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

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 1.5T 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.

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

“…During patient preparation, the equipment available and personnel training are some of the main factors to analyse. In these experiments, we used a dedicated interventional coil prototype "DuoFlex Coil Suite" (GE Healthcare, Waukesha, WI, USA) [14]. Other approaches, such as the use of integrated surface coils for MRI tables should be investigated.…”

“…Rube et al [14] describes in more detail the experimental set-up, also included in the "Appendix." Methodology Two clinicians with different expertise level carried out the experiments: a senior interventional radiologist (consultant) with more than 20 years of experience in vascular procedures and MRI diagnostic (A) and a trainee physician with no experience in clinical interventional radiology (B).…”

“…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].…”

X-ray to MR: the progress of flexible instruments for endovascular navigation

“…Their investigation showed insignificant temperature elevation during near-real-time MR sequences. A preclinical in-vitro (phantom) study was performed using the same guidewires to test the feasibility of a developed framework for guiding endovascular interventions in MR environments [132]. Further, a recent iteration of the EPflex MRLine guidewire was employed in the evaluation of an MR conditional cardiac phantom [133].…”

Real-time CMR guidance for intracardiac and great vessel pressure mapping in patients with congenital heart disease using an MR conditional guidewire—results of 25 patients

“…Earlier versions of the guidewire and its markers used in this trial were evaluated in experimental animal studies and phantoms for vena cava filter positioning in the inferior vena cava and stenting in regions such as the renal arteries by magnetic resonance (13,14). Lately, in studies with phantoms, similar guide wires equipped with discrete markers have been used to show that percutaneous angioplasty can also be performed under MR guidance (15). We present the following article in accordance with the MDAR reporting checklist (available at http://dx.doi.…”