Simultaneous T2 -weighted real-time MRI of two orthogonal slices.

PURPOSE: MR guidance is used during therapy to detect and compensate for lesion motion. T2 -weighted MRI often has a superior lesion contrast in comparison to T1 -weighted real-time imaging. The purpose of this work was to design a fast T2 -weighted sequence capable of simultaneously acquiring two orthogonal slices, enabling real-time tracking of lesions. METHODS: To generate a T2 contrast in two orthogonal slices simultaneously, a sequence (Ortho-SFFP-Echo) was designed that samples the T2 -weighted spin echo (S- ) signal in a TR-interleaved acquisition of two slices. Slice selection and phase-encoding directions are swapped between the slices, leading to a unique set of spin-echo signal conditions. To minimize motion-related signal dephasing, additional flow-compensation strategies are implemented. In both the abdominal breathing phantom and in vivo experiments, a time series was acquired using Ortho-SSFP-Echo. The centroid of the target was tracked in postprocessing steps. RESULTS: In the phantom, the lesion could be identified and delineated in the dynamic images. In the volunteer experiments, the kidney was visualized with a T2 contrast at a temporal resolution of 0.45 s under free-breathing conditions. A respiratory belt demonstrated a strong correlation with the time course of the kidney centroid in the head-foot direction. A hypointense saturation band at the slice overlap did not inhibit lesion tracking in the semi-automatic postprocessing steps. CONCLUSION: The Ortho-SFFP-Echo sequence delivers real-time images with a T2 -weighted contrast in two orthogonal slices. The sequence allows for simultaneous acquisition, which could be beneficial for real-time motion tracking in radiotherapy or interventional MRI.

Scalable and modular 8-channel transmit and 8-channel flexible receive coil array for 19 F MRI of large animals.

PURPOSE: To introduce an RF coil system consisting of an 8-channel transmit (Tx) and 8-channel receive (Rx) coil arrays for 19 F MRI of large animals. METHODS: The Tx efficiency and homogeneity of the 8-element loop coil array (loop size: 6 × 15 cm2 ) were simulated for two different pig models rendered from MR images. An 8-channel Rx coil array consisting of a flexible 6-channel posterior and a 2-channel planar anterior array was designed to fit on the abdomen of an average-sized pig in supine position. Measurements were performed in a grid phantom and ex vivo on a pig model with perfluoroctylbromide (PFOB)-filled tubes inserted in the thorax. RESULTS: Measured and simulated Tx efficiency and homogeneity for the 8-channel and 5-channel arrays were in good agreement: 1.87 ± 0.22µT/√kW versus 1.96 ± 0.29µT/√kW, and 2.29 ± 0.39µT/√kW versus 2.41 ± 0.37µT/√kW. An isolation of 38 ± 8 dB is achieved between the 19 F Tx and Rx elements, and over 30 dB between the 1 H and 19 F elements. The PFOB-filled vials could be clearly identified within the cadaver abdomen with an SNR of 275 ± 51 for a 3D gradient-echo sequence with 2-mm isotropic resolution and 12 averages, acquired in 9:52 min:s. Performance of the Tx array was robust against phase and amplitude mismatches at the input ports. CONCLUSIONS: A modular and scalable Tx array offers improved Tx efficiency in 19 F MRI of large animals with various sizes. Although conventional birdcage coils have superior Tx efficiency within the target region of interest, scalability of the Tx array to animal size is a major benefit. The described 19 F coil provides homogeneous excitation and high sensitivity detection in large pig models.

RF-induced heating of interventional devices at 23.66 MHz.

