MRI-guided endovascular intervention: current methods and future potential

ABSTRACT

Introduction

Image-guided endovascular interventions, performed using the insertion and navigation of catheters through the vasculature, have been increasing in number over the years, as minimally invasive procedures continue to replace invasive surgical procedures. Such endovascular interventions are almost exclusively performed under x-ray fluoroscopy, which has the best spatial and temporal resolution of all clinical imaging modalities. Magnetic resonance imaging (MRI) offers unique advantages and could be an attractive alternative to conventional x-ray guidance, but also brings with it distinctive challenges.

Areas covered

In this review, the benefits and limitations of MRI-guided endovascular interventions are addressed, systems and devices for guiding such interventions are summarized, and clinical applications are discussed.

Expert opinion

MRI-guided endovascular interventions are still relatively new to the interventional radiology field, since significant technical hurdles remain to justify significant costs and demonstrate safety, design, and robustness. Clinical applications of MRI-guided interventions are promising but their full potential may not be realized until proper tools designed to function in the MRI environment are available. Translational research and further preclinical studies are needed before MRI-guided interventions will be practical in a clinical interventional setting.

KEYWORDS:

• MRI-guided
• endovascular intervention
• interventional radiology
• interventional MRI
• minimally invasive surgery
• robot-assisted
• MRI safety
• real-time MRI

Article highlights

• Interventional MRI possesses unique benefits over standard x-ray fluoroscopy including superior soft-tissue contrast, no ionizing radiation, and measurement of quantitative biomarkers.

• Due to the significant technical effort and expertise needed, MRI-guided endovascular interventions are only recommended for situations in which MRI provides a significant advantage over other modalities.

• Current commercially available interventional devices lack MRI compatibility and safety profiles. Key characteristics must include the ability to visualize the distal tip without sacrificing MRI safety and mechanical performance.

• Clinical adoption of interventional MRI requires future generations of MRI-conditional and MRI-safe devices to facilitate better tracking and treatment in real-time.

Declaration of interest

Steven W. Hetts declares Grant support from NIH paid to UCSF; Research contracts from Siemens Medical Solutions, Route 92 Medical, and Stryker Neurovascular paid to UCSF; Payments from Data Safety and Monitoring Committee for Imperative Care, Cerenovus, and MicroVention Terumo; Equity in ThrombX and Filtro, Inc. None of these are directly relevant to the work presented. Kerstin Mueller is an Employee of Siemens Medical Solutions USA Inc. Alastair J. Martin has received a research grant support from ClearPoint Neuro and is a consultant for Iota Biosciences. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewers disclosure

One of the reviewers has several investments in companies that produce iMRI components and own patents in that field. The other peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This work was supported by the National Insitutes of Health (NIH) under Grant R01 EB012031.