Dick Alexander J, Raman Venkatesh K, Raval Amish N, Guttman Michael A, Thompson Richard B, Ozturk Cengizhan, Peters Dana C, Stine Annette M, Wright Victor J, Schenke William H, Lederman Robert J
Cardiovascular Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
Catheter Cardiovasc Interv. 2005 Mar;64(3):265-74. doi: 10.1002/ccd.20302.
We tested the feasibility and safety of invasive magnetic resonance imaging (MRI) during peripheral angioplasty. Real-time MRI can image soft tissue and may potentially guide therapeutic procedures without ionizing radiation or nephrotoxic contrast. MRI-guided diagnostic catheterization has been described recently, but safe and conspicuous catheter devices are not widely available. An active guidewire, which serves as an MRI receiver antenna, might be useful to guide catheterization or even to image atheroma. We describe a combined interventional suite offering both X-ray fluoroscopy and real-time MRI. We used a 0.030'' active guidewire receiver coil for invasive MRI after X-ray lesion traversal in patients undergoing percutaneous iliofemoral artery revascularization. Intravascular MRI was compared with noninvasive MRI, X-ray angiography, and intravascular ultrasound (IVUS). Seven eligible patients consented to participate, but three were excluded because of lengthy revascularization procedures. Four remaining patients safely underwent combined X-ray fluoroscopy and real-time magnetic resonance imaging (XMR) transport, continuous monitoring, and all imaging modalities. There was no device dislodgment, contamination or evidence of heating. The intravascular MRI coil was well visualized except at the tip, but did not provide superior mural imaging compared with IVUS. Therefore, because an adequate safety and workflow experience was obtained, enrollment was terminated after only four subjects. Invasive MRI is feasible and apparently safe during peripheral angioplasty. Patients can safely be transported and monitored in an XMR interventional suite. An active quarter-wavelength guidewire coil does not provide superior imaging compared with IVUS, but provides satisfactory guidewire visualization. These tools may prove useful for advanced therapeutic procedures in the future.
我们测试了外周血管成形术期间进行有创磁共振成像（MRI）的可行性和安全性。实时MRI能够对软组织成像，并且有可能在不使用电离辐射或肾毒性造影剂的情况下指导治疗操作。近期已有关于MRI引导下诊断性导管插入术的报道，但安全且显眼的导管设备尚未广泛可得。一种作为MRI接收天线的有源导丝可能有助于引导导管插入术，甚至对动脉粥样硬化进行成像。我们描述了一种同时具备X线透视和实时MRI功能的联合介入设备。在接受经皮髂股动脉血运重建术的患者中，在X线引导下穿过病变部位后，我们使用了一根0.030英寸的有源导丝接收线圈进行有创MRI检查。将血管内MRI与无创MRI、X线血管造影和血管内超声（IVUS）进行了比较。七名符合条件的患者同意参与研究，但三名患者因血运重建过程冗长而被排除。其余四名患者安全地接受了X线透视和实时磁共振成像（XMR）联合转运、连续监测以及所有成像方式。未出现设备移位、污染或发热迹象。血管内MRI线圈除尖端外均清晰可见，但与IVUS相比，其对血管壁成像并无优势。因此，由于已获得足够的安全性和操作流程经验，仅纳入四名受试者后即终止入组。在外周血管成形术期间，有创MRI是可行的且显然是安全的。患者能够在XMR介入设备中安全地进行转运和监测。与IVUS相比，有源四分之一波长导丝线圈并未提供更优的成像效果，但能实现令人满意的导丝可视化。这些工具未来可能会被证明对高级治疗操作有用。
