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Fusco A, Luciano A, Cesareni M, De Ruvo E, Borrelli A, Tufaro G, Ferrazza AM, Chiocchi M, Calò L, Stefanini M. Complication detection in MRI guided cardiac ablation: Atrial wall damage and hepatic oedema. Radiol Case Rep 2024; 19:3613-3617. [PMID: 38983305 PMCID: PMC11228640 DOI: 10.1016/j.radcr.2024.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 07/11/2024] Open
Abstract
Magnetic resonance imaging is a novel imaging technique for guiding electrophysiology based ablation operations for atrial flutter and typical atrial fibrillation. When compared to standard electrophysiology ablation, this innovative method allows for better outcomes. Intra-procedural imaging is important for following the catheter in real time throughout the ablation operation while also seeing cardiac architecture and determining whether the ablation is being completed appropriately utilizing oedema sequences. At the same time, intra-procedural imaging allows immediate visualization of any complications of the procedure. We describe a case of a 67 year old male underwent an isthmus-cavo-tricuspid magnetic resonance-guided thermoablation procedure for atrial flutter episodes. During the procedure we noted an atypical focal thinning of the right atrial wall at the isthmus cava-tricuspidal zone. The post-procedural Black Blood T2 STIR showed an area of hyperintensity at the hepatic dome and glissonian capsule, which was consistent with intraparenchymal hepatic oedema, in close proximity to the atrial finding. Given the opportunity to direct monitoring of adjacent tissues, we aim to highlight with our case the ability of magnetic resonance-guided cardiac ablation to immediately detect peri-procedural complications in the ablative treatment of atrial fibrillation.
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Affiliation(s)
- Armando Fusco
- Policlinico Casilino, Department of diagnostic imaging and Interventional Radiology, Rome, Italy
| | - Alessandra Luciano
- Policlinico Casilino, Department of diagnostic imaging and Interventional Radiology, Rome, Italy
| | - Matteo Cesareni
- Policlinico Casilino, Department of diagnostic imaging and Interventional Radiology, Rome, Italy
| | | | - Alessio Borrelli
- San Carlo di Nancy Hospital, Department of Cardiology, Rome, Italy
| | - Giuseppe Tufaro
- Policlinico Casilino, Department of Anesthesiology, Rome, Italy
| | | | - Marcello Chiocchi
- Univerity of Tor Vergata, Department of diagnostic imaging and Interventional Radiology, Rome, Italy
| | - Leonardo Calò
- Policlinico Casilino, Department of Cardiology, Rome, Italy
| | - Matteo Stefanini
- Policlinico Casilino, Department of diagnostic imaging and Interventional Radiology, Rome, Italy
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Tampakis K, Pastromas S, Sykiotis A, Kampanarou S, Kourgiannidis G, Pyrpiri C, Bousoula M, Rozakis D, Andrikopoulos G. Real-time cardiovascular magnetic resonance-guided radiofrequency ablation: A comprehensive review. World J Cardiol 2023; 15:415-426. [PMID: 37900261 PMCID: PMC10600785 DOI: 10.4330/wjc.v15.i9.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/10/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
Cardiac magnetic resonance (CMR) imaging could enable major advantages when guiding in real-time cardiac electrophysiology procedures offering high-resolution anatomy, arrhythmia substrate, and ablation lesion visualization in the absence of ionizing radiation. Over the last decade, technologies and platforms for performing electrophysiology procedures in a CMR environment have been developed. However, performing procedures outside the conventional fluoroscopic laboratory posed technical, practical and safety concerns. The development of magnetic resonance imaging compatible ablation systems, the recording of high-quality electrograms despite significant electromagnetic interference and reliable methods for catheter visualization and lesion assessment are the main limiting factors. The first human reports, in order to establish a procedural workflow, have rationally focused on the relatively simple typical atrial flutter ablation and have shown that CMR-guided cavotricuspid isthmus ablation represents a valid alternative to conventional ablation. Potential expansion to other more complex arrhythmias, especially ventricular tachycardia and atrial fibrillation, would be of essential impact, taking into consideration the widespread use of substrate-based strategies. Importantly, all limitations need to be solved before application of CMR-guided ablation in a broad clinical setting.
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Affiliation(s)
- Konstantinos Tampakis
- Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, Athens 11526, Greece.
| | - Sokratis Pastromas
- Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - Alexandros Sykiotis
- Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | | | - Georgios Kourgiannidis
- Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - Chrysa Pyrpiri
- Department of Radiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - Maria Bousoula
- Department of Anesthesiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - Dimitrios Rozakis
- Department of Anesthesiology, Henry Dunant Hospital Center, Athens 11526, Greece
| | - George Andrikopoulos
- Department of Pacing & Electrophysiology, Henry Dunant Hospital Center, Athens 11526, Greece
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Rogers T, Campbell-Washburn AE, Ramasawmy R, Yildirim DK, Bruce CG, Grant LP, Stine AM, Kolandaivelu A, Herzka DA, Ratnayaka K, Lederman RJ. Interventional cardiovascular magnetic resonance: state-of-the-art. J Cardiovasc Magn Reson 2023; 25:48. [PMID: 37574552 PMCID: PMC10424337 DOI: 10.1186/s12968-023-00956-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Transcatheter cardiovascular interventions increasingly rely on advanced imaging. X-ray fluoroscopy provides excellent visualization of catheters and devices, but poor visualization of anatomy. In contrast, magnetic resonance imaging (MRI) provides excellent visualization of anatomy and can generate real-time imaging with frame rates similar to X-ray fluoroscopy. Realization of MRI as a primary imaging modality for cardiovascular interventions has been slow, largely because existing guidewires, catheters and other devices create imaging artifacts and can heat dangerously. Nonetheless, numerous clinical centers have started interventional cardiovascular magnetic resonance (iCMR) programs for invasive hemodynamic studies or electrophysiology procedures to leverage the clear advantages of MRI tissue characterization, to quantify cardiac chamber function and flow, and to avoid ionizing radiation exposure. Clinical implementation of more complex cardiovascular interventions has been challenging because catheters and other tools require re-engineering for safety and conspicuity in the iCMR environment. However, recent innovations in scanner and interventional device technology, in particular availability of high performance low-field MRI scanners could be the inflection point, enabling a new generation of iCMR procedures. In this review we review these technical considerations, summarize contemporary clinical iCMR experience, and consider potential future applications.
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Affiliation(s)
- Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA.
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St NW, Suite 4B01, Washington, DC, 20011, USA.
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - D Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Laurie P Grant
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Annette M Stine
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Aravindan Kolandaivelu
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
- Johns Hopkins Hospital, Baltimore, MD, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
| | - Kanishka Ratnayaka
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA.
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4
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Yildirim DK, Uzun D, Bruce CG, Khan JM, Rogers T, Schenke WH, Ramasawmy R, Campbell-Washburn A, Herzka D, Lederman RJ, Kocaturk O. An interventional MRI guidewire combining profile and tip conspicuity for catheterization at 0.55T. Magn Reson Med 2023; 89:845-858. [PMID: 36198118 PMCID: PMC9712240 DOI: 10.1002/mrm.29466] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/04/2022] [Accepted: 09/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE We describe a clinical grade, "active", monopole antenna-based metallic guidewire that has a continuous shaft-to-tip image profile, a pre-shaped tip-curve, standard 0.89 mm (0.035″) outer diameter, and a detachable connector for catheter exchange during cardiovascular catheterization at 0.55T. METHODS Electromagnetic simulations were performed to characterize the magnetic field around the antenna whip for continuous tip visibility. The active guidewire was manufactured using medical grade materials in an ISO Class 7 cleanroom. RF-induced heating of the active guidewire prototype was tested in one gel phantom per ASTM 2182-19a, alone and in tandem with clinical metal-braided catheters. Real-time MRI visibility was tested in one gel phantom and in-vivo in two swine. Mechanical performance was compared with commercial equivalents. RESULTS The active guidewire provided continuous "profile" shaft and tip visibility in-vitro and in-vivo, analogous to guidewire shaft-and-tip profiles under X-ray. The MRI signal signature matched simulation results. Maximum unscaled RF-induced temperature rise was 5.2°C and 6.5°C (3.47 W/kg local background specific absorption rate), alone and in tandem with a steel-braided catheter, respectively. Mechanical characteristics matched commercial comparator guidewires. CONCLUSION The active guidewire was clearly visible via real-time MRI at 0.55T and exhibits a favorable geometric sensitivity profile depicting the guidewire continuously from shaft-to-tip including a unique curved-tip signature. RF-induced heating is clinically acceptable. This design allows safe device navigation through luminal structures and heart chambers. The detachable connector allows delivery and exchange of cardiovascular catheters while maintaining guidewire position. This enhanced guidewire design affords the expected performance of X-ray guidewires during human MRI catheterization.
