Control of intravascular catheters using an array of active steering coils.

PURPOSE: To extend the concept of deflecting the tip of a catheter with the magnetic force created in an MRI system through the use of an array of independently controllable steering coils located in the catheter tip, and to present methods for visualization of the catheter and/or surrounding areas while the catheter is deflected. METHODS: An array of steering coils made of 42-gauge wire was built over a 2.5 Fr (0.83 mm) fiber braided microcatheter. Two of the coils were 70 turn axial coils separated by 1 cm, and the third was a 15-turn square side coil that was 2 x 4 mm2. Each coil was driven independently by a pulse width modulation (PWM) current source controlled by a microprocessor that received commands from a MATLAB routine that dynamically set current amplitude and direction for each coil. The catheter was immersed in a water phantom containing 1% Gd-DTPA that was placed at the isocenter of a 1.5 T MRI scanner. Deflections of the catheter tip were measured from image-based data obtained with a real-time radio frequency (RF) spoiled gradient echo sequence (GRE). The small local magnetic fields generated by the steering coils were exploited to generate a hyperintense signal at the catheter tip by using a modified GRE sequence that did not include slice-select rewinding gradients. Imaging and excitation modes were implemented by synchronizing the excitation of the steering coil array with the scanner by ensuring that no current was driven through the coils during the data acquisition window; this allowed visualization of the surrounding tissue while not affecting the desired catheter position. RESULTS: Deflections as large as 2.5 cm were measured when exciting the steering coils sequentially with a 100 mA maximum current per coil. When exciting a single axial coil, the deflection was half this value with 30% higher current. A hyperintense catheter tip useful for catheter tracking was obtained by imaging with the modified GRE sequence. Clear visualization of the areas surrounding the catheter was obtained by using the excitation and imaging mode even with a repetition time (TR) as small as 10 ms. CONCLUSIONS: A new system for catheter steering is presented that allows large deflections through the use of an integrated array of steering coils. Additionally, two imaging techniques for tracking the catheter tip and visualization of surrounding areas, without interference from the active catheter, were shown. Together the demonstrated steerable catheter, control system and the imaging techniques will ultimately contribute to the development of a steerable system for interventional MRI procedures.

Magnetic resonance imaging-guided renal artery stent placement in a Swine model: comparison of two tracking techniques.

BACKGROUND: Magnetic resonance (MR)-guided interventions have evolved from a pure research application to a preclinical method over the last decade. Among the device-tracking techniques, susceptibility artifact-based tracking relies on the contrast between the surrounding blood and the device, and radiofrequency coil-based tracking relies on the local gradient field amplification in a resonating circuit attached to the interventional device. PURPOSE: To evaluate the feasibility and precision of susceptibility artifact-based and microcoil-based MR guidance methods for renal artery stent placement in a swine model. MATERIAL AND METHODS: MR imaging-guided renal artery stent placements were performed in six fully anesthetized pigs using a 1.5T short-bore MR scanner. Susceptibility artifact-based tracking with manual scan-plane adjustments and microcoil tracking with automatic scan-plane adjustments were used for renal artery stent placements in three pigs in each group. With both methods, near real-time steady-state free-precession (SSFP) imaging was used. Differences between the two tracking approaches on stenting time, total procedure time, and stent position were measured. RESULTS: The microcoil-based approach yielded a shorter mean procedure time (17 vs. 23 min). There was no relevant difference for the mean stenting time (12 vs. 13 min). The mean stent deviation from the aortic wall with the susceptibility approach was larger than with the microcoil approach (10 vs. 4.0 mm). CONCLUSION: For MRI-guided renal artery stent placement, the microcoil-based technique had a shorter procedure time and a higher stent placement precision than the susceptibility artifact-based approach.

Distinguishing viable from infarcted myocardium after experimental ischemia and reperfusion by using nuclear magnetic resonance imaging.

