title: Fusion guidance in endovascular peripheral artery interventions: a feasibility study.
abstract: OBJECTIVE
  This study was designed to evaluate the feasibility of endovascular guidance by means of live fluoroscopy fusion with magnetic resonance angiography (MRA) and computed tomography angiography (CTA).
  
  
  METHODS
  Fusion guidance was evaluated in 20 endovascular peripheral artery interventions in 17 patients. Fifteen patients had received preinterventional diagnostic MRA and two patients had undergone CTA. Time for fluoroscopy with MRA/CTA coregistration was recorded. Feasibility of fusion guidance was evaluated according to the following criteria: for every procedure the executing interventional radiologists recorded whether 3D road-mapping provided added value (yes vs. no) and whether PTA and/or stenting could be performed relying on the fusion road-map without need for diagnostic contrast-enhanced angiogram series (CEAS) (yes vs. no). Precision of the fusion road-map was evaluated by recording maximum differences between the position of the vasculature on the virtual CTA/MRA images and conventional angiography.
  
  
  RESULTS
  Average time needed for image coregistration was 5 ± 2 min. Three-dimensional road-map added value was experienced in 15 procedures in 12 patients. In half of the patients (8/17), intervention was performed relying on the fusion road-map only, without diagnostic CEAS. In two patients, MRA roadmap showed a false-positive lesion. Excluding three patients with inordinate movements, mean difference in position of vasculature on angiography and MRA/CTA road-map was 1.86 ± 0.95 mm, implying that approximately 95 % of differences were between 0 and 3.72 mm (2 ± 1.96 standard deviation).
  
  
  CONCLUSIONS
  Fluoroscopy with MRA/CTA fusion guidance for peripheral artery interventions is feasible. By reducing the number of CEAS, this technology may contribute to enhance procedural safety.
authors: Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands, anni.sailer@mumc.nl.
authors: Anna M
authors: AM
authors: Sailer
authors: Michiel W
authors: MW
authors: de Haan
authors: Rick
authors: R
authors: de Graaf
authors: Willem H
authors: WH
authors: van Zwam
authors: Geert Willem H
authors: GW
authors: Schurink
authors: Patricia J
authors: PJ
authors: Nelemans
authors: Joachim E
authors: JE
authors: Wildberger
authors: Marco
authors: M
authors: Das
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D005471:Fluoroscopy; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D007089:Image Enhancement; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009942:Organometallic Compounds; D058729:Peripheral Arterial Disease / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000473:pathology; D015642:Radiology, Interventional / Q000379:methods*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol