Interventional CMR: Clinical Applications and Future Directions

Abstract

Interventional cardiovascular magnetic resonance (iCMR) promises to enable radiation-free catheterization procedures and to enhance contemporary image guidance for structural heart and electrophysiological interventions. However, clinical translation of exciting pre-clinical interventions has been limited by availability of devices that are safe to use in the magnetic resonance (MR) environment. We discuss challenges and solutions for clinical translation, including MR-conditional and MR-safe device design, and how to configure an interventional suite. We review the recent advances that have already enabled diagnostic MR right heart catheterization and simple electrophysiologic ablation to be performed in humans and explore future clinical applications.

Shape memory polymers with enhanced visibility for magnetic resonance- and X-ray imaging modalities

“…Magnetic resonance (MR) imaging offers an alternative technique for device monitoring during minimally invasive delivery and follow-up procedures. [1–4] Herein we present the development of a shape memory polymer (SMP) porous scaffold that can be visualized via MR-imaging, as well as possible imaging via X-ray fluoroscopy for dual imaging modality procedures.…”

“…[8] The use of MR imaging as an alternative for pediatric applications provides a safer method of visualizing both the procedure and post-operative images for both the patient and the technicians. [1–4]…”

“…[1,2,9] However, there appears to be a lack of bulk materials that are visible under MR-imaging. Most articles discussing the incorporation of MR-visible moieties are on topics including microspheres, liposomal structures, and other nano- or micro-scale devices.…”

“…Devices that do incorporate MR-visibility either do so passively, such as embolic coils that will induce an artifact due to the metallic structure, or actively, and require radio-frequency modifications. [1,2,9] While passive modifications to materials are the easiest to manufacture, there is limited work for polymers on the scale necessary for tissue scaffolds and medical devices.…”

A Magnetic Resonance Imaging–Conditional External Cardiac Defibrillator for Resuscitation Within the Magnetic Resonance Imaging Scanner Bore

“…MRI-guided excision and ablation of head 12 , spine 13 , abdominal 14 and pelvic 15 tumors is performed at hundreds of sites world-wide. Intra-operative MRI guidance during cardiac electro-physiological (EP) mapping and thermal ablative procedures has been under development in animal models for the past 15 years 16–18 . These animal EP procedures have shown that MRI methods can detect the causes for arrhythmia recurrence post-procedure and can also determine the exact amount of tissue that has been ablated.…”