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Affiliation(s)
- Dursun Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Dogangun Uzun
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
| | - Christopher G. Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Jaffar M. Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - William H. Schenke
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Adrienne Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Daniel Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, MD, USA
| | - Ozgur Kocaturk
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
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Tuna EE, Franson D, Seiberlich N, Çavuşoğlu MC. Deformable cardiac surface tracking by adaptive estimation algorithms. Sci Rep 2023; 13:1387. [PMID: 36697497 PMCID: PMC9877032 DOI: 10.1038/s41598-023-28578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
This study presents a particle filter based framework to track cardiac surface from a time sequence of single magnetic resonance imaging (MRI) slices with the future goal of utilizing the presented framework for interventional cardiovascular magnetic resonance procedures, which rely on the accurate and online tracking of the cardiac surface from MRI data. The framework exploits a low-order parametric deformable model of the cardiac surface. A stochastic dynamic system represents the cardiac surface motion. Deformable models are employed to introduce shape prior to control the degree of the deformations. Adaptive filters are used to model complex cardiac motion in the dynamic model of the system. Particle filters are utilized to recursively estimate the current state of the system over time. The proposed method is applied to recover biventricular deformations and validated with a numerical phantom and multiple real cardiac MRI datasets. The algorithm is evaluated with multiple experiments using fixed and varying image slice planes at each time step. For the real cardiac MRI datasets, the average root-mean-square tracking errors of 2.61 mm and 3.42 mm are reported respectively for the fixed and varying image slice planes. This work serves as a proof-of-concept study for modeling and tracking the cardiac surface deformations via a low-order probabilistic model with the future goal of utilizing this method for the targeted interventional cardiac procedures under MR image guidance. For the real cardiac MRI datasets, the presented method was able to track the points-of-interests located on different sections of the cardiac surface within a precision of 3 pixels. The analyses show that the use of deformable cardiac surface tracking algorithm can pave the way for performing precise targeted intracardiac ablation procedures under MRI guidance. The main contributions of this work are twofold. First, it presents a framework for the tracking of whole cardiac surface from a time sequence of single image slices. Second, it employs adaptive filters to incorporate motion information in the tracking of nonrigid cardiac surface motion for temporal coherence.
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Affiliation(s)
- E Erdem Tuna
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA.
| | - Dominique Franson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Nicole Seiberlich
- Department of Radiology, Michigan Medicine, University of Michigan, Ann-Anbor, MI, 48109, USA
| | - M Cenk Çavuşoğlu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
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Qin C, Murali S, Lee E, Supramaniam V, Hausenloy DJ, Obungoloch J, Brecher J, Lin R, Ding H, Akudjedu TN, Anazodo UC, Jagannathan NR, Ntusi NAB, Simonetti OP, Campbell-Washburn AE, Niendorf T, Mammen R, Adeleke S. Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems. Eur Heart J Cardiovasc Imaging 2022; 23:e246-e260. [PMID: 35157038 PMCID: PMC9159744 DOI: 10.1093/ehjci/jeab286] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.
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Affiliation(s)
- Cathy Qin
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjana Murali
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Elsa Lee
- School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Derek J Hausenloy
- Division of Medicine, University College London, London, UK
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Hatter Cardiovascular Institue, UCL Institute of Cardiovascular Sciences, University College London, London, UK
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Johnes Obungoloch
- Department of Biomedical Engineering, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rongyu Lin
- School of Medicine, University College London, London, UK
| | - Hao Ding
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Theophilus N Akudjedu
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Science, Bournemouth University, Poole, UK
| | | | - Naranamangalam R Jagannathan
- Department of Electrical Engineering, Indian Institute of Technology, Chennai, India
- Department of Radiology, Sri Ramachandra University Medical College, Chennai, India
- Department of Radiology, Chettinad Hospital and Research Institute, Kelambakkam, India
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrück Centre for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Regina Mammen
- Department of Cardiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Sola Adeleke
- School of Cancer & Pharmaceutical Sciences, King’s College London, Queen Square, London WC1N 3BG, UK
- High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
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Ranjan P, Ro R, Lerakis S. Multislice Computed Tomography (MSCT) and Cardiovascular Magnetic Resonance (CMR) Imaging for Coronary and Structural Heart Disease. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Schmidt EJ, Elahi H, Meyer ES, Baumgaertner R, Neri L, Berger RD, Tandri H, Hunter DW, Cohen SP, Oberdier MT, Halperin HR. Reduced Motion External Defibrillation (RMD): Reduced Subject Motion with Equivalent Defibrillation Efficiency validated in Swine. Heart Rhythm 2022; 19:1165-1173. [PMID: 35240311 DOI: 10.1016/j.hrthm.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND External defibrillators are used for arrhythmia cardioversion and for defibrillating during cardiac arrest. During defibrillation, short-duration Biphasic pulses cause intense motion due to rapid chest-wall muscle contraction. A reduced-motion external defibrillator (RMD) was constructed by integrating a commercial defibrillator with a Tetanizing-waveform generator. A long-duration low-amplitude Tetanizing-waveform slowly stimulated the chest musculature prior to the Biphasic pulse, reducing muscle contraction during the shock. OBJECTIVE Evaluate RMD defibrillation in swine for subject-motion during defibrillation pulses and for defibrillation effectiveness. RMD defibrillation can reduce the duration of arrhythmia ablation-therapy or simplify cardioversion procedures. METHODS The Tetanizing unit delivered a triangular 1-kHz pulse of 0.25-2.0sec duration and 10-100Volt peak amplitude, subsequently triggering the conventional defibrillator to output standard 1-200J energy Biphasic pulses at the next R-wave. Forward-limb motion was evaluated by measuring Peak Acceleration and Limb Work during RMD (Tetanizing+Biphasic) or Biphasic-pulse-only waveforms at 10-3sec sampling-rate. Seven swine were arrested electrically and subsequently defibrillated. Biphasic-pulse-only and RMD defibrillations were repeated 25-35 times/swine, varying Tetanizing parameters and the Biphasic-pulse energy. Defibrillation thresholds (DFTs) were established by measuring the minimum energy required to restore sinus-rhythm with Biphasic-pulse-only or RMD defibrillations. RESULTS Two forward-limb acceleration-peaks occurred during both the Tetanizing-waveform and Biphasic-pulse, indicating rapid and slower nociceptic (pain-sensation) nerve-fiber activation. Optimal RMD Tetanizing-parameters (25-35V, 0.25-0.75sec duration), relative to Biphasic-pulse-only defibrillations, resulted in 74+10% smaller Peak Accelerations and 85+10% reduced Limb Work. DFT energies were identical, comparing RMD to Biphasic-pulse-only defibrillations. CONCLUSION Relative to conventional defibrillations, RMD defibrillations maintain rhythm-restoration efficiency with drastically reduced subject-motion.
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Affiliation(s)
- Ehud J Schmidt
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD.
| | - Hassan Elahi
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
| | - Eric S Meyer
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
| | | | - Luca Neri
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
| | - Ronald D Berger
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
| | | | - David W Hunter
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
| | | | - Matt T Oberdier
- Medicine (Cardiology), Johns Hopkins University, Baltimore, MD
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Amin EK, Campbell-Washburn A, Ratnayaka K. MRI-Guided Cardiac Catheterization in Congenital Heart Disease: How to Get Started. Curr Cardiol Rep 2022; 24:419-429. [PMID: 35107702 PMCID: PMC8979923 DOI: 10.1007/s11886-022-01659-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Cardiac magnetic resonance imaging provides radiation-free, 3-dimensional soft tissue visualization with adjunct hemodynamic data, making it a promising candidate for image-guided transcatheter interventions. This review focuses on the benefits and background of real-time magnetic resonance imaging (MRI)-guided cardiac catheterization, guidance on starting a clinical program, and recent research developments. RECENT FINDINGS Interventional cardiac magnetic resonance (iCMR) has an established track record with the first entirely MRI-guided cardiac catheterization for congenital heart disease reported nearly 20 years ago. Since then, many centers have embarked upon clinical iCMR programs primarily performing diagnostic MRI-guided cardiac catheterization. There have also been limited reports of successful real-time MRI-guided transcatheter interventions. Growing experience in performing cardiac catheterization in the magnetic resonance environment has facilitated practical workflows appropriate for efficiency-focused cardiac catheterization laboratories. Most exciting developments in imaging technology, MRI-compatible equipment and MRI-guided novel transcatheter interventions have been limited to preclinical research. Many of these research developments are ready for clinical translation. With increasing iCMR clinical experience and translation of preclinical research innovations, the time to make the leap to radiation-free procedures is now.
