Evaluation of MR/Fluoroscopy–guided Portosystemic Shunt Creation in a Swine Model

Arepally, Aravind; Karmarkar, Parag; Qian, Di; Barnett, Brad P.; Atalar, Ergin

doi:10.1097/01.rvi.0000228493.07075.fc

Cited by 13 publications

(8 citation statements)

References 19 publications

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“…The recent development of high-field MR systems with a short magnet and a large bore, providing satisfactory patient access and excellent real-time capabilities, broadens the horizon of MR intervention [14,15]. The feasibility of MR-guided biopsy of different body parts in a short, widebore magnet has recently been shown [15].…”

Section: Introductionmentioning

confidence: 99%

MR-guided liver biopsy within a short, wide-bore 1.5 Tesla MR system

et al. 2008

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The purpose of this study was to evaluate the diagnostic efficacy of magnetic resonance (MR)-guided biopsy of focal liver lesions within a short, wide-bore 1.5-T MR system and to determine the duration and accuracy of needle placement using MR fluoroscopy guidance in 25 patients. Accuracy of needle placement was evaluated in two orthogonal planes, and the out-of-plane angle of needle deflection was measured. Needle positioning was characterised subjectively as centred, peripheral, or exterior relative to the lesion. Exterior positioning was corrected by a step-by-step procedure. Surgical resection (n = 6), previous histologies (n = 8), or clinical/radiological follow-up (n = 11) served as the 'gold standard'. The guidance needle could be placed successfully using MR fluoroscopy in 20 of 25 patients (80%). Needle placement was rated as 'centred' in 11 and as 'peripheral' in nine patients. Median needle deflection was 2.6 degrees, with a median deviation of 3.4 mm. In five patients, the direct approach failed or was rated as 'exterior'; therefore, repositioning after needle stabilisation with a stainless-steel stylet was necessary. The diagnostic yield of all biopsies was: sensitivity 95.5%, specificity 100.0% and accuracy 96.0%. In conclusion, MR-guided biopsies in a short, wide-bore MR system yielded highly reliable biopsy results, and in most cases the direct approach with MR fluoroscopy guidance proved to be fast and accurate.

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Section: Introductionmentioning

confidence: 99%

MR-guided liver biopsy within a short, wide-bore 1.5 Tesla MR system

et al. 2008

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“…28,29 The procedures have been aided by the use of non-MR-safe active guide wires and prototype or commercially available devices and were either solely MR-guided or combined with conventional catheterization before and after the procedure.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance–Guided Cardiac Interventions Using Magnetic Resonance–Compatible Devices

Tzifa

Krombach

Krämer

et al. 2010

Circ: Cardiovascular Interventions

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Background-Percutaneous cardiac interventions are currently performed under x-ray guidance. Magnetic resonance imaging (MRI) has been used to guide intravascular interventions in the past, but mainly in animals. Translation of MR-guided interventions into humans has been limited by the lack of MR-compatible and safe equipment, such as MR guide wires with mechanical characteristics similar to standard guide wires. The aim of the present study was to evaluate the safety and efficacy of a newly developed MR-safe and compatible passive guide wire in aiding MR-guided cardiac interventions in a swine model and describe the 2 first-in-man solely MR-guided interventions. Methods and Results-In the preclinical trial, the new MR-compatible wire aided the performance of 20 interventions in 5 swine. These consisted of balloon dilation of nondiseased pulmonary and aortic valves, aortic arch, and branch pulmonary arteries. After ethics and regulatory authority approval, the 2 first-in-man MR-guided interventions were performed in a child and an adult, both with elements of valvar pulmonary stenosis. Catheter manipulations were monitored with real-time MRI sequence with interactive modification of imaging plane and slice position. Temporal resolution was 11 to 12 frames/s. Catheterization procedure times were 110 and 80 minutes, respectively. Both patients had successful relief of the valvar stenosis and no procedural complications. Conclusions-The described preclinical study and case reports are encouraging that with the availability of the new MR-compatible and safe guide wire, certain percutaneous cardiac interventions will become feasible to perform solely under MR guidance in the future. A clinical trial is underway in our institution. (Circ Cardiovasc Interv. 2010;3:585-592.)

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“…In the meantime more complex interventions have been performed under MR-guidance such as endovascular stenting of aortic aneurysms and dissections ( Fig. 10) (2,72), as well as carotid, iliac, and renal arteries (21,22,33,40,73), different embolization techniques (74,75), septum occlusions (76), inferior vena cave placement (77), recanalization of chronic total occlusions (2), as well as the creation of intrahepatic and extrahepatic porto-systemic shunts (78,79).…”

Section: Endovascular Applicationsmentioning

confidence: 99%

MR‐guided intravascular interventions: Techniques and applications

Bock

Wacker

2008

Magnetic Resonance Imaging

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Magnetic resonance imaging (MRI) offers several advantages over other imaging modalities that make it an attractive imaging tool for diagnostic and therapeutic procedures. This tremendous potential of MRI has provided the rationale for increased attention toward MR-guided endovascular interventions. MR guidance has been used recently to navigate endovascular catheters and deliver stents, vena cava filters, embolization materials, and septum closure devices. However, its potential goes beyond just copying existing procedures toward the development of new minimally invasive techniques that cannot be performed with conventional guiding techniques. Because of technical limitations and safety issues associated with some of the currently available devices, a limited number of clinical studies have been performed so far. The overall success for this developing field requires considerable interdisciplinary research within both the interventional and the MR community. Only through a combined effort can this complex technology find its way into clinical practice. This review discusses the hardware and software improvements that have helped to advance endovascular interventions under MR imaging guidance from a pure research tool to become a clinical reality. In addition, technical and safety issues specific to endovascular MR image guidance will be described and practical applications will be shown that take advantage of the benefits of MR for endovascular interventions.

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Evaluation of MR/Fluoroscopy–guided Portosystemic Shunt Creation in a Swine Model

Cited by 13 publications

References 19 publications

MR-guided liver biopsy within a short, wide-bore 1.5 Tesla MR system

MR-guided liver biopsy within a short, wide-bore 1.5 Tesla MR system

Magnetic Resonance–Guided Cardiac Interventions Using Magnetic Resonance–Compatible Devices

MR‐guided intravascular interventions: Techniques and applications

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