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Interventional CMR

Non-invasive Imaging: Magnetic Resonance Imaging

Clinical MR-guided Interventions
Dr Muthurangu reiterated his message from last year’s conference that there is still poor dissemination of MR-guided interventions, and suggested the question was “not can we, but should we?” He discussed the benefits of MR versus conventional angiography, however verification is needed in terms of cost-effectiveness and improving patient outcomes. He suggested that the number of patients required to power RCTs would be high, even for more straightforward interventions such as coarctation stenting; however, he called for proponents of MR-guided intervention to be ambitious and push for involvement in a wide variety of applications in search of the “killer app” that could firmly establish MRI’s interventional value. He concluded by saying that for now, the use of XMR in pulmonary hypertension has proven benefits in dedicated hybrid labs in paediatrics, but could potentially be feasible in any well co-located environment for adult patients.

New MR-acquisitions

Dr Faranesh described MRI-intervention protocols, including novel interactive control parameters developed at the NHLBI. He showed how local field gradients created by interventional devices can be used to create positive contrast, opening the door to a wider range of “off-the-shelf” interventional equipment. He went on to describe using Gadolinium-tipped balloons to aid MRI-catheter navigation, and the development of new active devices. He stressed the need for real-time imaging with fast acquisition times, particularly in paediatrics and pharmacological provocation studies, and the use of low flip angles to reduce the SAR and local heating.

Safety and Regulatory Approval of New Devices
Mr Wedan described the rigorous processes of regulatory approval involved in bringing devices and sequences from a prototype stage to clinical applications, including aftermarket mechanisms (customer feedback and adverse event reporting). He gave an example of potential safety mechanisms that could be introduced by vendors during MRI-guided procedures that would prevent inappropriate SAR levels and local heating from catheters if used outside of their approved conditions.

Paving the Way Towards MR-guided Dilatation and Stenting of Coarctation
Dr Ewert discussed the potential benefits of MRI specifically in coarctation. He compared it to the steep learning curve of TOE use ASD closure, and noted that whilst proof of concept for interventional MRI has been around 10 years, it has not yet been widely adopted. A major issue is the poor availability of MRI-compatible equipment (guidewires, catheters etc.) and he called for more involvement from industry. Sufficient spatial and temporal resolution is still a limitation compared with conventional angiography; however the technology continues to evolve. He concluded that for MR-guided procedures to have a more prominent role in the future a stronger partnership with interventional colleagues with clear, defined roles and a broader range of applications is needed.

MR-guided Interventions
Professor Neizel-Wittke outlined the role of renal denervation therapy in patients with resistant hypertension, and the importance of judicious patient selection, particularly following the controversies of the Simplicity HNT-3 trial results. She demonstrated the advanced MRI-suite set-up in Düsseldorf and how this has been used for performing renal denervation in pigs using active tracking with MRI to map and target the ablation site. This has the potential benefits of both providing lesion imaging through T2-weighted sequences, and the possibility of establishing an endpoint (oedema) to confirm successful ablation.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.