Hybrid Approach for Biliary Interventions Employing MRI-Guided Bile Duct Puncture with Near-Real-Time Imaging.
OBJECTIVE
To assess the feasibility of a hybrid approach employing MRI-guided bile duct (BD) puncture for subsequent fluoroscopy-guided biliary interventions in patients with non-dilated (≤3 mm) or dilated BD (≥3 mm) but unfavorable conditions for ultrasonography (US)-guided BD puncture.


METHODS
A total of 23 hybrid interventions were performed in 21 patients. Visualization of BD and puncture needles (PN) in the interventional MR images was rated on a 5-point Likert scale by two radiologists. Technical success, planning time, BD puncture time and positioning adjustments of the PN as well as technical success of the biliary intervention and complication rate were recorded.


RESULTS
Visualization even of third-order non-dilated BD and PN was rated excellent by both radiologists with good to excellent interrater agreement. MRI-guided BD puncture was successful in all cases. Planning and BD puncture times were 1:36 ± 2.13 (0:16-11:07) min. and 3:58 ± 2:35 (1:11-9:32) min. Positioning adjustments of the PN was necessary in two patients. Repeated capsular puncture was not necessary in any case. All biliary interventions were completed successfully without major complications.


CONCLUSIONS
A hybrid approach which employs MRI-guided BD puncture for subsequent fluoroscopy-guided biliary intervention is feasible in clinical routine and yields high technical success in patients with non-dilated BD and/or unfavorable conditions for US-guided puncture. Excellent visualization of BD and PN in near-real-time interventional MRI allows successful cannulation of the BD.
Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. Christian.Wybranski@uk-koeln.de.
Christian
http://orcid.org/0000-0003-3324-6114
C
Wybranski
Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany.
Maciej
M
Pech
Institute of Biometry and Medical Informatics, Otto-von-Guericke University Medical School, Magdeburg, Germany.
Anke
A
Lux
Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany.
Jens
J
Ricke
Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany.
Frank
F
Fischbach
Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany.
Katharina
K
Fischbach
D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000000981:diagnostic imaging*; D002404:Catheterization; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000379:methods*
Bile duct puncture; Interventional MRI; Near-real-time MRI-guidance; PTBD