MR‐guided percutaneous sclerotherapy of low‐flow vascular malformations: Clinical experience using a 1.5 tesla MR system

Abstract

Purpose To demonstrate the feasibility, safety, and effectiveness of image-guided sclerotherapy of low-flow vascular malformations using a 1.5-Tesla magnetic resonance (MR) scanner with real-time imaging capability and in-suite fluoroscopy. Materials and Methods 33 procedures were performed with real-time 1.5-Tesla MR-guidance on 22 patients with a vascular malformation in the neck (n = 2), chest (n = 6), abdomen and pelvis (n = 15), and extremities (n = 11). Quantitative analysis was performed for changes in (a) planning time, (b) targeting time (interval between needle skin puncture and lesion access), (c) intervention time (interval between needle skin puncture and needle removal), and (d) total procedure time. Qualitative analysis was performed for (a) success of therapy and (b) occurrence of complications. Results Technical success was achieved in 29 out of 33 procedures. The average planning time did not significantly change between the first seven procedures and the last seven procedures (P = 0.447). The average targeting time decreased by 0:24:45 (hours:minutes:seconds) (P = 0.043), the average intervention time decreased by 0:26:58 (P = 0.022), and the average procedure time decreased by 0:28:41 (P = 0.046) when comparing the first seven procedures and the last seven procedures. Overall, there was an improvement in the patients’ predominant symptoms following 82% of procedures, including a significant decrease in average pain following therapy (P < 0.001). There was a minor complication rate of 3% with no major complications. Conclusion MR-guided percutaneous sclerotherapy seems to be a safe, effective, and versatile technique for treating low-flow vascular malformations.

Magnetic resonance – guided treatment of low-flow vascular malformations and the technologies to potentiate adoption

“…Two of the treatment needles can also be seen (yellow oval). Reproduced with permission, John Wiley and Sons, Inc. ( 11 ).…”

“…This setup used projectors connected to graphics outputs which allowed the operator to monitor treatment in real time while the technologist received protocol instructions in the control room ( 10 ). By 2016, hybrid 1.5 T MRI-fluoroscopy angiography suites emerged with wide-bore MR scanners; for example, the Magnetom Espree combined with the Axiom Artis X fluoroscopy system and the interactive front end interface (Siemens Healthcare, Erlangen, Germany) ( 11 ). These systems were set up in a modular configuration to select fluoroscopic or MR capabilities according to procedural demands ( 11 ).…”

“…By 2016, hybrid 1.5 T MRI-fluoroscopy angiography suites emerged with wide-bore MR scanners; for example, the Magnetom Espree combined with the Axiom Artis X fluoroscopy system and the interactive front end interface (Siemens Healthcare, Erlangen, Germany) ( 11 ). These systems were set up in a modular configuration to select fluoroscopic or MR capabilities according to procedural demands ( 11 ). Logistics of these procedures in IR such as department configurations that consider surrounding magnetic zones to periprocedural maintenance requirements have been previously outlined and discussed ( 12 ).…”

“…Workflow #2 used the in-suite fluoroscopy, which allowed for the safe delivery of larger volumes of ETOH. Reproduced with permission, John Wiley and Sons, Inc. ( 11 ).…”

Percutaneous MR Imaging-Guided Laser Ablation and Cryoablation for the Treatment of Pediatric and Adult Symptomatic Peripheral Soft Tissue Vascular Anomalies

“…Magnetic resonance (MR) imaging has been established as an effective imaging modality for both the characterization and diagnosis of VAs given the excellent soft tissue resolution as well as the capability of monitoring of treatment response in VA, and may be particularly helpful in low-flow anomalies (5,14). MR imaging-guided sclerotherapy has shown to be feasible and safe, with promising early clinical outcomes using both 1.5-T and 3.0-T MR imaging systems (15)(16)(17). MR imaging-guided and monitored thermal ablation is an established therapy in the treatment of primary and recurrent malignancies, particularly prostate cancer (18,19).…”