OBJECTIVE: Low-field MRI systems are expected to cause less RF heating in conventional interventional devices due to lower Larmor frequency. We systematically evaluate RF-induced heating of commonly used intravascular devices at the Larmor frequency of a 0.55 T system (23.66 MHz) with a focus on the effect of patient size, target organ, and device position on maximum temperature rise. MATERIALS AND METHODS: To assess RF-induced heating, high-resolution measurements of the electric field, temperature, and transfer function were combined. Realistic device trajectories were derived from vascular models to evaluate the variation of the temperature increase as a function of the device trajectory. At a low-field RF test bench, the effects of patient size and positioning, target organ (liver and heart) and body coil type were measured for six commonly used interventional devices (two guidewires, two catheters, an applicator and a biopsy needle). RESULTS: Electric field mapping shows that the hotspots are not necessarily localized at the device tip. Of all procedures, the liver catheterizations showed the lowest heating, and a modification of the transmit body coil could further reduce the temperature increase. For common commercial needles no significant heating was measured at the needle tip. Comparable local SAR values were found in the temperature measurements and the TF-based calculations. CONCLUSION: At low fields, interventions with shorter insertion lengths such as hepatic catheterizations result in less RF-induced heating than coronary interventions. The maximum temperature increase depends on body coil design.

Radio-frequency induced heating of intra-cranial EEG electrodes: The more the colder?

Many neurological disorders are analyzed and treated with implantable electrodes. Many patients with such electrodes have to undergo MRI examinations - often unrelated to their implant - at the risk of radio-frequency induced heating. The number of electrode contact sites of these implants keeps increasing due to improvements in manufacturing and computational algorithms. Electrode grids with multiple receive channels couple to the RF fields present in MRI, but, due to their proximity, a combination of leads has a coupling response which is not a superposition of the individual leads' response. To investigate the problem of RF-induced heating of coupled multi-lead implants, temperature mapping was performed on a set of intra-cranial electroencephalogram (icEEG) electrode grid prototypes with increasing number of contact sites (1-16). Additionally, electric field measurements were used to investigate the radio-frequency heating characteristics of the implants in different media combinations, simulating the device being partially immersed inside the patient. MR measurements show RF-induced heating up to 19.6 K for the single electrode, reducing monotonically with larger number of contact sites to a minimum of 0.9 K for the largest grid. The SAR calculated from temperature measurements agrees well with electric field mapping: The same trend is visible for different insertion lengths, however, the energy dissipated by the whole implant varies with the grid size and insertion length. Thus, in the tested circumstances, a larger electrode number either reduced or had a similar risk of RF induced heating, indicating, that the size of electrode grids is a design parameter, which can be used to change an implants RF response and in turn to reduce the risk of RF induced heating and improve the safety of patient with neuro-implants undergoing MRI examinations.

Passive needle guide tracking with radial acquisition and phase-only cross-correlation.

PURPOSE: Acceleration of a passive tracking sequence based on phase-only cross-correlation (POCC) using radial undersampling. METHODS: The phase-only cross-correlation (POCC) algorithm allows passive tracking of interventional instruments in real-time. In a POCC sequence, two cross-sectional images of a needle guide with a positive MR contrast are continuously acquired from which the instrument trajectory is calculated. Conventional Cartesian imaging for tracking is very time consuming; here, a higher temporal resolution is achieved using a highly undersampled radial acquisition together with a modified POCC algorithm that incorporates the point-spread-function. Targeting and needle insertion is performed in two phantom experiments with 16 fiducial targets, each using 4 and 16 radial projections for passive tracking. Additionally, targeting of eight deep lying basivertebral veins in the lumbar spines is performed for in vivo proof-of-application with four radial projections for needle guide tracking. RESULTS: The radially undersampled POCC sequence yielded in the phantom experiments a lateral targeting accuracy of 1.1 ± 0.4 mm and 1.0 ± 0.5 mm for 16 and 4 radial projections, respectively, without any statistically significant difference. In the in vivo application, a mean targeting duration of 62 ± 13 s was measured. CONCLUSION: Radial undersampling can drastically reduce the acquisition time for passive tracking in a POCC sequences for MR-guided needle interventions without compromising the targeting accuracy.

Magnetic resonance imaging for pathobiological assessment and interventional treatment of the coronary arteries.

