stress, without needing to perform laborious measurements that are prone to errors. This article describes MR image-guided or MR image-assisted cardiac catheterization procedures for diagnosis and intervention in children.

CHIC: cylindrical helix imaging coordinate registration fiducial for MRI-guided interventions

Accurate placement of tubular shaped surgical tools is necessary for a large variety of image-guided medical interventions. In this process, localization of the instrument, or a robotic assistant manipulating the instrument, is crucial for successful registration of physical space to medical image space. Various fiducial frames and registration methods have been proposed and discussed in literature. However, these frames are typically bulky in size or otherwise not appropriate for use with MR imaging. In particular, it is impossible or awkward to integrate them with the surgical tools. This paper presents the design a compact Cylindrical Helix Imaging Coordinate Registration Fiducial (CHIC) and algorithm to precisely and robustly localize the frame in 6 degree of freedom (DOF). The mathematical model of the frame is developed and evaluated with simulation. This cylindrical shaped frame is particularly suitable for mounting to the distal end of tubular shape surgical tools, which provides a direct imaging visualization of frame, tool and possibly the surgical sites. The paper uses MRI-guided surgical procedure as a focusing application, although the broader aim is development of a versatile registration frame that is usable for a variety of image-guided procedures ranging from ultrasound to fluoroscopy and computerized tomography (CT). Accuracy and performance were evaluated in three cases: simulated images with artificial noise, arbitrarily re-sliced 3D MRI volume, and real 3T MRI images.

Tuning and amplification strategies for intravascular imaging coils

The manufacturing of intravascular imaging coils poses several challenges. Due to their size, it can be difficult to incorporate local matching networks and signal amplifiers. The goal of this study is to investigate tuning and amplification strategies for intravascular coils and to assess the signal-to-noise benefits of incorporating a matching network and/or miniature amplifier into catheter-based intravascular imaging devices at various locations in the signal chain. The results suggest that the use of a low-noise amplifier close to the receiving coil enables the use of miniature coaxial cables to be used despite being noisy. Moreover, an improvement in the signal-to-noise ratio of over 75% is presented over conventional intravascular coil configurations where the matching circuit and low-noise amplifier are placed at the proximal end. Therefore, designing devices for intravascular applications capable of generating high signal-to-noise ratio images becomes more feasible, also allowing for significant reductions in scan time.

A novel active MR probe using a miniaturized optical link for a 1.5-T MRI scanner

Applying an active intravascular MR catheter device that allows signal transmission from the catheter tip requires special means to avoid radiofrequency-induced heating. This article presents a novel, miniaturized all-optical active MR probe to use with real-time MRI in minimally invasive interventions for catheter guidance and intravascular imaging. An optical link transmits the received MR signals from the catheter tip to the MR receiver with inherently radiofrequency-safe optical fibers. Furthermore, power is supplied optically to the transmitter as well. The complete integration into a small tube of 6-Fr (2-mm diameter) size with a 7-Fr (2.33-mm diameter) rigid tubing was realized using chip components for the optical modulator and a novel miniaturized optical bench fabricated from silicon substrates with 3D self-aligning structures for fiber integration. In MRI phantom measurements, projection-based tip tracking and high-resolution imaging were successfully performed with the optical link inside a 1.5-T MRI scanner. Images were obtained in a homogeneous phantom liquid, and first pictures were acquired from inside a kiwi that demonstrates the potential of the MR-safe optical link. The signal-to-noise ratio has significantly improved compared with former systems, and it is demonstrated that the novel optical link exhibits a signal-to-noise ratio comparable to a direct electrical link.

Multimode intravascular RF coil for MRI-guided interventions

PURPOSE

To demonstrate the feasibility of using a single intravascular radiofrequency (RF) probe connected to the external magnetic resonance imaging (MRI) system via a single coaxial cable to perform active tip tracking and catheter visualization and high signal-to-noise ratio (SNR) intravascular imaging.

MATERIALS AND METHODS

A multimode intravascular RF coil was constructed on a 6F balloon catheter and interfaced to a 1.5T MRI scanner via a decoupling circuit. Bench measurements of coil impedances were followed by imaging experiments in saline and phantoms.

RESULTS

The multimode coil behaves as an inductively coupled transmit coil. The forward-looking capability of 6 mm was measured. A greater than 3-fold increase in SNR compared to conventional imaging using optimized external coil was demonstrated. Simultaneous active tip tracking and catheter visualization was demonstrated.

