Interventional MRI-guided local delivery of agents into swine bile duct walls using MR-compatible needle-integrated balloon catheter system

Abstract

Purpose To investigate the feasibility of interventional magnetic resonance imaging (MRI)-guided local agent delivery into pig common bile duct (CBD) walls using a newly-designed MR-compatible, needle-integrated balloon catheter system. Materials and Methods We first designed a needle-integrated balloon catheter system that is comprised of a 22-G MR-compatible Chiba biopsy needle and a conventional 12mm×2cm balloon catheter. Under fluoroscopy guidance, a custom needle/balloon system was positioned into the target CBD via a transcholecystic access. T1-weighted MR imaging was used to localize and reposition the needle/balloon system in the target. A 0.5-mL mixture of motexafin gadolinium (MGd) and trypan blue dye as well as 5-fluorouracil (5-Fu) was delivered into the CBD wall through the needle/balloon system. Post-infusion T1-weighted MR imaging was obtained and contrast-to-noise ratios (CNR) of CBD walls of pre- and post-MGd/blue infusions were compared by a paired t-test. In addition, post-infusion x-ray cholangiography was achieved to evaluate the potential injuries of CBDs by the needle/balloon system. Subsequent histologic analysis was performed to correlate and confirm the imaging findings. Results Post-infusion cholangiogram didn’t show any extravasation of contrast agent, indicating no procedure-related damage to the CBDs. MR imaging demonstrated the clear enhancement of the target bile duct walls infused with MGd/trypan blue dye with average penetration depth of 4.7±1.2mm. The average CNR of the post-infusion bile ducts was significant higher than that of the pre-infusion bile ducts (110.6±22 vs 5.7±2.8, p<0.0001). Histology depicted the blue dye staining and red fluorescence of MGd through the target CBD walls, which was well correlated with the imaging findings. Conclusions It is feasible to use the new MR compatible, needle-integrated balloon catheter system for intrabiliary local agent delivery into CBD walls under MR imaging guidance, which may open new avenues for efficient management of pancreatobiliary malignancies using MR-guided interventional oncology.

Multimodal molecular imaging evaluation for early diagnosis and prognosis of cholangiocarcinoma

“…The results showed that the distribution of MGd in the choledochus wall was clearly displayed by MR imaging (Fig. 6 ) [ 76 ].

Fig.

…”

“…C , D Cross-sectional images of the choledochus before ( C ) and after injection ( D ). Reproduced from Zhang et al [ 76 ] …”