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Preclinical feasibility of a technology framework for MRI-guided iliac angioplasty

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Abstract

Purpose

Interventional MRI has significant potential for image guidance of iliac angioplasty and related vascular procedures. A technology framework with in-room image display, control, communication and MRI-guided intervention techniques was designed and tested for its potential to provide safe, fast and efficient MRI-guided angioplasty of the iliac arteries.

Methods

A 1.5-T MRI scanner was adapted for interactive imaging during endovascular procedures using new or modified interventional devices such as guidewires and catheters. A perfused vascular phantom was used for testing. Pre-, intra- and post-procedural visualization and measurement of vascular morphology and flow was implemented. A detailed analysis of X-ray fluoroscopic angiography workflow was conducted and applied. Two interventional radiologists and one physician in training performed 39 procedures. All procedures were timed and analyzed.

Results

MRI-guided iliac angioplasty procedures were successfully performed with progressive adaptation of techniques and workflow. The workflow, setup and protocol enabled a reduction in table time for a dedicated MRI-guided procedure to 6 min 33 s with a mean procedure time of 9 min 2 s, comparable to the mean procedure time of 8 min 42 s for the standard X-ray-guided procedure.

Conclusions

MRI-guided iliac vascular interventions were found to be feasible and practical using this framework and optimized workflow. In particular, the real-time flow analysis was found to be helpful for pre- and post-interventional assessments. Design optimization of the catheters and in vivo experiments are required before clinical evaluation.

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References

  1. Bartorelli AL, Marenzi G (2008) Contrast-induced nephropathy. J Interv Cardiol 21:74–85

    Article  PubMed  Google Scholar 

  2. Martin CJ (2009) A review of radiology staff doses and dose monitoring requirements. Radiat Prot Dosim 136:140–57

    Article  CAS  Google Scholar 

  3. Gedroyc WM (2000) Interventional magnetic resonance imaging. BJU Int 86:174–80

    Article  PubMed  Google Scholar 

  4. Schaefers G, Melzer A (2006) Testing methods for MR safety and compatibility of medical devices. Minim Invasive Ther Allied Technol 15:71–5

    Article  PubMed  Google Scholar 

  5. Weiss CR, Nour SG, Lewin JS (2008) MR-guided biopsy: a review of current techniques and applications. J Magn Reson Imaging 27:311–25

    Article  PubMed  Google Scholar 

  6. Yutzy SR, Duerk JL (2008) Pulse sequences and system interfaces for interventional and real-time MRI. J Magn Reson Imaging 27:267–75

    Article  PubMed  Google Scholar 

  7. Smink J, Häkkinen M, Holthuizen R, Krueger S, Ries M, Berber Y, Moonen C, Köhler M, Vahala E (2011) eXTernal Control (XTC): a flexible, real-time, low-latency, bi-directional scanner interface. Proc Intl Soc Mag Reson Med 20:1755

    Google Scholar 

  8. Lorenz CH, Kirchberg KJ, Zuehlsdorff S, Speier P, Caylus M, Borys W, Moeller T, Guttman MA (2005) Interactive Frontend (IFE): a platform for graphical MR scanner control and scan automation. Proc Intl Soc Mag Reson Med 13. Miami, FL, USA, pp 2170

  9. Santos JM, Wright GA, Pauly JM (2004) Flexible real-time magnetic resonance imaging framework. Conf Proc IEEE Eng Med Biol Soc, San Francisco, CA, USA, pp 1048–51

  10. Rube MA, Seifert P, Bernhard U, Kakchingtabam D, Andre P, Melzer A (2012) Novel MR-safe guidewire with passive Iron-Platinum alloy nanoparticles for MR-guided interventions. Proc Intl Soc Mag Reson Med 20. Melbourne, pp 4239

  11. Guttman MA, Ozturk C, Raval AN, Raman VK, Dick AJ, Desilva R, Karmarkar P, Lederman RJ, Mcveigh ER (2007) Interventional cardiovascular procedures guided by real-time MR imaging? An interactive interface using multiple slices, adaptive projection modes and live 3D renderings. J Magn Reson Imaging 1435:1429–1435

    Article  Google Scholar 

  12. Melzer A, Michitsch S, Konak S, Schaefers G, Bertsch T (2004) Nitinol in magnetic resonance imaging. Minim Invasive Ther Allied Technol 13:261–71