Early reperfusion has the potential for salvaging ischemic myocardium at risk for infarction. To test the ability of nuclear magnetic resonance (NMR) imaging to differentiate between stunned and infarcted myocardium early after reperfusion, 16 mongrel dogs underwent transient occlusion of the left anterior descending artery or a diagonal branch for 30, 60 or 180 min followed by reperfusion. To identify the area at risk for infarction and to assess the extent of hypoperfusion and reperfusion, two-dimensional and contrast echocardiography were performed at baseline study, during coronary occlusion and at three separate times during reperfusion (before NMR imaging, immediately after NMR imaging and 12 to 14 h later). Wall thickening in the control and ischemic zones and the circumferential extent of abnormal wall motion were analyzed at each time point using short-axis echocardiograms. Nuclear magnetic resonance imaging at 1.5 tesla was performed 2 to 3.5 h (mean 2.7 +/- 0.5) after reperfusion. Short-axis, multislice spin-echo images (TE 26 and TE 60) were obtained. Signal intensity was measured in the control and ischemic areas and expressed as a percent difference compared with normal myocardium. All dogs demonstrated a significant decrease in wall thickening and abnormal wall motion before and after NMR imaging. Seven of the eight dogs with infarction had an area of increased signal intensity on TE 60 images. The mean percent difference in signal intensity compared with adjacent normal myocardium was 127 +/- 68% (p = 0.002). None of the eight dogs without infarction had a visually apparent change in signal intensity on TE 60 images (mean percent difference versus control area 13 +/- 11%), despite regional systolic dysfunction documented by echocardiography at the time of imaging. The area of increased signal intensity correlated with infarct size (r = 0.69), although overestimation by NMR imaging occurred. The area of increased signal intensity did not correlate with the extent of echocardiographic contrast defect during coronary occlusion (risk area). This study demonstrates that NMR imaging can be applied early after coronary reperfusion to assess the potential for recovery of dysfunctional myocardium. In addition, by using a TE 60 multislice spin-echo imaging sequence at 1.5 tesla, quantification of the extent of infarction also may be possible.

Generation and observation of radio frequency thermal lesion ablation for interventional magnetic resonance imaging.

RATIONALE AND OBJECTIVES: Recently, there has been increased interest in interventional magnetic resonance (MR) imaging and minimally invasive cancer therapy via radio frequency (RF) thermal ablation. In this work, we examined RF thermal lesion generation in phantoms and ex vivo bovine liver and correlated them with MR images under a variety of conditions, which begins our assessment of the role of MR imaging in this new method for cancer treatment. METHODS: Radio frequency lesions were created in gel phantoms and ex vivo bovine liver, using stationary (bovine liver) and variable speed (gel) moving electrodes to create lesions with shapes mimicking tumors. Ex vivo bovine liver lesions were made with the tissue held at room temperature (n = 4) and in a 37 degrees C saline bath (n = 3) using a 16-gauge electrode (tip temperature: 70 degrees C, 80 degrees C, and 90 degrees C; ablation time: 1-13 minutes). Electrical impedance and RF power were plotted during ablation. After ablation, RF-induced lesions were imaged with a 0.2-tesla (T) MR system using a variety of pulse sequences. RESULTS: Complex shaped lesions were created successfully in phantoms. Averaged maximum ex vivo lesion volume made at 90 degrees C ablation experiments holding the tissue temperature at 37 degrees C and at room temperature were 1.58 +/- 0.35 cm3 and 1.0 +/- 0.26 cm3 respectively (confidence interval: 90%). The aspect ratios and RF power of the lesions decreased as ablations proceeded. Impedance dropped during the first 2 minutes of the ablation. Ex vivo lesions appeared as regions of low-signal amplitude in T2-weighted MR images. CONCLUSIONS: Phantom ablation experience may be useful and applicable in thermotherapy planning. Lesions made in ex vivo bovine liver held at 37 degrees C via a saline bath are larger than those created at room temperature. Lesions shapes are ablation time dependent until thermal equilibrium is reached. Impedance reduction and lesion formation are related; 0.2-T MR systems can image RF energy-induced thermal lesions.

