title: Percutaneous punctures with MR imaging guidance: comparison between MR imaging-enhanced fluoroscopic guidance and real-time MR Imaging guidance.
abstract: OBJECTIVE
  To evaluate and compare the technical accuracy and feasibility of magnetic resonance (MR) imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance for percutaneous puncture procedures in phantoms and animals.
  
  
  METHODS
  The experimental protocol was approved by the institutional animal care and use committee. Punctures were performed in phantoms, aiming for markers (20 each for MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance), and pigs, aiming for anatomic landmarks (10 for MR imaging-enhanced fluoroscopic guidance and five for MR imaging guidance). To guide the punctures, T1-weighted three-dimensional (3D) MR images of the phantom or pig were acquired. Additional axial and coronal T2-weighted images were used to visualize the anatomy in the animals. For MR imaging-enhanced fluoroscopic guidance, phantoms and pigs were transferred to the fluoroscopic system after initial MR imaging and C-arm computed tomography (CT) was performed. C-arm CT and MR imaging data sets were coregistered. Prototype navigation software was used to plan a puncture path with use of MR images and to superimpose it on fluoroscopic images. For real-time MR imaging, an interventional MR imaging prototype for interactive real-time section position navigation was used. Punctures were performed within the magnet bore. After completion, 3D MR imaging was performed to evaluate the accuracy of insertions. Puncture durations were compared by using the log-rank test. The Mann-Whitney U test was applied to compare the spatial errors.
  
  
  RESULTS
  In phantoms, the mean total error was 8.6 mm ± 2.8 with MR imaging-enhanced fluoroscopic guidance and 4.0 mm ± 1.2 with real-time MR imaging guidance (P < .001). The mean puncture time was 2 minutes 10 seconds ± 44 seconds with MR imaging-enhanced fluoroscopic guidance and 37 seconds ± 14 with real-time MR imaging guidance (P < .001). In the animal study, a tolerable distance (<1 cm) between target and needle tip was observed for both MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance. The mean total error was 7.7 mm ± 2.4 with MR imaging-enhanced fluoroscopic guidance and 7.9 mm ± 4.9 with real-time MR imaging guidance (P = .77). The mean puncture time was 5 minutes 43 seconds ± 2 minutes 7 seconds with MR imaging-enhanced fluoroscopic guidance and 5 minutes 14 seconds ± 2 minutes 25 seconds with real-time MR imaging guidance (P = .68).
  
  
  CONCLUSIONS
  Both MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance demonstrated reasonable and similar accuracy in guiding needle placement to selected targets in phantoms and animals.
authors.affiliation: Department of Radiology, Hannover Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany. meyer.bernhard@mh-hannover.de
authors.forename: Bernhard Christian
authors.initials: BC
authors.lastname: Meyer
authors.forename: Alexander
authors.initials: A
authors.lastname: Brost
authors.forename: Dara L
authors.initials: DL
authors.lastname: Kraitchman
authors.forename: Wesley D
authors.initials: WD
authors.lastname: Gilson
authors.forename: Norbert
authors.initials: N
authors.lastname: Strobel
authors.forename: Joachim
authors.initials: J
authors.lastname: Hornegger
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Lewin
authors.forename: Frank K
authors.initials: FK
authors.lastname: Wacker
mesh_terms: D000818:Animals; D001707:Biopsy, Needle / Q000379:methods*; D003199:Computer Systems; D005240:Feasibility Studies; D005471:Fluoroscopy / Q000379:methods*; D061705:Image-Guided Biopsy / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D019047:Phantoms, Imaging; D011677:Punctures / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013552:Swine