Feasibility of Contrast-Enhanced and Nonenhanced MRI for Intraprocedural and Postprocedural Lesion Visualization in Interventional Electrophysiology

Nordbeck, Peter; Hiller, K. H.; Fidler, Florian; Warmuth, Marcus; Burkard, Natalie; Nahrendorf, Matthias; Jakob, Peter M.; Quick, Harald H.; Ertl, Georg; Bauer, Wolfgang R.; Ritter, Oliver

doi:10.1161/circimaging.110.957670

Cited by 41 publications

(27 citation statements)

References 25 publications

(30 reference statements)

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“…3,4 Late gadolinium enhancement (LGE) methods provide high contrast between healthy myocardium and the ablation lesions. 3,[5][6][7] However, acute lesion appearance on the LGE image varies with the time between the Gd-DTPA injection and image acquisition because of the wash-in/wash-out kinetics, 7 particularly in areas associated with microvascular obstruction. Shortly after Gd-DTPA injection, the lesion contains hypoenhanced regions in typical LGE acquisitions.…”

Section: Clinical Perspective On P 727mentioning

confidence: 99%

Intrinsic Contrast for Characterization of Acute Radiofrequency Ablation Lesions

Çelik

Ramanan

Barry

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Cardiac arrhythmias reflect abnormal electric activity in the heart. Radiofrequency ablation (RFA) is used to treat different arrhythmias by thermally damaging tissue regions and eliminating irregular action potential propagation paths. To ensure a permanent electric block, RFA must create a continuous line of transmural lesions.1 Notwithstanding extensive efforts, the success rates of the RFA operations are still low, 2 likely because of the lack of tools to validate the lesion extent. Current ablation methods rely on suboptimal fluoroscopy and electrophysiology electroanatomic systems; fluoroscopy has poor soft tissue contrast, and even with electroanatomic systems locating and characterizing the ablation lesions are challenging. More importantly, it is difficult to predict which of the lesions that yield a conduction block in the acute setting will maintain a block in the chronic setting. Clinical Perspective on p 727MRI is a powerful tool to detect ablation lesions because of its high soft tissue contrast. Double inversion fast spin echo (DIR) sequence demonstrates intrinsic T 2 -weighted contrast and quickly detect lesions, but DIR images lack specificity and provide poor border visibility. 3,4 Late gadolinium enhancement (LGE) methods provide high contrast between healthy myocardium and the ablation lesions. 3,[5][6][7] However, acute lesion appearance on the LGE image varies with the time between the Gd-DTPA injection and image acquisition because of the wash-in/wash-out kinetics, 7 particularly in areas associated with microvascular obstruction. Shortly after Gd-DTPA injection, the lesion contains hypoenhanced regions in typical LGE acquisitions. Then Gd-DTPA starts to enter the lesion, and a bright rim becomes visible. As the bright rim expands toward the center of the lesion over the ensuing minutes, wash-out mechanisms also begin to diminish the contrast at the outer border of the lesion. The lesion severity can also affect the wash-in/wash-out kinetics. As a second consideration, a recent study reported that the scar size measured 3 months after ablation with LGE images is <50% of that measured acutely. 6 One of the possible reasons for this © 2014 American Heart Association, Inc. Original ArticleBackground-Both intrinsic contrast (T 1 and T 2 relaxation and the equilibrium magnetization) and contrast agent (gadolinium)-enhanced MRI are used to visualize and evaluate acute radiofrequency ablation lesions. However, current methods are imprecise in delineating lesion extent shortly after the ablation. Methods and Results-Fifteen lesions were created in the endocardium of 13 pigs. A multicontrast inversion recovery steady state free precession imaging method was used to delineate the acute ablation lesions, exploiting T 1 -weighted contrast. T 2 and M o * maps were also created from fast spin echo data in a subset of pigs (n=5) to help characterize the change in intrinsic contrast in the lesions. Gross pathology was used as reference for the lesion size comparison, and the lesion structures were confirm...

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Section: Clinical Perspective On P 727mentioning

confidence: 99%

Intrinsic Contrast for Characterization of Acute Radiofrequency Ablation Lesions

Çelik

Ramanan

Barry

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…Визуализация повреждения предсердий сред-ствами контрастированной МРТ или с помощью раз-личных модификаций Т2-взвешенного спин-эхо исследования используется в кардиологии доста-точно давно, но почти исключительно для характери-стики повреждения миокарда при различных элек-тродеструкционных процедурах в ходе аблации пред-сердных аритмий [7,8]. Такой подход безусловно важен и неоспорим, поскольку методы контрастиро-ванной МРТ обладают исключительной, практиче-ски безальтернативной чувствительностью в выявле-нии всех форм повреждения миокарда [9].…”

