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Nijsink H, Overduin CG, Willems LH, Warlé MC, Fütterer JJ. Current State of MRI-Guided Endovascular Arterial Interventions: A Systematic Review of Preclinical and Clinical Studies. J Magn Reson Imaging 2022; 56:1322-1342. [PMID: 35420239 PMCID: PMC9790618 DOI: 10.1002/jmri.28205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND MRI guidance of arterial endovascular interventions could be beneficial as it does not require radiation exposure, allows intrinsic blood-tissue contrast, and enables three-dimensional and functional imaging, however, clinical applications are still limited. PURPOSE To review the current state of MRI-guided arterial endovascular interventions and to identify the most commonly reported challenges. STUDY TYPE Systematic review. POPULATION Pubmed, Embase, Web of Science, and The Cochrane Library were systematically searched to find relevant articles. The search strategy combined synonyms for vascular pathology, endovascular therapy, and real-time MRI guidance. FIELD STRENGTH/SEQUENCE No field strength or sequence restrictions were applied. ASSESSMENT Two reviewers independently identified and reviewed the original articles and extracted relevant data. STATISTICAL TESTS Results of the included original articles are reported. RESULTS A total of 24,809 studies were identified for screening. Eighty-eight studies were assessed for eligibility, after which data were extracted from 43 articles (6 phantom, 33 animal, and 4 human studies). Reported technical success rates for animal and human studies ranged between 42% to 100%, and the average complication rate was 5.8% (animal studies) and 8.8% (human studies). Main identified challenges were related to spatial and temporal resolution as well as safety, design, and scarcity of current MRI-compatible endovascular devices. DATA CONCLUSION MRI guidance of endovascular arterial interventions seems feasible, however, included articles included mostly small single-center case series. Several hurdles remain to be overcome before larger trials can be undertaken. Main areas of research should focus on adequate imaging protocols with integrated tracking of dedicated endovascular devices.
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Affiliation(s)
- Han Nijsink
- Department of Medical ImagingRadboudumcNijmegenNetherlands
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Kilbride BF, Narsinh KH, Jordan CD, Mueller K, Moore T, Martin AJ, Wilson MW, Hetts SW. MRI-guided endovascular intervention: current methods and future potential. Expert Rev Med Devices 2022; 19:763-778. [PMID: 36373162 PMCID: PMC9869980 DOI: 10.1080/17434440.2022.2141110] [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: 04/06/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Image-guided endovascular interventions, performed using the insertion and navigation of catheters through the vasculature, have been increasing in number over the years, as minimally invasive procedures continue to replace invasive surgical procedures. Such endovascular interventions are almost exclusively performed under x-ray fluoroscopy, which has the best spatial and temporal resolution of all clinical imaging modalities. Magnetic resonance imaging (MRI) offers unique advantages and could be an attractive alternative to conventional x-ray guidance, but also brings with it distinctive challenges. AREAS COVERED In this review, the benefits and limitations of MRI-guided endovascular interventions are addressed, systems and devices for guiding such interventions are summarized, and clinical applications are discussed. EXPERT OPINION MRI-guided endovascular interventions are still relatively new to the interventional radiology field, since significant technical hurdles remain to justify significant costs and demonstrate safety, design, and robustness. Clinical applications of MRI-guided interventions are promising but their full potential may not be realized until proper tools designed to function in the MRI environment are available. Translational research and further preclinical studies are needed before MRI-guided interventions will be practical in a clinical interventional setting.
