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Nijsink H, Overduin CG, Willems LH, Warlé MC, Fütterer JJ. Current State of MRI-Guided Endovascular Arterial Interventions: A Systematic Review of Preclinical and Clinical Studies. J Magn Reson Imaging 2022; 56:1322-1342. [PMID: 35420239 PMCID: PMC9790618 DOI: 10.1002/jmri.28205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND MRI guidance of arterial endovascular interventions could be beneficial as it does not require radiation exposure, allows intrinsic blood-tissue contrast, and enables three-dimensional and functional imaging, however, clinical applications are still limited. PURPOSE To review the current state of MRI-guided arterial endovascular interventions and to identify the most commonly reported challenges. STUDY TYPE Systematic review. POPULATION Pubmed, Embase, Web of Science, and The Cochrane Library were systematically searched to find relevant articles. The search strategy combined synonyms for vascular pathology, endovascular therapy, and real-time MRI guidance. FIELD STRENGTH/SEQUENCE No field strength or sequence restrictions were applied. ASSESSMENT Two reviewers independently identified and reviewed the original articles and extracted relevant data. STATISTICAL TESTS Results of the included original articles are reported. RESULTS A total of 24,809 studies were identified for screening. Eighty-eight studies were assessed for eligibility, after which data were extracted from 43 articles (6 phantom, 33 animal, and 4 human studies). Reported technical success rates for animal and human studies ranged between 42% to 100%, and the average complication rate was 5.8% (animal studies) and 8.8% (human studies). Main identified challenges were related to spatial and temporal resolution as well as safety, design, and scarcity of current MRI-compatible endovascular devices. DATA CONCLUSION MRI guidance of endovascular arterial interventions seems feasible, however, included articles included mostly small single-center case series. Several hurdles remain to be overcome before larger trials can be undertaken. Main areas of research should focus on adequate imaging protocols with integrated tracking of dedicated endovascular devices.
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Affiliation(s)
- Han Nijsink
- Department of Medical ImagingRadboudumcNijmegenNetherlands
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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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Magnetic Resonance-Guided Passive Catheter Tracking for Endovascular Therapy. Magn Reson Imaging Clin N Am 2015; 23:591-605. [PMID: 26499277 DOI: 10.1016/j.mric.2015.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The use of MR guidance for endovascular intervention is appealing because of its lack of ionizing radiation, high-contrast visualization of vessel walls and adjacent soft tissues, multiplanar capabilities, and potential to incorporate functional information such as flow, fluid dynamics, perfusion, and cardiac motion. This review highlights state-of-the-art imaging techniques and hardware used for passive tracking of endovascular devices in interventional MR imaging, including negative contrast, passive contrast, nonproton multispectral, and direct current techniques. The advantages and disadvantages of passive tracking relative to active tracking are also summarized.
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Jia F, Yuan H, Zhou D, Zhang J, Wang X, Fang J. Knee MRI under varying flexion angles utilizing a flexible flat cable antenna. NMR IN BIOMEDICINE 2015; 28:460-467. [PMID: 25740180 DOI: 10.1002/nbm.3264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 12/04/2014] [Accepted: 12/30/2014] [Indexed: 06/04/2023]
Abstract
The aim of this study is to fabricate and test a novel flexible flat cable antenna (FFCA) for MRI of the knee at different flexion angles. The FFCA was made of a flat cable, a tuning/matching circuit and a signal transmission line. To test its feasibility and validity, in vitro and in vivo experiments were carried out on a 3.0 T MR scanner. The in vitro experiment suggested that the proposed FFCA could achieve a high signal-to-noise ratio (SNR) of 336, while the SNR of an eight-channel knee coil was 291, and phantom images from the FFCA are homogeneously distributed. In the in vivo experiment, the FFCA had a higher SNR of 169 in the region of interest and more than 48.5 cm of longitudinal coverage, while the corresponding values for the commercial coil were 153 and 22.5 cm. Finally, five sagittal knee images at different flexion angles were acquired. The FFCA could acquire satisfactory knee images at different flexion angles, with the advantages of simplicity, low cost, large field of view and high SNR. It may therefore be further used to improve MR image quality of the knee joint.
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Affiliation(s)
- Fan Jia
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
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Sapontis J, Hill J. The role of adjunctive imaging in chronic total occlusions. Interv Cardiol 2013. [DOI: 10.2217/ica.13.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Erturk MA, El-Sharkawy AMM, Moore J, Bottomley PA. 7 Tesla MRI with a transmit/receive loopless antenna and B1-insensitive selective excitation. Magn Reson Med 2013; 72:220-6. [PMID: 23963978 DOI: 10.1002/mrm.24910] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/25/2013] [Accepted: 07/15/2013] [Indexed: 11/10/2022]
Abstract
PURPOSE Use of external coils with internal detectors or conductors is challenging at 7 Tesla (T) due to radiofrequency (RF) field (B1 ) penetration, B1 -inhomogeneity, mutual coupling, and potential local RF heating. The present study tests whether the near-quadratic gains in signal-to-noise ratio and field-of-view with field-strength previously reported for internal loopless antennae at 7T can suffice to perform MRI with an interventional transmit/receive antenna without using any external coils. METHODS External coils were replaced by semi-rigid or biocompatible transmit/receive loopless antennae requiring only a few Watts of peak RF power. Slice selection was provided by spatially selective B1 -insensitive composite RF pulses that compensate for the antenna's intrinsically nonuniform B1 -field. Power was adjusted to maintain local temperature rise ≤1°C. Fruit, intravascular MRI of diseased human vessels in vitro, and MRI of rabbit aorta in vivo are demonstrated. RESULTS Scout MRI with the transmit/receive antennae yielded a ≤10 cm cylindrical field-of-view, enabling subsequent targeted localization at ∼100 μm resolution in 10-50 s and/or 50 μm MRI in ∼2 min in vitro, and 100-300 μm MRI of the rabbit aorta in vivo. CONCLUSION A simple, low-power, one-device approach to interventional MRI at 7T offers the potential of truly high-resolution MRI, while avoiding issues with external coil excitation and interactions at 7T.
