Real-Time MRI Guided Intervention
This presentation is the property of its rightful owner.
Sponsored Links
1 / 34

Presenter Disclosure Information PowerPoint PPT Presentation


  • 68 Views
  • Uploaded on
  • Presentation posted in: General

Real-Time MRI Guided Intervention Henry R. Halperin, M.D., M.A., F.A.H.A. Johns Hopkins University School of Medicine Departments of Medicine, Radiology, Biomedical Engineering Baltimore, MD USA. Presenter Disclosure Information. Henry R Halperin, MD, MA.

Download Presentation

Presenter Disclosure Information

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Presenter disclosure information

Real-Time MRI Guided Intervention Henry R. Halperin, M.D., M.A., F.A.H.A.Johns Hopkins University School of MedicineDepartments of Medicine, Radiology, Biomedical EngineeringBaltimore, MD USA


Presenter disclosure information

Presenter Disclosure Information

Henry R Halperin, MD, MA

Disclosure Information...The following relationships exist related to this presentation:

Equity Interest: Lexmed, Significant

Equity Interest: Surgivision, Modest

Grant Support: RO1 HL64795, K24 HL04194, Significant Consulting Fees: Boston Scientific, Modest

Off label use: Catheters in MRI, Gadolinium for cardiac studies


3d image integration

3D Image Integration

Current State of the Art


Pulmonary vein isolation atrial fibrillation ablation

Pulmonary Vein Isolation: Atrial Fibrillation Ablation


Can achieve 100 pv isolation

Can Achieve ~100% PV Isolation

But:

20-50% recurrence rate


Underestimation of gaps lesions cannot be visualized directly

Underestimation of Gaps:Lesions cannot be visualized directly

Dong, Halperin, et al: Circulation. 2006;113:186-194.

Gaps can have reversible conduction block !


Underestimation of lesion presence

Underestimation of Lesion Presence

  • Conventional PVI using X-rays and Navx

  • Pt moved to MRI scanner via transport system

  • Viability imaging with MRI

  • 40% of Navx marked ablation sites did not have lesions

Rhode K, Knowles B, Razavi R: SCMR 2009


Real time mr guided intervention

Real-Time MR Guided Intervention

The Future and/or Now?


Presenter disclosure information

Rationale for Using MRI

  • Accurate anatomy

  • Visualize different kinds of soft tissue (ablated)

  • Real-time 3-D imaging

  • No ionizing radiation

  • Similar cost as bi-plane x-ray system


Real time mr guided studies

Real-Time MR Guided Studies

The technology


Mri compatible clinical catheters

500

~

~

<

MRI Compatible Clinical Catheters

  • Irvine Biomedical Inc

  • IDE and IRB Approved

  • Limited imaging power (SAR)

Nazarian et al: Circulation. 2008 Jul 15;118(3):223-9


Presenter disclosure information

500

~

~

SAR Amplification Factor

<

  • Improved torque transmission (non-magnetic wire braid)

  • Improved heating suppression

Improved MRI Compatible Catheters

Susil et al: Mag Res Med, 47(3):584-600, 2002


Presenter disclosure information

IEGM Recording During MR Imaging

MRI compatible catheter in RV apex.

GE 1.5T CV/I

Fiesta (SSFP)

TR/TE 3.2/1.1

FA 45o

FOV 48x12cm

ST 2cm

128x32

BW 128 kHz

10 frames/sec

IEGM


Intracardiac electrograms with multiple catheters

Intracardiac Electrograms(with multiple catheters)

HRA

HBE

RVA

Outside Scanner Inside Scanner During Imaging

Nazarian et al: Circulation. 2008 Jul 15;118(3):223-9


Catheter manipulation using real time imaging

Catheter ManipulationUsing Real Time Imaging


Catheter manipulation

Catheter Manipulation


Dynamic heart with real time plane

Dynamic Heart with Real-Time Plane


Mr guided studies

MR Guided Studies

What does it give us?


Lesion visualization

Lesion Visualization


Presenter disclosure information

Imaging Ablated Ventricular Tissue

Pre Ablation Post Ablation

Lardo et al, Circ 2000;

102(6):698-705


Gadolinium lesion enhancement

Gadolinium Lesion Enhancement

Dickfeld et al, JACC, 2006;47:370-8


Accuracy of lesion size estimates

Accuracy of Lesion Size Estimates

Contrast-Void

Delayed Enhancement

Dickfeld et al, JACC, 2006;47:370-8


Mri thermography proton precession rate phase is temperature sensitive

MRI Thermography (Proton precession rate (phase) is temperature sensitive)

DEMRI

Path

Temperature Evolution


One lesion placed under mri guidance

One Lesion Placed under MRI Guidance


Presenter disclosure information

LA Imaging Compared with Histology

MR Image

MRI

Histopathology

Histology

R = 0.89, p < 0.001, n=20

Lardo et al, Circ 2000;102(6):698-705


Imaging la ablation chronically

Imaging LA Ablation Chronically

Wylie J, Peters D, Josephson M, Manning W, et al: Heart Rhythm 2008;5:656‚Äď662


Imaging la ablation chronically after second procedure completion of isolation

Imaging LA Ablation Chronically(after second procedure - completion of isolation)

McGann C, Marrouche N, et al: J Am Coll Cardiol 2008;52:1263‚Äď71


Closing the gaps in linear lesions

Closing the Gaps in Linear Lesions

Prediction of Conduction Block


Filling in gaps and conduction block

Pace

20 ms

Sense

40 ms

Gap Closed

Pace

Pace

Sense

Sense

Conduction Block

Filling In Gaps and Conduction Block

Gap Open

Pace

Sense


Real time mri guided study in patients

Real-Time MRI Guided Study in Patients

IDE and IRB Approved


Mr guided ep study setup

MR Guided EP Study Setup

  • Conscious Sedation

  • Monitoring

    • O2 Sat

    • NIBP

    • ECG

Nazarian et al: Circulation. 2008 Jul 15;118(3):223-9


Real time mri guided ep study

Real-Time MRI Guided EP Study

Nazarian et al: Circulation.

2008 Jul 15;118(3):223-9


Summary

Summary

  • MR can be used to guide catheter navigation in real time

  • MR images can be obtained in real time duringelectrogram acquisition and during ablation

  • Ablated tissue and true anatomy can be visualized

  • Imaging characteristics may be able to predict the presence of conduction block

  • This approach may improve safety and efficacy of many ablations

  • Ablations in patients to start end of summer


Investigators

Hiroshi Ashikaga

Ergin Atalar

Ronald Berger

David Bluemke

Paul Bottomley

Hugh Calkins

Timm Dickfeld

Jun Dong

Yoav Dori

Rob Evers

Owen Faris

Ahmet Genc

Michael Guttman

Rozann Hansford

Ritsushi Kato

Lars Lickfett

Investigators

  • Aravindin Kolandeavelu

  • Jennifer LaCorte

  • Albert Lardo

  • Joao Lima

  • Elliot McVeigh

  • Glenn Meininger

  • Frank Miller

  • Saman Nazarian

  • Erez Nevo

  • Nael Osman

  • Ravi Ranjan

  • Ariel Roguin

  • Meiyappan Solaiyappan

  • Robert Susil

  • Menekhem Zviman


  • Login