CONCLUSION

It is feasible to perform 1) active tip tracking, 2) catheter visualization, and 3) high SNR imaging using a single multimode intravascular RF coil that is connected to the external system via a single coaxial cable.

Development of a 0.014-in., anti-solenoid loop MR imaging guidewire for intravascular 3.0-T MR imaging

PURPOSE

This study aimed to develop a 0.014-in., anti-solenoid loop (ASL) magnetic resonance imaging guidewire (MRIG) for intravascular 3.0-T MR imaging.

MATERIALS AND METHODS

We first designed the ASL MRIG, which was made of a coaxial cable with its extended inner conductor and outer conductor connected to two micro-anti-solenoids. We then evaluated in vitro the functionality of the ASL MRIG by imaging a "vessel" in a phantom and achieving signal-to-noise ratio (SNR) and SNR contour map of the new 0.014-in. ASL MRIG. Subsequently, we validated in vivo the feasibility of using the ASL MRIG to generate intravenous 3.0-T MR images of parallel iliofemoral arteries of near-human-sized living pigs.

RESULTS

In vitro evaluation showed that the 0.014-in. ASL MRIG functioned well as a receiver coil with the 3.0-T MR scanner, clearly displaying the vessel wall with even distribution of MR signals and SNR contours from the ASL MRIG. Of the in vivo studies, the new ASL MRIG enabled us to successfully generate intravenous 3.0-T MR imaging of the iliofemoral arteries.

CONCLUSION

This study confirms that it is possible to build such small-looped MRIG at 0.014 in. for intravascular 3.0-T MR imaging.

Reverse polarized inductive coupling to transmit and receive radiofrequency coil arrays

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.

Multimodality cardiovascular molecular imaging technology

Cardiovascular molecular imaging is a new discipline that integrates scientific advances in both functional imaging and molecular probes to improve our understanding of the molecular basis of the cardiovascular system. These advances are driven by in vivo imaging of molecular processes in animals, usually small animals, and are rapidly moving toward clinical applications. Molecular imaging has the potential to revolutionize the diagnosis and treatment of cardiovascular disease. The 2 key components of all molecular imaging systems are the molecular contrast agents and the imaging system providing spatial and temporal localization of these agents within the body. They must deliver images with the appropriate sensitivity and specificity to drive clinical applications. As work in molecular contrast agents matures and highly sensitive and specific probes are developed, these systems will provide the imaging technologies required for translation into clinical tools. This is the promise of molecular medicine.

An expandable catheter loop coil for intravascular MRI in larger blood vessels

The present study proposes a catheter system with an expandable coil etched on a polyimide foil. The catheter system combines the advantages of a small insertion diameter when the coil is rolled up in a protective carrier sheath with an increased signal-to-noise ratio (SNR) and penetration depth when the coil is pushed out. After imaging, the coil can be retracted into the sheath and folded back into the initial rolled-up configuration due to the tapered geometry of the carrier foil. The catheter system was tested on two healthy anesthetized pigs, including tracking and high-resolution intravascular imaging. To reduce artifacts in high-resolution images induced by catheter motion in the pulsatile blood flow, a motion-gating method was implemented that combines a flow-compensated two-dimensional fast low angle shot (FLASH) imaging sequence with the acquisition of projection data for retrospective gating. Using the projection data for motion detection, image SNR was increased by up to 500% over uncorrected images, and anatomic structures of 150 microm size could be differentiated in the aorta.

Surgically implantable magnetic resonance angiography coils improve resolution to allow visualization of blood flow dynamics

BACKGROUND

Magnetic resonance angiography (MRA) is clinically useful but of limited applicability to small animal models due to poor signal resolution, with typical voxel sizes of 1 mm(3) that are insufficient to analyze vessels of diameter <1 mm. We determined whether surgically implantable, extravascular MRA coils increase signal resolution adequately to examine blood flow dynamics

METHODS

A custom MRA coil was surgically implanted near the carotid artery of a New Zealand White rabbit. A stenosis was created in the carotid artery to induce complicated, non-laminar flow. Phase contrast images were obtained on multiple axial planes with 3T MRA and through-plane velocity profiles were calculated under laminar and complicated flow conditions. These velocity profiles were fit to a laminar flow model using ordinary least squares in order to quantify the degree of flow complication (Matlab). Flow was also measured with a Doppler flow probe; vessel diameters and flow velocities were compared with duplex ultrasound

