Fully MR‐guided hepatic artery catheterization for selective drug delivery: A feasibility study in pigs

Seppenwoolde, Jan‐Henry; Bartels, Lambertus W.; Weide, R. van der; Nijsen, J. Frank W.; Schip, Alfred D. van het; Bakker, Chris J.G.

doi:10.1002/jmri.20479

Cited by 35 publications

(27 citation statements)

References 36 publications

(48 reference statements)

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“…At this point, SPECT is the most obvious modality to use for dosimetry since SPECT-based dosimetry is sensitive and specific and MR imaging-based dose assessment is limited by artifacts and may be contraindicated in some patients (such as those with claustrophobia, metal devices, or shrapnel). However, MR imaging-based dosimetry continues to improve and might prove valuable for future purposes such as real-time dosimetry during MR imaging-guided radioembolization (31).…”

Section: Discussionmentioning

confidence: 99%

“…If predictive, a scout dose of 166 Ho-microspheres might allow pretreatment dosimetry and identification of patients who will not benefit from treatment because of an unfavorable biodistribution or patients who need extra precautions because of a high normal-liver absorbed dose. In addition, the favorable MR imaging characteristics of 166 Ho-microspheres may allow for administration under real-time MR imaging guidance with direct visualization of the distribution of microspheres (i.e., per-treatment dosimetry) (31). …”

Section: Discussionmentioning

confidence: 99%

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In Vivo Dosimetry Based on SPECT and MR Imaging of¹⁶⁶Ho-Microspheres for Treatment of Liver Malignancies

et al. 2013

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166 Ho-poly(L-lactic acid) microspheres allow for quantitative imaging with MR imaging or SPECT for microsphere biodistribution assessment after radioembolization. The purpose of this study was to evaluate SPECT-and MR imaging-based dosimetry in the first patients treated with 166 Ho radioembolization. Methods: Fifteen patients with unresectable, chemorefractory liver metastases of any origin were enrolled in this phase 1 study and were treated with 166 Ho radioembolization according to a dose escalation protocol . The contours of all liver segments and all discernible tumors were manually delineated on T2-weighted posttreatment MR images and registered to the posttreatment SPECT images (n 5 9) or SPECT/CT images (n 5 6) and MR imagingbased R 2 * maps (n 5 14). Dosimetry was based on SPECT (n 5 15) and MR imaging (n 5 9) for all volumes of interest, tumor-tonontumor (T/N) activity concentration ratios were calculated, and correlation and agreement of MR imaging-and SPECT-based measurements were evaluated. Results: The median overall T/N ratio was 1.4 based on SPECT (range, 0.9-2.8) and 1.4 based on MR imaging (range, 1.1-3.1). In 6 of 15 patients (40%), all tumors had received an activity concentration equal to or higher than the normal liver (T/N ratio $ 1). Analysis of SPECT and MR imaging measurements for dose to liver segments yielded a high correlation (R 2 5 0.91) and a moderate agreement (mean bias, 3.7 Gy; 95% limits of agreement, 211.2 to 18.7). Conclusion: With the use of 166 Ho-microspheres, in vivo dosimetry is feasible on the basis of both SPECT and MR imaging, which enables personalized treatment by selective targeting of inadequately treated tumors. Radi oembolization is an interventional oncologic treatment during which radioactive microspheres are administered in the arterial vessels supplying the liver and its tumors. The rationale behind this intraarterial liver treatment is that liver tumors are predominantly supplied by arterial blood, in contrast to the nontumorous liver, which relies mainly on the portal vein for its blood supply. Injection of a substance into the hepatic artery will therefore selectively target the tumorous tissue (1). Currently, the commercially available microspheres that are used for radioembolization are labeled with 90 Y. To be able to quantitatively evaluate the optimal and selective distribution of microspheres to the liver tumors, posttreatment imaging is indispensable. For that reason, optimization of posttreatment imaging of 90 Y-microspheres with bremsstrahlung SPECT and PET has recently gained interest (2-5).166 Ho-poly(L-lactic acid) microspheres have been developed at our institute as an alternative to 90 Y-microspheres specifically to be able to visualize the in vivo biodistribution of microspheres after radioembolization. 166 Ho-microspheres can be imaged with both SPECT and MR imaging, using the emission of g-photon radiation and the paramagnetic properties of holmium, respectively (6-10). Exploiting these qualities, multimodal dosimetry becomes feasible,...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In Vivo Dosimetry Based on SPECT and MR Imaging of¹⁶⁶Ho-Microspheres for Treatment of Liver Malignancies

et al. 2013

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“…After the initial introduction of promising approaches for interventions on the kidney [50], liver [51], and heart [52,53], it took almost 8 years for a new generation of materials and MRI techniques to bring new possibilities. MR-guided vascular intervention is dependent on the availability of suitable catheters and guide wires.…”