MR of ballistic materials: imaging artifacts and potential hazards.

The most common ballistic materials available in the urban setting were studied for their MR effects on deflection force, rotation, heating, and imaging artifacts at 1.5 T to determine the potential efficacy and safety for imaging patients with ballistic injuries. The 28 missiles tested covered the range of bullet types and materials suggested by the Cleveland Police Department. The deflection force was measured by the New method. Rotation was evaluated 30 min after bullets had been placed in a 10% (weight per weight) ballistic gelatin designed to simulate brain tissue, with the long axis of the bullet placed parallel and perpendicular to the Z axis of the magnet. Heating was measured with alcohol thermometers by imaging for 1 hr alternatively with gradient-echo and spin-echo sequences (RF absorption = 0.033 and 0.326 w/kg respectively). Image artifacts on routine sequences were evaluated. All the steel-containing bullets except for the Winchester armor-piercing 38 caliber exhibited deflection. A nonsteel 7.38-mm Mauser also deflected. Deflection range was 514 to 15,504 dynes. Rotation occurred when the bullets were not parallel to the Z axis. Temperature changes were not significant. Deflecting projectiles resulted in obliteration of the image. The artifacts from other projectiles were small but varied by content. The artifact of the Winchester armor-piercing 38-caliber bullet was similar to those without steel. Bullets that contain steel or ferromagnetic contaminates such as nickel can be rotated within the MR unit.(ABSTRACT TRUNCATED AT 250 WORDS)

Some noise properties of 2DFT MR images from asymmetrically sampled data.

This report describes noise statistics in 2DFT MR images, expanding the earlier work of Henkelman and others to include variably asymmetric sampling and conjugate synthesis reconstruction. The effects of low-order polynomial and Fourier phase correction used with conjugate synthesis are also explicitly considered. This analysis shows that complex images obtained by conjugate synthesis have an elliptical noise distribution, with the smaller axis corresponding to the imaginary image channel. Derivations and simulations predict a ratio of mean to standard deviation in the background of magnitude images varying from the known value of square root of pi/(4 - pi) (approximately 1.91) for full symmetry to square root of 2/(pi - 2) (approximately 1.32) at fully asymmetric or half-echo sampling; these predictions are validated over a range of asymmetry by experimental measurements. These results are important for predicting and interpreting image noise when using asymmetric sampling.

A rapid look-up table method for reconstructing MR images from arbitrary K-space trajectories.

Look-up tables (LUTs) are a common method for increasing the speed of many algorithms. Their use can be extended to the reconstruction of nonuniformly sampled k-space data using either a discrete Fourier transform (DFT) algorithm or a convolution-based gridding algorithm. A table for the DFT would be precalculated arrays of weights describing how each data point affects all of image space. A table for a convolution-based gridding operation would be a precalculated table of weights describing how each data point affects a small k-space neighborhood. These LUT methods were implemented in C++ on a modest personal computer system; they allowed a radial k-space acquisition sequence, consisting of 180 views of 256 points each, to be gridded in 36.2 ms, or, in approximately 800 ns/point. By comparison, a similar implementation of the gridding operation, without LUTs, required 45 times longer (1639.2 ms) to grid the same data. This was possible even while using a 4 x 4 Kaiser-Bessel convolution kernel, which is larger than typically used. These table-based computations will allow real time reconstruction in the future and can currently be run concurrently with the acquisition allowing for completely real-time gridding.

An optimal design method for magnetic resonance imaging gradient waveforms.

A method of using nonlinear constrained optimization to design gradient waveforms for magnetic resonance imaging is described. Formulation and solution of the waveform optimization problem are described and example waveforms are presented for a variety of design objectives and constraint sets. Most design objectives can be expressed as linear or quadratic functions of the discrete parameter set, and most constraint functions are linear. Thus, linear and quadratic programming techniques can be utilized to solve the optimization problem. Among the objectives considered are: minimize RMS current; minimize waveform slewing; minimize waveform moments to reduce motion induced dephasing; minimize echo time (TE) for given imaging and motion refocusing conditions; maximize the gradient amplitude during RF application and sampling and the area of the phase encoding waveform to maximize resolution; and minimize or maximize the gradient b factor or diffusion sensitivity. This optimal design procedure produces physically realizable waveforms which optimally achieve specific imaging and motion artifact reduction goals, and it is likely to reduce waveform design time by making it more scientifically (rather than heuristically) based.