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Affiliation(s)
- Elena K Amin
- Division of Pediatric Cardiology, UCSF Benioff Children's Hospitals, University of California, San Francisco, San Francisco, CA, USA.
| | - Adrienne Campbell-Washburn
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology, Rady Children's Hospital, University of California, San Diego, 3020 Children's Way, San Diego, CA, USA
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10
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Rier SC, Vreemann S, Nijhof WH, van Driel VJHM, van der Bilt IAC. Interventional cardiac magnetic resonance imaging: current applications, technology readiness level, and future perspectives. Ther Adv Cardiovasc Dis 2022; 16:17539447221119624. [PMID: 36039865 PMCID: PMC9434707 DOI: 10.1177/17539447221119624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) provides excellent temporal and spatial resolution, tissue characterization, and flow measurements. This enables major advantages when guiding cardiac invasive procedures compared with X-ray fluoroscopy or ultrasound guidance. However, clinical implementation is limited due to limited availability of technological advancements in magnetic resonance imaging (MRI) compatible equipment. A systematic review of the available literature on past and present applications of interventional MR and its technology readiness level (TRL) was performed, also suggesting future applications. METHODS A structured literature search was performed using PubMed. Search terms were focused on interventional CMR, cardiac catheterization, and other cardiac invasive procedures. All search results were screened for relevance by language, title, and abstract. TRL was adjusted for use in this article, level 1 being in a hypothetical stage and level 9 being widespread clinical translation. The papers were categorized by the type of procedure and the TRL was estimated. RESULTS Of 466 papers, 117 papers met the inclusion criteria. TRL was most frequently estimated at level 5 meaning only applicable to in vivo animal studies. Diagnostic right heart catheterization and cavotricuspid isthmus ablation had the highest TRL of 8, meaning proven feasibility and efficacy in a series of humans. CONCLUSION This article shows that interventional CMR has a potential widespread application although clinical translation is at a modest level with TRL usually at 5. Future development should be directed toward availability of MR-compatible equipment and further improvement of the CMR techniques. This could lead to increased TRL of interventional CMR providing better treatment.
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Affiliation(s)
- Sophie C Rier
- Cardiology Division, Department of Cardiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, Postbus 40551, The Hague 2504 LN, The Netherlands
| | - Suzan Vreemann
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands Siemens Healthineers Nederland B.V., Den Haag, The Netherlands
| | - Wouter H Nijhof
- Siemens Healthineers Nederland B.V., Den Haag, The Netherlands
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Meierhofer C, Belker K, Shehu N, Latus H, Mkrtchyan N, Naumann S, Martinoff S, Stern H, Eicken A, Ewert P. Real-time CMR guidance for intracardiac and great vessel pressure mapping in patients with congenital heart disease using an MR conditional guidewire-results of 25 patients. Cardiovasc Diagn Ther 2021; 11:1356-1366. [PMID: 35070804 PMCID: PMC8748488 DOI: 10.21037/cdt-20-575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2024]
Abstract
BACKGROUND The aim of this study was to test a CE-certified MR-conditional guidewire to facilitate blood pressure measurement in cardiovascular magnetic resonance (CMR) using fluid-filled catheters in patients with congenital heart disease (CHD). The main purpose was to determine procedural success in a post market clinical follow-up (PMCF) for routine procedure in a diagnostic and interventional workflow. Real-time CMR provides high quality imaging without the risk of exposing the patient to X-rays, especially for patients with irregular heart anatomy and patients who are susceptible to radiation and iodinated contrast media. To date, the assessment of blood pressure gradients is not a common feature of CMR, as these gradients cannot be accurately evaluated in routine CMR. METHODS Twenty-five CHD patients who were planned for combined clinical CMR and diagnostic and/or interventional catheterization were enrolled in the trial. Prior to inclusion, a specific procedure for catheterization in CMR was defined, encompassing the assessment of pressure and pressure gradients in the heart and great vessels. RESULTS By the use of an MR-conditional guidewire we successfully measured specific pressure and pressure gradients in up to 92% of cases with liquid-filled catheters which were guided exclusively under CMR guidance. There were no guidewire-related adverse events, and guidewire guidance and manipulation of catheters were successful. CONCLUSIONS Using a MR-conditional guidewire assists in easily reaching targets in the heart and great vessels and makes the catheter itself visible, so that invasive blood pressure assessment by CMR guidance with liquid-filled catheters can be improved. KEYWORDS Cardiovascular magnetic resonance (CMR); congenital heart disease (CHD); cardiac catheterization; magnetic resonance; pressure; guidewire.
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Affiliation(s)
- Christian Meierhofer
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Kristina Belker
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Nerejda Shehu
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Heiner Latus
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Naira Mkrtchyan
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Susanne Naumann
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Stefan Martinoff
- Radiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Heiko Stern
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Andreas Eicken
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Peter Ewert
- Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Heart Alliance, Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Berlin, Germany
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12
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Velasco Forte MN, Roujol S, Ruijsink B, Valverde I, Duong P, Byrne N, Krueger S, Weiss S, Arar Y, Reddy SRV, Schaeffter T, Hussain T, Razavi R, Pushparajah K. MRI for Guided Right and Left Heart Cardiac Catheterization: A Prospective Study in Congenital Heart Disease. J Magn Reson Imaging 2021; 53:1446-1457. [PMID: 33155758 PMCID: PMC8247035 DOI: 10.1002/jmri.27426] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Improvements in outcomes for patients with congenital heart disease (CHD) have increased the need for diagnostic and interventional procedures. Cumulative radiation risk is a growing concern. MRI-guided interventions are a promising ionizing radiation-free, alternative approach. PURPOSE To assess the feasibility of MRI-guided catheterization in young patients with CHD using advanced visualization passive tracking techniques. STUDY TYPE Prospective. POPULATION A total of 30 patients with CHD referred for MRI-guided catheterization and pulmonary vascular resistance analysis (median age/weight: 4 years / 15 kg). FIELD STRENGTH/SEQUENCE 1.5T; partially saturated (pSAT) real-time single-shot balanced steady-state free-precession (bSSFP) sequence. ASSESSMENT Images were visualized by a single viewer on the scanner console (interactive mode) or using a commercially available advanced visualization platform (iSuite, Philips). Image quality for anatomy and catheter visualization was evaluated by three cardiologists with >5 years' experience in MRI-catheterization using a 1-5 scale (1, poor, 5, excellent). Catheter balloon signal-to-noise ratio (SNR), blood and myocardium SNR, catheter balloon/blood contrast-to-noise ratio (CNR), balloon/myocardium CNR, and blood/myocardium CNR were measured. Procedure findings, feasibility, and adverse events were recorded. A fraction of time in which the catheter was visible was compared between iSuite and the interactive mode. STATISTICAL TESTS T-test for numerical variables. Wilcoxon signed rank test for categorical variables. RESULTS Nine patients had right heart catheterization, 11 had both left and right heart catheterization, and 10 had single ventricle circulation. Nine patients underwent solely MRI-guided catheterization. The mean score for anatomical visualization and contrast between balloon tip and soft tissue was 3.9 ± 0.9 and 4.5 ± 0.7, respectively. iSuite provided a significant improvement in the time during which the balloon was visible in relation to interactive imaging mode (66 ± 17% vs. 46 ± 14%, P < 0.05). DATA CONCLUSION MRI-guided catheterizations were carried out safely and is feasible in children and adults with CHD. The pSAT sequence offered robust and simultaneous high contrast visualization of the catheter and cardiac anatomy. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Mari Nieves Velasco Forte
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
- Cardiovascular Pathology UnitInstitute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of SevilleSevilleSpain
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Bram Ruijsink
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
| | - Israel Valverde
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
- Cardiovascular Pathology UnitInstitute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of SevilleSevilleSpain
| | - Phuoc Duong
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
| | - Nick Byrne
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Medical PhysicsGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | | | | | - Yousef Arar
- Department of PediatricsUT Southwestern Medical CenterDallasTexasUSA
| | | | - Tobias Schaeffter
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
| | - Tarique Hussain
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of PediatricsUT Southwestern Medical CenterDallasTexasUSA
| | - Reza Razavi
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
| | - Kuberan Pushparajah
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Department of Congenital Heart DiseaseEvelina London Children's Hospital, Guy's and St Thomas' NHS Foundation TrustLondonUK
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13
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Yildirim DK, Bruce C, Uzun D, Rogers T, O'Brien K, Ramasawmy R, Campbell-Washburn A, Herzka DA, Lederman RJ, Kocaturk O. A 20-gauge active needle design with thin-film printed circuitry for interventional MRI at 0.55T. Magn Reson Med 2021; 86:1786-1801. [PMID: 33860962 DOI: 10.1002/mrm.28804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/05/2021] [Accepted: 03/23/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE This work aims to fabricate RF antenna components on metallic needle surfaces using biocompatible polyester tubing and conductive ink to develop an active interventional MRI needle for clinical use at 0.55 Tesla. METHODS A custom computer numeric control-based conductive ink printing method was developed. Based on electromagnetic simulation results, thin-film RF antennas were printed with conductive ink and used to fabricate a medical grade, 20-gauge (0.87 mm outer diameter), 90-mm long active interventional MRI needle. The MRI visibility performance of the active needle prototype was tested in vitro in 1 gel phantom and in vivo in 1 swine. A nearly identical active needle constructed using a 44 American Wire Gauge insulated copper wire-wound RF receiver antenna was a comparator. The RF-induced heating risk was evaluated in a gel phantom per American Society for Testing and Materials (ASTM) 2182-19. RESULTS The active needle prototype with printed RF antenna was clearly visible both in vitro and in vivo under MRI. The maximum RF-induced temperature rise of prototypes with printed RF antenna and insulated copper wire antenna after a 3.96 W/kg, 15 min. long scan were 1.64°C and 8.21°C, respectively. The increase in needle diameter was 98 µm and 264 µm for prototypes with printed RF antenna and copper wire-wound antenna, respectively. CONCLUSION The active needle prototype with conductive ink printed antenna provides distinct device visibility under MRI. Variations on the needle surface are mitigated compared to use of a 44 American Wire Gauge copper wire. RF-induced heating tests support device RF safety under MRI. The proposed method enables fabrication of small diameter active interventional MRI devices having complex geometries, something previously difficult using conventional methods.