X-ray-based fluoroscopy is the standard tool for diagnostics and intervention in coronary artery disease. In recent years, computed tomography has emerged as a non-invasive alternative to coronary angiography offering detection of coronary calcification and imaging of the vessel lumen by the use of iodinated contrast agents. Even though currently available invasive or non-invasive techniques can show the degree of vessel stenosis, they are unable to provide information about biofunctional plaque properties, e.g. plaque inflammation. Furthermore, the use of radiation and the necessity of iodinated contrast agents remain unfavourable prerequisites. Magnetic resonance imaging (MRI) is a radiation-free alternative to X-ray which offers anatomical and functional imaging contrasts fostering the idea of non-invasive biofunctional assessment of the coronary vessel wall. In combination with molecular contrast agents that target-specific epitopes of the vessel wall, MRI might reveal unique plaque properties rendering it, for example, 'vulnerable and prone to rupture'. Early detection of these lesions may allow for early or prophylactic treatment even before an adverse coronary event occurs. Besides diagnostic imaging, advances in real-time image acquisition and motion compensation now provide grounds for MRI-guided coronary interventions. In this article, we summarize our research on MRI-based molecular imaging in cardiovascular disease and feature our advances towards real-time MRI-based coronary interventions in a porcine model.

La fluoroscopia con rayos X es la herramienta estándar para el diagnóstico y la intervención de coronariopatías. En los últimos años, la tomografía computarizada se ha convertido en una alternativa atraumática a la coronariografía, ya que se puede detectar la calcificación coronaria y ver a través de imágenes las luces de los vasos sanguíneos mediante el uso de medios de contraste yodados. Si bien las técnicas traumáticas o atraumáticas disponibles actualmente pueden mostrar el grado de la estenosis vascular, no pueden proporcionar información sobre las propiedades biofuncionales de la placa de ateroma, por ejemplo, inflamación de la placa de ateroma. Por otra parte, el uso de radiación y la necesidad de agentes de contraste yodados siguen siendo requisitos desfavorables. La resonancia magnética (RM) es una alternativa sin radiación a los rayos X que proporciona contrates de imagen con información anatómica y funcional, lo cual refuerza la idea del diagnóstico biofuncional atraumático de las paredes de los vasos coronarios. En combinación con medios de contraste molecular que actúan sobre epítopos específicos de las paredes de los vasos, la RM puede poner de manifiesto propiedades particulares de la placa de ateroma mediante su representación, por ejemplo, «vulnerabilidad y predisposición a rotura¼. La detección precoz de este tipo de lesiones puede facilitar un tratamiento a tiempo o preventivo antes de que tenga lugar una complicación coronaria grave.Además del diagnóstico por imagen, los avances en la adquisición de imágenes en tiempo real y la compensación del movimiento sirven de base para las intervenciones coronarias guiadas por RM. En este artículo, ofrecemos un resumen de nuestra investigación sobre imagen molecular con resonancia magnética en enfermedades cardiovasculares y presentamos nuestros avances hacia las intervenciones coronarias con RM en tiempo real en un modelo porcino.

Simultaneous slice excitation for accelerated passive marker tracking via phase-only cross correlation (POCC) in MR-guided needle interventions.

OBJECTIVE: To accelerate a passive tracking sequence based on phase-only cross correlation (POCC) using simultaneous slice excitation. METHODS: For magnetic resonance (MR)-guided biopsy procedures, passive markers have been proposed that can be automatically localized online using a POCC-based tracking sequence. To accelerate the sequence, a phase-offset multiplanar (POMP) excitation technique was implemented to acquire tracking images. In a phantom experiment, the POMP-POCC sequence was tested and compared with the sequential non-accelerated version in terms of duration and accuracy. Further, technical feasibility of the POMP-POCC sequence was tested in a patient undergoing a prostate biopsy. RESULTS: The temporal resolution of the POMP-POCC tracking sequence is accelerated by 33% compared with the sequential approach. In phantom experiments, the POMP-POCC and sequential sequences yielded the same targeting accuracy of 1.6 ± 0.7 mm. Technical proof of concept of the new sequence could be demonstrated in a successful in vivo prostate biopsy. CONCLUSION: POMP-POCC tracking can substantially reduce the duration of localization of passive markers in MR-guided needle interventions without compromising targeting accuracy.