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Affiliation(s)
- M Arcan Erturk
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA; Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
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An intravascular loopless monopole antenna for vessel wall MR imaging at 3.0 T. Magn Reson Imaging 2013; 31:150-5. [PMID: 22902470 DOI: 10.1016/j.mri.2012.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 06/05/2012] [Accepted: 06/26/2012] [Indexed: 11/21/2022]
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MR imaging of hydrogel filament embolic devices loaded with superparamagnetic iron oxide or gadolinium. Neuroradiology 2010; 53:449-56. [DOI: 10.1007/s00234-010-0744-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
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Neizel M, Krämer N, Bönner F, Schütte A, Krüger S, Kelm M, Günther RW, Kühl HP, Krombach GA. Rapid Right Ventricular Pacing with MR-compatible Pacemaker Lead for MR-guided Aortic Balloon Valvuloplasty in Swine. Radiology 2010; 255:799-804. [DOI: 10.1148/radiol.10091419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ratnayaka K, Faranesh AZ, Guttman MA, Kocaturk O, Saikus CE, Lederman RJ. Interventional cardiovascular magnetic resonance: still tantalizing. J Cardiovasc Magn Reson 2008; 10:62. [PMID: 19114017 PMCID: PMC2637847 DOI: 10.1186/1532-429x-10-62] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 12/29/2008] [Indexed: 12/30/2022] Open
Abstract
The often touted advantages of MR guidance remain largely unrealized for cardiovascular interventional procedures in patients. Many procedures have been simulated in animal models. We argue these opportunities for clinical interventional MR will be met in the near future. This paper reviews technical and clinical considerations and offers advice on how to implement a clinical-grade interventional cardiovascular MR (iCMR) laboratory. We caution that this reflects our personal view of the "state of the art."
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Affiliation(s)
- Kanishka Ratnayaka
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Cardiology Division, Children's National Medical Center, Washington, DC, USA
| | - Anthony Z Faranesh
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael A Guttman
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ozgur Kocaturk
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christina E Saikus
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Robert J Lederman
- Translational Medicine Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Park JK, Rhee TK, Cashen TA, Shin W, Resnick SA, Gehl JA, Schirf BE, Wang D, Larson AC, Carroll TJ, Omary RA. MR Imaging Assessment of Changes in Renal Function with Renal Artery Stent Placement in Swine. J Vasc Interv Radiol 2007; 18:1409-16. [DOI: 10.1016/j.jvir.2007.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Park JK, Rhee TK, Cashen TA, Shin W, Schirf BE, Gehl JA, Larson AC, Prasad PV, Li D, Carroll TJ, Omary RA. Renal Artery Stenosis in Swine: Feasibility of MR Assessment of Renal Function during Percutaneous Transluminal Angioplasty. Radiology 2007; 244:144-50. [PMID: 17495175 DOI: 10.1148/radiol.2433060184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively test--in a swine model of renal artery stenosis (RAS)--the hypothesis that magnetic resonance (MR) imaging can reveal changes in renal function at the time of percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS In this animal care and use committee-approved study, high-grade unilateral RAS was surgically induced in six pigs. MR imaging at 3.0 T was used for intraprocedural assessment of the anatomic and physiologic changes induced by x-ray-guided PTA. With use of MR imaging, changes in single-kidney glomerular filtration rate, extraction fraction, and renal blood flow were assessed during PTA. The arterial diameter of stenosis before and after PTA was assessed by using conventional digital subtraction angiography. Mean changes in functional and anatomic parameters were compared by using the Wilcoxon signed rank test (alpha = .05). RESULTS At digital subtraction angiography, the mean percentage of stenosis was 69% +/- 10 (standard deviation) before PTA and 26% +/- 10 after PTA (P<.03). Mean pre- and post-PTA extraction fraction values were 0.11 +/- 0.03 and 0.19 +/- 0.06, respectively (P<.03). The mean single-kidney glomerular filtration rate before PTA, 19 mL/min +/- 13, increased to 41 mL/min +/- 33 after PTA (P<.03). There was no significant change in mean renal blood flow after PTA (P=.44). CONCLUSION In swine, MR imaging can reveal changes in renal function after x-ray-guided PTA for unilateral RAS.
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Affiliation(s)
- Jonathan K Park
- Department of Radiology, Northwestern University Feinberg School of Medicine, 448 E Ontario St, Suite 700, Chicago, IL 60611, USA
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Rhee TK, Park JK, Cashen TA, Shin W, Schirf BE, Gehl JA, Larson AC, Carr JC, Li D, Carroll TJ, Omary RA. Comparison of intraarterial MR angiography at 3.0 T with X-ray digital subtraction angiography for detection of renal artery stenosis in swine. J Vasc Interv Radiol 2006; 17:1131-7. [PMID: 16868166 DOI: 10.1097/01.rvi.0000228469.10687.2c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the accuracy of catheter-directed intraarterial (IA) magnetic resonance (MR) angiography at 3.0 T with that of x-ray digital subtraction angiography (DSA) for the measurement of renal artery stenosis (RAS) in swine. MATERIALS AND METHODS Unilateral hemodynamically significant RAS (>50%) was induced surgically in six pigs with use of reverse cable ties. One to two weeks after surgery, each pig underwent x-ray DSA and MR angiography before and after percutaneous transluminal balloon angioplasty (PTA). X-ray DSA was performed before and after PTA of RAS by injection of iodinated contrast agent through a 5-F multiple-side hole angiographic catheter placed in the abdominal aorta under fluoroscopic guidance. MR angiography of RAS was performed before and after PTA of RAS on a 3.0-T clinical MR imager with use of gadolinium-based contrast agent. MR angiography and DSA images were analyzed with the full width at half maximum method. Percent stenosis measurements between x-ray DSA and MR angiography were compared with a paired t test and were correlated with linear regression and Bland Altman analysis (alpha = 0.05). RESULTS Six cases of RAS were induced and imaged successfully with DSA and MR angiography techniques before and after PTA. On x-ray DSA, median stenoses was 64% (95% CI 57%-80%) before PTA and 20% (95% CI 5%-32%) after PTA. Corresponding MR angiography median stenosis measurement was 69% (95% CI 58%-80%) before PTA and 26% (95% CI 16%-36%) after PTA. A paired t test comparison did not show a difference between DSA and MR angiography (P = .16). RAS measurements on MR angiography correlated closely (P < .01) with DSA measurements (r(2) = 0.92). CONCLUSION In swine, the accuracy of catheter-directed IA MR angiography with use of a clinical 3.0-T MR imaging unit for the measurement of RAS was similar to that of conventional x-ray DSA.
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Affiliation(s)
- Thomas K Rhee
- Department of Radiology, Northwestern University, 448 East Ontario Street, Suite 700, Chicago, IL 60611, USA
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Affiliation(s)
- Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1538, USA.