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Affiliation(s)
- Dursun Korel Yildirim
- Institute of Biomedical Engineering, Bogazici University, Kandilli Campus, Istanbul, Turkey.,Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Dogangun Uzun
- Institute of Biomedical Engineering, Bogazici University, Kandilli Campus, Istanbul, Turkey.,Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kendall O'Brien
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adrienne Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel A Herzka
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ozgur Kocaturk
- Institute of Biomedical Engineering, Bogazici University, Kandilli Campus, Istanbul, Turkey.,Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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14
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Susceptibility artifacts from metallic markers and cardiac catheterization devices on a high-performance 0.55 T MRI system. Magn Reson Imaging 2020; 77:14-20. [PMID: 33309924 DOI: 10.1016/j.mri.2020.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/27/2020] [Accepted: 12/06/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Visualization of passive devices during MRI-guided catheterizations often relies on a susceptibility artifact from the device itself or added susceptibility markers that impart a unique imaging signature. High-performance low field MRI systems offer reduced RF-induced heating of metallic devices during MRI-guided invasive procedures, but susceptibility artifacts are expected to diminish with field strength, reducing device visualization. In this study, field strength and orientation dependence of artifacts from susceptibility markers and metallic guidewires were evaluated using a prototype high-performance 0.55 T MRI system. MATERIALS AND METHODS Artifact volume from nitinol and stainless steel passive susceptibility markers was quantified using histogram analysis of pixel intensities from three-dimensional gradient echo images at 0.55 T, 1.5 T and 3 T. In addition, visibility of commercially available clinical catheterization devices was compared between 0.55 T and 1.5 T using real-time bSSFP in phantoms and in vivo. RESULTS A low-tensile strength stainless-steel marker produced field strength- and orientation-dependent artifact size (1.7 cm3, 1.95 cm3, 2.21 cm3 at 0.55 T, 1.5 T, 3 T, respectively). Whereas, a high-tensile strength steel marker, of the same alloy, produced field strength- and orientation-independent artifact size (3.35 cm3, 3.41 cm3, 3.42 cm3 at 0.55 T, 1.5 T, 3 T, respectively). Visibility of commercially available nitinol guidewires was reduced at 0.55 T, but imaging signature could be maintained using high-susceptibility stainless steel markers. DISCUSSION AND CONCLUSION High-susceptibility stainless-steel markers generate field-independent artifacts between 0.55 T, 1.5 T and 3 T, indicating magnetic saturation at fields <0.55 T. Thus, artifact size can be tailored such that interventional devices produce identical imaging signatures across field strengths.
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15
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Situ Y, Birch SCM, Moreyra C, Holloway CJ. Cardiovascular magnetic resonance imaging for structural heart disease. Cardiovasc Diagn Ther 2020; 10:361-375. [PMID: 32420118 DOI: 10.21037/cdt.2019.06.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cardiovascular magnetic resonance (CMR) has increasingly become a powerful imaging technique over the past few decades due to increasing knowledge about clinical applications, operator experience and technological advances, including the introduction of high field strength magnets, leading to improved signal-to-noise ratio. Its success is attributed to the free choice of imaging planes, the wide variety of imaging techniques, and the lack of harmful radiation. Developments in CMR have led to the accurate evaluation of cardiac structure, function and tissues characterisation, so this non-invasive technique has become a powerful tool for a broad range of cardiac pathologies. This review will provide an introduction of magnetic resonance imaging (MRI) physics, an overview of the current techniques and clinical application of CMR in structural heart disease, and illustrated examples of its use in clinical practice.
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Affiliation(s)
- Yiling Situ
- St Vincent's Hospital Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Kensington, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, Australia
| | | | - Camila Moreyra
- St Vincent's Hospital Sydney, New South Wales, Australia
| | - Cameron J Holloway
- St Vincent's Hospital Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Kensington, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, Australia
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16
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Abstract
In recent years, interventional cardiac magnetic resonance imaging (iCMR) has evolved from attractive theory to clinical routine at several centers. Real-time cardiac magnetic resonance imaging (CMR fluoroscopy) adds value by combining soft-tissue visualization, concurrent hemodynamic measurement, and freedom from radiation. Clinical iCMR applications are expanding because of advances in catheter devices and imaging. In the near future, iCMR promises novel procedures otherwise unsafe under standalone X-Ray guidance.
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17
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Wenker S, van Lieshout C, Frederix G, van der Heijden J, Loh P, Chamuleau SAJ, van Slochteren F. MRI-guided pulmonary vein isolation for atrial fibrillation: what is good enough? An early health technology assessment. Open Heart 2019; 6:e001014. [PMID: 31798911 PMCID: PMC6861091 DOI: 10.1136/openhrt-2019-001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/29/2019] [Accepted: 09/12/2019] [Indexed: 11/03/2022] Open
Abstract
Next to anticoagulation, pulmonary vein isolation (PVI) is the most important interventional procedure in the treatment of atrial fibrillation (AF). Despite widespread clinical application of this therapy, patients often require multiple procedures to reach clinical success. In contrast to conventional imaging modalities, MRI allows direct visualisation of the ablation lesion. Therefore, the use of real-time MRI to guide cardiac electrophysiology procedures may increase clinical effectiveness. An essential aspect, from a decision-making point of view, is the effect on costs and the potential cost-effectiveness of new technologies. Generally, health technology assessment (HTA) studies are performed when innovations are close to clinical application. However, early stage HTA can inform users, researchers and funders about the ultimate clinical and economic potential of a future innovation. Ultimately, this can guide funding allocation. In this study, we performed an early HTA evaluate MRI-guided PVIs. Methods We performed an economic evaluation using a decision tree with a time-horizon of 1 year. We calculated the clinical effectiveness (defined as the proportion of patients that is long-term free of AF after a single procedure) required for MRI-guided PVI to be cost-effective compared with conventional treatment. Results Depending on the cost-effectiveness threshold (willingness to pay for one additional quality-of-life adjusted life year (QALY), interventional MRI (iMRI) guidance for PVI can be cost-effective if clinical effectiveness is 69.8% (at €80 000/QALY) and 77.1% (at €20 000/QALY), compared with 64% for fluoroscopy-guided procedures. Conclusion Using an early HTA, we established a clinical effectiveness threshold for interventional MRI-guided PVIs that can inform a clinical implementation strategy. If crucial technologies are developed, it seems plausible that iMRI-guided PVIs will be able to reach this threshold.