Mapping of functional domains of the lipid kinase phosphatidylinositol 4-kinase type III alpha involved in enzymatic activity and hepatitis C virus replication.

UNLABELLED: The lipid kinase phosphatidylinositol 4-kinase III alpha (PI4KIIIα) is an endoplasmic reticulum (ER)-resident enzyme that synthesizes phosphatidylinositol 4-phosphate (PI4P). PI4KIIIα is an essential host factor for hepatitis C virus (HCV) replication. Interaction with HCV nonstructural protein 5A (NS5A) leads to kinase activation and accumulation of PI4P at intracellular membranes. In this study, we investigated the structural requirements of PI4KIIIα in HCV replication and enzymatic activity. Therefore, we analyzed PI4KIIIα mutants for subcellular localization, reconstitution of HCV replication in PI4KIIIα knockdown cell lines, PI4P induction in HCV-positive cells, and lipid kinase activity in vitro. All mutants still interacted with NS5A and localized in a manner similar to that of the full-length enzyme, suggesting multiple regions of PI4KIIIα are involved in NS5A interaction and subcellular localization. Interestingly, the N-terminal 1,152 amino acids were dispensable for HCV replication, PI4P induction, and enzymatic function, whereas further N-terminal or C-terminal deletions were deleterious, thereby defining the minimal PI4KIIIα core enzyme at a size of ca. 108 kDa. Additional deletion of predicted functional motifs within the C-terminal half of PI4KIIIα also were detrimental for enzymatic activity and for the ability of PI4KIIIα to rescue HCV replication, with the exception of a proposed nuclear localization signal, suggesting that the entire C-terminal half of PI4KIIIα is involved in the formation of a minimal enzymatic core. This view was supported by structural modeling of the PI4KIIIα C terminus, suggesting a catalytic center formed by an N- and C-terminal lobe and an armadillo-fold motif, which is preceded by three distinct alpha-helical domains probably involved in regulation of enzymatic activity. IMPORTANCE: The lipid kinase PI4KIIIα is of central importance for cellular phosphatidylinositol metabolism and is a key host cell factor of hepatitis C virus replication. However, little is known so far about the structure of this 240-kDa protein and the functional importance of specific subdomains regarding lipid kinase activity and viral replication. This work focuses on the phenotypic analysis of distinct PI4KIIIα mutants in different biochemical and cell-based assays and develops a structural model of the C-terminal enzymatic core. The results shed light on the structural and functional requirements of enzymatic activity and the determinants required for HCV replication.

The lipid kinase phosphatidylinositol-4 kinase III alpha regulates the phosphorylation status of hepatitis C virus NS5A.

The lipid kinase phosphatidylinositol 4-kinase III alpha (PI4KIIIα) is an essential host factor of hepatitis C virus (HCV) replication. PI4KIIIα catalyzes the synthesis of phosphatidylinositol 4-phosphate (PI4P) accumulating in HCV replicating cells due to enzyme activation resulting from its interaction with nonstructural protein 5A (NS5A). This study describes the interaction between PI4KIIIα and NS5A and its mechanistic role in viral RNA replication. We mapped the NS5A sequence involved in PI4KIIIα interaction to the carboxyterminal end of domain 1 and identified a highly conserved PI4KIIIα functional interaction site (PFIS) encompassing seven amino acids, which are essential for viral RNA replication. Mutations within this region were also impaired in NS5A-PI4KIIIα binding, reduced PI4P levels and altered the morphology of viral replication sites, reminiscent to the phenotype observed by silencing of PI4KIIIα. Interestingly, abrogation of RNA replication caused by mutations in the PFIS correlated with increased levels of hyperphosphorylated NS5A (p58), indicating that PI4KIIIα affects the phosphorylation status of NS5A. RNAi-mediated knockdown of PI4KIIIα or pharmacological ablation of kinase activity led to a relative increase of p58. In contrast, overexpression of enzymatically active PI4KIIIα increased relative abundance of basally phosphorylated NS5A (p56). PI4KIIIα therefore regulates the phosphorylation status of NS5A and viral RNA replication by favoring p56 or repressing p58 synthesis. Replication deficiencies of PFIS mutants in NS5A could not be rescued by increasing PI4P levels, but by supplying functional NS5A, supporting an essential role of PI4KIIIα in HCV replication regulating NS5A phosphorylation, thereby modulating the morphology of viral replication sites. In conclusion, we demonstrate that PI4KIIIα activity affects the NS5A phosphorylation status. Our results highlight the importance of PI4KIIIα in the morphogenesis of viral replication sites and its regulation by facilitating p56 synthesis.