Semiautomatic 3-D image registration as applied to interventional MRI liver cancer treatment.

We evaluated semiautomatic, voxel-based registration methods for a new application, the assessment and optimization of interventional magnetic resonance imaging (I-MRI) guided thermal ablation of liver cancer. The abdominal images acquired on a low-field-strength, open I-MRI system contain noise, motion artifacts, and tissue deformation. Dissimilar images can be obtained as a result of different MRI acquisition techniques and/or changes induced by treatments. These features challenge a registration algorithm. We evaluated one manual and four automated methods on clinical images acquired before treatment, immediately following treatment, and during several follow-up studies. Images were T2-weighted, T1-weighted Gd-DTPA enhanced, T1-weighted, and short-inversion-time inversion recovery (STIR). Registration accuracy was estimated from distances between anatomical landmarks. Mutual information gave better results than entropy, correlation, and variance of gray-scale ratio. Preprocessing steps such as masking and an initialization method that used two-dimensional (2-D) registration to obtain initial transformation estimates were crucial. With proper preprocessing, automatic registration was successful with all image pairs having reasonable image quality. A registration accuracy of approximately equal to 3 mm was achieved with both manual and mutual information methods. Despite motion and deformation in the liver, mutual information registration is sufficiently accurate and robust for useful applications in I-MRI thermal ablation therapy.

Validation of object-induced MR distortion correction for frameless stereotactic neurosurgery.

Spatial fidelity is a paramount issue in image guided neurosurgery. Until recently, three-dimensional computed tomography (3D CT) has been the primary modality because it provides fast volume capture with pixel level (1 mm) accuracy. While three-dimensional magnetic resonance (3D MR) images provide superior anatomic information, published image capture protocols are time consuming and result in scanner- and object-induced magnetic field inhomogeneities which raise inaccuracy above pixel size. Using available scanner calibration software, a volumetric algorithm to correct for object-based geometric distortion, and a Fast Low Angle SHot (FLASH) 3D MR-scan protocol, we were able to reduce mean CT to MR skin-adhesed fiducial marker registration error from 1.36 to 1.09 mm. After dropping the worst one or two of six fiducial markers, mean registration error dropped to 0.62 mm (subpixel accuracy). Three dimensional object-induced error maps present highest 3D MR spatial infidelity at the tissue interfaces (skin/air, scalp/skull) where frameless stereotactic fiducial markers are commonly applied. The algorithm produced similar results in two patient 3D MR-scans.

Dynamic tracking in interventional MRI using wavelet-encoded gradient-echo sequences.

This work describes a newly developed magnetic resonance imaging (MRI) data-acquisition strategy which replaces the standard Fourier phase-encoding with the spatially localized coefficients of wavelet-encoding and offers a new technique for image guidance when combined with a dynamic tracking algorithm. By using this new technique, only a specific fraction of the entire raw data set needs to be updated and reconstructed to visualize the movement of an interventional device during an MR guided procedure. The combination of wavelet-encoding and a dynamic tracking algorithm was implemented in two-dimensional and three-dimensional gradient-echo sequences on a 0.2-T open C-arm-shaped MR system (Siemens, Erlangen Germany) and tested in phantom and in vitro experiments. When applying the wavelet-encoding direction parallel to the movement of a straight interventional device, only those spatially localized wavelet-coefficients mainly affected by the interventional device are updated. This led to potential increases of the image frame rate by a factor of up to seven.

Methods for providing probe position and temperature information on MR images during interventional procedures.

