High resolution intravascular MRI and MRS by using a catheter receiver coil

Pulse sequences for interventional magnetic resonance imaging

Interventional magnetic resonance imaging (iMRI) is different from diagnostic magnetic resonance imaging (MRI) in its spatial, temporal, and contrast resolution requirements due to its specific clinical applications. As a result, the pulse sequences used in iMRI often are significantly different than those used in the more conventional diagnostic arena. The focus of this article is to summarize how iMRI is different from diagnostic MRI, to describe a variety of MRI pulse sequences and sequence strategies that have evolved because of these differences, and to describe some MRI sequence strategies that are in development and may be seen in future iMRI applications.

Reduction of resonant RF heating in intravascular catheters using coaxial chokes

The incorporation of RF coils into the tips of intravascular devices has been shown to enable the localization of catheters and guidewires under MR guidance. Furthermore, such coils can be used for endoluminal imaging. The long cable required to connect the coil with the scanner input inadvertently acts as a dipole antenna which picks up RF energy from the body coil during transmit. Currents are induced on the cable which can lead to localized heating of surrounding tissue. Cables of various lengths were measured to determine if a resonance in the heating as a function of cable length could be found. Coaxial chokes with a length of lambda/4 were added to coaxial cables to reduce the amplitude of the currents induced on the cable shield. A 0.7-mm diameter triaxial cable, small enough to fit into a standard intravascular device, was developed and measured both with and without a coaxial choke. It is demonstrated that resonant heating does occur and that it can be significantly reduced by avoiding a resonant length of cable and by including coaxial chokes on the cable.

Effects of temperature and histopathologic preparation on the size and morphology of atherosclerotic carotid arteries as imaged by MRI

Using magnetic resonance imaging the effects of temperature, formalin fixation, and decalcification on the size and morphology of atherosclerotic arteries were evaluated. Ten ex vivo carotid arteries were scanned fresh at body and room temperature and formalin-fixed and decalcified at room temperature. Different spin-echo pulse sequences were used and absolute T2 values calculated. During processing for histopathology, the contrast between the arterial layers increased. From body to room temperature there were significant increases in size (4%-7%), T2 of media (60--> 68 msec), and fibrous plaque component (95--> 110 msec). Formalin fixation caused significant increases in size (2%-3%) and media T2 (68--> 74 msec). Decalcification caused significant shrinkage (2%-5%) and decrease in T2 of media (74--> 53 msec) and fibrous plaque component (118--> 76 msec). Thus temperature and preparation have profound effects on contrast, size, and T2 of atherosclerotic arteries. Ex vivo experiments should be performed on fresh specimens at body temperature. J. Magn. Reson. Imaging 1999;10:876-885.

Vascular stents as RF antennas for intravascular MR guidance and imaging

Stent deployment is used to improve the immediate and long-term results of vascular interventions in various vascular sites. X-ray angiography as an imaging modality is often limited in providing an accurate assessment with regard to vessel size, plaque calcification, or stent deployment. In this study, the potential of using the stent endoprothesis as a radiofrequency (RF) receive-only probe for MR guidance and lesion imaging was investigated. Three different principles were developed to visualize stents actively, the first employing the stent as a loop antenna, the second employing the stent in an electrical dipole configuration, and the third employing the stent in a hybrid configuration as a coaxial line antenna. The three configurations resulted in different signal characteristics. Based on two of these antenna configurations, stent deployment devices were built and evaluated in in vitro as well as in vivo sheep experiments. Active stent visualization allows real-time MR guidance through the vessel tree and monitoring of stent deployment. In addition, the stent antenna may become useful for high resolution imaging of the vessel wall. Magn Reson Med 42:738-745, 1999.

Single-loop coil concepts for intravascular magnetic resonance imaging

Compared with other coil designs that have been investigated for intravascular use, the single-loop coil can be designed with a very small diameter for insertion into small vessels and with a longitudinal extent over several centimeters for multislice imaging. If it designed to be expandable inside the target vessel, then it combines these features with increased signal-to-noise ratio (SNR) and penetration depth. Expandable single-loop coils that are capable of meeting these requirements were developed and integrated into two different commercial catheter-based delivery systems: a self-expandable, single-loop made from NiTinol and a single-loop coil mounted on an inflatable balloon. The influence of a small-diameter coaxial cable for remote tuning and matching on the coil performance was investigated. Calculations showed the dependence of the signal on the separation between the conductors. The comparison of both catheter approaches in in vitro flow experiments and in an in vivo pig experiment revealed the influence of pulsatile flow on image quality during intravascular imaging with these designs.

