Kevan Anderson

Innovations in imaging for chronic total occlusions: a glimpse into the future of angiography’s blind-spot

Chronic total occlusions (CTOs) are a subset of lesions that present a considerable burden to cardiovascular patients. There exists a strong clinical desire to improve non-surgical options for CTO revascularization. While several techniques, devices, and guide wires have been developed and refined for use in CTOs, the inability of angiography to adequately visualize occluded arterial segments makes interventions in this setting technically challenging. This review describes the current status of several invasive and non-invasive imaging techniques that may facilitate improved image guidance during CTO revascularization, with the goals of improving procedure safety and efficacy while reducing the time required to complete these interventions. Cardiac imaging also has important potential roles in selecting patients most likely to benefit from revascularization as well as pre-procedural planning, post-procedural assessment of revascularized segments and long-term outcomes studies. Modalities discussed include non-invasive techniques, such as CT(computed tomography) angiography and cardiac magnetic resonance imaging (MRI), as well as invasive techniques, such as intravascular ultrasound, optical coherence tomography, intravascular MRI, and conventional angiography. While some of these techniques have some evidence to support their use at present, others are at earlier stages of development. Strategies that combine imaging techniques with the use of interventional therapies may provide significant opportunities to improve results in CTO interventions and represent an active area of investigation.

Electrostatic forward-viewing scanning probe for Doppler optical coherence tomography using a dissipative polymer catheter

A novel flexible scanning optical probe is constructed with a finely etched optical fiber strung through a platinum coil in the lumen of a dissipative polymer. The packaged probe is 2.2 mm in diameter with a rigid length of 6mm when using a ball lens or 12 mm when scanning the fiber proximal to a gradient-index (GRIN) lens. Driven by constant high voltage (1-3 kV) at low current (< 5 microA), the probe oscillates to provide wide forward-viewing angle (13 degrees and 33 degrees with ball and GRIN lens designs, respectively) and high-frame-rate (10-140 fps) operation. Motion of the probe tip is observed with a high-speed camera and compared with theory. Optical coherence tomography (OCT) imaging with the probe is demonstrated with a wavelength-swept source laser. Images of an IR card as well as in vivo Doppler OCT images of a tadpole heart are presented. This optomechanical design offers a simple, inexpensive method to obtain a high-frame-rate forward-viewing scanning probe.

Forward-looking intravascular orthogonal-solenoid coil for imaging and guidance in occlusive arterial disease.

Recent intravascular imaging coil configurations have focused on side‐viewing catheters capable of imaging the vessel wall of a patent vessel. These designs suffer from the presence of signal nulls and the inability to image in front of a device when it is oriented along the main static field. This is of particular importance when a device is being navigated through an occlusive lesion. To address these limitations we propose a new intravascular coil design consisting of two independent orthogonal solenoids located at the catheter tip. The two coils are oriented in such a way that signal nulls are eliminated and imaging is possible in planes located directly in front of the catheter. Complete characterization of the spatial signal‐to‐noise ratio (SNR) distribution of the design is presented. The coil configuration was fabricated on a 6F guide catheter, and its use is demonstrated in phantoms and in vivo. Magn Reson Med 60:489–495, 2008.

Safely assessing radiofrequency heating potential of conductive devices using image-based current measurements.

Many procedures involving catheters and implanted medical devices could benefit from MRI guidance but are currently contraindicated due to risk of significant heating near linear conductive structures. A priori safety prediction is impossible in vivo and thus, safety is typically investigated in vitro by directly measuring temperature rise. Existing methods of investigating safety are inflexible and provide few data. Furthermore, they are fundamentally limited because dangerous temperatures rises can only be investigated if induced. A method of remotely predicting safety is necessary for ensuring safety in patients.