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15
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Raval AN, Karmarkar PV, Guttman MA, Ozturk C, Sampath S, DeSilva R, Aviles RJ, Xu M, Wright VJ, Schenke WH, Kocaturk O, Dick AJ, Raman VK, Atalar E, McVeigh ER, Lederman RJ. Real-time magnetic resonance imaging-guided endovascular recanalization of chronic total arterial occlusion in a swine model. Circulation 2006; 113:1101-7. [PMID: 16490819 PMCID: PMC1428785 DOI: 10.1161/circulationaha.105.586727] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular recanalization (guidewire traversal) of peripheral artery chronic total occlusion (CTO) can be challenging. X-ray angiography resolves CTO poorly. Virtually "blind" device advancement during x-ray-guided interventions can lead to procedure failure, perforation, and hemorrhage. Alternatively, MRI may delineate the artery within the occluded segment to enhance procedural safety and success. We hypothesized that real-time MRI (rtMRI)-guided CTO recanalization can be accomplished in an animal model. METHODS AND RESULTS Carotid artery CTO was created by balloon injury in 19 lipid-overfed swine. After 6 to 8 weeks, 2 underwent direct necropsy analysis for histology, 3 underwent primary x-ray-guided CTO recanalization attempts, and the remaining 14 underwent rtMRI-guided recanalization attempts in a 1.5-T interventional MRI system. Real-time MRI intervention used custom CTO catheters and guidewires that incorporated MRI receiver antennae to enhance device visibility. The mean length of the occluded segments was 13.3+/-1.6 cm. The rtMRI-guided CTO recanalization was successful in 11 of 14 swine and in only 1 of 3 swine with the use of x-ray alone. After unsuccessful rtMRI (n=3), x-ray-guided attempts were also unsuccessful. CONCLUSIONS Recanalization of long CTO is entirely feasible with the use of rtMRI guidance. Low-profile clinical-grade devices will be required to translate this experience to humans.
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Affiliation(s)
- Amish N Raval
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1538, USA
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Omary RA, Gehl JA, Schirf BE, Green JD, Lu B, Pereles FS, Huang J, Larson AC, Li D. MR Imaging– versus Conventional X-ray Fluoroscopy–guided Renal Angioplasty in Swine: Prospective Randomized Comparison. Radiology 2006; 238:489-96. [PMID: 16436813 DOI: 10.1148/radiol.2382050109] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To test the hypothesis that the technical success rates, complication rates, and procedural times for magnetic resonance (MR) imaging-guided percutaneous transluminal angioplasty (PTA) and conventional (x-ray) fluoroscopy-guided PTA for treatment of renal artery stenosis are similar. MATERIALS AND METHODS The study was animal care and use committee approved. After surgically inducing bilateral renal artery stenosis in 11 swine, the authors performed baseline digital subtraction angiography. They transferred each animal to a 1.5-T MR imaging unit and randomly decided which artery would be treated with MR-guided PTA. With MR imaging guidance, angioplastic devices were tracked by using active and passive techniques. Vascular depiction was achieved by using catheter-directed MR angiography. Stenotic vessels were dilated by using 5-6-mm-diameter balloon catheters. PTA was then performed in the contralateral artery by using conventional fluoroscopy-guided techniques. With the intention to treat, the authors compared the technical success (residual stenosis < 50%) rates, complication rates, and procedural times for each guidance method. They compared technical successes and complications by using the McNemar test and procedural times by using a paired t test, with P < .05 indicating a significant difference. RESULTS The authors successfully dilated nine (82%) of 11 renal arteries with MR guidance and all 11 arteries (100%) with conventional fluoroscopic guidance. The difference was not significant (P = .5). Complications occurred in three (27%) arteries with MR guidance and in one (9%) artery with fluoroscopic guidance, with no significant differences (P = .5). The mean MR-guided PTA procedural time was 46 minutes longer than the fluoroscopy-guided PTA procedural time; this difference was significant (P = .01). CONCLUSION In a small cohort of swine, the authors did not observe a significant difference between MR imaging- and conventional fluoroscopy-guided renal artery PTA in terms of success and complication rates. However, no evidence of similarity between the techniques should be assumed. Procedural times differed significantly.
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Affiliation(s)
- Reed A Omary
- Departments of Radiology, Biomedical Engineering, and Preventive Medicine, Northwestern University, Suite 700, 448 E Ontario St, Chicago, IL 60611, USA
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Green JD, Omary RA, Schirf BE, Tang R, Lu B, Gehl JA, Huang JJ, Carr JC, Pereles FS, Li D. Comparison of X-ray fluoroscopy and interventional magnetic resonance imaging for the assessment of coronary artery stenoses in swine. Magn Reson Med 2006; 54:1094-9. [PMID: 16217784 PMCID: PMC1343514 DOI: 10.1002/mrm.20699] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The accuracy of a two-step interventional MRI protocol to quantify coronary artery disease was compared to the clinical gold standard, X-ray angiography. Studies were conducted in nine swine with a surgically induced stenosis in the proximal left circumflex coronary artery. The two-step protocol consisted of catheter-directed magnetic resonance angiography (MRA), which was first used to localize the stenosis, followed by MRI cross-sectional images to quantify the degree of stenosis without the use of contrast agent. Line signal intensity profiles were drawn across the vessel diameter at the stenosis site and proximal to the stenosis for each data set to measure percentage stenosis for each animal. Catheter-directed MRA successfully detected eight of nine stenoses. Cross-sectional MRI accurately quantified each stenosis, with strong agreement to the measurements made using X-ray fluoroscopy (intraclass correlation coefficient = 0.955; P < 0.05). This study demonstrates that in the future interventional MRI may be an alternative to X-ray angiography for the detection and quantification of coronary artery disease.
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Affiliation(s)
| | | | | | | | | | | | - J. Jenny Huang
- Preventive Medicine, Northwestern University, Chicago, IL
| | | | | | - Debiao Li
- Departments of Radiology
- Biomedical Engineering, and
- Please send correspondence to: Debiao Li, Ph. D., Suite 700, 448 East Ontario St., Chicago, IL 60611, Tel: (312) 926-4245, Fax: (312) 926-5991. E-mail:
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Abstract
Magnetic resonance imaging (MRI), which provides superior soft-tissue imaging and no known harmful effects, has the potential as an alternative modality to guide various medical interventions. This review will focus on MR-guided endovascular interventions and present its current state and future outlook. In the first technical part, enabling technologies such as developments in fast imaging, catheter devices, and visualization techniques are examined. This is followed by a clinical survey that includes proof-of-concept procedures in animals and initial experience in human subjects. In preclinical experiments, MRI has already proven to be valuable. For example, MRI has been used to guide and track targeted cell delivery into or around myocardial infarctions, to guide atrial septal puncture, and to guide the connection of portal and systemic venous circulations. Several investigational MR-guided procedures have already been reported in patients, such as MR-guided cardiac catheterization, invasive imaging of peripheral artery atheromata, selective intraarterial MR angiography, and preliminary angioplasty and stent placement. In addition, MR-assisted transjugular intrahepatic portosystemic shunt procedures in patients have been shown in a novel hybrid double-doughnut x-ray/MRI system. Numerous additional investigational human MR-guided endovascular procedures are now underway in several medical centers around the world. There are also significant hurdles: availability of clinical-grade devices, device-related safety issues, challenges to patient monitoring, and acoustic noise during imaging. The potential of endovascular interventional MRI is great because as a single modality, it combines 3-dimensional anatomic imaging, device localization, hemodynamics, tissue composition, and function.
