MR-guided endovascular interventions: a comprehensive review on techniques and applications

Abstract

The magnetic resonance (MR) guidance of endovascular interventions is probably one of the greatest challenges of clinical MR research. MR angiography is not only an imaging tool for the vasculature but can also simultaneously depict high tissue contrast, including the differentiation of the vascular wall and perivascular tissues, as well as vascular function. Several hurdles had to be overcome to allow MR guidance for endovascular interventions. MR hardware and sequence design had to be developed to achieve acceptable patient access and to allow real-time or near real-time imaging. The development of interventional devices, both applicable and safe for MR imaging (MRI), was also mandatory. The subject of this review is to summarize the latest developments in real-time MRI hardware, MRI, visualization tools, interventional devices, endovascular tracking techniques, actual applications and safety issues.

Wireless Accelerometer for MRI-Guided Interventional Procedures

“…Localization via micro-receiver coils can also provide a wireless solution if the coils are well tuned, matched and de-coupled to one another but this can be technically challenging and very costly. Consequently, it is more common for micro-coil tracking to be used with a conductive wire which introduces safety issues such as radiofrequency heating [5]. In addition, inhomogeneities within the B 0 field can affect micro-coil localization.…”

“…In particular, MRI guidance has been adopted for minimally-invasive procedures such as biopsy and tissue ablation in breast, prostate, orthopaedic and vascular applications [1][2][3][4][5]. A number of specialist interventional MR scanners, often with open configuration, have been employed effectively for minimally-invasive procedures [6,7].…”

“…However, the presence of static and time-varying magnetic fields creates a difficult environment for device localization, in terms of both system operation and safety considerations. Various interface devices such as trackballs and joysticks as well as optical and MR-based fiducial tracking devices have been used previously but usually need complex contact with the operator or line of sight access for correct operation [5,6]. Widespread clinical adoption of MRI-guidance for clinical procedures will require more straight-forward visualization of instrument and target tissue within the field-of-view (FOV).…”

Comparative ergonomic workflow and user experience analysis of MRI versus fluoroscopy-guided vascular interventions: an iliac angioplasty exemplar case study

“…However, MRI environments present operational challenges that need to be addressed in order to make MRI-guided procedures comparable to fluoroscopy in terms of safety, efficiency and efficacy, and acceptable for clinical practice. Much of the currently published research focuses on overcoming technical limitations and safety issues [2,3]. In addition, concerns on the potential longer procedural times have been reported in previous studies [4].…”

“…The technology, devices and MRI protocols involved in this work and a detailed description of the environmental setup were first presented in Rube et al [14]. In contrast, this paper focuses in the procedural protocol evaluation, which is done from multiple viewpoints with regard to previously cited authors [2,3,8]. The framework included a time-based and cognitive task analysis via CRPA to assess clinical performance in several different scenarios using the MRI-guided protocol.…”