title: Percutaneous MR imaging-guided transvascular access of mesenteric venous system: study in swine model.
abstract: OBJECTIVE
  To determine if, with use of magnetic resonance (MR) imaging guidance alone, transcaval puncture of the superior mesenteric vein (SMV) and/or portal vein is feasible with a percutaneous femoral vein approach.
  
  
  METHODS
  The Institutional Animal Care and Use Committee approved the animal studies. Ten inferior vena cava (IVC)-SMV punctures were performed in six pigs. An active MR intravascular needle system was used for all transvascular punctures, and all procedures were performed with a 1.5-T MR unit. The needle was introduced via a 12-F femoral vein sheath and advanced into the IVC by using a real-time gradient-recalled-echo sequence (3.4/1.2 [repetition time msec/echo time msec], 45 degrees flip angle, and six to eight frames per second). Fast transverse spoiled gradient-recalled acquisition in the steady state (SPGR) (6.0/1.5, 60 degrees flip angle, one frame per second) was performed to confirm needle trajectory. The needle system was advanced under real-time MR imaging to puncture the SMV. The location of the needle tip was confirmed with a fast spin-echo sequence (1904/4.5, 36-cm field of view). A direct MR portogram was obtained after the administration of gadopentetate dimeglumine at a concentration of 25% with fast SPGR (6/1.3, 90 degrees flip angle, no section selection, three frames per second). Success was defined as entry into the mesenteric venous system without traversal of any retroperitoneal organs or adjacent vasculature.
  
  
  RESULTS
  Successful MR imaging-guided IVC-SMV punctures were performed in all 10 procedures (100%). The needle was fully visualized as it traversed the retroperitoneum and entered the SMV. MR portograms were successfully obtained following all punctures through the needle. Conventional transverse MR imaging helped confirm that the needle did not traverse any retroperitoneal organs or vessels.
  
  
  CONCLUSIONS
  With use of only MR imaging guidance and an active MR imaging intravascular needle system, the authors were able to successfully puncture the SMV from the IVC with direct visualization of the needle and all retroperitoneal structures.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutes, Blalock 545, 600 N Wolfe St, Baltimore, MD 21287, USA. aarepal@jhmi.edu
authors.forename: Aravind
authors.initials: A
authors.lastname: Arepally
authors.forename: Parag V
authors.initials: PV
authors.lastname: Karmarkar
authors.forename: Clifford
authors.initials: C
authors.lastname: Weiss
authors.forename: Ergin
authors.initials: E
authors.lastname: Atalar
mesh_terms: D000818:Animals; D008279:Magnetic Resonance Imaging; D008643:Mesentery / Q000098:blood supply*; D011677:Punctures / Q000295:instrumentation*; D013552:Swine; D014682:Vena Cava, Inferior / Q000601:surgery*