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Affiliation(s)
- Cengizhan Ozturk
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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McVeigh ER, Guttman MA, Kellman P, Raval AN, Lederman RJ. Real-time, Interactive MRI for cardiovascular interventions. Acad Radiol 2005; 12:1121-7. [PMID: 16112512 PMCID: PMC2169205 DOI: 10.1016/j.acra.2005.05.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2005] [Revised: 05/29/2005] [Accepted: 02/15/2005] [Indexed: 11/25/2022]
Affiliation(s)
- Elliot R McVeigh
- Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room B1D416, Bethesda, MD 20892-106, USA.
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Hofmann LV, Liddell RP, Eng J, Wasserman BA, Arepally A, Lee DS, Bluemke DA. Human peripheral arteries: feasibility of transvenous intravascular MR imaging of the arterial wall. Radiology 2005; 235:617-22. [PMID: 15858101 DOI: 10.1148/radiol.2352040340] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Feasibility of in vivo transvenous intravascular magnetic resonance (MR) imaging of the human arterial wall was determined. All subjects provided written informed consent, and institutional review board approved the study. Six arteries in six patients were imaged with a guidewire placed in the iliac vein (n = 5) or left renal vein (n = 1). Pre- and postcontrast T1-weighted and T2-weighted transvenous MR imaging were performed. An atherosclerotic plaque with a fibrous cap was identified on 27 (42%) of 64 images of veins without stents; intimal hyperplasia in a renal artery with a stent was identified on 12 images. Contrast-to-noise ratios (CNRs) on arterial wall postcontrast T1-weighted images were superior to those on images obtained with other sequences (P < .001), and the postcontrast images demonstrated the greatest number of plaques with a low-signal intensity core and fibrous cap. Preliminary results show that transvenous MR imaging is feasible for high-spatial-resolution imaging of the arterial wall and atherosclerotic plaque. Postcontrast T1-weighted imaging affords greatest CNR for the arterial wall.
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Affiliation(s)
- Lawrence V Hofmann
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Blalock 545, 600 N Wolfe Street, Baltimore, MD 21287, USA.
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Abstract
Although x-ray fluoroscopy (XRF) has guided diagnostic and therapeutic transcatheter procedures for decades, certain limitations still exist. XRF still visualizes tissue poorly and relies on projection of shadows that do not convey depth information. Adjunctive echocardiography overcomes some of these limitations but still suffers suboptimal or unreliable imaging windows. Furthermore, ionizing radiation exposure in children imparts a cancer risk. An interventional platform using real-time magnetic resonance imaging (MRI) may offer superior image guidance without radiation. Although there are many remaining challenges, but real-time MRI has the potential to revolutionize transcatheter therapeutics.
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Affiliation(s)
- A N Raval
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, MD 20892-1538, USA
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Olin JW, Kaufman JA, Bluemke DA, Bonow RO, Gerhard MD, Jaff MR, Rubin GD, Hall W. Atherosclerotic Vascular Disease Conference. Circulation 2004; 109:2626-33. [PMID: 15173045 DOI: 10.1161/01.cir.0000128521.02390.72] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tsekos NV, Atalar E, Li D, Omary RA, Serfaty JM, Woodard PK. Magnetic resonance imaging-guided coronary interventions. J Magn Reson Imaging 2004; 19:734-49. [PMID: 15170780 DOI: 10.1002/jmri.20071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Magnetic resonance imaging (MRI) guidance for coronary interventions offers potential advantages over conventional x-ray angiography. Advantages include the use of nonionizing radiation, combined assessment of anatomy and function, and three-dimensional assessment of the coronary arteries leading to the myocardium. These advantages have prompted a series of recent studies in this field. Real-time coronary MR angiography, with low-dose catheter-directed intraarterial (IA) infusion of contrast media, has achieved in-plane spatial resolution as low as 0.8 x 0.8 mm2 and temporal resolution as short as 130 msec per image. Catheter-based IA injection of contrast agent has proven useful in the collection of multislice and three-dimensional images, not only for coronary intervention guidance, but also in the assessment of regional myocardial perfusion fed by the affected vessel. Actively visible guidewires and guiding catheters, based on the loopless antenna concept, have been effectively used to negotiate tortuous coronary vessels during catheterization, permitting placement of coronary angioplasty balloon catheters. Passive tracking approaches have been used to image contrast agent-filled coronary catheters and to place susceptibility-based endovascular stents. Although the field is in its infancy, these early results demonstrate the feasibility for performing MRI-guided coronary interventions. Although further methodological and technical developments are required before these methods become clinically applicable, we anticipate that MRI someday will be included in the armamentarium of techniques used to diagnose and treat coronary artery disease.
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Affiliation(s)
- Nikolaos V Tsekos
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri 63110, USA.
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Hofmann LV, Liddell RP, Arepally A, Montague B, Yang X, Bluemke DA. In Vivo Intravascular MR Imaging: Transvenous Technique for Arterial Wall Imaging. J Vasc Interv Radiol 2003; 14:1317-27. [PMID: 14551280 DOI: 10.1097/01.rvi.0000092904.31640.be] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine, in vivo, the potential for transvenous magnetic resonance (MR) imaging of the arterial wall and to assess appropriate MR pulse sequences for this method. MATERIALS AND METHODS MR imaging was performed on 19 vessels (right renal artery, N = 9; left renal artery N = 2; external iliac artery, N = 4; abdominal aorta, N = 4) in nine swine. The animals were either low-density lipoprotein receptor knockout (N = 5) or Yucatan mini-pigs fed an atherogenic diet for 6 to 11 weeks (N = 4). The intravascular MR coil/guide wire (IVMRG) (Surgi-Vision, Gaithersburg, MD) was introduced via the external iliac vein into the inferior vena cava (IVC). The following electrocardiograph-gated MR pulse sequences were obtained: T1-weighted precontrast with and without fat saturation and T1-weighted postcontrast with fat saturation. Two observers scored wall signal and conspicuity and classified the vessel as normal, abnormal, or stented. Images were compared with histopathologic findings. RESULTS The T1-weighted precontrast without fat saturation, T1-weighted precontrast with fat saturation, and T1-weighted postcontrast images correlated with histopathologic findings in 12 of 15 vessels, eight of 10 vessels, and 14 of 16 vessels, respectively. Abnormal histopathologic findings included: arterial wall thickening (N = 3), arterial dissection (N = 2), focal fibrous plaque (N = 2), adherent thrombus (N = 1). The T1-weighted postcontrast images were not compromised by artifacts and had the highest score for vessel wall signal and conspicuity. T1-weighted precontrast images were compromised by chemical shift artifact and poor blood suppression. Negligible artifacts were created by the platinum stent. CONCLUSION The T1-weighted fat saturated postcontrast pulse sequence was superior to other sequences for transvenous MR imaging of the arterial wall.
