Improved passive catheter tracking with positive contrast for CMR-guided cardiac catheterization using partial saturation (pSAT)

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Abstract

Background

Cardiac catheterization is a common procedure in patients with congenital heart disease (CHD). Although cardiovascular magnetic resonance imaging (CMR) represents a promising alternative approach to fluoroscopy guidance, simultaneous high contrast visualization of catheter, soft tissue and the blood pool remains challenging. In this study, a novel passive tracking technique is proposed for enhanced positive contrast visualization of gadolinium-filled balloon catheters using partial saturation (pSAT) magnetization preparation.

Methods

The proposed pSAT sequence uses a single shot acquisition with balanced steady-state free precession (bSSFP) readout preceded by a partial saturation pre-pulse. This technique was initially evaluated in five healthy subjects. The pSAT sequence was compared to conventional bSSFP images acquired with (SAT) and without (Non-SAT) saturation pre-pulse. Signal-to-noise ratio (SNR) of the catheter balloon, blood and myocardium and the corresponding contrast-to-noise ratio (CNR) are reported. Subjective assessment of image suitability for CMR-guidance and ideal pSAT angle was performed by three cardiologists. The feasibility of the pSAT sequence is demonstrated in two adult patients undergoing CMR-guided cardiac catheterization.

Results

The proposed pSAT approach provided better catheter balloon/blood contrast and catheter balloon/myocardium contrast than conventional Non-SAT sequences. It also resulted in better blood and myocardium SNR than SAT sequences. When averaged over all volunteers, images acquired with a pSAT angle of 20° to 40° enabled simultaneous visualization of the catheter balloon and the cardiovascular anatomy (blood and myocardium) and were found suitable for CMR-guidance in >93% of cases. The pSAT sequence was successfully used in two patients undergoing CMR-guided diagnostic cardiac catheterization.

Conclusions

The proposed pSAT sequence offers real-time, simultaneous, enhanced contrast visualization of the catheter balloon, soft tissues and blood. This technique provides improved passive tracking capabilities during CMR-guided catheterization in patients.

Electronic supplementary material

The online version of this article (doi:10.1186/s12968-017-0368-0) contains supplementary material, which is available to authorized users.

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Most cited references 30

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Dynamic autocalibrated parallel imaging using temporal GRAPPA (TGRAPPA).

Peter Kellman, Felix A. Breuer, Mark Griswold … (2005)

Current parallel imaging techniques for accelerated imaging require a fully encoded reference data set to estimate the spatial coil sensitivity information needed for reconstruction. In dynamic parallel imaging a time-interleaved acquisition scheme can be used, which eliminates the need for separately acquiring additional reference data, since the signal from directly adjacent time frames can be merged to build a set of fully encoded full-resolution reference data for coil calibration. In this work, we demonstrate that a time-interleaved sampling scheme, in combination with autocalibrated GRAPPA (referred to as TGRAPPA), allows one to easily update the coil weights for the GRAPPA algorithm dynamically, thereby improving the acquisition efficiency. This method may update coil sensitivity estimates frame by frame, thereby tracking changes in relative coil sensitivities that may occur during the data acquisition. Copyright 2005 Wiley-Liss, Inc.

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Adaptive sensitivity encoding incorporating temporal filtering (TSENSE).

Peter Kellman, Frederick Epstein, Elliot Mcveigh (2001)

A number of different methods have been demonstrated which increase the speed of MR acquisition by decreasing the number of sequential phase encodes. The UNFOLD technique is based on time interleaving of k-space lines in sequential images and exploits the property that the outer portion of the field-of-view is relatively static. The differences in spatial sensitivity of multiple receiver coils may be exploited using SENSE or SMASH techniques to eliminate the aliased component that results from undersampling k-space. In this article, an adaptive method of sensitivity encoding is presented which incorporates both spatial and temporal filtering. Temporal filtering and spatial encoding may be combined by acquiring phase encodes in an interleaved manner. In this way the aliased components are alternating phase. The SENSE formulation is not altered by the phase of the alias artifact; however, for imperfect estimates of coil sensitivities the residual artifact will have alternating phase using this approach. This is the essence of combining temporal filtering (UNFOLD) with spatial sensitivity encoding (SENSE). Any residual artifact will be temporally frequency-shifted to the band edge and thus may be further suppressed by temporal low-pass filtering. By combining both temporal and spatial filtering a high degree of alias artifact rejection may be achieved with less stringent requirements on accuracy of coil sensitivity estimates and temporal low-pass filter selectivity than would be required using each method individually. Experimental results that demonstrate the adaptive spatiotemporal filtering method (adaptive TSENSE) with acceleration factor R = 2, for real-time nonbreath-held cardiac MR imaging during exercise induced stress are presented.

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Real-time MRI-guided right heart catheterization in adults using passive catheters.

