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Real-time magnetic resonance imaging guidance improves the yield of endomyocardial biopsy
© Rogers et al. 2016
- Published: 27 January 2016
- Late Gadolinium Enhancement
- Diagnostic Yield
- Endomyocardial Biopsy
- Late Gadolinium Enhancement Imaging
- Fluorescent Microsphere
In current practice, the diagnostic yield of endomyocardial biopsy is low because the procedure is performed ‘blind' using X-ray fluoroscopy guidance and because many pathologies affect the myocardium in a patchy distribution. We hypothesized that biopsy performed under direct realtime MRI guidance would have superior diagnostic yield, in an animal model of focal myocardium pathology.
An active visualization MR conditional bioptome was designed and built for transcatheter endomyocardial biopsy (MRI Interventions, Irvine, CA). A porcine model of focal myocardial pathology that enhances with late gadolinium enhancement imaging and that contained fluorescent tags that are easily identifiable under ultraviolet light was created. Under X-ray fluoroscopy, selective coronary artery catheterization was performed and 3 mL of fluorescent microspheres (NuFlow Hydrocoat, 15μm diameter, 5 million spheres/mL) was infused, followed by 2 mL of 100% ethanol to create a focal lesion. Animals were survived for min 7 days, after which each animal underwent both MRI and X-ray guided biopsy. Specimens were analysed using a Leica MZFIII dissecting microscope under transmitted or ultraviolet light with a 400-480 nm band pass filter.
Endomyocardial biopsy under direct real-time MRI guidance using an active visualization MRI-conditional bioptome is feasible. Using this bioptome we demonstrate targeted biopsy of focal myocardial pathology. Compared with X-ray fluoroscopy guided endomyocardial biopsy, MRI guidance substantially improves the diagnostic yield in an animal model of focal myocardial pathology.
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/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.