RESULTS

Carotid artery blood flow was 24.7 +/- 2.6 ml/min prior to stenosis creation and reduced to 12.0 +/- 1.7 ml/min following injury (n=3). An MRA voxel size of 0.1 x 0.1 x 5 mm was achieved. The control carotid artery diameter was 1.9 +/- 0.1 mm, and cross-sectional images containing 318 +/- 22 voxels were acquired (n=26). Velocity profiles resembled laminar flow proximal to the stenosis, and then became more complicated just proximal and distal to the stenosis. Laminar flow conditions returned downstream of the stenosis

CONCLUSION

Implantable, extra-vascular coils enable small MRA voxel sizes to reproducibly calculate complex velocity profiles under both laminar and complicated flow in a small animal model. This technique may be applied to study blood flow dynamics of vessel remodeling and atherogenesis.

Improved in-stent lumen visualization using intravascular MRI and a balanced steady-state free-precession sequence

RATIONALE AND OBJECTIVES

To investigate the ability of an intravascular magnetic resonance (MR) loopless antenna to reduce the radiofrequency shielding of a vascular stent during signal reception as a way to improve the visualization of the in-stent lumen.

METHODS AND MATERIALS

Using a balanced steady-state free-precession (bSSFP) sequence and a dedicated vascular phantom, the signal-to-noise ratio (SNR) inside the lumen of a stent is evaluated as a function of the nominal flip angle and compared with the results obtained for a reference vessel without a stent. All experiments are performed using successively an intravascular loopless antenna and surface arrays coils. Using an optimized protocol, in vitro in-stent restenosis visualization and quantification experiments are performed to evaluate the validity of an approach using an intravascular antenna and cross-sectional images to depict a vascular lesion inside a stent.

RESULTS

The use of a loopless antenna effectively eliminates the radiofrequency shielding effect of the stent during signal reception. Furthermore, using a bSSFP sequence with a carefully chosen nominal flip angle, an equally good blood SNR can be obtained inside and outside the stent. Results of in vitro in-stent restenosis quantification measurements using the proposed method illustrate the benefits arising from the use of the intravascular antenna.

CONCLUSION

In the perspective of MR-guided vascular interventions, the presented results illustrate that the use of an intravascular antenna can significantly facilitate imaging inside a vascular stent. Potential applications include the monitoring of stent deployment as well as visualization and quantification of in-stent restenosis during an intervention.

Comparative evaluation of the geometrical accuracy of intravascular magnetic resonance imaging: a phantom study

RATIONALE AND OBJECTIVES

To evaluate and compare the accuracy of cross-sectional imaging using an intravascular antenna in the context of vascular morphological measurements performed during a magnetic resonance imaging (MRI)-guided vascular intervention.

MATERIALS AND METHODS

Cross-sectional imaging of a multimodality vascular phantom was performed using intravascular and surface MRI, multidetector computed tomography, and intravascular ultrasound (IVUS). Using a balanced steady-state free-precession sequence, 18 sequences parameters sets were investigated (12 for intravascular MRI and 6 for surface MRI). Vessel diameters for all images and modalities were computed using an automated vessel segmentation algorithm.

RESULTS

Using IVUS as a gold standard, imaging using an intravascular antenna leads to an increase in geometrical accuracy in comparison to traditional surface MRI. This level of accuracy appears to follow a significant inverse proportionality relation in respect to vessel wall signal-to-noise ratio (SNR). Taking into account the rapid decrease in SNR as a function of the distance to the intravascular antenna, these results imply that, for a given level of geometrical accuracy, faster sequences can be used for the imaging of smaller vessels.

CONCLUSION

Imaging using an intravascular antenna appears as a valuable assistance to increase the accuracy of vascular morphological measurements. This increase in geometrical accuracy would be beneficial during the realization of an MRI-guided intervention, either to perform pretreatment measurements or to assess the outcome of the procedure. Acquisition parameters should be tailored to vessel size and procedural time constraints.

Interventional cardiovascular magnetic resonance: still tantalizing

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."