MR Safety of Inductively Coupled and Conventional Intraoral Coils.

PURPOSE: Intraoral coils (IOCs) in magnetic resonance imaging (MRI) significantly improve the signal-to-noise ratio compared with conventional extraoral coils. To assess the safety of IOCs, we propose a 2-step procedure to evaluate radiofrequency-induced heating of IOCs and compare maximum temperature increases in 3 different types of IOCs. METHODS: The 2-step safety assessment consists of electric field measurements and simulations to identify local hotspots followed by temperature measurements during MRI. With this method, 3 different coil types (inductively coupled IFC, transmit/receive tLoop, and receive-only tLoopRx) were tested at 1.5 T and 3 T for both tuned and detuned coil states. High SAR and regular MRI protocols were applied for 2 coil positions. RESULTS: The measured E field maps display distinct hotspots for all tuned IOCs, which were reduced by at least 40-fold when the IOCs were detuned. Maximum temperature rise was higher when the coils were positioned at the periphery of the phantom with the coil planes parallel to B0. When neither active nor passive detuning was applied, maximum temperature increase of ΔT = 1.3/0.5/1.8 K was found for IFC/tLoop/tLoopRx coils. Hotspots detected by E field measurements, and simulations were consistent. In the simulations, the results were different for homogeneous phantoms compared with full anatomical models. The 2-step test procedure is applicable to different coil types. CONCLUSIONS: The results indicate that a risk for radiofrequency-induced heating exists for tuned IOCs, so that adequate detuning circuits need to be integrated in the coils to ensure safe operation.

Combination of high resolution MRI with 3D-printed needle guides for ex vivo myocardial biopsies.

Magnetic resonance imaging (MRI) provides a multitude of techniques to detect and characterize myocardial infarction. To correlate MRI findings with histology, in most cases terminal animal studies are performed; however, precise extraction and spatial correlation of myocardial tissue samples to MRI image data is difficult. In this proof of concept study, we present a 3D-printing technique to facilitate the extraction of tissue samples from myocardial regions. Initially, seven pig hearts embedded in formaldehyde were imaged on a clinical 3 T system to define biopsy targets on high resolution ex vivo images. Magnitude images and R2*-maps acquired with a 3D multi-echo gradient echo sequence and 0.58 mm isotropic resolution were used to create digital models of the cardiac anatomy. Biopsy guides were 3D-printed to steer the extraction of myocardial samples. In total, 61 tissue samples were extracted with an average offset of the tissue sample location from the target location of 0.59 ± 0.36 mm. This offset was not dependent on the distance of the target point to the epicardial surface. Myocardial tissue could be extracted from all samples. The presented method enables extraction of myocardial tissue samples that are selected by ex vivo MRI with submillimeter precision.

Cardioaortic dimensions in German landrace pigs derived from cardiac magnetic resonance imaging.

