Purpose: To implement and optimize a real-time pulse sequence and user interface to perform intravascular interventions using active catheter tracking.
Materials and Methods:In magnetic resonance (MR)-guided interventions, small radio-frequency coils can be used to rapidly determine the device position (active tracking). In this work, active catheter tracking was combined with a dedicated real-time pulse sequence and user interface. The pulse sequence offered the imaging contrasts fast low angle shot (FLASH), true Fast imaging with steady state precession (TrueFISP), and projection MR digital subtraction angiography (MR-DSA), which could be selected by the radiologist from within the scanner room at any time during the intervention. Automatic slice positioning was added to the real-time pulse sequence so that the location of the tracking coils defined the image slice position and orientation. The technique was assessed in phantoms and animal experiments.Results: At a reaction time of 24 msec and a frame rate of three images per second, the movement of an active intravascular catheter could be monitored in the aorta and the renal arteries of a pig. With interactive contrast and orientation changes, the renal vasculature could be assessed by a fully MR-guided catheterization in less than 10 minutes.
Conclusion:With carefully designed active catheters, a dedicated user interface, and an optimized pulse sequence intravascular interventions can successfully be performed by a single operator from within the MR scanner room.
MR-guided intravascular interventions require image update rates of up to 10 images per second, which can be achieved using parallel imaging. However, parallel imaging requires many coil elements, which increases reconstruction times and thus compromises real-time image reconstruction. In this study a dynamic coil selection (DCS) algorithm is presented that selects a subset of receive coils to reduce image reconstruction times. The center-of-sensitivity coordinates and the relative signal intensities are determined for each coil in a prescan. During the intervention m coils are selected for reconstruction using a coil ranking based on the distance to the current slice or catheter position. In a phantom experiment for m ؍ 6, an optimal signal-to-background ratio (SBR) was achieved and foldover artifacts were avoided. In three animal experiments involving catheter manipulation in the aorta and the right heart chamber, the anatomy was successfully visualized at frame rates of about 5 Hz using active catheter tracking. Magn Reson Med 56:1156 -1162, 2006.
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