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Affiliation(s)
- Bridget F. Kilbride
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Kazim H. Narsinh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Teri Moore
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Alastair J. Martin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Mark W. Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Steven W. Hetts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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Yaras YS, Yildirim DK, Herzka DA, Rogers T, Campbell-Washburn AE, Lederman RJ, Degertekin FL, Kocaturk O. Real-time device tracking under MRI using an acousto-optic active marker. Magn Reson Med 2020; 85:2904-2914. [PMID: 33347642 DOI: 10.1002/mrm.28625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/30/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This work aims to demonstrate the use of an "active" acousto-optic marker with enhanced visibility and reduced radiofrequency (RF) -induced heating for interventional MRI. METHODS The acousto-optic marker was fabricated using bulk piezoelectric crystal and π-phase shifted fiber Bragg grating (FBGs) and coupled to a distal receiver coil on an 8F catheter. The received MR signal is transmitted over an optical fiber to mitigate RF-induced heating. A photodetector converts the optical signal into electrical signal, which is used as the input signal to the MRI receiver plug. Acousto-optic markers were characterized in phantom studies. RF-induced heating risk was evaluated according to ASTM 2182 standard. In vivo real-time tracking capability was tested in an animal model under a 0.55T scanner. RESULTS Signal-to-noise ratio (SNR) levels suitable for real-time tracking were obtained by using high sensitivity FBG and piezoelectric transducer with resonance matched to Larmor frequency. Single and multiple marker coils integrated to 8F catheters were readout for position and orientation tracking by a single acousto-optic sensor. RF-induced heating was significantly reduced compared to a coax cable connected reference marker. Real-time distal tip tracking of an active device was demonstrated in an animal model with a standard real-time cardiac MR sequence. CONCLUSION Acousto-optic markers provide sufficient SNR with a simple structure for real-time device tracking. RF-induced heating is significantly reduced compared to conventional active markers. Also, multiple RF receiver coils connected on an acousto-optic modulator can be used on a single catheter for determining catheter orientation and shape.
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Affiliation(s)
- Yusuf S Yaras
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Micromachined Sensors and Transducers Group, Atlanta, Georgia, USA
| | - Dursun Korel Yildirim
- National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Daniel A Herzka
- National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Toby Rogers
- National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | | | - Robert J Lederman
- National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - F Levent Degertekin
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Micromachined Sensors and Transducers Group, Atlanta, Georgia, USA
| | - Ozgur Kocaturk
- Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Istanbul, Turkey
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Poly(acrylic acid) microspheres loaded with superparamagnetic iron oxide nanoparticles for transcatheter arterial embolization and MRI detectability: In vitro and in vivo evaluation. Int J Pharm 2017; 527:31-41. [DOI: 10.1016/j.ijpharm.2017.04.069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/17/2017] [Accepted: 04/28/2017] [Indexed: 02/07/2023]
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Lillaney PV, Yang JK, Losey AD, Martin AJ, Cooke DL, Thorne BRH, Barry DC, Chu A, Stillson C, Do L, Arenson RL, Saeed M, Wilson MW, Hetts SW. Endovascular MR-guided Renal Embolization by Using a Magnetically Assisted Remote-controlled Catheter System. Radiology 2016; 281:219-28. [PMID: 27019290 DOI: 10.1148/radiol.2016152036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose To assess the feasibility of a magnetically assisted remote-controlled (MARC) catheter system under magnetic resonance (MR) imaging guidance for performing a simple endovascular procedure (ie, renal artery embolization) in vivo and to compare with x-ray guidance to determine the value of MR imaging guidance and the specific areas where the MARC system can be improved. Materials and Methods In concordance with the Institutional Animal Care and Use Committee protocol, in vivo renal artery navigation and embolization were tested in three farm pigs (mean weight 43 kg ± 2 [standard deviation]) under real-time MR imaging at 1.5 T. The MARC catheter device was constructed by using an intramural copper-braided catheter connected to a laser-lithographed saddle coil at the distal tip. Interventionalists controlled an in-room cart that delivered electrical current to deflect the catheter in the MR imager. Contralateral kidneys were similarly embolized under x-ray guidance by using standard clinical catheters and guidewires. Changes in renal artery flow and perfusion were measured before and after embolization by using velocity-encoded and perfusion MR imaging. Catheter navigation times, renal parenchymal perfusion, and renal artery flow rates were measured for MR-guided and x-ray-guided embolization procedures and are presented as means ± standard deviation in this pilot study. Results Embolization was successful in all six kidneys under both x-ray and MR imaging guidance. Mean catheterization time with MR guidance was 93 seconds ± 56, compared with 60 seconds ± 22 for x-ray guidance. Mean changes in perfusion rates were 4.9 au/sec ± 0.8 versus 4.6 au/sec ± 0.6, and mean changes in renal flow rate were 2.1 mL/min/g ± 0.2 versus 1.9 mL/min/g ± 0.2 with MR imaging and x-ray guidance, respectively. Conclusion The MARC catheter system is feasible for renal artery catheterization and embolization under real-time MR imaging in vivo, and quantitative physiologic measures under MR imaging guidance were similar to those measured under x-ray guidance, suggesting that the MARC catheter system could be used for endovascular procedures with interventional MR imaging. (©) RSNA, 2016.