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Affiliation(s)
- Lawrence V Hofmann
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, Blalock 545, 600 North Wolfe Street, Baltimore, Maryland 21287, USA.
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Abstract
Minimally invasive interventional radiological procedures, such as balloon angioplasty, stent placement or coiling of aneurysms, play an increasingly important role in the treatment of patients suffering from vascular disease. The non-destructive nature of magnetic resonance imaging (MRI), its ability to combine the acquisition of high quality anatomical images and functional information, such as blood flow velocities, perfusion and diffusion, together with its inherent three dimensionality and tomographic imaging capacities, have been advocated as advantages of using the MRI technique for guidance of endovascular radiological interventions. Within this light, endovascular interventional MRI has emerged as an interesting and promising new branch of interventional radiology. In this review article, the authors will give an overview of the most important issues related to this field. In this context, we will focus on the prerequisites for endovascular interventional MRI to come to maturity. In particular, the various approaches for device tracking that were proposed will be discussed and categorized. Furthermore, dedicated MRI systems, safety and compatibility issues and promising applications that could become clinical practice in the future will be discussed.
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Affiliation(s)
- L W Bartels
- Department of Radiology, Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, Room E.01.335, 3584 CX Utrecht, The Netherlands.
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Omary RA, Green JD, Schirf BE, Li Y, Finn JP, Li D. Real-time magnetic resonance imaging-guided coronary catheterization in swine. Circulation 2003; 107:2656-9. [PMID: 12756160 DOI: 10.1161/01.cir.0000074776.88681.f5] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We tested the hypothesis that real-time magnetic resonance imaging (MRI) can guide coronary artery catheterization in swine via a percutaneous femoral artery approach. METHODS AND RESULTS In 12 pigs, we accessed femoral arteries percutaneously. We used 6- or 7-French coronary Judkins catheters filled with dilute 4% gadolinium (Gd) contrast agent and coaxially inserted 0.030-inch diameter active guidewires as endovascular devices. For catheter tracking, we used a 2-dimensional (2D) inversion recovery-prepared spoiled gradient echo sequence at a temporal resolution of 7 frames/s. For guidewire tracking, we used 2D steady-state free precession imaging at a temporal resolution of 9 frames/s. Coronary artery catheterization under MRI guidance was successful in 12/12 pigs. Successful coronary catheterization was verified by obtaining MR angiographic images after direct catheter-based injections of dilute Gd. CONCLUSIONS Real-time MRI-guided catheterization of coronary arteries in swine is feasible via a percutaneous femoral artery approach. Selective coronary MR angiography can then be performed with dilute contrast agent injections.
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Affiliation(s)
- Reed A Omary
- Department of Radiology, Northwestern University, Chicago, Ill, USA.
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Yang X, Atalar E, Zerhouni EA. Intravascular MR imaging and intravascular MR-guided interventions. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2003; 2:85-96. [PMID: 12623594 DOI: 10.1080/acc.2.2.85.96] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Intravascular MR technology, using an intravascularly placed MR receiver probe to acquire high-resolution angiographic MR images (i.e. intravascular MR imaging) and to guide cardiovascular interventional therapies (i.e. intravascular MR-guided interventions), is a new, very attractive development in the field of MR imaging. The new technology offers unique advantages for cardiovascular imaging and interventions, including superior contrast capability and multiplanar imaging capabilities without the use of contrast agents and with no risk of ionizing radiation. Thecombination of intravascular MR techniques with other advanced MR imaging techniques, such as functional MR imaging, will open new avenues for the future comprehensive management of cardiovascular atherosclerotic disease. Further improvements in intravascular MR fluoroscopy with true real-time display, analogous to X-ray fluoroscopy, will dramatically establish the role of intravascular MR technology in modern medicine.
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Affiliation(s)
- Xiaoming Yang
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kuehne T, Saeed M, Higgins CB, Gleason K, Krombach GA, Weber OM, Martin AJ, Turner D, Teitel D, Moore P. Endovascular stents in pulmonary valve and artery in swine: feasibility study of MR imaging-guided deployment and postinterventional assessment. Radiology 2003; 226:475-81. [PMID: 12563142 DOI: 10.1148/radiol.2262011639] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the feasibility of using magnetic resonance (MR) imaging to guide stent deployment in the pulmonary valve and artery and evaluate, after stent deployment, the position and morphology of and blood flow through the stent. MATERIALS AND METHODS Angiography and 1.5-T MR imaging were performed in a dual-imaging suite. Nitinol stents were placed in the pulmonary valve and main pulmonary artery in five pigs by using MR imaging guidance. For interactive MR imaging monitoring of catheter manipulation and stent delivery, balanced fast field-echo and T1-weighted turbo field-echo sequences were used. Visualization of the delivery system was based on T2* (with air as the contrast material) or T1 (with gadodiamide as the contrast material). After stent deployment, the position and morphology of and flow through the stent were verified with multiphase multisection balanced fast field-echo and velocity-encoded cine MR imaging. Findings at angiography and postmortem examination also helped verify stent placement. The paired Student t test was used for data analysis. RESULTS The stent was successfully deployed in all animals. The stent was placed distal to the pulmonary valve in four animals and across the pulmonary valve in one animal. The position and morphology of the stent were clearly depicted on balanced fast field-echo images. In the animal with the stent placed across the pulmonary valve, the pulmonary regurgitant fraction was 37%; this was not seen in the animals with stents placed distal to the pulmonary valve. No complication (eg, stent migration, intramural injury, or vascular perforation) was noted during the intervention. Findings at angiography and postmortem examination confirmed the position of the stents. CONCLUSION MR imaging has the potential to guide stent placement in the pulmonary valve or artery and to evaluate flow volume within the stent lumen after the intervention.