    Article  PubMed  Google Scholar 

  13. Bock M, Wacker FK (2008) MR-guided intravascular interventions: techniques and applications. J Magn Reson Imaging 27:326–38

    Article  PubMed  Google Scholar 

  14. Bakker CJ, Hoogeveen RM, Weber J, van Vaals JJ, Viergever M a, Mali WP (1996) Visualization of dedicated catheters using fast scanning techniques with potential for MR-guided vascular interventions. Magn Reson Med 36:816–820

    Article  CAS  PubMed  Google Scholar 

  15. Burl M, Coutts G a, Young IR (1996) Tuned fiducial markers to identify body locations with minimal perturbation of tissue magnetization. Magn Reson Med 36:491–493

    Article  CAS  PubMed  Google Scholar 

  16. Bock M, Umathum R, Zuehlsdorff S, Volz S, Fink C, Hallscheidt P, Zimmermann H, Nitz W, Semmler W (2005) Interventional magnetic resonance imaging: an alternative to image guidance with ionising radiation. Radiat Prot Dosim 117:74–8

    Article  CAS  Google Scholar 

  17. Ratnayaka K, Faranesh AZ, Guttman MA, Kocaturk O, Saikus CE, Lederman RJ (2008) Interventional cardiovascular magnetic resonance: still tantalizing. J Cardiovasc Magn Reson 10:62–85

    Article  PubMed Central  PubMed  Google Scholar 

  18. Schmidt EJ, Mallozzi RP, Thiagalingam A et al (2009) Electroanatomic map** and radiofrequency ablation of porcine left atria and atrioventricular nodes using magnetic resonance catheter tracking. Circ Arrhythm Electrophysiol 2:695–704

  19. Radau PE, Pintilie S, Flor R, Biswas L, Oduneye SO, Ramanan V, Anderson KA, Wright GA (2011) VURTIGO: visualization platform for teal-time, MRI-guided cardiac electroanatomic map**. In: Camara O, Konukoglu E, Pop M, Rhode K, Sermesant M, Young A (eds) STACOM. Springer, Berlin, pp 244–253

    Google Scholar 

  20. Wolska-Krawczyk M, Rube MA, Immel E, Melzer A, Buecker A (2014) Heating and safety of a new MR-compatible guidewire prototype versus a standard nitinol guidewire. Radiol Phys Technol 7:95–101

    Article  PubMed  Google Scholar 

  21. Rube MA, Holbrook AB, Cox BF, Melzer A Wireless MR tracking of interventional devices using phase-field dithering and projection reconstruction. Magn Reson Imaging [E-Pub ahead of print]. doi:10.1016/j.mri.2014.03.007

  22. Fernández-Gutiérrez F, Barnett I, Taylor B, Houston G, Melzer A (2013) Framework for detailed workflow analysis and modelling for simulation of multi-modal image-guided interventions. J Enterp Inf Manag 26:75–90

    Article  Google Scholar 

  23. Du YP, Parker DL, Davis WL, Cao G (1994) Reduction of partial-volume artifacts with zero-filled interpolation in three-dimensional MR angiography. J Magn Reson Imaging 4:733–41

    Article  CAS  PubMed  Google Scholar 

  24. Immel E, Melzer A (2006) Improvement of the MR imaging behavior of vascular implants. Minim Invasive Ther Allied Technol 15:85–92

    Article  PubMed  Google Scholar 

  25. Kaiser M, Detert M, Rube MA, Eldirdiri A, Elle OJ, Melzer A, Schmidt B, Rose G (2013) Resonant marker design and fabrication techniques for device visualization during interventional magnetic resonance imaging. Biomed Tech (in review)

  26. Rube MA, Immel E, Toomey R, Wolska-Krawczyk, Melzer A (2011) Semi-active resonant markers for interventional device localization in real-time MR Imaging. In: Szold A, Shoham M (eds) Proc 23rd Conf Soc Med Innov Technol. Tel Aviv, Israel, pp SSG17-07

  27. Konings MK, Bartels LW, Smits HF, Bakker CJ (2000) Heating around intravascular guidewires by resonating RF waves. J Magn Reson Imaging 12:79–85

    Article  CAS  PubMed  Google Scholar 

  28. Nitz WR, Oppelt A, Renz W, Manke C, Lenhart M, Link J (2001) On the heating of linear conductive structures as guide wires and catheters in interventional MRI. J Magn Reson Imaging 13:105–14

