Real-time MR fluoroscopy for MR-guided iliac artery stent placement

Buecker, Arno; Neuerburg, J; Adam, Gerhard; Glowinski, A.; Schaeffter, Tobias; Rasche, Volker; Vaals, J. J. Van; Molgaard-Nielsen, A.; Guenther, Rolf W.

doi:10.1002/1522-2586(200010)12:4<616::aid-jmri15>3.0.co;2-f

Cited by 65 publications

(33 citation statements)

References 32 publications

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“…10,11 To our knowledge, the current report represents the first MR-guided coronary artery stent placement. Improved gradient performance, ultrafast reconstruction capabilities, 14 and recently developed software tools for "on-the-fly" interactive MR scanning 18 now offer the potential for real-time MR imaging with sufficient contrast and spatial resolution for MR-guided coronary interventions.…”

Section: Discussionmentioning

confidence: 99%

“…10 The system is equipped with a dedicated real-time reconstruction system 14 and online image display at the magnet. For signal reception, a five-element commercial cardiac synergy coil was used.…”

Section: Mr Imaging Systemmentioning

confidence: 99%

“…4 The combination of MR plaque information with interventional MR-guided coronary stent placement may provide a favorable clinical potential. In contrast to MR-guided stent placement in peripheral arteries, 10,11 coronary MR-guided interventions must accommodate the substantial motion artifacts originating from the respiratory and the cardiac cycles. 12 In addition, MR-guided coronary artery interventions are especially challenging because of the small size and the tortuous anatomy of the coronary vessels.…”

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confidence: 99%

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Magnetic Resonance–Guided Coronary Artery Stent Placement in a Swine Model

et al. 2002

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Background-Magnetic resonance (MR)-guided coronary artery stent placement is a challenging vascular intervention because of the small size of the coronary arteries combined with incessant motion during the respiratory and cardiac cycles. These obstacles necessitate higher temporal and higher spatial resolution real-time MR imaging techniques when compared with interventional peripheral MR angiography. Methods and Results-A new, ultrafast, real-time MR imaging technique that combines steady-state free precession (SSFP) for high signal-to-noise ratio and radial k-space sampling (rSSFP) for motion artifact suppression was implemented on a 1.5-T clinical whole-body interventional MR scanner. The sliding window reconstruction technique yielded a frame rate of 15/s allowing for data acquisition during free breathing and without cardiac triggering. Eleven balloon-expandable stainless steel coronary stents were placed in both coronary arteries of 7 pigs (40 to 70 kg body weight) using a nitinol guidewire and passive device visualization. Position of the coronary stents was controlled by a navigator-gated free-breathing ECG-triggered three-dimensional SSFP coronary MRA sequence and confirmed visually on the ex vivo heart. The presented real-time MR imaging sequence reliably allowed for high-quality coronary MR fluoroscopy without motion artifacts in all pigs. Ten of 11 coronary stents were correctly placed under MR guidance. One stent dislodged proximally from the left main coronary artery because of too-small balloon size. Stent dislocation was correctly predicted during real-time MR imaging. Conclusion-The presented approach allows for real-time MR-guided coronary artery stent placement in a swine model.

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Section: Discussionmentioning

confidence: 99%

Section: Mr Imaging Systemmentioning

confidence: 99%

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confidence: 99%

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Magnetic Resonance–Guided Coronary Artery Stent Placement in a Swine Model

et al. 2002

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“…Tracking of microcoils (13,24,25), involving imaging of bright spots, has also been achieved using PR with just a few projections (26,27). The present investigation differs from previous studies in that PR was employed with greater undersampling factors, active catheters combined with anatomy were imaged, and adjustable temporal resolution was employed.…”

Section: Discussionmentioning

confidence: 99%

Undersampled projection reconstruction for active catheter imaging with adaptable temporal resolution and catheter‐only views

Peters

Lederman

Dick

et al. 2003

Magnetic Resonance in Med

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In this study undersampled projection reconstruction (PR) was used for rapid catheter imaging in the heart, employing steadystate free precession (SSFP) contrast. Active catheters and phased-array coils were used for combined imaging of anatomy and catheter position in swine. Real-time imaging of catheter position was performed with relatively high spatial and temporal resolution, providing 2 ؋ 2 ؋ 8 mm spatial resolution and four to eight frames per second. Two interactive features were introduced. The number of projections (Np) was adjusted interactively to trade off imaging speed and artifact reduction, allowing acquisition of high-quality or high-frame-rate images. Thin-slice imaging was performed, with interactive requests for thick-slab projection images of the signal received solely from the active catheter. Briefly toggling on catheter-only projection images was valuable for verifying that the catheter tip was contained within the selected slice, or for locating the catheter when part of it was outside the selected slice. A crucial feature of vascular interventional procedures is catheter or guidewire imaging or tracking. This requires good contrast, and high temporal and spatial resolution for the device and surrounding anatomy. One important obstacle in MRI is that increased spatial resolution is often obtained at the cost of increased scan time (i.e., decreased temporal resolution). It is also sometimes difficult to observe the distal portion and catheter tip during catheter manipulations in the acquired slice, because the catheter tip often lies outside of the slice. These challenges regarding high temporal and spatial resolution, and device localization in a thin slice were addressed using undersampled projection reconstruction (PR), or radial imaging, for active catheter imaging in the aorta and cardiac chambers.Different interventional tasks have different imaging requirements. For example, gross catheter movements in the aorta require high temporal resolution. Fine device placement (such as selective artery engagement or stent placement) requires high image quality, which may come at the expense of temporal resolution. Undersampled PR acquires radial lines of k-space (projections). PR permits the independent adjustment of temporal resolution at constant spatial resolution, by reducing the number of projections (Np); however, aliasing artifacts may appear. For PR, the spatial resolution is determined primarily by the readout resolution (Nr), while the Np determines the level of artifact (1). Reduction of Np provides improved temporal resolution, decreases SNR by the square root of scan time, increases artifacts due to undersampling, and results in little change in the nominal spatial resolution.The present investigation employed combined imaging of an active catheter and anatomy using a phased-array coil, in a thin slice. The catheter acted as a coil tuned to receive MR signal throughout its length. Neither thin-slice nor thick-slab projection imaging is optimal for visualizing invasive devices. I...

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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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Real-time MR fluoroscopy for MR-guided iliac artery stent placement

Cited by 65 publications

References 32 publications

Magnetic Resonance–Guided Coronary Artery Stent Placement in a Swine Model

Magnetic Resonance–Guided Coronary Artery Stent Placement in a Swine Model

Undersampled projection reconstruction for active catheter imaging with adaptable temporal resolution and catheter‐only views

MR‐guided intravascular interventions: Techniques and applications

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