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Affiliation(s)
- Titus Kuehne
- Department of Radiology, University of California San Francisco, 505 Parnassus Ave, L308, San Francisco, CA 94143-0628, USA
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Serfaty JM, Yang X, Foo TK, Kumar A, Derbyshire A, Atalar E. MRI-guided coronary catheterization and PTCA: A feasibility study on a dog model. Magn Reson Med 2003; 49:258-63. [PMID: 12541245 DOI: 10.1002/mrm.10393] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this work was to demonstrate the feasibility of MRI-guided coronary artery catheterization and intervention in a dog model. Experiments were performed on 10 healthy dogs. A 9F introducer sheath was placed through a right carotid artery cutdown. A prototype 0.014-inch coronary MRI guidewire, a prototype 7 French MRI-guiding catheter, and two flexible surface coils were connected to a GE 1.5 T CV/i scanner for simultaneous visualization of the guidewire, guiding catheter, and chest anatomy. Images were displayed in real time on an in-room monitor. A nongated, single-slice fast gradient-echo sequence was used to obtain real-time images of the catheters and background anatomy during the intervention. Fifteen selective catheterizations were attempted in the coronary arteries, and all were successful. Selective injection of diluted gadolinium into the MRI-guiding catheter provided dynamic 2D projection coronary angiography in all cases, confirming successful catheterization. Percutaneous transluminal coronary angioplasty (PTCA) was attempted after two catheterizations, and all attempts were successful. Inflation of the balloon angioplasty catheter was performed successfully in the left anterior and circumflex arteries. Our results indicate that coronary artery catheterization and intracoronary balloon angioplasty are feasible with MRI guidance only. MRI guidance may be used as an alternative to X-ray guidance in coronary artery interventions in the future.
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Omary RA, Green JD, Fang WS, Viohl I, Finn JP, Li D. Use of internal coils for independent and direct MR imaging-guided endovascular device tracking. J Vasc Interv Radiol 2003; 14:247-54. [PMID: 12582194 DOI: 10.1097/01.rvi.0000058328.82956.15] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To test the hypotheses that a single internal guide wire coil (i) permits independent and direct depiction of guide wires and catheters and (ii) improves catheter-tracking accuracy and depiction compared to external receiver coils. MATERIALS AND METHODS Standard 5-6-F angiographic catheters were filled with dilute 4% gadolinium chelate. A single 0.030-inch-diameter internal guide wire coil was placed inside the catheter. True fast imaging with steady-state precession was used to directly visualize the guide wire. Inversion recovery-prepared fast low-angle shot technique was used to track catheters over a thick slice. In phantom experiments, we compared catheter signal-to-noise ratios (SNRs) with the internal coil and a phased-array surface coil with use of the Wilcoxon signed-rank test. Tip-tracking accuracy was assessed with use of linear regression. In pigs (n = 7), catheters and guide wires were independently tracked in real time. RESULTS In phantoms, catheter SNR with the internal coil (12.0) was significantly greater than that with the surface coil (4.0; P =.001). Tip-tracking accuracy was also improved with use of the internal coil (R(2) = 0.94 vs 0.50). In swine vasculature, catheters and guide wires could be directly and independently tracked at 1.7-2.0 frames per second. Catheters were clearly visualized with use of the internal coil, with a typical catheter background contrast-to-noise ratio of 6.6. Catheters were not visible with use of the external coil because of the small catheter size compared to the slice thickness. CONCLUSION Internal guide wire coils permit independent and direct depiction of guide wires and catheters in vivo for MR imaging-guided endovascular interventions. They also improve catheter tracking accuracy and depiction compared to external coils.
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Affiliation(s)
- Reed A Omary
- Department of Radiology, Northwestern University Medical School, 676 North St. Clair, Suite 800, Chicago, Illinois 60611, USA.
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Green JD, Omary RA, Finn JP, Chung YC, Tang R, Li Y, Vasireddy S, Li D. Two- and three-dimensional MR coronary angiography with intraarterial injections of contrast agent in dogs: a feasibility study. Radiology 2003; 226:272-7. [PMID: 12511701 DOI: 10.1148/radiol.2261011848] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Magnetic resonance (MR) images of coronary arteries were acquired with an inversion recovery-prepared technique after intraarterial injection of contrast material in five dogs. Real-time two-dimensional projection images were obtained with a temporal resolution of 3 frames per second. Three-dimensional electrocardiographically triggered high-spatial-resolution images were obtained with a fraction of the contrast agent required for intravenous injections. Background tissues were adequately suppressed in all images. On the basis of this experimental data, the optimal contrast agent concentration for two-dimensional real-time projection imaging was 6%. This preliminary work shows that contrast material-enhanced MR angiography with intraarterial injections is feasible with the proposed techniques.
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Affiliation(s)
- Jordin D Green
- Department of Radiology, Northwestern University Medical School, 448 E Ontario St, Suite 700, Chicago, IL 60611, USA
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Kahn T, Schulz T, Moche M, Prothmann S, Schneider JP. Klinischer Einsatz der interventionellen MRT (iMRT). Z Med Phys 2003; 13:151-6. [PMID: 14562536 DOI: 10.1078/0939-3889-00163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The integration of diagnostic and therapeutic procedures by MRI is based on the combination of excellent morphologic and functional imaging. The spectrum of MR-guided interventions includes biopsies, thermal ablation procedures, vascular applications, and intraoperative MRI. In all these applications, different scientific groups have obtained convincing results in basic developments as well as in clinical use. Interventional MRI (iMRI) is expected to attain an important role in interventional radiology, minimal invasive therapy, and monitoring of surgical procedures.
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Affiliation(s)
- Thomas Kahn
- Klinik und Poliklinik für Diagnostische Radiologie, Universität Leipzig
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Tsekos NV, Woodard PK, Foster GJ, Moustakidis P, Sharp TL, Herrero P, Gropler RJ. Dynamic coronary MR angiography and first-pass perfusion with intracoronary administration of contrast agent. J Magn Reson Imaging 2002; 16:311-9. [PMID: 12205588 DOI: 10.1002/jmri.10161] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate whether dynamic imaging of the coronary arteries can be performed with intracoronary infusion of low-dose gadolinium (Gd)-based contrast agent and assess the effect of long duration and multiple infusions on the image signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). MATERIALS AND METHODS Dynamic coronary magnetic resonance (MR) imaging (130 msec/image) and contrast agent first pass myocardial perfusion studies were performed with intracoronary infusions of low-dose Gd-based MR contrast agent on dogs (N = 4) using a fast multislice gradient recalled echo (GRE) sequence. RESULTS Contrast-enhanced coronary arteries were clearly imaged during infusion periods as long as 2.3 minutes. The SNR and CNR of the contrast-enhanced coronary arteries remained essentially unchanged over multiple consecutive angiographic sessions. In addition, we demonstrated that first pass studies performed with intracoronary injection of MR contrast agent can be used as a means of assessing regional myocardial perfusion. CONCLUSION These studies demonstrated that, using intracoronary infusion of Gd, coronary magnetic resonance angiography (MRA) can be performed with high temporal resolution, and multiple low-dose slow infusions of Gd-based MR contrast agent can be performed without compromise of the vessel SNR and CNR.
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Affiliation(s)
- Nikolaos V Tsekos
- Cardiovascular Imaging Laboratory, Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, Missouri 63110, USA.
