Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10/Room 2C713, 9000 Rockville Pike, Bethesda, MD, 20892-1538, USA.
Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St NW, Suite 4B01, Washington, DC, 20011, USA.
J Cardiovasc Magn Reson. 2023 Aug 14;25(1):48. doi: 10.1186/s12968-023-00956-7.
Transcatheter cardiovascular interventions increasingly rely on advanced imaging. X-ray fluoroscopy provides excellent visualization of catheters and devices, but poor visualization of anatomy. In contrast, magnetic resonance imaging (MRI) provides excellent visualization of anatomy and can generate real-time imaging with frame rates similar to X-ray fluoroscopy. Realization of MRI as a primary imaging modality for cardiovascular interventions has been slow, largely because existing guidewires, catheters and other devices create imaging artifacts and can heat dangerously. Nonetheless, numerous clinical centers have started interventional cardiovascular magnetic resonance (iCMR) programs for invasive hemodynamic studies or electrophysiology procedures to leverage the clear advantages of MRI tissue characterization, to quantify cardiac chamber function and flow, and to avoid ionizing radiation exposure. Clinical implementation of more complex cardiovascular interventions has been challenging because catheters and other tools require re-engineering for safety and conspicuity in the iCMR environment. However, recent innovations in scanner and interventional device technology, in particular availability of high performance low-field MRI scanners could be the inflection point, enabling a new generation of iCMR procedures. In this review we review these technical considerations, summarize contemporary clinical iCMR experience, and consider potential future applications.
经导管心血管介入越来越依赖于先进的成像技术。X 射线透视提供了出色的导管和器械可视化效果，但对解剖结构的可视化效果较差。相比之下，磁共振成像（MRI）提供了出色的解剖结构可视化效果，并可以生成与 X 射线透视相似的实时成像帧率。尽管 MRI 作为心血管介入的主要成像方式的实现进展缓慢，但主要是因为现有的导丝、导管和其他设备会产生成像伪影，并可能产生危险的过热。尽管如此，许多临床中心已经开始介入心血管磁共振（iCMR）计划，用于侵入性血液动力学研究或电生理程序，以利用 MRI 组织特征的明显优势，量化心脏腔室功能和流量，并避免电离辐射暴露。更复杂的心血管介入的临床实施具有挑战性，因为导管和其他工具需要进行重新设计，以确保在 iCMR 环境中的安全性和可视性。然而，最近的扫描和介入设备技术创新，特别是高性能低场 MRI 扫描仪的可用性，可能是一个转折点，使新一代 iCMR 程序成为可能。在这篇综述中，我们回顾了这些技术考虑因素，总结了当代临床 iCMR 经验，并考虑了潜在的未来应用。
