title: Invasive human magnetic resonance imaging: feasibility during revascularization in a combined XMR suite.
abstract: We tested the feasibility and safety of invasive magnetic resonance imaging (MRI) during peripheral angioplasty. Real-time MRI can image soft tissue and may potentially guide therapeutic procedures without ionizing radiation or nephrotoxic contrast. MRI-guided diagnostic catheterization has been described recently, but safe and conspicuous catheter devices are not widely available. An active guidewire, which serves as an MRI receiver antenna, might be useful to guide catheterization or even to image atheroma. We describe a combined interventional suite offering both X-ray fluoroscopy and real-time MRI. We used a 0.030'' active guidewire receiver coil for invasive MRI after X-ray lesion traversal in patients undergoing percutaneous iliofemoral artery revascularization. Intravascular MRI was compared with noninvasive MRI, X-ray angiography, and intravascular ultrasound (IVUS). Seven eligible patients consented to participate, but three were excluded because of lengthy revascularization procedures. Four remaining patients safely underwent combined X-ray fluoroscopy and real-time magnetic resonance imaging (XMR) transport, continuous monitoring, and all imaging modalities. There was no device dislodgment, contamination or evidence of heating. The intravascular MRI coil was well visualized except at the tip, but did not provide superior mural imaging compared with IVUS. Therefore, because an adequate safety and workflow experience was obtained, enrollment was terminated after only four subjects. Invasive MRI is feasible and apparently safe during peripheral angioplasty. Patients can safely be transported and monitored in an XMR interventional suite. An active quarter-wavelength guidewire coil does not provide superior imaging compared with IVUS, but provides satisfactory guidewire visualization. These tools may prove useful for advanced therapeutic procedures in the future.
authors.affiliation: Cardiovascular Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Dick
authors.forename: Venkatesh K
authors.initials: VK
authors.lastname: Raman
authors.forename: Amish N
authors.initials: AN
authors.lastname: Raval
authors.forename: Michael A
authors.initials: MA
authors.lastname: Guttman
authors.forename: Richard B
authors.initials: RB
authors.lastname: Thompson
authors.forename: Cengizhan
authors.initials: C
authors.lastname: Ozturk
authors.forename: Dana C
authors.initials: DC
authors.lastname: Peters
authors.forename: Annette M
authors.initials: AM
authors.lastname: Stine
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Wright
authors.forename: William H
authors.initials: WH
authors.lastname: Schenke
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lederman
mesh_terms: D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon; D004869:Equipment Safety; D005240:Feasibility Studies; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D007383:Intermittent Claudication / Q000175:diagnosis* / Q000628:therapy; D007432:Intraoperative Period; D018810:Magnetic Resonance Angiography / Q000295:instrumentation / Q000592:standards; D009873:Operating Rooms; D011872:Radiology Department, Hospital; D018084:Ultrasonography, Interventional
references.citation: J Cardiovasc Magn Reson. 2002;4(4):431-42
references.pmid: 12549231
references.citation: Phys Med Biol. 2003 Jul 21;48(14):R37-64
references.pmid: 12894968
references.citation: J Vasc Interv Radiol. 2003 Oct;14(10):1317-27
references.pmid: 14551280
references.citation: Circulation. 2003 Dec 9;108(23):2899-904
references.pmid: 14656911
references.citation: Lancet. 2003 Dec 6;362(9399):1877-82
references.pmid: 14667742
references.citation: Magn Reson Med. 2004 Apr;51(4):668-75
references.pmid: 15065238
references.citation: J Magn Reson Imaging. 1998 Jan-Feb;8(1):220-5
references.pmid: 9500284
references.citation: J Magn Reson Imaging. 1998 Jan-Feb;8(1):226-34
references.pmid: 9500285
references.citation: J Magn Reson Imaging. 1998 Nov-Dec;8(6):1338-42
references.pmid: 9848749
references.citation: Radiology. 1999 Sep;212(3):876-84
references.pmid: 10478260
references.citation: J Am Coll Cardiol. 2005 Jun 21;45(12):2069-77
references.pmid: 15963411
references.citation: Magn Reson Med. 2003 Feb;49(2):216-22
references.pmid: 12541240
references.citation: Circulation. 2003 Jan 7;107(1):132-8
references.pmid: 12515755
references.citation: Circulation. 2002 Jul 23;106(4):511-5
references.pmid: 12135954
references.citation: Med Sci Monit. 2002 Jul;8(7):MT113-7
references.pmid: 12118208
references.citation: Circulation. 2002 Mar 19;105(11):1282-4
references.pmid: 11901036
references.citation: Circulation. 2002 Feb 19;105(7):874-9
references.pmid: 11854130
references.citation: Magn Reson Med. 2002 Jan;47(1):187-93
references.pmid: 11754458
references.citation: J Magn Reson Imaging. 2001 Jul;14(1):56-62
references.pmid: 11436215
references.citation: J Magn Reson Imaging. 2001 Jan;13(1):105-14
references.pmid: 11169811
references.citation: Int J Epidemiol. 2000 Jun;29(3):424-8
references.pmid: 10869313
references.citation: J Magn Reson Imaging. 2003 May;17(5):615-9
references.pmid: 12720273
references.citation: Magn Reson Med. 2003 Aug;50(2):383-90
references.pmid: 12876715