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Affiliation(s)
- Steven Wenker
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris van Lieshout
- Julius Centre, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Frederix
- Julius Centre, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Peter Loh
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frebus van Slochteren
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Campbell-Washburn AE, Ramasawmy R, Restivo MC, Bhattacharya I, Basar B, Herzka DA, Hansen MS, Rogers T, Bandettini WP, McGuirt DR, Mancini C, Grodzki D, Schneider R, Majeed W, Bhat H, Xue H, Moss J, Malayeri AA, Jones EC, Koretsky AP, Kellman P, Chen MY, Lederman RJ, Balaban RS. Opportunities in Interventional and Diagnostic Imaging by Using High-Performance Low-Field-Strength MRI. Radiology 2019; 293:384-393. [PMID: 31573398 PMCID: PMC6823617 DOI: 10.1148/radiol.2019190452] [Citation(s) in RCA: 212] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/06/2019] [Accepted: 08/15/2019] [Indexed: 12/24/2022]
Abstract
Background Commercial low-field-strength MRI systems are generally not equipped with state-of-the-art MRI hardware, and are not suitable for demanding imaging techniques. An MRI system was developed that combines low field strength (0.55 T) with high-performance imaging technology. Purpose To evaluate applications of a high-performance low-field-strength MRI system, specifically MRI-guided cardiovascular catheterizations with metallic devices, diagnostic imaging in high-susceptibility regions, and efficient image acquisition strategies. Materials and Methods A commercial 1.5-T MRI system was modified to operate at 0.55 T while maintaining high-performance hardware, shielded gradients (45 mT/m; 200 T/m/sec), and advanced imaging methods. MRI was performed between January 2018 and April 2019. T1, T2, and T2* were measured at 0.55 T; relaxivity of exogenous contrast agents was measured; and clinical applications advantageous at low field were evaluated. Results There were 83 0.55-T MRI examinations performed in study participants (45 women; mean age, 34 years ± 13). On average, T1 was 32% shorter, T2 was 26% longer, and T2* was 40% longer at 0.55 T compared with 1.5 T. Nine metallic interventional devices were found to be intrinsically safe at 0.55 T (<1°C heating) and MRI-guided right heart catheterization was performed in seven study participants with commercial metallic guidewires. Compared with 1.5 T, reduced image distortion was shown in lungs, upper airway, cranial sinuses, and intestines because of improved field homogeneity. Oxygen inhalation generated lung signal enhancement of 19% ± 11 (standard deviation) at 0.55 T compared with 7.6% ± 6.3 at 1.5 T (P = .02; five participants) because of the increased T1 relaxivity of oxygen (4.7e-4 mmHg-1sec-1). Efficient spiral image acquisitions were amenable to low field strength and generated increased signal-to-noise ratio compared with Cartesian acquisitions (P < .02). Representative imaging of the brain, spine, abdomen, and heart generated good image quality with this system. Conclusion This initial study suggests that high-performance low-field-strength MRI offers advantages for MRI-guided catheterizations with metal devices, MRI in high-susceptibility regions, and efficient imaging. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Grist in this issue.
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Affiliation(s)
- Adrienne E. Campbell-Washburn
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Rajiv Ramasawmy
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Matthew C. Restivo
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Ipshita Bhattacharya
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Burcu Basar
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Daniel A. Herzka
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Michael S. Hansen
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Toby Rogers
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - W. Patricia Bandettini
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Delaney R. McGuirt
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Christine Mancini
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - David Grodzki
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Rainer Schneider
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Waqas Majeed
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Himanshu Bhat
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Hui Xue
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Joel Moss
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Ashkan A. Malayeri
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Elizabeth C. Jones
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Alan P. Koretsky
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Peter Kellman
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Marcus Y. Chen
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Robert J. Lederman
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
| | - Robert S. Balaban
- From the Cardiovascular Branch, Division of Intramural Research,
National Heart, Lung, and Blood Institute, National Institutes of Health,
Bethesda, Md (A.E.C.W., R.R., M.C.R., I.B., B.B., D.A.H., M.S.H., T.R., W.P.B.,
D.R.M., C.M., M.Y.C., R.J.L.); Siemens Healthcare GmbH, Erlangen, Germany (D.G.,
R.S.); Siemens Medical Solutions Inc, Malvern Pa (W.M., H.B.); Systems Biology
Center, Division of Intramural Research, National Heart, Lung, and Blood
Institute, National Institutes of Health, 10 Center Dr, Building 10, Room
4C-1581, Bethesda, MD 20892-1458 (H.X., P.K., R.S.B.); Pulmonary Branch,
Division of Intramural Research, National Heart, Lung, and Blood Institute,
National Institutes of Health, Bethesda, MD (J.M.); Department of Radiology and
Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Md
(A.A.M., E.C.J.); and Laboratory of Functional and Molecular Imaging, Division
of Intramural Research, National Institute of Neurologic Disorders and Stroke,
National Institutes of Health, Bethesda, Md (A.P.K.)
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19
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Alipour A, Meyer ES, Dumoulin CL, Watkins RD, Elahi H, Loew W, Schweitzer J, Olson G, Chen Y, Tao S, Guttman M, Kolandaivelu A, Halperin HR, Schmidt EJ. MRI Conditional Actively Tracked Metallic Electrophysiology Catheters and Guidewires With Miniature Tethered Radio-Frequency Traps: Theory, Design, and Validation. IEEE Trans Biomed Eng 2019; 67:1616-1627. [PMID: 31535979 DOI: 10.1109/tbme.2019.2941460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Cardiovascular interventional devices typically have long metallic braids or backbones to aid in steerability and pushability. However, electromagnetic coupling of metallic-based cardiovascular interventional devices with the radiofrequency (RF) fields present during Magnetic Resonance Imaging (MRI) can make a device unsafe for use in an MRI scanner. We aimed to develop MRI conditional actively-tracked cardiovascular interventional devices by sufficiently attenuating induced currents on the metallic braid/tube and internal-cabling using miniaturized resonant floating RF traps (MBaluns). METHOD MBaluns were designed for placement at multiple locations along a conducting cardiovascular device to prevent the establishment of standing waves and to dissipate RF-induced energy. The MBaluns were constructed with loosely-wound solenoids to be sensitive to transverse magnetic fields created by both surface currents on the device's metallic backbone and common-mode currents on internal cables. Electromagnetic simulations were used to optimize MBalun parameters. Following optimization, two different MBalun designs were applied to MR-actively-tracked metallic guidewires and metallic-braided electrophysiology ablation catheters. Control-devices were constructed without MBaluns. MBalun performance was validated using network-analyzer quantification of current attenuation, electromagnetic Specific-Absorption-Rate (SAR) analysis, thermal tests during high SAR pulse sequences, and MRI-guided cardiovascular navigation in swine. RESULTS Electromagnetic SAR simulations resulted in ≈20 dB attenuation at the tip of the wire using six successive MBaluns. Network-analyzer tests confirmed ∼17 dB/MBalun surface-current attenuation. Thermal tests indicated temperature decreases of 5.9 °C in the MBalun-equipped guidewire tip. Both devices allowed rapid vascular navigation resulting from good torquability and MR-Tracking visibility. CONCLUSION MBaluns increased device diameter by 20%, relative to conventional devices, providing a spatially-efficient means to prevent heating during MRI. SIGNIFICANCE MBaluns allow use of long metallic components, which improves mechanical performance in active MR-guided interventional devices.