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Affiliation(s)
- Prasheel V Lillaney
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Jeffrey K Yang
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Aaron D Losey
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Alastair J Martin
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Daniel L Cooke
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Bradford R H Thorne
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - David C Barry
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Andrew Chu
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Carol Stillson
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Loi Do
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Ronald L Arenson
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Maythem Saeed
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Mark W Wilson
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
| | - Steven W Hetts
- From the Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, Room 320, San Francisco, CA 94107-5705 (P.V.L., J.K.Y., A.D.L., A.J.M., D.L.C., B.R.H.T., C.S., L.D., R.L.A., M.S., M.W.W., S.W.H.); and Penumbra, Alameda, Calif (D.C.B., A.C.)
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Comparative ergonomic workflow and user experience analysis of MRI versus fluoroscopy-guided vascular interventions: an iliac angioplasty exemplar case study. Int J Comput Assist Radiol Surg 2015; 10:1639-50. [DOI: 10.1007/s11548-015-1152-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 01/26/2015] [Indexed: 12/12/2022]
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Radioembolization Dosimetry: The Road Ahead. Cardiovasc Intervent Radiol 2014; 38:261-9. [DOI: 10.1007/s00270-014-1042-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/28/2014] [Indexed: 12/25/2022]
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Eibofner F, Wojtczyk H, Graf H, Clasen S. Magnetic resonance visualization of conductive structures by sequence-triggered direct currents and spin-echo phase imaging. Med Phys 2014; 41:062301. [PMID: 24877833 DOI: 10.1118/1.4875679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Instrument visualization in interventional magnetic resonance imaging (MRI) is commonly performed via susceptibility artifacts. Unfortunately, this approach suffers from limited conspicuity in inhomogeneous tissue and disturbed spatial encoding. Also, susceptibility artifacts are controllable only by sequence parameters. This work presents the basics of a new visualization method overcoming such problems by applying sequence-triggered direct current (DC) pulses in spin-echo (SE) imaging. SE phase images allow for background free current path localization. METHODS Application of a sequence-triggered DC pulse in SE imaging, e.g., during a time period between radiofrequency excitation and refocusing, results in transient field inhomogeneities. Dependent on the additional z-magnetic field from the DC, a phase offset results despite the refocusing pulse. False spatial encoding is avoided by DC application during periods when read-out or slice-encoding gradients are inactive. A water phantom containing a brass conductor (water equivalent susceptibility) and a titanium needle (serving as susceptibility source) was used to demonstrate the feasibility. Artifact dependence on current strength and orientation was examined. RESULTS Without DC, the brass conductor was only visible due to its water displacement. The titanium needle showed typical susceptibility artifacts. Applying triggered DC pulses, the phase offset of spins near the conductor appeared. Because SE phase images are homogenous also in regions of persistent field inhomogeneities, the position of the conductor could be determined with high reliability. Artifact characteristic could be easily controlled by amperage leaving sequence parameters unchanged. For an angle of 30° between current and static field visualization was still possible. CONCLUSIONS SE phase images display the position of a conductor carrying pulsed DC free from artifacts caused by persistent field inhomogeneities. Magnitude and phase images are acquired simultaneously under the same conditions without the use of extra measurement time. The presented technique offers many advantages for precise instrument localization in interventional MRI.