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Abstract
In the setting of MRI-guided endovascular interventions, catheter-directed Gd-enhanced MRA offers many of the same capabilities as conventional x-ray DSA. Local injections permit rapid depiction of blood vessels and help guide interventions. The primary benefit of IA injections is significant reduction of administered contrast-agent dose compared with conventional IV injections. Another major benefit is facilitated background suppression, including that of adjacent vascular beds. As MRI guidance methods improve, catheter-based Gd injections should gain expanded use in clinical practice.
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Affiliation(s)
- Reed A Omary
- Department of Radiology, Northwestern University Medical School, Chicago, IL 60611, USA.
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Kuehne T, Saeed M, Moore P, Gleason K, Reddy G, Teitel D, Higgins CB. Influence of blood-pool contrast media on MR imaging and flow measurements in the presence of pulmonary arterial stents in swine. Radiology 2002; 223:439-45. [PMID: 11997550 DOI: 10.1148/radiol.2232010975] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare the effects of various stents on magnetic resonance (MR) imaging flow volume measurements and to determine the value of a blood-pool MR imaging contrast medium in assessment of vascular stents. MATERIALS AND METHODS In 11 pigs, six nitinol stents (Memotherm), four platinum stents (NuMed), and one elgiloy stent (Wallstent) were placed in the main pulmonary artery under x-ray fluoroscopic guidance. MR imaging was performed 3 months after stent placement before and after injection of NC100150 contrast medium. Blood flow volumes were assessed with velocity-encoded cine MR imaging through and next to the stent. The signal-to-noise ratio and width of susceptibility artifacts of the stents also were determined. Measurements were analyzed with the paired Student t test and Bland-Altman test, where appropriate. RESULTS Blood flow volumes measured through the nitinol and platinum stents disclosed no significant difference between velocity-encoded cine MR imaging measurements through and next to the stent. On cine MR images, small susceptibility artifacts were observed around the nitinol and platinum stents. Signal-to-noise ratio in the stent lumen was reduced in nitinol and platinum stents when compared with that next to the stent. The elgiloy stent produced severe susceptibility artifacts, making measurement of flow volumes impossible. NC100150 injection caused no significant effect on flow volume measurements. It improved the signal-to-noise ratio of the pulmonary arterial lumen outside and, to a lesser extent, inside the stent. CONCLUSION Assessment of morphology and flow volumes through nitinol and platinum stents is feasible with MR imaging. Blood-pool contrast media provide persistent signal enhancement in the pulmonary artery and, to a lesser extent, in the lumina of nitinol and platinum stents.
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Affiliation(s)
- Titus Kuehne
- Department of Radiology, Division of Pediatric Cardiology, University of California San Francisco, 505 Parnassus Ave, L308, San Francisco, CA 94143-0628, USA
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Omary RA, Henseler KP, Unal O, Maciolek LJ, Finn JP, Li D, Nemcek AA, Vogelzang RL, Grist TM. Comparison of intraarterial and IV gadolinium-enhanced MR angiography with digital subtraction angiography for the detection of renal artery stenosis in pigs. AJR Am J Roentgenol 2002; 178:119-23. [PMID: 11756103 DOI: 10.2214/ajr.178.1.1780119] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Catheter-based intraarterial injections of gadolinium are useful during MR imaging-guided endovascular procedures to generate rapid vascular road maps. Using an animal model of renal artery stenosis, we tested the hypothesis that intraarterial gadolinium-enhanced MR angiography is as accurate as IV gadolinium-enhanced MR angiography and digital subtraction angiography (DSA). We also tested the hypothesis that intraarterial MR angiography uses less gadolinium than IV MR angiography. MATERIALS AND METHODS We induced bilateral renal artery stenosis in five pigs. All pigs underwent comparative imaging with DSA, IV MR angiography, and aortic catheter-directed intraarterial MR angiography. For IV and intraarterial MR angiography, we used the same three-dimensional acquisition. We assessed differences in quantitative stenosis measurements among DSA, IV MR angiography, and intraarterial MR angiography using the Wilcoxon's signed rank test. RESULTS Mean stenosis measurements (+/-SD) were as follows: DSA, 58% +/- 12%; IV MR angiography, 63% +/- 9.3%; and intraarterial MR angiography, 64% +/- 11%. There were no statistically significant differences in accuracy between DSA and IV MR angiography (p = 0.06), DSA and intraarterial MR angiography (p = 0.16), or IV and intraarterial MR angiography (p = 0.70). Intraarterial MR angiography used a mean gadolinium dose of 5.6 mL, compared with 9 mL for IV MR angiography. CONCLUSION In swine, IV and intraarterial MR angiography have a similar accuracy for detecting renal artery stenosis. Intraarterial MR angiography uses smaller doses of injected gadolinium.
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Affiliation(s)
- Reed A Omary
- Department of Radiology, Northwestern University Medical School, 676 N. St. Claire St., Ste. 800, Chicago, IL 60611, USA
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Yang X, Liu H, Li D, Zhou X, Jung WC, Deans AE, Cui Y, Cheng L. Digital optical imaging of green fluorescent proteins for tracking vascular gene expression: feasibility study in rabbit and human cell models. Radiology 2001; 219:171-5. [PMID: 11274553 DOI: 10.1148/radiology.219.1.r01ap23171] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the feasibility of using a sensitive digital optical imaging technique to detect green fluorescent protein (GFP) expressed in rabbit vasculature and human arterial smooth muscle cells. MATERIALS AND METHODS A GFP plasmid was transfected into human arterial smooth muscle cells to obtain a GFP-smooth muscle cell solution. This solution was imaged in cell phantoms by using a prototype digital optical imaging system. For in vivo validation, a GFP-lentivirus vector was transfected during surgery into the carotid arteries of two rabbits, and GFP-targeted vessels were harvested for digital optical imaging ex vivo. RESULTS Optical imaging of cell phantoms resulted in a spatial resolution of 25 microm/pixel. Fluorescent signals were detected as diffusely distributed bright spots. At ex vivo optical imaging of arterial tissues, the average fluorescent signal was significantly higher (P <.05) in GFP-targeted tissues (mean +/- SD, 9,357.3 absolute units of density +/- 1,001.3) than in control tissues (5,633.7 absolute units of density +/- 985.2). Both fluorescence microscopic and immunohistochemical findings confirmed these differences between GFP-targeted and control vessels. CONCLUSION The digital optical imaging system was sensitive to GFPs and may potentially provide an in vivo imaging tool to monitor and track vascular gene transfer and expression in experimental investigations.
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Affiliation(s)
- X Yang
- Department of Radiology, the Johns Hopkins University School of Medicine, Outpatient Center, Rm 4243, 601 N Caroline St, Baltimore, MD 21287-0845, USA.
