MR imaging-guided biliary drainage in an open low-field system: First clinical experiences

Abstract

RAPID COMMUNICATION nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nPurpose: To test the feasibility of MR imaging (MRI)-guided percutaneous biliary drainages in patients using an open MRsystem. Methods: 6 patients with mechanical cholestasis underwent MRI-guided puncture and catheterization of the biliary system following intervention planning with magnetic resonance cholangiography (MRC) in an open low-field MR system. Data on the number of punctures required, success in establishing external and internal drainage, and total procedure time were compared to those of 6 patients who underwent biliary drainage with fluoroscopic guidance. Results: MRC facilitated intervention planning in all patients. Near-real-time MR imaging enabled interactive positioning of the devices. The bile ducts were punctured under MRI control in three patients in the first, in two in the second, and in one in the third attempt. MRI-guided puncture was faster than the fluoroscopic procedure. Catheterization for external drainage was successful in all patients. Passing the obstructions was not possible under MRI guidance. The procedure time for MRI-guided catheterization was longer than in the conventional technique. Conclusion: MRI-guidance allows reliable placement of an external biliary drainage in an open low-field MR system.

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 2: Liver and Other Applications in Oncology

“…Thus, the need to perform percutaneous interventions under MRI guidance is also increasing. In addition to use in the simple biopsy of tissue samples and aspirations [2 -8], MR-guided treatment types such as sclerotherapy [9,10], targeted injections [11 -13], drainage [14,15] and local tumor treatment [16,17] have been described.…”

“…This is also possible in the case of open MRI scanners with 2 horizontally arranged magnetic poles that allow good access to the patient depending on the diameter of the poles and the size of the opening between the poles. In the case of a small pole diameter, access is good but the quality of the almost real-time imaging is limited due to the low field strength of these systems [14,25]. Horizontally open MRI scanners with higher field strengths provide higher image quality [12] but commercial availability is currently still limited.…”

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“…These techniques can be applied not only for diagnostic purposes but also during an intervention. The first MR-guided endoluminal applications were percutaneous cholangiographies with drainage (MR-PTCD) (16) and percutaneous nephrostomies (17). The first step during these combined percutaneous-endoluminal interventions is similar to a biopsy procedure.…”

MR image-guided needle biopsies with a combination of augmented reality and MRI: A pilot study in phantoms and animals

“…MR imaging guidance for interventional procedures is receiving increasing attention [8,11,[13][14][15]. MRI has many potential advantages that make it an attractive tool to guide diagnostic as well as therapeutic procedures.…”