Forward-looking intravascular orthogonal-solenoid coil for imaging and guidance in occlusive arterial disease

Recent intravascular imaging coil configurations have focused on side-viewing catheters capable of imaging the vessel wall of a patent vessel. These designs suffer from the presence of signal nulls and the inability to image in front of a device when it is oriented along the main static field. This is of particular importance when a device is being navigated through an occlusive lesion. To address these limitations we propose a new intravascular coil design consisting of two independent orthogonal solenoids located at the catheter tip. The two coils are oriented in such a way that signal nulls are eliminated and imaging is possible in planes located directly in front of the catheter. Complete characterization of the spatial signal-to-noise ratio (SNR) distribution of the design is presented. The coil configuration was fabricated on a 6F guide catheter, and its use is demonstrated in phantoms and in vivo.

Adapting the clinical MRI software environment for real-time navigation of an endovascular untethered ferromagnetic bead for future endovascular interventions

A dedicated software architecture for a novel interventional method allowing the navigation of ferromagnetic endovascular devices using a standard real-time clinical MRI system is shown. Through a specially developed software environment integrating a tracking method and a real-time controller algorithm, a clinical 1.5T Siemens Avanto MRI system is adapted to provide new functionality for potential automated interventional applications. The proposed software architecture was successfully validated through in vivo controlled navigation inside the carotid artery of a swine. Here we present how this MRI-upgraded software environment could also be used in more complex vasculature models through the real-time navigation of a 1.5 mm diameter chrome steel bead in two different MR-compatible phantoms with flowless and quiescent flow conditions. The developed platform and software modules needed for such navigation are also presented. Real-time tracking achieved through a dedicated positioning method based on an off-resonance excitation technique has also been successfully integrated in the software platform while maintaining adequate real-time performance. These preliminary feasibility experiments suggest that navigation of such devices can be achieved using a similar software architecture on other conventional clinical MRI systems at an operational closed-loop control frequency of 32 Hz.

Real-time magnetic resonance imaging guidance for cardiovascular procedures

Magnetic resonance imaging (MRI) of the cardiovascular system has proven to be an invaluable diagnostic tool. Given the ability to allow for real-time imaging, MRI guidance of intraoperative procedures can provide superb visualization, which can facilitate a variety of interventions and minimize the trauma of the operations as well. In addition to the anatomic detail, MRI can provide intraoperative assessment of organ and device function. Instruments and devices can be marked to enhance visualization and tracking, all of which is an advance over standard X-ray or ultrasonic imaging.

MR-guided biopsy: a review of current techniques and applications

Biopsy has become a cornerstone of modern medicine and most modern biopsies are performed percutaneously using image guidance, typically computed tomography or ultrasound. MR-guided biopsy offers many advantages over these more traditional modalities, and the recent development of interventional MR imaging techniques has made MR-guided percutaneous biopsies and aspirations a clinical reality. As the field of MR-guided procedures continues to expand and to attract more attention from radiologists, it is important to understand the concepts, techniques, applications, advantages, and limitations of MR-guided biopsy/percutaneous procedures. Radiologists should also recognize the need for their significant involvement in the technical aspects of MR-guided procedures, since several user-defined parameters can alter device visualization in the MR imaging environment and affect procedure safety. This article reviews the prerequisites, systems, and applications of MR-guided biopsy.

Sequence design and software environment for real-time navigation of a wireless ferromagnetic device using MRI system and single echo 3D tracking

Software architecture for the navigation of a ferromagnetic untethered device in a 1D and 2D phantom environment is briefly described. Navigation is achieved using the real-time capabilities of a Siemens 1.5 T Avanto MRI system coupled with a dedicated software environment and a specially developed 3D tracking pulse sequence. Real-time control of the magnetic core is executed through the implementation of a simple PID controller. 1D and 2D experimental results are presented.

Interventional cardiovascular procedures guided by real-time MR imaging: an interactive interface using multiple slices, adaptive projection modes and live 3D renderings

PURPOSE

To develop and test a novel interactive real-time MRI environment that facilitates image-guided cardiovascular interventions.

MATERIALS AND METHODS

Color highlighting of device-mounted receiver coils, accelerated imaging of multiple slices, adaptive projection modes, live three-dimensional (3D) renderings and other interactive features were utilized to enhance navigation of devices and targeting of tissue.

RESULTS

Images are shown from several catheter-based interventional procedures performed in swine that benefit from this custom interventional MRI interface. These include endograft repair of aortic aneurysm, balloon septostomy of the cardiac interatrial septum, angioplasty and stenting, and endomyocardial cell injection, all using active catheters containing MRI receiver coils.

CONCLUSION

Interactive features not available on standard clinical scanners enhance real-time MRI for guiding cardiovascular interventional procedures.