Pigs are frequently applied as animal models in cardiovascular research due to their anatomical and physiological similarity to humans. For study planning and refinement, precise knowledge of the cardioaortic dimensions is essential. In a retrospective single-center study, the cardioaortic dimensions and left ventricular function of German Landrace pigs were assessed using cardiac MRI. All parameters were compared between male and female pigs and analyzed for correlation with body weight. In total, 15 pigs were included (7 male and 8 female, weight 60.9 ± 7.0 kg). The left ventricle revealed an end-diastolic diameter of 50.5 ± 4.4 mm and an ejection fraction of 51.2 ± 9.8%. The diameters of the ascending and descending aorta were 21.3 ± 2.3 and 16.2 ± 1.4 mm, respectively. There were no significant differences between male and female pigs, except that males had a smaller end-diastolic left ventricular volume (p = 0.041). A moderate correlation was found between body weight and the aortic annulus diameter (R = 0.57, p = 0.027). In conclusion, cardiac MRI allows precise quantification of porcine cardioaortic dimensions. For medical device testing, size differences between pigs and humans should be considered.

Quantifying myocardial perfusion during MR-guided interventions without exogenous contrast agents: intra-arterial spin labeling.

PURPOSE: To test intra-arterial spin labeling (iASL) using active guiding catheters for myocardial perfusion measurements during magnetic resonance (MR)-guided interventions in a pig study. METHODS: In this work, a single-loop radiofrequency (RF) coil at the tip of a 6F active coronary catheter was used as a transmit coil for local spin labeling. The transmit magnetic RF field (B1) of the coil and the labeling efficiency were determined, and iASL was tested in two pigs after the catheter was engaged in the aortic root, the ostium of the left coronary artery (LCA) under MR-guidance. The iASL effect was assessed by the signal difference between spin-labeling On and control (spin-labeling OFF) images, and in a cross-correlation between ON/Off states of spin-labeling a binary labeling paradigm. In addition, quantitative myocardial perfusion was calculated from the iASL experiments. RESULTS: The maximum B1 in the vicinity of the catheter coil was 2.1 µT. A strong local labeling effect with a labeling efficiency of 0.45 was achieved with iASL both in vitro and in vivo. In both pigs, the proximal myocardial segments supplied by the LCA showed significant labelling effect up to distances of 60 mm from the aortic root with a relative signal difference of (3.14 ±â€¯2.89)% in the first and (3.50 ±â€¯1.25)% in the second animal. The mean correlation coefficients were R = 0.63 ±â€¯0.22 and 0.42 ±â€¯0.16, respectively. The corresponding computed myocardial perfusion values in this region of the myocardium were similar to those obtained with contrast perfusion methods ((1.2 ±â€¯1.1) mL/min/g and (0.8 ±â€¯0.6) mL/min/g). CONCLUSION: The proposed iASL method demonstrates the feasibility of selective myocardial perfusion measurements during MR-guided coronary interventions, which with further technical improvements may provide an alternative to exogenous contrast-based perfusion. Due to the invasive nature of the iASL method, it can potentially be used in concert with MRI-guided coronary angioplasty.

Role of annexin A2 in the production of infectious hepatitis C virus particles.

Hepatitis C virus (HCV) is an important human pathogen affecting 170 million chronically infected individuals. In search for cellular proteins involved in HCV replication, we have developed a purification strategy for viral replication complexes and identified annexin A2 (ANXA2) as an associated host factor. ANXA2 colocalized with viral nonstructural proteins in cells harboring genotype 1 or 2 replicons as well as in infected cells. In contrast, we found no obvious colocalization of ANXA2 with replication sites of other positive-strand RNA viruses. The silencing of ANXA2 expression showed no effect on viral RNA replication but resulted in a significant reduction of extra- and intracellular virus titers. Therefore, it seems likely that ANXA2 plays a role in HCV assembly rather than in genome replication or virion release. Colocalization studies with individually expressed HCV nonstructural proteins indicated that NS5A specifically recruits ANXA2, probably by an indirect mechanism. By the deletion of individual NS5A subdomains, we identified domain III (DIII) as being responsible for ANXA2 recruitment. These data identify ANXA2 as a novel host factor contributing, with NS5A, to the formation of infectious HCV particles.

Catheter-based Arterial Input Function Determination for Myocardial Perfusion Measurements.