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Affiliation(s)
- Frank Eibofner
- Section on Experimental Radiology, University Hospital Tübingen, Tübingen D-72076, Germany
| | - Hanne Wojtczyk
- Section on Experimental Radiology, University Hospital Tübingen, Tübingen D-72076, Germany
| | - Hansjörg Graf
- Section on Experimental Radiology, University Hospital Tübingen, Tübingen D-72076, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen D-72076, Germany
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Losey AD, Lillaney P, Martin AJ, Cooke DL, Wilson MW, Thorne BRH, Sincic RS, Arenson RL, Saeed M, Hetts SW. Magnetically assisted remote-controlled endovascular catheter for interventional MR imaging: in vitro navigation at 1.5 T versus X-ray fluoroscopy. Radiology 2014; 271:862-9. [PMID: 24533872 DOI: 10.1148/radiol.14132041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare in vitro navigation of a magnetically assisted remote-controlled (MARC) catheter under real-time magnetic resonance (MR) imaging with manual navigation under MR imaging and standard x-ray guidance in endovascular catheterization procedures in an abdominal aortic phantom. MATERIALS AND METHODS The 2-mm-diameter custom clinical-grade microcatheter prototype with a solenoid coil at the distal tip was deflected with a foot pedal actuator used to deliver 300 mA of positive or negative current. Investigators navigated the catheter into branch vessels in a custom cryogel abdominal aortic phantom. This was repeated under MR imaging guidance without magnetic assistance and under conventional x-ray fluoroscopy. MR experiments were performed at 1.5 T by using a balanced steady-state free precession sequence. The mean procedure times and percentage success data were determined and analyzed with a linear mixed-effects regression analysis. RESULTS The catheter was clearly visible under real-time MR imaging. One hundred ninety-two (80%) of 240 turns were successfully completed with magnetically assisted guidance versus 144 (60%) of 240 turns with nonassisted guidance (P < .001) and 119 (74%) of 160 turns with standard x-ray guidance (P = .028). Overall mean procedure time was shorter with magnetically assisted than with nonassisted guidance under MR imaging (37 seconds ± 6 [standard error of the mean] vs 55 seconds ± 3, P < .001), and time was comparable between magnetically assisted and standard x-ray guidance (37 seconds ± 6 vs 44 seconds ± 3, P = .045). When stratified by angle of branch vessel, magnetic assistance was faster than nonassisted MR guidance at turns of 45°, 60°, and 75°. CONCLUSION In this study, a MARC catheter for endovascular navigation under real-time MR imaging guidance was developed and tested. For catheterization of branch vessels arising at large angles, magnetically assisted catheterization was faster than manual catheterization under MR imaging guidance and was comparable to standard x-ray guidance.
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Affiliation(s)
- Aaron D Losey
- From the Department of Radiology and Biomedical Imaging, School of Medicine, University of California-San Francisco, 185 Berry St, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705
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de Leeuw H, Moerland MA, van Vulpen M, Seevinck PR, Bakker CJG. A dual-plane co-RASOR technique for accurate and rapid tracking and position verification of an Ir-192 source for single fraction HDR brachytherapy. Phys Med Biol 2013; 58:7829-39. [DOI: 10.1088/0031-9155/58/21/7829] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dominguez-Viqueira W, Karimi H, Lam WW, Cunningham CH. A controllable susceptibility marker for passive device tracking. Magn Reson Med 2013; 72:269-75. [PMID: 23921910 DOI: 10.1002/mrm.24899] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/06/2013] [Accepted: 07/01/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE To design and demonstrate a new susceptibility-based tracking device with an artifact that can be mechanically turned on and off, thus permitting tracking and imaging at the device tip with limited artifact. METHODS The magnetic susceptibilities of readily obtainable grades of titanium and graphite were measured. Using numerical optimization, layer thicknesses for three concentric cylinders were found where the field from the graphite layer maximally cancelled the fields from titanium layers. The tracking elements were fabricated for an outer diameter of 3 mm and attached to a catheter to show feasibility of detection in phantoms and in vivo. RESULTS The device was successfully integrated into a 9F catheter, and its use with conventional guidewires under fluoroscopy was demonstrated by guiding the catheter through the bifurcation into the carotid artery. MR images including the catheter tip were acquired with the device in both the "on" and "off" positions. CONCLUSION A new passive tracking device with a susceptibility effect that can be enabled and disabled by sliding one of the components was designed, fabricated, and demonstrated in phantoms and in vivo. The device may also be integrated into many different interventional MR devices such as needles, ultrasound transducers for prostate biopsy, or any catheter-based devices.