Interventional magnetic resonance imaging (MRI) can be defined as the use of MR images for guiding and monitoring interventional procedures (e.g., biopsy, drainage) or minimally invasive therapy (e.g., thermal ablation). This work describes the development of a prototype graphical user interface and the appropriate software methods to accurately overlay a representation of a rigid interventional device [e.g., biopsy needle, radio-frequency (RF) probe] onto an MR image given only the probe's spatial position and orientation as determined from a three-dimensional (3-D) localizer used for interactive scan plane definition. This permits 1) "virtual tip tracking," where the probe tip location is displayed on the image without the use of separate receiver coils or a "road map" image data set, and, 2) "extending" the probe to predict its path if it were directly moved forward toward the target tissue. Further, this paper describes the design and implementation of a method to facilitate the monitoring of thermal ablation procedures by displaying and overlaying temperature maps from temperature sensitive MR acquisitions. These methods provide rapid graphical updates of probe position and temperature changes to aid the physician during the actual interventional MRI procedures without altering the usual operation of the MR imager.

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.

Magnetic resonance image-guided biopsy and aspiration.

Recent advances in magnet design and magnetic resonance (MR) system technology coupled with the development of fast gradient-echo pulse sequences have contributed to the increasing interest in interventional magnetic resonance imaging (MRI). Minimally invasive diagnostic and therapeutic image-based intervention can now be performed under near real-time MR guidance, taking advantage of the high tissue contrast, spatial resolution, vascular conspicuity and multiplanar capabilities of MRI to achieve safe and precise needle placement. This is particularly advantageous for needle navigation in regions of complex anatomy, such as the suprahyoid neck. This article discusses the theoretical concepts and clinical applications of MR for guidance for biopsy and aspiration, and highlights the technical developments that provide the foundation for interventional MRI.

Velocity quantification in magnetic resonance imaging.

A variety of methods has been developed for quantitating flow in vivo. These are usually based on the principles of velocity-phase or TOF information. The former allows a point-by-point 2D image of velocity, but also has other manifestations involving real-time 1D projections or 1D projections with 1D velocity information (flow zeugmatography). The TOF methods use the in-flow of unsaturated spins into a saturated region (for example) to estimate flow. The concepts, features, and clinical applications of these and other techniques are reviewed in this article.

Analysis of imaging axes significance in motion artifact suppression technique (MAST): MRI of turbulent flow and motion.

Recently, a new technique has been demonstrated which effectively refocusses the dephasing effects of spins moving during application of MR imaging gradients. This paper presents an analysis of imaging axes significance in spin dephasing for motion occurring along the slice select, read and phase-encoding directions. A flow phantom under constant flow conditions in all experiments was used to provide complete spin dephasing when "traditional" imaging gradients were used. The MAST technique was used to refocus along various combinations of imaging axes, and variable number of terms from the Taylor expansion of motion along them. Results indicate that motion along any imaging axis can be refocussed effectively when MAST gradients are used along only the slice select and read axis.

In-plane flow velocity quantification along the phase encoding axis in MRI.

In-plane flow quantification in MRI offers the potential for assessing vessel patency, and both volume flow rate and flow velocity. These techniques will have definite future impact on MR angiography. The method used in this paper employs motion artifact suppression technique (MAST) gradients to refocus spins travelling along any of the three imaging axes while encoding the velocity component along the phase encoding axis. This method has several advantages over in-plane flow quantification along the read axis. Primarily, flow voids due to complete spin dephasing can be eliminated (or reduced), wider velocity limits can be measured, and gradients can be designed which are sensitive to only velocity along the phase axis with no additional effect from higher order derivatives, or motion along the read axis. Flow phantom studies, carried out on 19 mm inside diameter glass tubes, have produced accurate results for flow rates ranging from 0.6 gallons per minute (GPM) to 2.5 GPM, corresponding to a mean velocity range from 13.2 cm/sec to 55.3 cm/sec. Reynolds numbers varied from 2,700 to 11,500. Errors were less than or equal to 8% over the range of flow rates studied.

Modified gradients for motion suppression: variable echo time and variable bandwidth.