Section: Discussionunclassified

Contrast Magnetic Resonance Investigation in Patients After Myocardial Infarction and Tachiarrhythmias

Usov¹,

Бабокин²,

Мочула³

et al. 2014

Russ J Cardiol

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Представлены результаты использования магнитно-резонансной томографии сердца с парамагнитным контрастированием для визуального выявления оча-гов повреждения миокарда, провоцирующих развитие предсердных нарушений ритма у пациентов с перенесенным обширным инфарктом левого желудочка. Показано, что объем левого предсердия более 75 см 3 и накопление контраста-парамагнетика в миокарде предсердий с индексом усиления в Т1-взв. спин-эхо режиме более 1,27 являются прогностическими факторами в отношении разви-тия наджелудочковых тахиаритмий, а магнитно-резонансная томография серд ца с контрастированием является важным дополнительным методом исследования у пациентов с предсердными нарушениями ритма сердца. We present the results of MRI study of the heart with paramagnetic contrasting for visualization of the foci of myocardial damage, that lead to atrial tachiarrhythmias in patients with severe infarction of the left ventricle. It is shown that the volume of the left atrium more than 75 cm 3 and accumulation of paramagnetic contrast in atrial myocardium with the enhancement T1-adj. spin-echo regimen index more than 1,27 are prognostic factors for atrial tachiarrhythmias, and MRI of the heart with contrast is an important additional method of patients' investigation with atrial rhythm disorders. Russ

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“…In recent years, however, initial simple electrophysiological studies [68] as well as ablation procedures [69,70] have been performed, e. g. isthmus ablation of patients with atrial flutter under passive catheter guide [71] (▶ Fig. 5).…”

Section: Mr-guided Cardiac Ablationmentioning

confidence: 99%

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

Barkhausen

Kahn

Krombach

et al. 2017

Fortschr Röntgenstr

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ABSTR AC TBackground MRI is attractive for the guiding and monitoring of interventional procedures due to its high intrinsic soft tissue contrast and the possibility to measure physiologic parameters like flow and cardiac function.Method The current status of interventional MRI for the clinical routine was analyzed.Results The effort needed for the development of MR-safe monitoring systems and instruments initially resulted in the application of interventional MRI only for procedures that could not be performed by other means. Accordingly, biopsy of lesions in the breast, which are not detectable by other modalities, has been performed under MRI guidance for decades. Currently, biopsies of the prostate under MRI guidance are established in a similar fashion. At many sites blind biopsy has already been replaced by MR-guided biopsy or at least by the fusion of MR images with ultrasound. Cardiovascular This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.interventions are performed at several centers for ablation as a treatment for atrial fibrillation. Conclusion IntroductionMRI has an intrinsically high soft-tissue contrast and can be used to measure physiological parameters, such as blood flow (flow rate and flow volume), diffusion, temperature, and movement. Since its introduction into the clinical routine in the 1980 s, it has also been used for guiding and monitoring interventions. However, in contrast to CT and ultrasound, the use of MRI for guiding interventions requires significant technical effort. Due to the disruptive effect of the strong main magnetic field and the alternating electromagnetic fields, the monitoring of patients during an intervention by measuring ECG signals, oxygen saturation, or blood pressure requires special equipment. These monitoring systems must not interfere with the MRI scan and must be MR-safe (according to DIN EN 62 570:2010 -05). The list of requirements regarding monitoring equipment provides an indication of the development effort, with suitable monitoring equipment representing only one of the components necessary for MR-guided interventions.In addition to MRI safety, all catheters and instruments must be adapted to this modality. To ensure MRI safety, metal must be largely avoided since, depending on the length and orientation to the main magnetic field, it can heat up and consequently even result in burns. Achieving rigidity and torsion stability of catheters or guide wires without the use of metal for reinforcement represents a technical challenge. In the case of needles, breaking resistance is one of the more difficult properties to achieve for MR-safe designs. Moreover, instruments must be able to be effectively visualized without adjacent structures being superimposed by artifacts. The tip must be able to be identified and definitively differentiated from the shaft since MRI as a cross-sectional imaging method typically uses individual slices even for guiding interventions and does not use projections as in fluoroscopy...

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Feasibility of Contrast-Enhanced and Nonenhanced MRI for Intraprocedural and Postprocedural Lesion Visualization in Interventional Electrophysiology

Cited by 41 publications

References 25 publications

Intrinsic Contrast for Characterization of Acute Radiofrequency Ablation Lesions

Intrinsic Contrast for Characterization of Acute Radiofrequency Ablation Lesions

Contrast Magnetic Resonance Investigation in Patients After Myocardial Infarction and Tachiarrhythmias

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

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