    Article  CAS  PubMed  Google Scholar 

  29. Rothgang E, Gilson WD, Wacker F, Hornegger J, Lorenz CH, Weiss CR (2013) Rapid freehand MR-guided percutaneous needle interventions: an image-based approach to improve workflow and feasibility. J Magn Reson Imaging 37:1202–1212

    Article  PubMed  Google Scholar 

  30. Weiger M, Brunner DO, Dietrich BE, Müller CF, Pruessmann KP (2013) ZTE imaging in humans. Magn Reson Med 70:328–32

    Article  PubMed  Google Scholar 

  31. Grodzki DM, Heisman B (2013) Quiet T1-weighted head scanning using PETRA. Proc Intl Soc Mag Reson Med 21. Salt Lake City, UT, USA, pp 456

  32. Hoffmann R, Thomas C, Rempp H, Schmidt D, Pereira PL, Claussen CD, Clasen S (2012) Performing MR-guided biopsies in clinical routine: factors that influence accuracy and procedure time. Eur Radiol 22:663–71

    Article  PubMed  Google Scholar 

  33. Kleinerman R a (2006) Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol 36(Suppl 2):121–125

    Article  PubMed Central  PubMed  Google Scholar 

  34. Mathews JD, Forsythe AV, Brady Z et al (2013) Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ. doi:10.1136/bmj.f2360

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Acknowledgments

We thank Leonard Fass and John Ferrut as well as Tom Breslin and Gabor Mizsei for their friendly and helpful support. We are in particular grateful for the help and input from Patricia Seifert, Bernhard Uihlein and Paul Borm. The authors are thankful for financial assistance provided by the FUSIMO (‘Patient-specific modeling and simulation of focused ultrasound in moving organs’) project funded under the European Community’s Seventh Framework Programme (FP7/2007–2013) for Research and Technological Development under Grant Agreement no 270186. The Marie Curie Initial Training Network supported this work, and the Integrated Interventional Imaging Operating System (IIIOS) project has received funding from the European Community’s Seventh Framework Programme (FP7/2007–2013) under Grant Agreement no 238802.

Conflict of interest

The Integrated Interventional Imaging Operating System (IIIOS) project has received funding from the European Community’s Seventh Framework Programme (FP7/2007–2013) under Grant Agreement no 238802. Martin A. Rube, Fabiola Fernandez-Gutierrez, Mahsa Fatahi, Benjamin F. Cox and Andrew B. Holbrook have received funding from the European Union (IIIOS project). Andrew B. Holbrook has also received funding from the following grants NIH R01-CA121163 and P01-CA159992. Helen McLeod has received funding from the European Union (FUSIMO project, Grant Agreement no 270186). Richard D. White has no conflicts of interest. Graeme J. Houston is director, shareholder, patent holder and receives royalty at Tayside Flow Technologies Ltd. Andreas Melzer is consultant and shareholder at INNOMEDIC GmbH, Herxheim, Germany.

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Authors and Affiliations

  1. Division of Imaging and Technology, Institute for Medical Science and Technology, University of Dundee, Wilson House, 1 Wurzburg Loan, Dundee, DD2 1FD, UK

    Martin A. Rube, Fabiola Fernandez-Gutierrez, Benjamin F. Cox, Helen McLeod, Mahsa Fatahi & Andreas Melzer

  2. Department of Radiology, Stanford University, 1201 Welch Rd, Stanford, CA, 94305, USA

    Andrew B. Holbrook

  3. Department of Clinical Radiology, Ninewells Hospital and Medical School, NHS Tayside, Dundee, DD1 9SY, UK

    J. Graeme Houston, Richard D. White & Helen McLeod

  4. Department of Clinical Radiology, University Hospital of Wales, Heath Park, Cardiff, CF144XW, UK

    Richard D. White

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  1. Martin A. Rube
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Correspondence to Martin A. Rube.

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Rube, M.A., Fernandez-Gutierrez, F., Cox, B.F. et al. Preclinical feasibility of a technology framework for MRI-guided iliac angioplasty. Int J CARS 10, 637–650 (2015). https://doi.org/10.1007/s11548-014-1102-0

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  • DOI: https://doi.org/10.1007/s11548-014-1102-0

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