Interventional cardiovascular procedures guided by real-time MR imaging: an interactive interface using multiple slices, adaptive projection modes and live 3D renderings

Michael A Guttman, Cenghizhan Ozturk, Amish N Raval, Venkatesh K Raman, Alexander J Dick, Ranil DeSilva, Parag Karmarkar, Robert J Lederman, Elliot R McVeigh, Michael A Guttman, Cenghizhan Ozturk, Amish N Raval, Venkatesh K Raman, Alexander J Dick, Ranil DeSilva, Parag Karmarkar, Robert J Lederman, Elliot R McVeigh

Abstract

Purpose: To develop and test a novel interactive real-time MRI environment that facilitates image-guided cardiovascular interventions.

Materials and methods: Color highlighting of device-mounted receiver coils, accelerated imaging of multiple slices, adaptive projection modes, live three-dimensional (3D) renderings and other interactive features were utilized to enhance navigation of devices and targeting of tissue.

Results: Images are shown from several catheter-based interventional procedures performed in swine that benefit from this custom interventional MRI interface. These include endograft repair of aortic aneurysm, balloon septostomy of the cardiac interatrial septum, angioplasty and stenting, and endomyocardial cell injection, all using active catheters containing MRI receiver coils.

Conclusion: Interactive features not available on standard clinical scanners enhance real-time MRI for guiding cardiovascular interventional procedures.

(c) 2007 Wiley-Liss, Inc.

Figures

Figure 1
Figure 1
This is a multi-slice real-time scan of a balloon inflation within a swine abdominal aorta. Two long axis views and one short axis view intersect the vessel. The arrows point to two dots in the 3D rendering which mark the ends of the balloon. The green color is from signal obtained from an active guide wire placed within the balloon catheter.
Figure 2
Figure 2
The use of interactive non-selective saturation is shown during an atrial-septal puncture and septostomy experiment. The active guide-wire is color-highlighted in green and blended with background long-axis (A) and short-axis (B) views. The first column shows the device across the septum and coiled in the left atrium. Saturation is enabled in the second and third columns, with the Gd-filled balloon clearly visible in the third column.
Figure 3
Figure 3
Radial correction (flattening) of the axial device profile is performed in real-time to enhance device image interpretation. The close-ups of slice 3 in (A) and (B) compare reconstruction with and without radial correction, respectively. This corrected image is shown in a 2D window as well as the 3D rendering (B).
Figure 4
Figure 4
This figure shows the effect of intensity compression using a square-root operator on a non-axial view of the active device. An active guide wire is shown in the descending aorta, entering a carotid artery. The intensity compression produces an effect that is qualitatively similar to radial correction in an axial view. The surrounding tissue further from the device becomes more visible.
Figure 5
Figure 5
To sharpen the device profile, we perform the opposite of compression using a square operator on the device image intensity. This sharpening allows more precise visualization of the device location. The active guide wire is highlighted in green, and small coils on a guiding catheter are highlighted in red. The active devices are seen in the descending aorta, entering a carotid artery.
Figure 6
Figure 6
Adaptive projection navigation (PRONAV) is illustrated for real-time 3D visualization of an active catheter and navigation towards infarct border tissue in a 2D image plane. This is an injection catheter containing two receivers: a small coil at the tip (red) and a loopless antenna along the shaft (green). A yellow dot marks the target tissue. The rendering is manually rotated during the scan to see the device trajectory from different angles, giving a 3D effect.

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