Section: Instruments and New Operating Concepts For Vascular Intervenmentioning

confidence: 99%

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

Barkhausen

Kahn

Krombach

et al. 2017

Fortschr Röntgenstr

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ABSTR AC TBackground MRI is attractive for the guiding and monitoring of interventional procedures due to its high intrinsic soft tissue contrast and the possibility to measure physiologic parameters like flow and cardiac function.Method The current status of interventional MRI for the clinical routine was analyzed.Results The effort needed for the development of MR-safe monitoring systems and instruments initially resulted in the application of interventional MRI only for procedures that could not be performed by other means. Accordingly, biopsy of lesions in the breast, which are not detectable by other modalities, has been performed under MRI guidance for decades. Currently, biopsies of the prostate under MRI guidance are established in a similar fashion. At many sites blind biopsy has already been replaced by MR-guided biopsy or at least by the fusion of MR images with ultrasound. Cardiovascular This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.interventions are performed at several centers for ablation as a treatment for atrial fibrillation. Conclusion IntroductionMRI has an intrinsically high soft-tissue contrast and can be used to measure physiological parameters, such as blood flow (flow rate and flow volume), diffusion, temperature, and movement. Since its introduction into the clinical routine in the 1980 s, it has also been used for guiding and monitoring interventions. However, in contrast to CT and ultrasound, the use of MRI for guiding interventions requires significant technical effort. Due to the disruptive effect of the strong main magnetic field and the alternating electromagnetic fields, the monitoring of patients during an intervention by measuring ECG signals, oxygen saturation, or blood pressure requires special equipment. These monitoring systems must not interfere with the MRI scan and must be MR-safe (according to DIN EN 62 570:2010 -05). The list of requirements regarding monitoring equipment provides an indication of the development effort, with suitable monitoring equipment representing only one of the components necessary for MR-guided interventions.In addition to MRI safety, all catheters and instruments must be adapted to this modality. To ensure MRI safety, metal must be largely avoided since, depending on the length and orientation to the main magnetic field, it can heat up and consequently even result in burns. Achieving rigidity and torsion stability of catheters or guide wires without the use of metal for reinforcement represents a technical challenge. In the case of needles, breaking resistance is one of the more difficult properties to achieve for MR-safe designs. Moreover, instruments must be able to be effectively visualized without adjacent structures being superimposed by artifacts. The tip must be able to be identified and definitively differentiated from the shaft since MRI as a cross-sectional imaging method typically uses individual slices even for guiding interventions and does not use projections as in fluoroscopy...

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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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Fully MR‐guided hepatic artery catheterization for selective drug delivery: A feasibility study in pigs

Abstract: Fully MR-guided real-time navigation of endovascular devices permits complex procedures such as selective intra-arterial delivery of therapeutic agents to parts of the liver.

Cited by 35 publications

References 36 publications

In Vivo Dosimetry Based on SPECT and MR Imaging of¹⁶⁶Ho-Microspheres for Treatment of Liver Malignancies

In Vivo Dosimetry Based on SPECT and MR Imaging of¹⁶⁶Ho-Microspheres for Treatment of Liver Malignancies

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

MR‐guided intravascular interventions: Techniques and applications

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Fully MR‐guided hepatic artery catheterization for selective drug delivery: A feasibility study in pigs

Abstract: Fully MR-guided real-time navigation of endovascular devices permits complex procedures such as selective intra-arterial delivery of therapeutic agents to parts of the liver.

Cited by 35 publications

References 36 publications

In Vivo Dosimetry Based on SPECT and MR Imaging of166Ho-Microspheres for Treatment of Liver Malignancies

In Vivo Dosimetry Based on SPECT and MR Imaging of166Ho-Microspheres for Treatment of Liver Malignancies

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

MR‐guided intravascular interventions: Techniques and applications

Contact Info

Product

Resources

About

In Vivo Dosimetry Based on SPECT and MR Imaging of¹⁶⁶Ho-Microspheres for Treatment of Liver Malignancies

In Vivo Dosimetry Based on SPECT and MR Imaging of¹⁶⁶Ho-Microspheres for Treatment of Liver Malignancies