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20
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Okada DR, Wu KC. Applications of Cardiac MR Imaging in Electrophysiology. Magn Reson Imaging Clin N Am 2019; 27:465-473. [PMID: 31279450 DOI: 10.1016/j.mric.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Chinnadurai P, Bismuth J. Intraoperative Imaging and Image Fusion for Venous Interventions. Methodist Debakey Cardiovasc J 2018; 14:200-207. [PMID: 30410650 DOI: 10.14797/mdcj-14-3-200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Advanced imaging for intraoperative evaluation of venous pathologies has played an increasingly significant role in this era of evolving minimally invasive surgical and interventional therapies. The evolution of dedicated venous stents and other novel interventional devices has mandated the need for advanced imaging tools to optimize safe and accurate device deployment. Most venous interventions are typically performed using a combination of standard 2-dimensional (2D) fluoroscopy, digital-subtraction angiography, and intravascular ultrasound imaging techniques. Latest generation computer tomography (CT) and magnetic resonance imaging (MRI) scanners have been shown to provide high-resolution 3D and 4D information about venous vasculature. In addition to morphological imaging, novel MRI techniques such as 3D time-resolved MR venography and 4D flow sequences can provide quantitative information and help visualize intricate flow patterns to better understand complex venous pathologies. Moreover, the high-fidelity information from multiple imaging techniques can be integrated using image fusion to overcome the limitations of current intraoperative imaging techniques. For example, the limitations of standard 2D fluoroscopy and luminal angiography can be compensated for by perivascular and soft-tissue information from MRI during complex venous interventions using image fusion techniques. Intraoperative dynamic evaluation of devices such as venous stents and real-time understanding of changes in flow patterns during venous interventions may be routinely available in future interventional suites with integrated multimodality CT or MR imaging capabilities. The purpose of this review is to discuss the outlook for intraoperative imaging and multimodality image fusion techniques and highlight their value during complex venous interventions.
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Affiliation(s)
| | - Jean Bismuth
- METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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22
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Abstract
Diagnostic and interventional cardiac catheterization is routinely used in the diagnosis and treatment of congenital heart disease. There are well-established concerns regarding the risk of radiation exposure to patients and staff, particularly in children given the cumulative effects of repeat exposure. Magnetic resonance imaging (MRI) offers the advantage of being able to provide better soft tissue visualization, tissue characterization, and quantification of ventricular volumes and vascular flow. Initial work using MRI catheterization employed fusion of x-ray and MRI techniques, with x-ray fluoroscopy to guide catheter placement and subsequent MRI assessment for anatomical and hemodynamic assessment. Image overlay of 3D previously acquired MRI datasets with live fluoroscopic imaging has also been used to guide catheter procedures.Hybrid x-ray and MRI-guided catheterization paved the way for clinical application and validation of this technique in the assessment of pulmonary vascular resistance and pharmacological stress studies. Purely MRI-guided catheterization also proved possible with passive catheter tracking. First-in-man MRI-guided cardiac catheter interventions were possible due to the development of MRI-compatible guidewires, but halted due to guidewire limitations.More recent developments in passive and active catheter tracking have led to improved visualization of catheters for MRI-guided catheterization. Improvements in hardware and software have also increased image quality and scanning times with better interactive tools for the operator in the MRI catheter suite to navigate through the anatomy as required in real time. This has expanded to MRI-guided electrophysiology studies and radiofrequency ablation in humans. Animal studies show promise for the utility of MRI-guided interventional catheterization. Ongoing investment and development of MRI-compatible guidewires will pave the way for MRI-guided diagnostic and interventional catheterization coming into the mainstream.
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Kenny D. Interventional Cardiology for Congenital Heart Disease. Korean Circ J 2018; 48:350-364. [PMID: 29671282 PMCID: PMC5940641 DOI: 10.4070/kcj.2018.0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/05/2018] [Indexed: 12/22/2022] Open
Abstract
Congenital heart interventions are now replacing surgical palliation and correction in an evolving number of congenital heart defects. Right ventricular outflow tract and ductus arteriosus stenting have demonstrated favorable outcomes compared to surgical systemic to pulmonary artery shunting, and it is likely surgical pulmonary valve replacement will become an uncommon procedure within the next decade, mirroring current practices in the treatment of atrial septal defects. Challenges remain, including the lack of device design focused on smaller infants and the inevitable consequences of somatic growth. Increasing parental and physician expectancy has inevitably lead to higher risk interventions on smaller infants and appreciation of the consequences of these interventions on departmental outcome data needs to be considered. Registry data evaluating congenital heart interventions remain less robust than surgical registries, leading to a lack of insight into the longer-term consequences of our interventions. Increasing collaboration with surgical colleagues has not been met with necessary development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.
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Affiliation(s)
- Damien Kenny
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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Corrigan FE, Maini A, Reginauld S, Lerakis S. Contemporary evaluation of mitral regurgitation – 3D echocardiography, cardiac magnetic resonance, and procedural planning. Expert Rev Cardiovasc Ther 2017; 15:715-725. [DOI: 10.1080/14779072.2017.1362981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Frank E. Corrigan
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Aneel Maini
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Shawn Reginauld
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Stamatios Lerakis
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Rogers T, Ratnayaka K, Khan JM, Stine A, Schenke WH, Grant LP, Mazal JR, Grant EK, Campbell-Washburn A, Hansen MS, Ramasawmy R, Herzka DA, Xue H, Kellman P, Faranesh AZ, Lederman RJ. CMR fluoroscopy right heart catheterization for cardiac output and pulmonary vascular resistance: results in 102 patients. J Cardiovasc Magn Reson 2017; 19:54. [PMID: 28750642 PMCID: PMC5530573 DOI: 10.1186/s12968-017-0366-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantification of cardiac output and pulmonary vascular resistance (PVR) are critical components of invasive hemodynamic assessment, and can be measured concurrently with pressures using phase contrast CMR flow during real-time CMR guided cardiac catheterization. METHODS One hundred two consecutive patients underwent CMR fluoroscopy guided right heart catheterization (RHC) with simultaneous measurement of pressure, cardiac output and pulmonary vascular resistance using CMR flow and the Fick principle for comparison. Procedural success, catheterization time and adverse events were prospectively collected. RESULTS RHC was successfully completed in 97/102 (95.1%) patients without complication. Catheterization time was 20 ± 11 min. In patients with and without pulmonary hypertension, baseline mean pulmonary artery pressure was 39 ± 12 mmHg vs. 18 ± 4 mmHg (p < 0.001), right ventricular (RV) end diastolic volume was 104 ± 64 vs. 74 ± 24 (p = 0.02), and RV end-systolic volume was 49 ± 30 vs. 31 ± 13 (p = 0.004) respectively. 103 paired cardiac output and 99 paired PVR calculations across multiple conditions were analyzed. At baseline, the bias between cardiac output by CMR and Fick was 5.9% with limits of agreement -38.3% and 50.2% with r = 0.81 (p < 0.001). The bias between PVR by CMR and Fick was -0.02 WU.m2 with limits of agreement -2.6 and 2.5 WU.m2 with r = 0.98 (p < 0.001). Correlation coefficients were lower and limits of agreement wider during physiological provocation with inhaled 100% oxygen and 40 ppm nitric oxide. CONCLUSIONS CMR fluoroscopy guided cardiac catheterization is safe, with acceptable procedure times and high procedural success rate. Cardiac output and PVR measurements using CMR flow correlated well with the Fick at baseline and are likely more accurate during physiological provocation with supplemental high-concentration inhaled oxygen. TRIAL REGISTRATION Clinicaltrials.gov NCT01287026 , registered January 25, 2011.
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Affiliation(s)
- Toby Rogers
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Kanishka Ratnayaka
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
- Department of Cardiology, Rady Children’s Hospital, San Diego, CA USA
| | - Jaffar M. Khan
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Annette Stine
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - William H. Schenke
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Laurie P. Grant
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Jonathan R. Mazal
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Elena K. Grant
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
- Department of Cardiology, Children’s National Medical Center, Washington, DC USA
| | - Adrienne Campbell-Washburn
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Michael S. Hansen
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Rajiv Ramasawmy
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Daniel A. Herzka
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Hui Xue
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Peter Kellman
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Anthony Z. Faranesh
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Robert J. Lederman
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD 20892-1538 USA
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Schmidt EJ, Watkins RD, Zviman MM, Guttman MA, Wang W, Halperin HA. A Magnetic Resonance Imaging-Conditional External Cardiac Defibrillator for Resuscitation Within the Magnetic Resonance Imaging Scanner Bore. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005091. [PMID: 27729363 DOI: 10.1161/circimaging.116.005091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Subjects undergoing cardiac arrest within a magnetic resonance imaging (MRI) scanner are currently removed from the bore and then from the MRI suite, before the delivery of cardiopulmonary resuscitation and defibrillation, potentially increasing the risk of mortality. This precludes many higher-risk (acute ischemic and acute stroke) patients from undergoing MRI and MRI-guided intervention. An MRI-conditional cardiac defibrillator should enable scanning with defibrillation pads attached and the generator ON, enabling application of defibrillation within the seconds of MRI after a cardiac event. An MRI-conditional external defibrillator may improve patient acceptance for MRI procedures. METHODS AND RESULTS A commercial external defibrillator was rendered 1.5 Tesla MRI-conditional by the addition of novel radiofrequency filters between the generator and commercial disposable surface pads. The radiofrequency filters reduced emission into the MRI scanner and prevented cable/surface pad heating during imaging, while preserving all the defibrillator monitoring and delivery functions. Human volunteers were imaged using high specific absorption rate sequences to validate MRI image quality and lack of heating. Swine were electrically fibrillated (n=4) and thereafter defibrillated both outside and inside the MRI bore. MRI image quality was reduced by 0.8 or 1.6 dB, with the generator in monitoring mode and operating on battery or AC power, respectively. Commercial surface pads did not create artifacts deeper than 6 mm below the skin surface. Radiofrequency heating was within US Food and Drug Administration guidelines. Defibrillation was completely successful inside and outside the MRI bore. CONCLUSIONS A prototype MRI-conditional defibrillation system successfully defibrillated in the MRI without degrading the image quality or increasing the time needed for defibrillation. It can increase patient acceptance for MRI procedures.
