MRI-guided percutaneous transhepatic cholangiodrainage: feasibility study in a porcine model.
OBJECTIVE
MRI-guided procedures combine high-quality imaging with lack of radiation. Percutaneous transhepatic cholangiodrainage under real-time MRI guidance (MRI-PTCD) seems promising, allowing targeted puncture and avoiding multiple blind passes and use of contrast, which are associated with standard PTCD's heaviest complications.


METHODS
Aim of this study was to investigate the feasibility of MRI-PTCD in three outbred piglets. Obstructive cholestasis was induced by common bile duct ligation. Two days later, MRI-PTCD was performed (open MRI, 1.0 Tesla) with prototype MRI-compatible accessories. Visualization was achieved with a balanced steady-state free precession real-time sequence (bSSFP: 0.75 frames/s, TR/TE [ms]: 7.2/3.6; flip angle: 45°; 200 × 200 matrix size; resolution: 1.3 × 1.3 mm(2), slice thickness: 7 mm). Cannulation of the bile ducts was followed by placement of Yamakawa drainages.


RESULTS
Twelve punctures were performed (four per animal, 10/12 successful); in 2/10 the bile ducts could not be cannulated. Animal survival was 100% and no significant complications occurred.


CONCLUSIONS
Initial data show that MRI-PTCD can be successfully performed. This may lead to establishment of a new optimized PTCD technique compared to the standard approach under fluoroscopy.
Department of Internal Medicine, Division of Hepatology & Gastroenterology, Charité Campus Virchow Clinic , Augustenburger Platz 1, D-13353, Berlin , Germany.
Ioannis S
IS
Papanikolaou
Ivo R
IR
van der Voort
Sascha S
SS
Chopra
Christian J
CJ
Seebauer
Jens
J
Rump
Maria G
MG
Papas
Konstantinos
K
Triantafyllou
Daniel C
DC
Baumgart
Ulf K
UK
Teichgräber
Bertram
B
Wiedenmann
Thomas
T
Rösch
D000818:Animals; D001652:Bile Ducts / Q000601:surgery*; D002404:Catheterization / Q000379:methods; D002779:Cholestasis / Q000601:surgery*; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D053783:Magnetic Resonance Imaging, Interventional; D025321:Surgery, Computer-Assisted; D013552:Swine
MRI guidance; MRI-PTCD; PTCD; real-time open MRI