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Cochennec F, Riga C, Hamady M, Cheshire N, Bicknell C. Improved catheter navigation with 3D electromagnetic guidance. J Endovasc Ther 2013; 20:39-47. [PMID: 23391082 DOI: 10.1583/12-3951.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the in vitro performance of an electromagnetic navigation system (ENS) in aortic arch branch cannulation and describe its role for fenestrated endograft deployment. METHODS Reconstructed multidetector computed tomography images of silicone phantoms representing the aortic arch and a thoracoabdominal aortic aneurysm were uploaded onto the StealthStation workstation, which provided 3-dimensional visualization of a guidewire by tracking sensors on its tip. For the evaluation of aortic arch branch cannulation, 9 operators were asked to cannulate the phantom's common carotid and left subclavian arteries using the (1) ENS, (2) a 2-dimensional (2D) screen setting simulating fluoroscopy, and (3) both imaging modalities. Analysis included procedure times, number of wall hits, and the Imperial College Complex Cannulation Scoring Tool (IC3ST) qualitative performance score. To evaluate the ability of the ENS during positioning of a fenestrated stent-graft over the visceral segment, a custom-made 4-vessel fenestrated stent-graft with sensors on the fenestrations was deployed 5 consecutive times using the ENS as the exclusive imaging technique. RESULTS In the aortic arch model, cannulation times were significantly longer in the ENS group. However, compared with the 2D version, using both imaging modalities reduced fluoroscopic times [median 26.5 seconds (IQR 19.7-30.7) vs. 87 seconds (IQR 64-128), p<0.0001] and wall hits [median 8.5 (IQR 16-38) vs. 14 (IQR 11-160, p<0.05), while improving IC3ST performance scores [31/35 (IQR 30-31.2) vs. 25/35 (IQR 24-27), p<0.05]. Following deployment of the endograft with tracked fenestrations, the 4 visceral vessels were cannulated in all cases using only the ENS. CONCLUSION The use of the ENS as a complementary imaging modality might be beneficial in terms of radiation exposure, cannulation performance, and positioning of intravascular devices.
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Sussman MS, Lindner U, Haider M, Kucharczyk W, Hlasny E, Trachtenberg J. Optimizing contrast agent concentration and spoiled gradient echo pulse sequence parameters for catheter visualization in MR-guided interventional procedures: an analytic solution. Magn Reson Med 2013; 70:333-40. [PMID: 23801423 DOI: 10.1002/mrm.24830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 11/09/2022]
Abstract
PURPOSE A critical requirement of MR-guided interventions is the visualization of an instrument (e.g., catheter, needle) during the procedure. One approach is to fill the instrument with a contrast agent. Previously, the optimization of contrast agent visualization was performed only empirically. In the present study, an analytic optimization of contrast agent SNR efficiency was performed for a spoiled gradient echo pulse sequence. METHODS Optimal flip angle, repetition time, echo time, and contrast agent concentration were derived analytically. The solution is valid for any contrast agent, provided the relationship between T1 , T2 , and doping concentration is known. RESULTS Phantom experiments validated the analytic optimization for Gd- and MnCl2 -based contrast agents. Results showed excellent agreement between experimentally predicted and theoretically observed magnetization behavior. In vivo experiments demonstrated optimized contrast agent visualization in brain, heart, and prostate applications. The results demonstrated the large SNR that can be achieved with analytic optimization. As a practical guideline, an 11% dilution of 500 mMol/L Gd-DTPA solution, repetition time ≈ 4 ms, echo time ≈ 1 ms, and θ ≈ 65° was found to provide a large SNR. CONCLUSION This study derived and validated a method for analytically optimizing contrast agent SNR efficiency. This information may be useful for visualizing instruments during MR-guided interventions.
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Affiliation(s)
- Marshall S Sussman
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada.
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Kandarpa K. Magnetic resonance imaging-guided endovascular interventions--are we there yet? J Vasc Interv Radiol 2013; 24:891-3. [PMID: 23707098 DOI: 10.1016/j.jvir.2013.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- Krishna Kandarpa
- Research and Development, Delcath Systems, Inc., New York, NY 10019, USA.