Magnetic resonance-compatible robotic and mechatronics systems for image-guided interventions and rehabilitation: a review study

The continuous technological progress of magnetic resonance imaging (MRI), as well as its widespread clinical use as a highly sensitive tool in diagnostics and advanced brain research, has brought a high demand for the development of magnetic resonance (MR)-compatible robotic/mechatronic systems. Revolutionary robots guided by real-time three-dimensional (3-D)-MRI allow reliable and precise minimally invasive interventions with relatively short recovery times. Dedicated robotic interfaces used in conjunction with fMRI allow neuroscientists to investigate the brain mechanisms of manipulation and motor learning, as well as to improve rehabilitation therapies. This paper gives an overview of the motivation, advantages, technical challenges, and existing prototypes for MR-compatible robotic/mechatronic devices.

Magnetically-assisted remote control (MARC) steering of endovascular catheters for interventional MRI: a model for deflection and design implications

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.

Investigation of micro-ultrasound for microvessel imaging in a model of chronic total occlusion

The aim of the current study is to investigate the ability of micro-ultrasound (microUS) to identify microvasculature in CTOs in vivo. Results are compared with MRI studies. CTOs were developed in nine porcine superficial femoral arteries (SFA) by percutaneous insertion of a dissolvable polymer plug. This model is characterized by acute thrombosis that later organizes into a fibrotic CTO containing abundant microchannels. 3D microUS images with Power Doppler (PD) overlays from the arteries were acquired at two timepoints: one and eight weeks after placement ofthe polymerplug. Phase contrast MRI and contrast enhanced MRI was also performed. Imaging was performed transcutaneously. Microvessels were identified in vivo in six of eight CTOs using microUS, and in three of seven CTO vessels with MRI, compared with five of seven seen histologically. PW Doppler profiles showed pulsatile blood velocities of approximately 2 cm/s. Intraluminal microvessels within CTOs can be consistently identified by 3D microUS. This technique appears to be more sensitive than MRI. MicroUS may play a role in guiding CTO interventions.

An overview on the advances in cardiovascular interventional MR imaging

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.

Correction of intensity inhomogeneity in MR images of vascular disease

We are involved in a comprehensive program to characterize atherosclerotic disease using multiple MR images having different contrast mechanisms (T1W, T2W, PDW, magnetization transfer, etc.) of human carotid and animal model arteries. We use specially designed intravascular and surface array coils that give high signal-to-noise but suffer from sensitivity inhomogeneity and significant noise. We present here a new non-parametric method for correcting the images without assumption of the number of different tissues. Intensity inhomogeneity is modeled with cubic spline and is locally optimized using an entropy criterion. Validation has been performed on a specially design neck phantom as well as actual MR scans on patient neck. This same algorithm has been successfully applied to the correction of very high resolution, intravascular coil images. The steep bias is corrected sufficiently to aid human interpretation of gray scales. It should also make possible computerized tissue classification.

Real-time Magnetic Resonance Gradient-based Propulsion of a Wireless Microdevice Using Pre-Acquired Roadmap and Dedicated Software Architecture

A new method for the propulsion of a spherical ferromagnetic device along a given path in a water filled phantom with no human interaction is presented using an 1.5 T Magnetic Resonance Imaging (MRI) clinical system. A special real time loop is implemented and presented that feeds the scanner with the appropriate gradients amplitudes and directions based on a pre-determined path. This paper studies the necessary propulsion conditions and limitations such as device dimensions and necessary gradient amplitude as well as overall latency problems such as communication delays and computation delays needed to achieve precise propulsion. It also presents a dedicated software environment for path control and validation, propulsion and tracking of such device.

Performance of interventions with manipulator-driven real-time MR guidance: implementation and initial in vitro tests

The purpose of this work was to implement and assess the performance of interventions inside a cylindrical magnetic resonance imaging (MRI) scanner with an MR-compatible manipulator system and manipulator-driven real-time MR guidance. The interventional system is based on a seven degree-of-freedom MR-compatible manipulator, which offers man-in-the-loop control either with a graphical user interface or with a master/slave device. The position and the orientation of the interventional tool are sent to an MR scanner for a manipulator-driven dynamic update of the imaging plane to track, visualize and guide the motion of an end-effector. Studies on phantoms were performed with a cylindrical 1.5-T scanner using an operator-managed triggered gradient-recalled echo (GRE) or a computer-managed dynamic True Fast Imaging with Steady Precession (TrueFISP). Targets were acquired with an accuracy of 3.2 mm and with an in-plane path orientation of 2.5 degrees relative to the prescribed one. Path planning, including negotiation of obstacles and needle bending, was successfully performed. The signal-to-noise ratio (SNR) of TrueFISP was 25.3+/-2.1 when the manipulator was idle and was 18.6+/-2.4 during its operation. The SNR of triggered GRE (acquired only when the manipulator was idle) was 61.3+/-1.8. In conclusion, this study shows the feasibility of performing manually directed interventions inside cylindrical MR scanners with real-time MRI.

