Magnetic resonance guided renal denervation using active tracking: first in vivo experience in Swine
Magnetic resonance guided renal denervation using active tracking: first in vivo experience in Swine
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DOI：
10.1007/s10554-017-1244-6
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发表时间：
2018-03-01
影响因子：
2.1
通讯作者：
Neizel-Wittke，M.
中科院分区：
文献类型：
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作者：
Boenner，F.;Haberkorn，S.;Neizel-Wittke，M.
介入性心血管磁共振（iCMR）可能会发展成为一种技术，通过结合术中指导和同步病变成像来提高心血管介入治疗的手术成功率。本研究的目的是证明的可行性和评估的安全性，肾交感神经去神经支配的实时iCMR使用主动跟踪。在1.5 T MRI系统（Achieva，Philips Healthcare，Best，Netherlands）中检查了6只猪，该系统配备有无创血流动力学控制和显示介入软件平台的室内监视器[Interventional MRI Suite（iSuite），Philips Research，Hamburg，德国]。使用具有主动跟踪功能的MR特定条件安全非灌注消融导管（Imricor，伯恩斯维尔，MN，USA）进行MR引导的肾脏去神经支配。使用TFE序列进行器械引导实时成像，使用3D非造影剂血管造影和速度编码成像评估血管通畅性。通过高分辨率T2 SPIR序列显示肾动脉水肿。去肾交感神经在所有病例中均可行，所有动物均存活。非造影剂血管造影显示肾动脉通畅，消融前后所有病例的血流条件相同，通过速度编码成像测量。水肿成像显示介入治疗前后肾动脉消融部位的相对信号强度显著增加（p < 0.05）。组织学检查未发现穿孔或出血迹象，同时可描述足够的消融病变。使用主动跟踪的MR引导的肾交感神经去神经是可行的，并且初始数据表明该手术的安全性。MR引导的肾交感神经去神经提供了高软组织对比度的固有强度，从而在不使用碘化造影剂或辐射的情况下提供目标信息。
Interventional cardiovascular magnetic resonance (iCMR) might evolve as a technique to improve procedural success rates in cardiovascular interventions by combining intraprocedural guidance and simultaneous lesion imaging. The objective of the present study was to prove feasibility and estimate safety of renal sympathetic denervation guided by real-time iCMR using active tracking. Six pigs were examined in a 1.5 T MRI-System (Achieva, Philips Healthcare, Best, Netherlands) equipped with non-invasive hemodynamic control and in-room monitors displaying an interventional software platform [Interventional MRI Suite (iSuite), Philips Research, Hamburg, Germany]. MR-guided renal denervation was performed using a MR conditional non-irrigated ablation catheter with active tracking (Imricor, Burnsville, MN, USA). Real-time imaging for device guidance was performed with a TFE sequence, vessel patency was assessed with a 3D non-contrast angiography and velocity encoded imaging. Oedema of the renal artery was visualized by a high-resolution T2 SPIR sequence. Renal sympathetic denervation was feasible in all cases with survival of all animals. Non-contrast angiography displayed renal artery patency accompanied by equal flow conditions before and after the ablation in all cases as measured by velocity encoded imaging. Oedema imaging displayed a significant increase in relative signal intensity at renal artery ablations sites pre and post intervention (p < 0.05). The histologic examination revealed no signs of perforation or bleeding, while sufficient ablation lesions could be depicted. MR-guided renal sympathetic denervation using active tracking is feasible and the initial data suggest safety of this procedure. MR-guided renal sympathetic denervation offers the inherent strength of high soft tissue contrast thereby providing target information without the use of iodinated contrast agents or radiation.