Abstract
BackgroundImage-guided endovascular interventions have gained increasing popularity in clinical practice, and magnetic resonance imaging (MRI) is emerging as an attractive alternative to X-ray fluoroscopy for guiding such interventions. Steering catheters by remote control under MRI guidance offers unique challenges and opportunities.MethodsIn this review, the benefits and limitations of MRI-guided remote control intervention are addressed, and the tools for guiding such interventions in the magnetic environment are summarized. Designs for remote control catheter guidance include a catheter tip electromagnetic microcoil design, a ferromagnetic sphere-tipped catheter design, smart material-actuated catheters, and hydraulically actuated catheters. Remote control catheter guidance systems were compared and contrasted with respect to visualization, safety, and performance. Performance is characterized by bending angles achievable by the catheter, time to achieve bending, degree of rotation achievable, and miniaturization capacity of the design. Necessary improvements for furthering catheter design, especially for use in the MRI environment, are addressed, as are hurdles that must be overcome in order to make MRI guided endovascular procedures more accessible for regular use in clinical practice.ConclusionsMR-guided endovascular interventions under remote control steering are in their infancy due to issues regarding safety and reliability. Additional experimental studies are needed prior to their use in humans.
Highlights
Image-guided endovascular interventions have gained increasing popularity in clinical practice, and magnetic resonance imaging (MRI) is emerging as an attractive alternative to X-ray fluoroscopy for guiding such interventions
A majority of interventions involve the use of a flexible catheter that is guided by the interventionalist into the appropriate vessels [9] under real-time X-ray fluoroscopy imaging
The last decade, including the development of near realtime dynamic MR “fluoroscopic” imaging sequences, steering catheters within blood vessels remains challenging as compared to steering of catheters under X-ray guidance
Summary
Image-guided endovascular interventions have gained increasing popularity in clinical practice, and magnetic resonance imaging (MRI) is emerging as an attractive alternative to X-ray fluoroscopy for guiding such interventions. The use of MRI for endovascular catheter navigation is a growing field of study with significant clinical promise, and many innovative techniques for guiding a catheter in the magnetic field of the MRI scanner are being proposed and tested [10,11]. The development of these augmented catheter guidance techniques stands to break down one of the most significant barriers to adoption of MRI as a realtime interventional guidance modality
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