A linear algebra based deprivation is presented to demonstrate that linearly time scaling an entire gradient waveform by a factor "R" exponentially increases its sensitivity to time derivatives of position by R(i + 1), where i refers to the i-th derivative of position (e.g., i = 1 is velocity). Thus, time scaling will preserve zero valued refocussing moments associated with artifact reduction techniques designed for motion occurring between excitation and detection. Typically, gradient waveforms for artifact reduction techniques are derived for use only at specific echo times. The time scaling described here allows for simple modification of refocussing gradient waveforms for use at variable echo times. Motion sensitivity associated with non-zero moment gradient waveforms can be easily predicted and modified using this technique, with consideration for field of view, resolution, and bandwidth. A clinical example is presented showing the predicted changes in sensitivity to nonrefocussed derivatives of position as the imaging gradients are time scaled. Further, trade-offs and alternatives in sensitivity to motion, slice thickness, image bandwidth, field of view and resolution will be discussed in conjunction with time scaling. This technique will have applicability in many situations involving MRI of moving tissue and a clinical example in cardiac imaging is presented.

Multiecho multimoment refocussing of motion in magnetic resonance imaging: MEM-MO-RE.

Gradient moment nulling techniques for refocussing of spin dephasing resulting from movement during application of magnetic resonance imaging gradients have gained widespread application. These techniques offer advantages over conventional imaging gradients by reducing motion artifacts due to intraview motion, and by recovering signal lost from spin dephasing. This paper presents a simple technique for designing multiecho imaging gradient waveforms that refocus dephasing from the interaction of imaging gradients and multiple derivatives of position. Multiple moments will be compensated at each echo. The method described relies on the fact that the calculation of time moments for nulled moment gradient waveforms is independent of the time origin chosen. Therefore, waveforms used to generate the second echo image for multiple echo sequences with echo times given by TEn = TE1 + (n - 1) * (TE2 - TE1) may also be used for generation of the third and additional echo images. All echoes will refocus the same derivatives of position. Multiecho, multimoment refocussing (MEM-MO-RE) images through the liver in a patient with ampullary adenocarcinoma metastatic to the liver demonstrate the application of the method in clinical scanning.

Percutaneous magnetic resonance image-guided biopsy and aspiration in the head and neck.

OBJECTIVE/HYPOTHESIS: To test the hypotheses that 1) magnetic resonance imaging (MRI)-guided biopsy and aspiration with an open 0.2-T system (Magnetom Open, Siemens, Erlangen, Germany) in the head and neck is feasible and successful and 2) procedure times can be sufficiently short to be well tolerated by the patient. METHODS: Sixty-one MRI-guided procedures were performed in 47 patients (ages, 6 mo-88 y) in the head and neck, including the mucosal sites and masticator and parapharyngeal spaces (n = 23), parotid space (n = 6), submandibular space (n = 2), cervical vertebral column/paraspinal tissues (n = 8), skull base (n = 3), larynx or hypopharynx (n = 3), and infrahyoid nodal chains and surrounding tissues (n = 16). A clinical C-arm imaging system was used, supplemented by an in-room radiofrequency-shielded liquid crystal monitor, rapid gradient echo sequences for needle guidance, and MRI-compatible anesthesia, monitoring, and surgical lighting equipment. Tissue sampling included fine-needle aspiration (n = 58) and cutting-needle core biopsy (n = 27), with 24 patients undergoing both procedures. Procedures were evaluated for success of needle placement, procedure time, and complications. RESULTS: Successful needle placement was accomplished in all cases without complication, with tissue sufficient for pathological diagnosis obtained for all but five patients with an average of 2.1 passes per patient. For fine-needle aspiration, average instrument time was 7.8 minutes per pass, and average cutting-needle core biopsy time was 9.2 minutes. CONCLUSIONS: Interactive MRI guidance for needle biopsy and aspiration of deep head and neck lesions is feasible, successful, and safe. Procedure times are sufficiently short to be well tolerated by the patient.