Transesophageal magnetic resonance imaging

The purpose of this study was to develop a non-invasive method of imaging the thoracic aorta that would provide both morphological detail within the aortic wall and information about regional aortic wall motion. An esophageal probe is described that allows transesophageal MR imaging (TEMRI) of the thoracic aorta and has several potential advantages over the competing non-vasculoinvasive techniques of transesophageal echocardiography (TEE) or standard MRI. The probe consists of a loopless antenna housed inside a modified Levin gastric tube, with external matching and tuning circuitry. Using this probe, the thoracic aorta has been imaged in longitudinal and cross-sectional views. Details of the aortic wall were readily seen. Tissue tagging for measurement of focal stress/strain relationships was demonstrated to be feasible. TEMRI avoids the risks inherent in intravascular MRI yet provides comparable image quality. Potential applications of the device are discussed.

High-resolution intravascular magnetic resonance imaging: monitoring of plaque formation in heritable hyperlipidemic rabbits

BACKGROUND

The individual makeup of atherosclerotic plaque has been identified as a dominant prognostic factor. With the use of an intravascular magnetic resonance (MR) catheter coil, we evaluated the effectiveness of high-resolution MR in the study of the development of atherosclerotic lesions in heritable hyperlipidemic rabbits.

METHODS AND RESULTS

Sixteen hyperlipidemic rabbits were investigated at the ages of 6, 12, 24, and 36 months. The aorta was studied with digital subtraction angiography and high-resolution MR with the use of a surface coil and an intravascular coil that consisted of a single-loop copper wire integrated in a 5F balloon catheter. Images were correlated with histological sections regarding wall thickness, plaque area, and plaque components. Digital subtraction angiography revealed no abnormalities in the 6- and 12-month-old rabbits and only mild stenoses in the 24- and 36-month-old rabbits. High-resolution imaging with surface coils resulted in an in-plane resolution of 234x468 microm. Delineation of the vessel wall was not possible in younger rabbits and correlated only poorly with microscopic measurements in the 36-month-old rabbits. Intravascular images achieved an in-plane resolution of 117x156 microm. Increasing thickness of the aortic wall and plaque area was observed with increasing age. In the 24- and 36-month-old animals, calcification could be differentiated from fibrous and fatty tissue on the basis of the T2-fast spin echo images, as confirmed by histological correlation.

CONCLUSIONS

Atherosclerotic evolution of hyperlipidemic rabbits can be monitored with high-resolution intravascular MR imaging. Image quality is sufficient to determine wall thickness and plaque area and to differentiate plaque components.

Autoperfused balloon catheter for intravascular MR imaging

An intravascular magnetic resonance (MR) imaging catheter for high-resolution imaging of vessel walls was developed. The catheter design is based on an autoperfusion balloon catheter that allows passive perfusion of blood during balloon inflation. The blood enters a central lumen through multiple sideholes of the catheter shaft proximal to the balloon. A remotely tuned, matched, and actively decoupled, expandable single-loop radiofrequency coil was mounted onto the balloon to receive intravascular MR signals. The autoperfusion rate through the catheter was determined experimentally relative to perfusion pressure. The catheter concept was evaluated in vitro on human femoral artery specimens and in vivo in the internal carotid artery of two pigs. The proposed catheter design allowed for maintained blood perfusion during the acquisition of high-resolution intravascular images. During perfusion, image quality remained unaffected by flow, motion, and pulsatility artifacts. The availability of an autoperfused intravascular catheter design can be considered an important step toward high-resolution atherosclerotic plaque imaging in critical vessels such as the carotid and coronary arteries.

Fast magnetic resonance imaging techniques

This article reviews fast magnetic resonance (MR) techniques currently used for body imaging. Improvements in gradient performance have made very short repetition and echo times on clinical scanners feasible, thus enabling subsecond image acquisition. The article provides a fundamental overview of the technical aspects from the concept of k-space and k-space segmentation technique, fast MR imaging techniques including fast spin echo, fast gradient echo with or without magnetization preparation to echo planar and hybrid techniques. The article also addresses the use of different fat suppression techniques in MR imaging of the body and improvements in coil technology to obtain faster images and higher signal-to-noise.