The quantification of myocardial perfusion with contrast agent (CA) tracers requires the precise knowledge of the arterial input function (AIF). In this study a method for MR-guided vascular interventions is evaluated that determines the AIF via an active tracking catheter during targeted CA injection. A phantom experiment with a dialysis filter was conducted to measure the AIF using an active catheter and a dynamic image series as reference. To compensate for dilution and coil sensitivity effects, correction methods were developed for the catheter-based AIF determination. From the dynamic MR measurements in the perfusion phantom quantitative perfusion maps were calculated by a deconvolution of the measured CA concentration with the AIF, and additional flow measurements were used to normalize the perfusion map. The signal-time-curves of the measured AIF using the catheter-based and imaging-based methods agree while the absolute values differ by a scaling factor of about 9. After normalization to the surrounding flow, both perfusion techniques are in excellent agreement. Catheter-based AIF measurements are feasible but require an additional normalization which can be determined from a flow measurement. The technique might enable faster perfusion measurements during cardiovascular interventions.

Analysis of the RF Excitation of Endovascular Stents in Small Gap and Overlap Scenarios Using an Electro-Optical E-field Sensor.

OBJECTIVE: To assess the effect of the electro-magnetic coupling of endovascular stents on their RF heating potential in MRI. METHODS: A custom-built electro-optic E-field probe is used to perform measurements of the scattered E-field at a distance of 2 mm to stent samples with submillimeter resolution. Various combinations of stent lengths are measured at 124 MHz (3T MRI Larmor frequency) with varying gap and overlap between the stents, with and without stent coating, and with distilled water and saline solution as surrounding media. The results are compared to theoretically derived E-field distributions. RESULTS: At an overlap of 10 mm the E-field pattern of two stents collapses to a single dipole indicating excellent coupling between the stents. E-field intensities substantially increase/decrease up to 5-fold/2.5-fold if the total length of the two combined stents is closer/further away from the resonance length of the single stents. Stent coating and conductivity of the surrounding medium strongly influence the E-field patterns of overlapping stents. Measured and calculated E-field patterns are in good agreement. CONCLUSION: Electro-optic E-field measurements are a valuable tool for RF safety assessments in both single as well as coupled stents. SIGNIFICANCE: RF induced heating of single stents during MRI has been extensively studied. However, in clinical practice often two or more stents are implanted in close proximity which can substantially change the pattern of the scattered electric fields and the localization and intensity of hot spots. In this study a detailed assessment of the coupling of stents during RF excitation is given.

Artifact quantification of venous stents in the MRI environment: Differences between braided and laser-cut designs.

PURPOSE: To quantify B0- and B1-induced imaging artifacts of braided venous stents and to compare the artifacts to a set of laser-cut stents used in venous interventions. METHODS: Three prototypes of braided venous stents with different geometries were tested in vitro. B0 field distortion maps were measured via the frequency shift Δf using multi-echo imaging. B1 distortions were quantified using the double angle method. The relative amplitudes B1rel were calculated to compare the intraluminal alteration of B1. Measurements were repeated with the stents in three different orientations: parallel, diagonal and orthogonal to B0. RESULTS: At 1.5 T, the braided stents induced a maximum frequency shift of Δfx<100Hz. Signal voids were limited to a distance of 2 mm to the stent walls at an echo time of 3 ms. No substantial difference in the B0 field distortions was seen between laser-cut and braided venous stents. B1rel maps showed strongly varying distortion patterns in the braided stents with the mean intraluminal B1rel ranging from 63±18% in prototype 1 to 98±38% in prototype 2. Compared to laser-cut stents the braided stents showed a 5 to 9 times higher coefficient of variation of the intraluminal B1rel. CONCLUSION: Braided venous stent prototypes allow for MR imaging of the intraluminal area without substantial signal voids due to B0-induced artifacts. Whereas B1 is attenuated homogeneously in laser-cut stents, the B1 distortion in braided stents is more inhomogeneous and shows areas with enhanced amplitude. This could potentially be used in braided stent designs for intraluminal signal amplification.