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Affiliation(s)
- Ehud J Schmidt
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.).
| | - Ronald D Watkins
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Menekhem M Zviman
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Michael A Guttman
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Wei Wang
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Henry A Halperin
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
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Weems AC, Szafron JM, Easley AD, Herting S, Smolen J, Maitland DJ. Shape memory polymers with enhanced visibility for magnetic resonance- and X-ray imaging modalities. Acta Biomater 2017; 54:45-57. [PMID: 28259837 PMCID: PMC5811198 DOI: 10.1016/j.actbio.2017.02.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 12/30/2022]
Abstract
Currently, monitoring of minimally invasive medical devices is performed using fluoroscopy. The risks associated with fluoroscopy, including increased risk of cancer, make this method especially unsuitable for pediatric device delivery and follow-up procedures. A more suitable method is magnetic resonance (MR) imaging, which makes use of harmless magnetic fields rather than ionizing radiation when imaging the patient; this method is safer for both the patient and the performing technicians. Unfortunately, there is a lack of research available on bulk polymeric materials to enhance MR-visibility for use in medical devices. Here we show the incorporation of both physical and chemical modifying agents for the enhancement of both MR and X-ray visibility. Through the incorporation of these additives, we are able to control shape recovery of the polymer without sacrificing the thermal transition temperatures or the mechanical properties. For long-term implantation, these MR-visible materials do not have altered degradation profiles, and the release of additives is well below significant thresholds for daily dosages of MR-visible compounds. We anticipate our materials to be a starting point for safer, MR-visible medical devices incorporating polymeric components. STATEMENT OF SIGNIFICANCE Shape memory polymers (SMPs) are polymeric materials with unique shape recovery abilities that are being considered for use in biomedical and medical device applications. This paper presents a methodology for the development of MR and X-ray visible SMPs using either a chemically loaded or physical loaded method during polymer synthesis. Such knowledge is imperative for the development and clinical application of SMPs for biomedical devices, specifically for minimally-invasive vascular occlusion treatments, and while there are studies pertaining to the visibility of polymeric particles, little work has been performed on the utility of biomaterials intended for medical devices and the impact of how adding multiple functionalities, such as imaging, may impact material safety and degradation.
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Affiliation(s)
- A C Weems
- Department of Biomedical Engineering, 5045 Emerging Technologies Building, 3120 TAMU Texas A&M University, College Station, TX 77843-3120, USA
| | - J M Szafron
- Department of Biomedical Engineering, 5045 Emerging Technologies Building, 3120 TAMU Texas A&M University, College Station, TX 77843-3120, USA
| | - A D Easley
- Department of Biomedical Engineering, 5045 Emerging Technologies Building, 3120 TAMU Texas A&M University, College Station, TX 77843-3120, USA
| | - S Herting
- Department of Biomedical Engineering, 5045 Emerging Technologies Building, 3120 TAMU Texas A&M University, College Station, TX 77843-3120, USA
| | - J Smolen
- Department of Biomedical Engineering, 5045 Emerging Technologies Building, 3120 TAMU Texas A&M University, College Station, TX 77843-3120, USA
| | - D J Maitland
- Department of Biomedical Engineering, 5045 Emerging Technologies Building, 3120 TAMU Texas A&M University, College Station, TX 77843-3120, USA.
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Suntharos P, Setser RM, Bradley-Skelton S, Prieto LR. Real-time three dimensional CT and MRI to guide interventions for congenital heart disease and acquired pulmonary vein stenosis. Int J Cardiovasc Imaging 2017; 33:1619-1626. [PMID: 28455631 DOI: 10.1007/s10554-017-1151-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/25/2017] [Indexed: 11/28/2022]
Abstract
To validate the feasibility and spatial accuracy of pre-procedural 3D images to 3D rotational fluoroscopy registration to guide interventional procedures in patients with congenital heart disease and acquired pulmonary vein stenosis. Cardiac interventions in patients with congenital and structural heart disease require complex catheter manipulation. Current technology allows registration of the anatomy obtained from 3D CT and/or MRI to be overlaid onto fluoroscopy. Thirty patients scheduled for interventional procedures from 12/2012 to 8/2015 were prospectively recruited. A C-arm CT using a biplane C-arm system (Artis zee, VC14H, Siemens Healthcare) was acquired to enable 3D3D registration with pre-procedural images. Following successful image fusion, the anatomic landmarks marked in pre-procedural images were overlaid on live fluoroscopy. The accuracy of image registration was determined by measuring the distance between overlay markers and a reference point in the image. The clinical utility of the registration was evaluated as either "High", "Medium" or "None". Seventeen patients with congenital heart disease and 13 with acquired pulmonary vein stenosis were enrolled. Accuracy and benefit of registration were not evaluated in two patients due to suboptimal images. The distance between the marker and the actual anatomical location was 0-2 mm in 18 (64%), 2-4 mm in 3 (11%) and >4 mm in 7 (25%) patients. 3D3D registration was highly beneficial in 18 (64%), intermediate in 3 (11%), and not beneficial in 7 (25%) patients. 3D3D registration can facilitate complex congenital and structural interventions. It may reduce procedure time, radiation and contrast dose.
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Affiliation(s)
- Patcharapong Suntharos
- Department of Pediatric Cardiology, Cleveland Clinic Children's, 9500 Euclid Avenue, Desk M-41, Cleveland, OH, 44195, USA.
| | | | - Sharon Bradley-Skelton
- Department of Pediatric Cardiology, Cleveland Clinic Children's, 9500 Euclid Avenue, Desk M-41, Cleveland, OH, 44195, USA
| | - Lourdes R Prieto
- Department of Pediatric Cardiology, Cleveland Clinic Children's, 9500 Euclid Avenue, Desk M-41, Cleveland, OH, 44195, USA
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Weems AC, Raymond JE, Easley AD, Wierzbicki MA, Gustafson T, Monroe M, Maitland DJ. Shape memory polymers with visible and near-infrared imaging modalities: Synthesis, characterization and in vitro analysis. RSC Adv 2017; 7:19742-19753. [PMID: 30288254 PMCID: PMC6168213 DOI: 10.1039/c6ra28165f] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Shape memory polymers (SMPs) are promising for non-invasive medical devices and tissue scaffolds, but are limited by a lack of visibility under clinical imaging. Fluorescent dyes are an alternative to radiocontrast agents in medical applications, they can be utilized in chemical sensors and monitors and may be anti-microbial agents. Thus, a fluorescent SMP could be a highly valuable biomaterial system. Here, we show that four fluorescent dyes (phloxine B (PhB), eosin Y (Eos), indocyanine green(IcG), and calcein (Cal)) can be crosslinked into the polymer backbone to enhance material optical properties without alteration of shape memory and thermomechanical properties. Examinations of the emission wavelengths of the materials compared with the dye solutions showed a slight red shift in the peak emissions, indicative of crosslinking of the material. Quantitative analysis revealed that PhB enabled visibility through 1 cm of blood and through soft tissue. We also demonstrate the utility of these methods in combination with radio-opaque microparticle additives and the use of laser-induced shape recovery to allow for rapid shape recovery below the glass transition temperature. The crosslinking of fluorescent dyes into the SMP enables tuning of physical properties and shape memory and independently of the fluorescence functionality. This fluorescent SMP biomaterial system allows for use of multiple imaging modalities with potential application in minimally invasive medical devices.
