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  • Oral presentation
  • Open Access

In-vitro evaluation of a novel MR-compatible cardiac bioptome catheter for MR-guided myocardial biopsies

  • 1,
  • 1,
  • 2,
  • 1 and
  • 1
Journal of Cardiovascular Magnetic Resonance201214 (Suppl 1) :O32

https://doi.org/10.1186/1532-429X-14-S1-O32

  • Published:

Keywords

  • Cardiac Magnetic Resonance
  • Myocarditis
  • Cardiac Magnetic Resonance Imaging
  • Soft Tissue Contrast
  • Acute Myocarditis

Background

Retrieval of myocardial biopsies under X-ray guidance in patients with unclear myocardial dysfunction or acute myocarditis is a difficult and potentially hazardous procedure since soft tissues only offer low X-ray contrast during the procedure and extraction of biopsies could cause myocardial rupture and concomitant haemopericardium. In contrast, cardiac magnetic resonance imaging provides excellent soft-tissue and anatomic information, especially for inflamed and fibrotic areas. MR-guided myocardial biopsies would therefore be attractive but could not be performed until now due to incompatible bioptome catheters leading to substantial image artifacts and significant device heating.

Evaluation a novel MR-compatible bioptome in in-vitro experiments to assess potential artifacts, safety aspects and performance of MR-guided navigation under real-time imaging in a cylindrical 1.5T system.

Methods

The bioptome was evaluated in a series of in-vitro experiments in an 1.5T MRI system (Philips Achieva). The specific device design (non-disclosure) avoided inducible currents and subsequent heating. The bioptome was introduced and navigated inside a) plastinated cow and swine hearts and b) a plastic heart model. The first model forms a true anatomic environment containing all relevant morphological structures (figure 1(A). The second model was derived from a human cardiac CT scan using rapid prototyping (figure 1(B)). Both phantom types were placed inside a saline filled plastic box. The MR-guidance was conducted with a continuous SSFP imaging sequence (frame rate=2 images/s) by visually tracking the artifact introduced by the metal element at the tip.

Figure 1

Results

The metal tip of the bioptome produced an artifact that allowed constant and precise ex-vivo tip localization. The artifact size was approximately 3.3x3 cm (figure 1(C),1(D)). The different structural elements of the heart and the target regions for the biopsy were clearly visible enabling a significantly better navigation of the tip than in conventional X-ray. The shaft of the bioptome caused no artifacts.

Conclusions

With the novel MR compatible bioptome, the superior CMR soft tissue visualization can be made available for MR-guided myocardial biopsies overcoming the limited soft tissue contrast on X-ray images. Clinically, this could significantly reduce the high amount of necessary specimen to overcome the sample error under X-ray and secondly improve the specificity and reliability of cardiac biopsies. Thirdly, MR-guided biopsies would minimize X-ray dose for the patient and especially the interventionalist.

Funding

None.

Authors’ Affiliations

(1)
Department of Cardiology, University of Heidelberg, Heidelberg, Germany
(2)
H. + H. Maslanka Chirurgische Instrumente GmbH, Tuttlingen, Germany

Copyright

© Seitz et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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