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Abstract
A one-dimensional intravascular MR (IVMR) technique for the measurement of pulsewave velocity in a single cardiac cycle is presented. The technique was used to measure pulsewave velocity in vivo in the intact rabbit model, where its sensitivity to different hemodynamic states was demonstrated using a pharmacological intervention with phenylephrine and nitroprusside. IVMR measurements of pulsewave velocity were found to increase with mean arterial pressure, as expected. Further, IVMR-based pulsewave velocity estimates were in agreement with those measured by pressure catheters and direct distensibility measurement. Because of their rapidity and highly localized nature, these measurements of vessel elasticity may complement the high-resolution vascular imaging information gained in an IVMR examination. This could allow assessment of atherosclerotic plaques and facilitate immediate treatment decisions. Magn Reson Med 45:53-60, 2001.
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Affiliation(s)
- B D Bolster
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Yang X, Atalar E. Intravascular MR imaging-guided balloon angioplasty with an MR imaging guide wire: feasibility study in rabbits. Radiology 2000; 217:501-6. [PMID: 11058652 DOI: 10.1148/radiology.217.2.r00oc17501] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop a technique for intravascular magnetic resonance (MR)-guided balloon angioplasty with use of an MR imaging guide wire. MATERIALS AND METHODS An MR imaging guide wire (0.6-mm loopless antenna) that could be placed within a balloon catheter was manufactured. The guide wire was expected to function as either an MR receiver probe in real-time MR imaging or a guide wire for use with interventional devices. Laparotomy was performed in eight rabbits, and a dilatable stenosis was created at the upper abdominal aorta. Balloon angioplasty, validated at pre- and postoperative MR aortography with renal contrast enhancement was performed by using a 1.5-T MR unit with a fast spoiled gradient-echo pulse sequence, short repetition and echo times, and a rate of three frames per second. RESULTS During MR tracking, the entire length of the MR imaging guide wire was always visible as a band of high signal intensity. In all cases, the MR imaging guide wires were passed through the aortic stenoses dilated by means of balloon inflation. Before balloon angioplasty, flow in the aorta distal to the stenosis was decreased, which caused mild contrast enhancement in each kidney. After balloon angioplasty, distal flow was restored, resulting in substantial renal enhancement. CONCLUSION The MR imaging guide wire is a potential tool for use in endovascular interventional MR imaging.
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Affiliation(s)
- X Yang
- Department of Radiology, Johns Hopkins University School of Medicine, Outpatient Center Rm 4243, 601 N Caroline St, Baltimore MD 21287-0845, USA.
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Serfaty JM, Yang X, Aksit P, Quick HH, Solaiyappan M, Atalar E. Toward MRI-guided coronary catheterization: visualization of guiding catheters, guidewires, and anatomy in real time. J Magn Reson Imaging 2000; 12:590-4. [PMID: 11042641 DOI: 10.1002/1522-2586(200010)12:4<590::aid-jmri11>3.0.co;2-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The success of x-ray fluoroscopy-guided coronary catheterization depends in part on the ability to obtain simultaneous and real-time visualization of the guidewire, guiding catheter, and anatomy of the chest. The hypothesis explored in this paper is that magnetic resonance imaging (MRI) could provide this ability. This hypothesis was tested with loopless antennas used as the guidewire and a guiding catheter and two surface coils, each connected to four different receiver channels of a GE 1.5-T CV/I MRI scanner. Experiments were conducted on six healthy dogs. Intravascular antennas were inserted in the right carotid artery and maneuvered in the aorta while running a fast gradient-echo sequence (TR/TE 5/1.3 msec, flip angle 7 degrees). Real-time projection images of the chest anatomy, together with the guidewire and guiding catheter, were obtained. Positioning of the MRI guiding catheter either in the descending aorta, ascending aorta, or heart was achieved easily. This study represents a step toward MRI-guided coronary catheterization.
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Affiliation(s)
- J M Serfaty
- Department of Radiology and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0845, USA
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Abstract
Several attributes make magnetic resonance imaging (MRI) attractive for guidance of intravascular therapeutic procedures, including high soft tissue contrast, imaging in arbitrary oblique planes, lack of ionizing radiation, and the ability to provide functional information, such as flow velocity or flow volume per unit time, in conjunction with morphologic information. For MR guidance of vascular interventions to be safe, the interventionalist must be able to visualize catheters and guidewires relative to the vascular system and surrounding tissues. A number of approaches for rendering instruments visible in an MR environment have been developed, including both passive and active techniques. Passive techniques depend on contrast agents or susceptibility artifacts that enhance the appearance of the catheter in the image itself, whereas active techniques rely on supplemental hardware built into the catheter, such as a radiofrequency (RF) coil. Additionally, the ability to introduce an RF coil mounted on a catheter presents the opportunity to obtain high-resolution images of the vessel wall. These images can provide the capability to distinguish and identify various plaque components. The additional capabilities of MRI could potentially open up new applications within the purview of vascular interventions beyond those currently performed under X-ray fluoroscopic guidance.
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Affiliation(s)
- M E Ladd
- Department of Radiology, University Hospital Essen, D-45122 Essen, Germany.
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Omary RA, Unal O, Koscielski DS, Frayne R, Korosec FR, Mistretta CA, Strother CM, Grist TM. Real-time MR imaging-guided passive catheter tracking with use of gadolinium-filled catheters. J Vasc Interv Radiol 2000; 11:1079-85. [PMID: 10997475 DOI: 10.1016/s1051-0443(07)61343-8] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To test the hypothesis that real-time magnetic resonance (MR) imaging-guided passive catheter tracking is feasible with use of dilute gadolinium (Gd)-filled catheters, to determine the optimal Gd concentration required for tracking, and to measure catheter tip tracking accuracy. MATERIALS AND METHODS The authors tested a real-time, T1-weighted, two-dimensional, spoiled gradient-recalled echo MR imaging sequence suitable for tracking catheters. In a yogurt phantom, the authors placed 5-F catheters filled with 2%-12% Gd solutions. MR imaging was performed with and without use of a projection dephaser that suppressed background signal. The authors measured signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and enhancement ratio to determine the optimal Gd concentration for catheter depiction. Catheter tip tracking accuracy was measured in an acrylic phantom with use of linear regression analysis, with goodness of fit assessed statistically with the F test. RESULTS Peak catheter SNR, CNR, and enhancement ratios were obtained with 4%-6% Gd concentrations. Tip tracking accuracy was determined to be +/- 0.41 mm (R2 = 0.99; P < .0001). MR imaging reconstructions were displayed up to 3.1 frames/sec. CONCLUSIONS Accurate MR imaging-guided passive catheter tracking was feasible in real-time with use of dilute Gd-filled catheters. This technique may have application in MR imaging-guided endovascular procedures.
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Affiliation(s)
- R A Omary
- Department of Radiology, University of Wisconsin-Madison Medical School, USA.
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