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Affiliation(s)
- A C Weems
- Biomedical Device Laboratory, Dept of Biomedical Engineering, Texas A&M University, College Station, TX, 77860
| | - J E Raymond
- Laboratory for Synthetic-Biologic Interface, Dept of Chemistry, Texas A&M University, College Station, TX, 77860
| | - A D Easley
- Biomedical Device Laboratory, Dept of Biomedical Engineering, Texas A&M University, College Station, TX, 77860
| | - M A Wierzbicki
- Biomedical Device Laboratory, Dept of Biomedical Engineering, Texas A&M University, College Station, TX, 77860
| | - T Gustafson
- Laboratory for Synthetic-Biologic Interface, Dept of Chemistry, Texas A&M University, College Station, TX, 77860
| | - Mbb Monroe
- Biomedical Device Laboratory, Dept of Biomedical Engineering, Texas A&M University, College Station, TX, 77860
| | - D J Maitland
- Biomedical Device Laboratory, Dept of Biomedical Engineering, Texas A&M University, College Station, TX, 77860
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Kenny DP, Hijazi ZM. Current Status and Future Potential of Transcatheter Interventions in Congenital Heart Disease. Circ Res 2017; 120:1015-1026. [DOI: 10.1161/circresaha.116.309185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 02/03/2023]
Abstract
Percutaneous therapies for congenital heart disease have evolved rapidly in the past 3 decades. This has occurred despite limited investment from industry and support from regulatory bodies resulting in a lack of specific device development. Indeed, many devices remain off-label with a best-fit approach often required, spurning an innovative culture within the subspecialty, which had arguably laid the foundation for many of the current and evolving structural heart interventions. Challenges remain, not least encouraging device design focused on smaller infants and the inevitable consequences of somatic growth. Data collection tools are emerging but remain behind adult cardiology and cardiac surgery and leading to partial blindness as to the longer-term consequences of our interventions. Tail coating on the back of developments in other fields of adult intervention will soon fail to meet the expanding needs for more precise interventions and biological materials. Increasing collaboration with surgical colleagues will require development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure that children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia, and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.
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Affiliation(s)
- Damien P. Kenny
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
| | - Ziyad M. Hijazi
- From the Our Lady’s Children’s Hospital, Crumlin, Dublin, Ireland; and Weill Cornell Medical College, Sidra Medical and Research Center, Doha, Qatar
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Abstract
Ablation of ventricular tachycardia (VT) in the setting of structural heart disease, previously reserved for highly experienced specialized centers, is being performed at more centers internationally as cardiac electrophysiologists gain advanced training. Interventional cardiac electrophysiologists need a high level of anatomic knowledge to guide a procedure that can carry significant risk. Understanding cardiac anatomy improves the chance of procedural success and also the likelihood of appropriate decision making if complications are encountered. This article focuses on selected anatomic regions where complex anatomy can be an impediment to successful VT ablation.
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Chubb H, Harrison JL, Weiss S, Krueger S, Koken P, Bloch LØ, Kim WY, Stenzel GS, Wedan SR, Weisz JL, Gill J, Schaeffter T, O’Neill MD, Razavi RS. Development, Preclinical Validation, and Clinical Translation of a Cardiac Magnetic Resonance - Electrophysiology System With Active Catheter Tracking for Ablation of Cardiac Arrhythmia. JACC Clin Electrophysiol 2017; 3:89-103. [DOI: 10.1016/j.jacep.2016.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/08/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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Campbell-Washburn AE, Rogers T, Basar B, Sonmez M, Kocaturk O, Lederman RJ, Hansen MS, Faranesh AZ. Positive contrast spiral imaging for visualization of commercial nitinol guidewires with reduced heating. J Cardiovasc Magn Reson 2015; 17:114. [PMID: 26695490 PMCID: PMC4688983 DOI: 10.1186/s12968-015-0219-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/09/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND CMR-guidance has the potential to improve tissue visualization during cardiovascular catheterization procedures and to reduce ionizing radiation exposure, but a lack of commercially available CMR guidewires limits widespread adoption. Standard metallic guidewires are considered to be unsafe in CMR due to risks of RF-induced heating. Here, we propose the use of RF-efficient gradient echo (GRE) spiral imaging for reduced guidewire heating (low flip angle, long readout), in combination with positive contrast for guidewire visualization. METHODS A GRE spiral sequence with 8 interleaves was used for imaging. Positive contrast was achieved using through-slice dephasing such that the guidewire appeared bright and the background signal suppressed. Positive contrast images were interleaved with anatomical images, and real-time image processing was used to produce a color overlay of the guidewire on the anatomy. Temperature was measured with a fiber-optic probe attached to the guidewire in an acrylic gel phantom and in vivo. RESULTS Left heart catheterization was performed on swine using the real-time color overlay for procedural guidance with a frame rate of 6.25 frames/second. Using our standard Cartesian real-time imaging (flip angle 60°), temperature increases up to 50 °C (phantom) and 4 °C (in vivo) were observed. In comparison, spiral GRE images (8 interleaves, flip angle 10°) generated negligible heating measuring 0.37 °C (phantom) and 0.06 °C (in vivo). CONCLUSIONS The ability to use commercial metallic guidewires safely during CMR-guided catheterization could potentially expedite clinical translation of these methods.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Toby Rogers
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Burcu Basar
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey.
| | - Merdim Sonmez
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Ozgur Kocaturk
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey.
| | - Robert J Lederman
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Michael S Hansen
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Anthony Z Faranesh
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
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Basar B, Rogers T, Ratnayaka K, Campbell-Washburn AE, Mazal JR, Schenke WH, Sonmez M, Faranesh AZ, Lederman RJ, Kocaturk O. Segmented nitinol guidewires with stiffness-matched connectors for cardiovascular magnetic resonance catheterization: preserved mechanical performance and freedom from heating. J Cardiovasc Magn Reson 2015; 17:105. [PMID: 26620420 PMCID: PMC4665398 DOI: 10.1186/s12968-015-0210-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conventional guidewires are not suitable for use during cardiovascular magnetic resonance (CMR) catheterization. They employ metallic shafts for mechanical performance, but which are conductors subject to radiofrequency (RF) induced heating. To date, non-metallic CMR guidewire designs have provided inadequate mechanical support, trackability, and torquability. We propose a metallic guidewire for CMR that is by design intrinsically safe and that retains mechanical performance of commercial guidewires. METHODS The NHLBI passive guidewire is a 0.035" CMR-safe, segmented-core nitinol device constructed using short nitinol rod segments. The electrical length of each segment is less than one-quarter wavelength at 1.5 Tesla, which eliminates standing wave formation, and which therefore eliminates RF heating along the shaft. Each of the electrically insulated segments is connected with nitinol tubes for stiffness matching to assure uniform flexion. Iron oxide markers on the distal shaft impart conspicuity. Mechanical integrity was tested according to International Organization for Standardization (ISO) standards. CMR RF heating safety was tested in vitro in a phantom according to American Society for Testing and Materials (ASTM) F-2182 standard, and in vivo in seven swine. Results were compared with a high-performance commercial nitinol guidewire. RESULTS The NHLBI passive guidewire exhibited similar mechanical behavior to the commercial comparator. RF heating was reduced from 13 °C in the commercial guidewire to 1.2 °C in the NHLBI passive guidewire in vitro, using a flip angle of 75°. The maximum temperature increase was 1.1 ± 0.3 °C in vivo, using a flip angle of 45°. The guidewire was conspicuous during left heart catheterization in swine. CONCLUSIONS We describe a simple and intrinsically safe design of a metallic guidewire for CMR cardiovascular catheterization. The guidewire exhibits negligible heating at high flip angles in conformance with regulatory guidelines, yet mechanically resembles a high-performance commercial guidewire. Iron oxide markers along the length of the guidewire impart passive visibility during real-time CMR. Clinical translation is imminent.
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Affiliation(s)
- Burcu Basar
- National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD, 20892-1538, USA.
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey.
| | - Toby Rogers
- National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD, 20892-1538, USA.
| | - Kanishka Ratnayaka
- National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD, 20892-1538, USA.
- Department of Cardiology, Children's National Medical Center, Washington DC, USA.
| | - Adrienne E Campbell-Washburn
- National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD, 20892-1538, USA.
| | - Jonathan R Mazal
- National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD, 20892-1538, USA.
| | - William H Schenke
- National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD, 20892-1538, USA.
| | - Merdim Sonmez
- National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD, 20892-1538, USA.
| | - Anthony Z Faranesh
- National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD, 20892-1538, USA.
| | - Robert J Lederman
- National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, MD, 20892-1538, USA.
| | - Ozgur Kocaturk
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey.
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