Zukunftstechnologien der kardiovaskulären Magnetresonanztomografie: interventionelle kardiovaskuläre MRT

Zusammenfassung

Die Vorteile der interventionellen kardiovaskulären MRT sind neben der fehlenden Strahlenbelastung und dem Verzicht auf jodhaltige Kontrastmittel auch die Möglichkeit der Darstellung von Morphologie und Funktionsparametern in einer Untersuchung. Zudem realisiert die MRT eine gute Darstellung des Weichteilgewebes. Vor allem in den Bereichen strukturelle Herzerkrankung, rhythmologische Störungen und Kardiomyopathien/Myokarditis hat die interventionelle kardiovaskuläre MRT großes Potenzial. Im Bereich der koronaren Herzerkrankung werden derzeit noch keine großen Vorteile der interventionellen MRT gegenüber der herkömmlichen Durchleuchtung gesehen. In mehreren klinischen Studien konnte bereits die Machbarkeit von MRT-gesteuerten diagnostischen Rechtsherzkathetern bei komplexen Patienten nachgewiesen werden. Auch MRT-gesteuerte diagnostische elektrophysiologische Untersuchungen und Ablationen wurden bereits unter Nutzung der Läsionsdarstellung im MRT realisiert. Zusätzlich konnten auch bereits erste MRT-gesteuerte Pulmonalklappensprengungen am Patienten durchgeführt werden. Für eine breite klinische Anwendung müssen jedoch noch einige Probleme gelöst werden; so müssen z. B. MR-kompatible Devices Einzug halten und es muss eine sicherere Ortung von Kathetern ermöglicht werden.

Abstract

The advantage of interventional cardiovascular interventions is the ability to provide information about morphology, soft tissue contrast and functional parameters in one examination without using ionizing radiation or iodid contrast agent. Especially in the areas of structural heart disease, rhythm disorders or cardiomyopathy/myocarditis there is great potential for interventional cardiovascular MRI. Clinical studies could already demonstrate the feasibility of MR-guided diagnostic right heart catheter in complexe patients. Furthermore, MR-guided electrophysiology examinations including ablations could be realized. Moreover, pulmonary valve implantations could be acomplished in patients. During the last years interventional cardiovascular MRI has made lots of improvement, however, for a widely used clinical use, still some problems have to be overcome including MR safe devices and especially localisation of these devices during the intervention.

Schlüsselwörter

interventionelle kardiovaskuläre MRT - strukturelle Herzerkrankung - elektrophysiologische Untersuchungen

Key words

interventional cardiovascular MRI - structural heart disease - electrophysiology

• Literatur

• 1 Yutzy SR, Duerk JL. Pulse sequences and system interfaces for interventional and real-time MRI. J Magn Reson Imaging 2008; 27: 267-275
• 2 Razavi R, Hill DL, Keevil SF et al. Cardiac catheterisation guided by MRI in children and adults with congenital heart disease. Lancet 2003; 362: 1877-1882
• 3 Kuehne T, Yilmaz S, Schulze-Neick I et al. Magnetic resonance imaging guided catheterisation for assessment of pulmonary vascular resistance: in vivo validation and clinical application in patients with pulmonary hypertension. Heart 2005; 91: 1064-1069
• 4 Muthurangu V, Taylor A, Andriantsimiavona R et al. Novel method of quantifying pulmonary vascular resistance by use of simultaneous invasive pressure monitoring and phase-contrast magnetic resonance flow. Circulation 2004; 110: 826-834
• 5 Ratnayaka K, Faranesh AZ, Hansen MS et al. Real-time MRI-guided right heart catheterization in adults using passive catheters. Eur Heart J 2013; 34: 380-389
• 6 Nordbeck P, Hiller KH, Fidler F et al. Feasibility of contrast-enhanced and nonenhanced MRI for intraprocedural and postprocedural lesion visualization in interventional electrophysiology: animal studies and early delineation of isthmus ablation lesions in patients with typical atrial flutter. Circ Cardiovasc Imaging 2011; 4: 282-294
• 7 Akoum N, Daccarett M, McGann C et al. Atrial fibrosis helps select the appropriate patient and strategy in catheter ablation of atrial fibrillation: a DE-MRI guided approach. J Cardiovasc Electrophysiol 2011; 22: 16-22
• 8 Mahnkopf C, Badger TJ, Burgon NS et al. Evaluation of the left atrial substrate in patients with lone atrial fibrillation using delayed-enhanced MRI: implications for disease progression and response to catheter ablation. Heart Rhythm 2010; 7: 1475-1481
• 9 Eitel C, Piorkowski C, Hindricks G et al. Electrophysiology study guided by real-time magnetic resonance imaging. Eur Heart J 2012; 33: 1975
• 10 Nordbeck P, Quick HH, Ladd ME et al. Real-time magnetic resonance guidance of interventional electrophysiology procedures with passive catheter visualization and tracking. Heart Rhythm 2011; Dec 19 [Epub ahead of print]
• 11 Sommer P, Grothoff M, Eitel C et al. Feasibility of real-time magnetic resonance imaging-guided electrophysiology studies in humans. Europace 2013; 15: 101-108
• 12 Nordbeck P, Beer M, Kostler H et al. Cardiac catheter ablation under real-time magnetic resonance guidance. Eur Heart J 2012; 33: 1977
• 13 Neizel M, Kramer N, Bonner F et al. Rapid right ventricular pacing with MR-compatible pacemaker lead for MR-guided aortic balloon valvuloplasty in swine. Radiology 2010; 255: 799-804
• 14 Kahlert P, Parohl N, Albert J et al. Real-time magnetic resonance imaging-guided transarterial aortic valve implantation: in vivo evaluation in swine. J Am Coll Cardiol 2012; 59: 192-193
• 15 Tzifa A, Krombach GA, Kramer N et al. Magnetic resonance-guided cardiac interventions using magnetic resonance-compatible devices: a preclinical study and first-in-man congenital interventions. Circ Cardiovasc Interv 2010; 3: 585-592
• 16 Mahrholdt H, Goedecke C, Wagner A et al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004; 109: 1250-1258
• 17 Leyva F, Taylor R, Foley PW et al. Left ventricular midwall fibrosis as a predictor of mortality and morbidity after cardiac resynchronization therapy in patients with nonischemic cardiomyopathy. J Am Coll Cardiol 2012; 60: 1659-1667
• 18 Hauck AJ, Kearney DL, Edwards WD. Evaluation of postmortem endomyocardial biopsy specimens from 38 patients with lymphocytic myocarditis: implications for role of sampling error. Mayo Clin Proc 1989; 64: 1235-1245
• 19 Koos R, Neizel M, Schummers G et al. Feasibility and initial experience of assessment of mechanical dyssynchrony using cardiovascular magnetic resonance and semi-automatic border detection. J Cardiovasc Magn Reson 2008; 10: 49
• 20 Nezafat R, Han Y, Peters DC et al. Coronary magnetic resonance vein imaging: imaging contrast, sequence, and timing. Magn Reson Med 2007; 58: 1196-1206
• 21 Neizel M, Kramer N, Schutte A et al. Magnetic resonance imaging of the cardiac venous system and magnetic resonance-guided intubation of the coronary sinus in swine: a feasibility study. Invest Radiol 2010; 45: 502-506