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Kagadis GC, Katsanos K, Karnabatidis D, Loudos G, Nikiforidis GC, Hendee WR. Emerging technologies for image guidance and device navigation in interventional radiology. Med Phys 2012; 39:5768-81. [PMID: 22957641 DOI: 10.1118/1.4747343] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Recent developments in image-guidance and device navigation, along with emerging robotic technologies, are rapidly transforming the landscape of interventional radiology (IR). Future state-of-the-art IR procedures may include real-time three-dimensional imaging that is capable of visualizing the target organ, interventional tools, and surrounding anatomy with high spatial and temporal resolution. Remote device actuation is becoming a reality with the introduction of novel magnetic-field enabled instruments and remote robotic steering systems. Robots offer several degrees of freedom and unprecedented accuracy, stability, and dexterity during device navigation, propulsion, and actuation. Optimization of tracking and navigation of interventional tools inside the human body will be critical in converting IR suites into the minimally invasive operating theaters of the future with increased safety and unsurpassed therapeutic efficacy. In the not too distant future, individual image guidance modalities and device tracking methods could merge into autonomous, multimodality, multiparametric platforms that offer real-time data of anatomy, morphology, function, and metabolism along with on-the-fly computational modeling and remote robotic actuation. The authors provide a concise overview of the latest developments in image guidance and device navigation, while critically envisioning what the future might hold for 2020 IR procedures.
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Affiliation(s)
- George C Kagadis
- Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece.
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Shih MCP, Rogers WJ, Bonatti H, Hagspiel KD. Real-time MR-guided retrieval of inferior vena cava filters: an in vitro and animal model study. J Vasc Interv Radiol 2011; 22:843-50. [PMID: 21482139 DOI: 10.1016/j.jvir.2011.01.428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 12/16/2010] [Accepted: 01/02/2011] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To develop interventional magnetic resonance (MR) guidance techniques for inferior vena cava (IVC) filter retrieval in vitro and demonstrate feasibility in vivo. MATERIALS AND METHODS Three optional IVC filters and their retrieval systems were investigated. Experiments were performed on a 1.5-T MR system. Real-time MR imaging was optimized by using a custom-built IVC phantom. A three-dimensional (3D) contrast-enhanced MR venography sequence was optimized in vitro for improved detection of thrombus trapped within the filters. Filters were then retrieved in vitro and in vivo in a swine model under MR guidance. In-vivo retrieval procedure time was measured. RESULTS The combination of one of the nitinol filters and a loop snare was suitable for real-time MR procedures. With a 90° flip angle, 3D MR venography allowed detection of simulated thrombus within the filter. A radial true fast imaging sequence with steady-state precession allowed visualization of the loop snare and IVC filter hook and successful retrieval of the filter in vivo and in vitro. In-vivo MR fluoroscopy time for retrieval was 97 seconds ± 51 (mean ± SD). CONCLUSIONS MR-guided retrieval of a nitinol-based IVC filter by using a loop snare is feasible with the use of optimized sequences and passive device tracking.
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Affiliation(s)
- Ming-Chen Paul Shih
- Department of Radiology and Medical Imaging, University of Virginia Health System, Lee Street, Charlottesville, VA 22908, USA
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Wojtczyk H, Graf H, Martirosian P, Ballweg V, Kraiger M, Pintaske J, Schick F. Quantification of direct current in electrically active implants using MRI methods. Z Med Phys 2011; 21:135-46. [PMID: 21277177 DOI: 10.1016/j.zemedi.2010.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 11/30/2010] [Accepted: 12/01/2010] [Indexed: 11/19/2022]
Abstract
The aim of this study was to evaluate a variety of phase- and magnitude-based MRI methods at 1.5 T and 3 T regarding their sensitivity and accuracy with respect to the quantification of electrical direct current via the induced magnetic field inhomogeneity. For this, a phantom was constructed which was specially designed to reduce RF effects and which provided a one-dimensional electrical direct current in a thin copper conductor perpendicular to the static magnetic field of the scanner. The current was varied between 4 mA and 472 mA. The analysis of FLASH phase images as well as trueFISP and MAGSUS images revealed that the accuracy of the MR current measurement depended on the method and the field strength: the mean of the absolute deviations of the measured current values from the adjusted current values varied between 9% and 21%. The phase measurement with a FLASH sequence was found to be more sensitive than the trueFISP and MAGSUS measurements. In FLASH magnitude images as well as in images of spin echo sequences with on- and off-resonant frequency selective saturation pulses the extension of the artifact increased with the electrical current. MRI methods for the quantification of electrical direct current might e.g. play a role in functional testing of electrically active devices in the human body in terms of measuring the present current. One-dimensional electrical direct current in a thin, straight conductor could also be applied to the visualization of instruments in interventional MRI procedures. Currents below 100 mA would be sufficient to create distinct artifacts, at least under simplified conditions (homogeneous background etc.).