Catheter-tracking FOV MR fluoroscopy

Recent improvements in intravascular magnetic resonance imaging techniques mandate an accurate method of monitoring the introduction of MR catheter probes into the vessel of interest. For this purpose, a novel imaging protocol and a display method have been designed. First, a roadmap 3D image data set with standard pulse sequences is obtained using an external imaging coil. Subsequently, using very narrow rectangular-FOV fast-spoiled gradient recalled (SPGR), a movie of the percutaneous placement procedure of an MR catheter probe is acquired at a rate of 7.3 frames/second. In this protocol, the probe is used to transmit RF pulses and receive MR signal. A computer program was written for image unwrapping and for displaying the unwrapped movie frames on the roadmap image. In an alternative protocol, the movie frames in two projection angles were acquired in an interleaved fashion. Frames were unwrapped and combined with a 3D roadmap and displayed on a Silicon Graphics workstation equipped with stereovision goggles. Using these methods, percutaneous catheter placement in a phantom and a dog was examined. In conclusion, a new visualization technique for MR catheter placement is proposed. Combining this technique with high resolution intravascular MRI techniques may result in a very useful diagnostic tool for the evaluation of atherosclerosis and other vessel diseases.

Intravascular MR-monitored balloon angioplasty: an in vivo feasibility study

PURPOSE

To develop a new method for monitoring balloon angioplasty by using an intravascular magnetic resonance (MR) imaging technique.

MATERIALS AND METHODS

Nine New Zealand White rabbits were used: seven for technique refinement, including surgery, device insertion, stenosis creation, and MR protocol development; and two for the final MR imaging of the balloon angioplasty. The in vivo experimental method involved insertion of a catheter antenna and a balloon catheter, via femoral arteriotomies bilaterally, into the target site of the upper abdominal aorta, where a stenosis was artificially created by binding a plastic cable tie. Then, the entire process of the dilation of the stenosis with balloon inflation was monitored under MR fluoroscopy.

RESULTS

Catheter insertions were successful, and a 5-mm-long stenosis of the aorta was produced in all nine rabbits. Eight complete balloon angioplasty procedures were satisfactorily monitored and recorded, showing clearly the stenosis of the aorta at the beginning of the procedure, the dilation of the stenosis during the balloon inflation, and the complete opening of the stenosis after balloon dilation.

CONCLUSION

Preliminary results of in vivo balloon angioplasty monitored with intravascular MR imaging are presented. MR fluoroscopy, based on the intravascular MR imaging technique, may represent a potential alternative to x-ray fluoroscopy for guiding interventional treatment of cardiovascular diseases.

Intravascular magnetic resonance imaging of aortic atherosclerotic plaque composition

Magnetic resonance imaging (MRI) may be an excellent tool to define atherosclerotic plaque composition, but surface MRI (SMRI) suffers from a low signal-to-noise ratio and low resolution of arterial images. Intravascular MRI (IVMRI) represents a potential solution for acquiring high-quality in vivo images of atherosclerotic plaques. Isolated segments of 11 thoracic human aortas obtained at autopsy were imaged by IVMRI using an intravascular receiver catheter coil designed and built at our institution. Images obtained by IVMRI were compared with corresponding images obtained by SMRI and with histopathological aortic cross sections. The intensity of intimal thickness and plaque components was graded by IVMRI and histopathology using a score of 1 for mild, 2 for moderate, and 3 for severe intensity. IVMRI had an agreement of 75% with histopathology in fibrous cap grading (37.5% expected, kappa = 0.60, P < 0.001) and of 74% in necrotic core grading (39% expected, kappa = 0.57, P < 0.001). Intraplaque calcification was correctly graded by IVMRI in six of the eight plaques in which histopathology recognized calcium. The analysis of intimal thickness showed 80% agreement between IVMRI and histopathology (52% expected, kappa = 0.59, P < 0.001). IVMRI image features were similar to those of SMRI. In addition, IVMRI accurately determined atherosclerotic plaque size in comparison with histopathology and SMRI (slope = 1.25 cm2, r = 0.99, P < 0.001 for luminal area by IVMRI vs histopathology; slope = 0.97 cm2, r = 0.996, P < 0.001 for luminal area by IVMRI vs SMRI). IVMRI has the potential to provide important prognostic information in patients with atherosclerosis because of its ability to accurately assess both plaque composition and size.