Magnetic Resonance Imaging of Venous Stents at 1.5 T: Susceptibility Artifacts and Radiofrequency Shielding.

PURPOSE: The aims of this study were to assess radiofrequency (RF) shielding and susceptibility-induced imaging artifacts of venous stents with different designs at 1.5 T and to analyze the relationship between stent designs, that is, cell geometry and RF shielding. METHODS: Twelve dedicated venous stents and 1 stent used for venous pathologies with 8 different designs from 5 different manufacturers were tested: Blueflow (plus medica, Düsseldorf, Germany), Sinus Obliquus, Sinus Venous, Sinus XL (Optimed, Ettlingen, Germany), Vici (Veniti, St. Louis, MO), Zilver Vena (Cook, Bjaeverskov, Denmark), and Venovo (Bard, Tempe, AZ). Two versions with different lengths were available from all stents except the Venovo. For each stent, B1 and frequency mapping was performed using the double angle method and gradient multiecho imaging. Each stent was measured in 3 different orientations: parallel, orthogonal, and at 45 degrees to B0. A correlation analysis was performed between the induced B1 field strength inside the stents and the geometries of the cells. RESULTS: Radiofrequency shielding was found to be strongly varying between different stent designs. The 120-mm-long Vici stent showed the lowest mean relative B1 amplitude of (38% ± 16%) when oriented parallel to B0. The highest mean B1 amplitude was measured inside the 100-mm-long Blueflow stent with diagonal orientation (90% ± 20%). Averaged over all stents, the shielding was 18% stronger when the stents are oriented orthogonal to B0 compared with a parallel orientation and the between-stent variation was lower for the orthogonal orientation (11%) compared with the parallel orientation (20%). For laser-cut stents, a linear correlation was found between the amount of RF shielding and the length of individual cells measured perpendicular to the stents' long axes. The woven stents showed a strongly inhomogeneous intraluminal RF shielding pattern, whereas the laser-cut stents provided a more homogeneous shielding pattern. No substantial susceptibility-induced frequency shifts were measured near all stents with a maximum shift of [INCREMENT]f = 96 Hz measured in the vicinity of the 150-mm-long Sinus Obliquus stent. CONCLUSION: Magnetic resonance imaging in the vicinity of commercially available venous stents is feasible at 1.5 T with no substantial susceptibility-induced artifacts but reduced transmit and receive B1 field strengths inside the stents. The strength and homogeneity of the intraluminal B1 depend on the stents' fabrication (woven or laser-cut) and cell geometry.

Real-time magnetic resonance imaging - guided coronary intervention in a porcine model.

X-ray fluoroscopy is the gold standard for coronary diagnostics and intervention. Magnetic resonance imaging is a radiation-free alternative to x-ray with excellent soft tissue contrast in arbitrary slice orientation. Here, we assessed real-time MRI-guided coronary interventions from femoral access using newly designed MRI technologies. Six Goettingen minipigs were used to investigate coronary intervention using real-time MRI. Catheters were custom-designed and equipped with an active receive tip-coil to improve visibility and navigation capabilities. Using modified standard clinical 5 F catheters, intubation of the left coronary ostium was successful in all animals. For the purpose of MR-guided coronary interventions, a custom-designed 8 F catheter was used. In spite of the large catheter size, and therefore limited steerability, intubation of the left coronary ostium was successful in 3 of 6 animals within seconds. Thereafter, real-time guided implantation of a non-metallic vascular scaffold into coronary arteries was possible. This study demonstrates that real-time MRI-guided coronary catheterization and intervention via femoral access is possible without the use of any contrast agents or radiation, including placement of non-metallic vascular scaffolds into coronary arteries. Further development, especially in catheter and guidewire technology, will be required to drive forward routine MR-guided coronary interventions as an alternative to x-ray fluoroscopy.

Publisher Correction: Real-time magnetic resonance imaging - guided coronary intervention in a porcine model.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.