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Affiliation(s)
- Hanne Wojtczyk
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Hoppe-Seyler-Straße, Germany.
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KURITA T, KURODA K, OHSAKA T. Gd-DTPA-based MR-visible Polymer for Direct Visualization of Interventional Devices. Magn Reson Med Sci 2011; 10:263-7. [DOI: 10.2463/mrms.10.263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
Cell based therapeutics are emerging as powerful regimens. To better understand the migration and proliferation mechanisms of implanted cells, a means to track cells in living subjects is essential, and to achieve that, a number of cell labeling techniques have been developed. Nanoparticles, with their superior physical properties, have become the materials of choice in many investigations along this line. Owing to inherent magnetic, optical or acoustic attributes, these nanoparticles can be detected by corresponding imaging modalities in living subjects at a high spatial and temporal resolution. These features allow implanted cells to be separated from host cells; and have advantages over traditional histological methods, as they permit non-invasive, real-time tracking in vivo. This review attempts to give a summary of progress in using nanotechnology to monitor cell trafficking. We will focus on direct cell labeling techniques, in which cells ingest nanoparticles that bear traceable signals, such as iron oxide or quantum dots. Ferritin and MagA reporter genes that can package endogenous iron or iron supplement into iron oxide nanoparticles will also be discussed.
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Affiliation(s)
- Ashwinkumar Bhirde
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN), National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institute of Health (NIH), Bethesda, MD 20892, USA
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Kurita T, Kuroda K, Ohsaka T. Magnetic Resonance-visible Coating for Endovascular Device Visualization: Gadolinium(III)–Diethylenetriaminepentaacetic Acid-based Insoluble Polymer Coating. CHEM LETT 2010. [DOI: 10.1246/cl.2010.1305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Evaluation of MR imaging guided steroid injection of the sacroiliac joints for the treatment of children with refractory enthesitis-related arthritis. Eur Radiol 2010; 21:1050-7. [DOI: 10.1007/s00330-010-1994-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 10/03/2010] [Accepted: 10/11/2010] [Indexed: 11/25/2022]
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Real-time MR navigation and localization of an intravascular catheter with ferromagnetic components. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2010; 23:153-63. [DOI: 10.1007/s10334-010-0214-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 03/26/2010] [Accepted: 04/20/2010] [Indexed: 11/25/2022]
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MRI after implantation of a novel femoral closure device following intra-arterial catheterisation: implications for subsequent contrast-enhanced MR angiography. Eur Radiol 2009; 20:1277-83. [PMID: 19936755 DOI: 10.1007/s00330-009-1661-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 10/19/2009] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess MRI safety aspects and artefacts of a novel femoral artery closure device during contrast-enhanced MR angiography in patients following intra-arterial catheterisation. METHODS Ten consecutive patients underwent MRI within 24 h of coronary angiography and placement of a femoral artery closure device. We used a T2-weighted gradient-echo MRI sequence to measure the device-related artefact size in comparison with a phantom image, phase-contrast flow measurement proximal to, at the level of and distal to the device to quantify potential differences in flow velocity and contrast-enhanced 3D gradient-echo MR angiography to differentiate potential femoral artery stenosis from device-related artefacts. RESULTS The mean size of the oval-shaped artefact was 8.4 x 6.6 mm (+/-1.0 x 0.8 mm) and was almost identical to the maximum artefact size of the phantom measurement (8.3 x 5.7 mm). Device placement did not result in an increased peak velocity (proximal 69 +/- 23 cm/s, at the level of 64 +/- 11 cm/s and distal to the device 63 +/- 12 cm/s, p = 0.67). The mean artefact penetration into the vessel lumen was 0.5 +/- 0.5 mm (percentage vessel narrowing 7.0 +/- 6%; range 0-16%). CONCLUSION The MR conditional StarClose femoral artery closure device was used safely within 24 h of deployment at 1.5 T. Despite clip-related artefacts MR angiography will allow for easy differentiation of clip-related artefacts from high-grade atherosclerotic stenosis.