Majdi Halabi, Kanishka Ratnayaka, Benjamin Wright … (2013)

Real-time MRI creates images with superb tissue contrast that may enable radiation-free catheterization. Simple procedures are the first step towards novel interventional procedures. We aim to perform comprehensive transfemoral diagnostic right heart catheterization in an unselected cohort of patients entirely using MRI guidance. We performed X-ray and MRI-guided transfemoral right heart catheterization in consecutive patients undergoing clinical cardiac catheterization. We sampled both cavae and both pulmonary arteries. We compared success rate, time to perform key steps, and catheter visibility among X-ray and MRI procedures using air-filled or gadolinium-filled balloon-tipped catheters. Sixteen subjects (four with shunt, nine with coronary artery disease, three with other) underwent paired X-ray and MRI catheterization. Complete guidewire-free catheterization was possible in 15 of 16 under both. MRI using gadolinium-filled balloons was at least as successful as X-ray in all procedure steps, more successful than MRI using air-filled balloons, and better than both in entering the left pulmonary artery. Total catheterization time and individual procedure steps required approximately the same amount of time irrespective of image guidance modality. Catheter conspicuity was best under X-ray and next-best using gadolinium-filled MRI balloons. In this early experience, comprehensive transfemoral right heart catheterization appears feasible using only MRI for imaging guidance. Gadolinium-filled balloon catheters were more conspicuous than air-filled ones. Further workflow and device enhancement are necessary for clinical adoption.

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Author and article information

Contributors

Mari Nieves Velasco Forte: mnieves.velasco@kcl.ac.uk

Kuberan Pushparajah: kuberan.pushparajah@gstt.nhs.uk

Tobias Schaeffter: tobias.schaeffter@kcl.ac.uk

Israel Valverde Perez: isra.valverde@kcl.ac.uk

Kawal Rhode: kawal.rhode@kcl.ac.uk

Bram Ruijsink: jacobus.ruijsink@kcl.ac.uk

Mazen Alhrishy: mazen.m.alhrishy@kcl.ac.uk

Nicholas Byrne: nicholas.byrne@kcl.ac.uk

Amedeo Chiribiri: amedeo.chiribiri@kcl.ac.uk

Tevfik Ismail: tevfik.ismail@kcl.ac.uk

Tarique Hussain: mohammad.hussain@utsouthwestern.edu

Reza Razavi: reza.razavi@kcl.ac.uk

Sébastien Roujol:

ORCID: http://orcid.org/0000-0002-7146-0552

+44 207 188 4597 , sebastien.roujol@kcl.ac.uk

Journal

Journal ID (nlm-ta): J Cardiovasc Magn Reson

Journal ID (iso-abbrev): J Cardiovasc Magn Reson

Title: Journal of Cardiovascular Magnetic Resonance

Publisher: BioMed Central (London )

ISSN (Print): 1097-6647

ISSN (Electronic): 1532-429X

Publication date (Electronic): 15 August 2017

Publication date PMC-release: 15 August 2017

Publication date Collection: 2017

Volume: 19

Electronic Location Identifier: 60

Affiliations

[1 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Division of Imaging Sciences and Biomedical Engineering, , King’s College London, St Thomas’ Hospital, ; 3rd Floor Lambeth Wing, Westminster Bridge Road, London, SE1 7EH UK

[2 ]GRID grid.420545.2, Department of Congenital Heart Disease, , Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, ; London, UK

[3 ]ISNI 0000 0004 1773 7922, GRID grid.414816.e, Cardiovascular Pathology Unit, , Institute of Biomedicine of Seville, IBIS, Virgen del Rocio University Hospital/CSIC/University of Seville, ; Seville, Spain

[4 ]GRID grid.420545.2, Department of Medical Physics, , Guy’s and St. Thomas’ NHS Foundation Trust, ; London, UK

[5 ]ISNI 0000 0000 9482 7121, GRID grid.267313.2, Dept. of Pediatrics, , University of Texas Southwestern Medical Center, ; 1935 Medical District Drive, Dallas, USA

Author information

Sébastien Roujol http://orcid.org/0000-0002-7146-0552

Article

Publisher ID: 368

DOI: 10.1186/s12968-017-0368-0

PMC ID: 5556659

PubMed ID: 28806996

SO-VID: d13dc406-8d4d-46e0-b405-84957ff595f9

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 20 February 2017

Date accepted : 29 June 2017

Funding

Funded by: National Institute for Health Research (GB)

Award ID: MRJKAGR

Custom metadata

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: interventional cmr,congenital heart disease,cardiac catheterization,device tracking

Data availability:

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: interventional cmr, congenital heart disease, cardiac catheterization, device tracking

Improved passive catheter tracking with positive contrast for CMR-guided cardiac catheterization using partial saturation (pSAT)

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Abstract

Background

Methods

Results

Conclusions

Electronic supplementary material

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Cardiovascular Innovations and Applications

Most cited references 30

Dynamic autocalibrated parallel imaging using temporal GRAPPA (TGRAPPA).

Adaptive sensitivity encoding incorporating temporal filtering (TSENSE).

Real-time MRI-guided right heart catheterization in adults using passive catheters.

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