MR imaging in assessing cardiovascular interventions and myocardial injury

Performing an MR-guided endovascular intervention requires (1) real-time tracking and guidance of catheters/guide wires to the target, (2) high-resolution images of the target and its surroundings in order to define the extent of the target, (3) performing a therapeutic procedure (delivery of stent or injection of gene or cells) and (4) evaluating the outcome of the therapeutic procedure. The combination of X-ray and MR imaging (XMR) in a single suite was designed for new interventional procedures. MR contrast media can be used to delineate myocardial infarcts and microvascular obstruction, thereby defining the target for local delivery of therapeutic agents under MR-guidance. Iron particles, or gadolinium- or dysprosium-chelates are mixed with the soluble injectates or stem cells in order to track intramyocardial delivery and distribution. Preliminary results show that genes encoded for vascular endothelial and fibroblast growth factor and cells are effective in promoting angiogenesis, arteriogenesis, perfusion and LV function. Angiogenic growth factors, genes and cells administered under MR-guided minimally invasive catheter-based procedures will open up new avenues in treating end-stage ischemic heart disease. The optimum dose of the therapeutic agents, delivery devices and real-time imaging techniques to guide the delivery are currently the subject of ongoing research. The aim of this review is to (1) provide an updated review of experiences using MR imaging to guide transcatheter therapy, (2) address the potential of cardiovascular magnetic resonance (MR) imaging and MR contrast media in assessing myocardial injury at a molecular level and labeling cells and (3) illustrate the applicability of the non-invasive MR imaging in the field of angiogenic therapies through recent clinical and experimental publications.

Needle positioning in interventional MRI procedure: real time optical localisation and accordance with the roadmap

This study presents a system designed to assist the surgeon during interventional procedures performed by Magnetic Resonance Imaging (MRI). In order to reach the target during guidance in a double obliquity trajectory, this system provides accurate information about both the entry point and the orientation of the needle.

Current Concepts in the Management of Intracranial Atherosclerotic Disease

MEDICALLY REFRACTORY, SYMPTOMATIC intracranial atherosclerotic disease has a poor prognosis. Based on the results of the Warfarin-Aspirin Symptomatic Intracranial Disease study, the risk of ipsilateral stroke at 1.8 years is between 13 and 14% in patients with symptomatic intracranial atherosclerosis. Synergistic advances in intracranial angioplasty and stenting, modern neuroimaging techniques, and periprocedural and postprocedural antithrombotic regimens are creating new models for the diagnosis and successful endovascular treatment of intracranial stenosis. In this article, the most recent clinical developments and concepts for the diagnosis and endovascular treatment of intracranial atherosclerotic disease are discussed.

In vivo cardiovascular catheterization under real-time MRI guidance

PURPOSE

To test the hypothesis that cardiac and coronary catheterization can be successfully performed under real-time MR guidance using a conventional x-ray angiographic catheter.

MATERIALS AND METHODS

Cardiac and coronary catheterization was conducted on eight farm pigs using a real-time True FISP sequence. A pigtail catheter was used for both left- and right-heart catheterizations performed on all eight animals, while an Amplatz or Judkins catheter was used for the right coronary catheterization that was attempted on five animals. The intravascular devices were visualized by means of their native susceptibility artifacts. For right coronary artery catheterizations, 25% diluted gadolinium (Gd) contrast material was injected to confirm engagement of the right coronary artery.

RESULTS

Cardiac catheterization of both the right- and left-heart chambers was successfully performed in all eight pigs. In addition, right coronary catheterization was successfully completed in four of the five pigs in which it was attempted. The procedure time for cardiac catheterization was one minute, while the time range required for coronary catheterization was 32-91 minutes.

CONCLUSION

This work demonstrates that MRI-guided cardiac catheterization using conventional X-ray angiographic catheters is feasible; however, coronary catheterization with this passive-tracking technique is limited.