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Nienaber CA, Kische S, Skriabina V, Ince H. Noninvasive Imaging Approaches to Evaluate the Patient With Known or Suspected Aortic Disease. Circ Cardiovasc Imaging 2009; 2:499-506. [DOI: 10.1161/circimaging.109.850206] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Christoph A. Nienaber
- From University Hospital Rostock, Department of Cardiology and Angiology, Rostock School of Medicine, Rostock, Germany
| | - Stephan Kische
- From University Hospital Rostock, Department of Cardiology and Angiology, Rostock School of Medicine, Rostock, Germany
| | - Valeria Skriabina
- From University Hospital Rostock, Department of Cardiology and Angiology, Rostock School of Medicine, Rostock, Germany
| | - Hüseyin Ince
- From University Hospital Rostock, Department of Cardiology and Angiology, Rostock School of Medicine, Rostock, Germany
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Simultaneous Dynamic Blood Oxygen Level-Dependent Magnetic Resonance Imaging of Foot and Calf Muscles. Invest Radiol 2009; 44:741-7. [DOI: 10.1097/rli.0b013e3181b248f9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kos S, Huegli R, Hofmann E, Quick HH, Kuehl H, Aker S, Kaiser GM, Borm PJA, Jacob AL, Bilecen D. MR-compatible polyetheretherketone-based guide wire assisting MR-guided stenting of iliac and supraaortic arteries in swine: Feasibility study. MINIM INVASIV THER 2009; 18:181-8. [DOI: 10.1080/13645700902921971] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Feasibility of Real-Time Magnetic Resonance–Guided Angioplasty and Stenting of Renal Arteries in Vitro and in Swine, Using a New Polyetheretherketone-Based Magnetic Resonance–Compatible Guidewire. Invest Radiol 2009; 44:234-41. [DOI: 10.1097/rli.0b013e31819b00f1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kos S, Huegli R, Hofmann E, Quick HH, Kuehl H, Aker S, Kaiser GM, Borm PJA, Jacob AL, Bilecen D. First magnetic resonance imaging-guided aortic stenting and cava filter placement using a polyetheretherketone-based magnetic resonance imaging-compatible guidewire in swine: proof of concept. Cardiovasc Intervent Radiol 2008; 32:514-21. [PMID: 19115070 DOI: 10.1007/s00270-008-9483-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 11/13/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to demonstrate feasibility of percutaneous transluminal aortic stenting and cava filter placement under magnetic resonance imaging (MRI) guidance exclusively using a polyetheretherketone (PEEK)-based MRI-compatible guidewire. Percutaneous transluminal aortic stenting and cava filter placement were performed in 3 domestic swine. Procedures were performed under MRI-guidance in an open-bore 1.5-T scanner. The applied 0.035-inch guidewire has a PEEK core reinforced by fibres, floppy tip, hydrophilic coating, and paramagnetic markings for passive visualization. Through an 11F sheath, the guidewire was advanced into the abdominal (swine 1) or thoracic aorta (swine 2), and the stents were deployed. The guidewire was advanced into the inferior vena cava (swine 3), and the cava filter was deployed. Postmortem autopsy was performed. Procedural success, guidewire visibility, pushability, and stent support were qualitatively assessed by consensus. Procedure times were documented. Guidewire guidance into the abdominal and thoracic aortas and the inferior vena cava was successful. Stent deployments were successful in the abdominal (swine 1) and thoracic (swine 2) segments of the descending aorta. Cava filter positioning and deployment was successful. Autopsy documented good stent and filter positioning. Guidewire visibility through applied markers was rated acceptable for aortic stenting and good for venous filter placement. Steerability, pushability, and device support were good. The PEEK-based guidewire allows either percutaneous MRI-guided aortic stenting in the thoracic and abdominal segments of the descending aorta and filter placement in the inferior vena cava with acceptable to good device visibility and offers good steerability, pushability, and device support.
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Affiliation(s)
- Sebastian Kos
- Institute of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
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Functional MR imaging as a new paradigm for image guidance. ACTA ACUST UNITED AC 2008; 34:675-85. [DOI: 10.1007/s00261-008-9481-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 10/30/2008] [Indexed: 01/30/2023]
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