Catheter Tracking With Phase Information in a Magnetic Resonance Scanner

The purpose of this study is to describe a new active technique for accurately determining both the position and orientation of the tip of a catheter during magnetic resonance (MR)-guided percutaneous cardiovascular procedures. The technique utilizes phase information introduced into the MR signal from a small receive coil located on the distal tip of the catheter. Phase patterns around a small receive coil are rich in information that is directly related to position and orientation. This information can be collected over a large spherical volume with a diameter several times that of the receive coil. The high degree of redundancy yields the potential for an accurate and robust method of catheter tracking. A tracking algorithm is presented that performs catheter tip localization using phase images acquired in two orthogonal planes without any a priori knowledge of catheter position. Associated experimentation demonstrating feasibility is also presented.

Parallel radiofrequency transmission at 3 tesla to improve safety in bilateral implanted wires in a heterogeneous model

Elongated implanted conductors can interact with the radiofrequency (RF) transmission field during MRI, posing safety concerns of excessive heating in patients with deep brain stimulators. A technique using parallel RF transmission (pTx) is evaluated on an anthropomorphic heterogeneous model with bilateral and unilateral curved wires.

Investigation of micro-ultrasound for microvessel imaging in a model of chronic total occlusion.

The aim of the current study is to investigate the ability of micro-ultrasound (μUS) to identify microvasculature in CTOs in vivo. Results are compared with MRI studies. CTOs were developed in nine porcine superficial femoral arteries (SFA) by percutaneous insertion of a dissolvable polymer plug. This model is characterized by acute thrombosis that later organizes into a fibrotic CTO containing abundant microchannels. 3D μUS images with Power Doppler (PD) overlays from the arteries were acquired at two timepoints: one and eight weeks after placement of the polymer plug. Phase contrast MRI and contrast enhanced MRI was also performed. Imaging was performed transcutaneously. Microvessels were identified in vivo in six of eight CTOs using μUS, and in three of seven CTO vessels with MRI, compared with five of seven seen histologically. PW Doppler profiles showed pulsatile blood velocities of ∼2 cm/s. Intraluminal microvessels within CTOs can be consistently identified by 3D μUS. This technique appears to be more sensitive than MRI. μUS may play a role in guiding CTO interventions.

Intrinsic MRI visualizes RF lesions within minutes after MR-guided ablation

Background MR visualization of RF lesions is an application of growing interest with the potential for translation to clinical ablation procedures. In particular, intrinsic-contrast MRI avoids the dynamic contrast produced in typical Gd-based MRI, and may differentiate the reversible and irreversible thermal injury thought to be caused by RF ablation. This distinction is important for assessing the permanence of ablation to eradicate the substrate of ventricular tachycardia in structural heart disease. In this study we investigate the potential of intrinsic-contrast MRI to visualize the features of thermal injury and evolution of RF lesions that may occur immediately after ablation.

Respiratory motion model based correction for improving the targeting accuracy of MRI-guided intracardiac electrophysiology procedures

Background Recently, there is an increased interest in using MRI to guide electrophysiology (EP) procedures as an alternative to X-ray fluoroscopy guidance, due to its excellent soft tissue contrast and lack of radiation. However, there exist tradeoffs between different MRI guidance schemes. Realtime 2D MR sequences are able to capture heart motion during an interventional setting, while sacrificing imaging quality, whereas high-resolution prior 3D roadmaps are static and do not reflect the respiratory motion of the heart. In this work, we explore the feasibility of deriving a motion model from these two complementary datasets, and evaluate its potential for improving the targeting accuracy of MRI-guided EP procedures.

Tuning and amplification strategies for intravascular imaging coils.

The manufacturing of intravascular imaging coils poses several challenges. Due to their size, it can be difficult to incorporate local matching networks and signal amplifiers. The goal of this study is to investigate tuning and amplification strategies for intravascular coils and to assess the signal‐to‐noise benefits of incorporating a matching network and/or miniature amplifier into catheter‐based intravascular imaging devices at various locations in the signal chain. The results suggest that the use of a low‐noise amplifier close to the receiving coil enables the use of miniature coaxial cables to be used despite being noisy. Moreover, an improvement in the signal‐to‐noise ratio of over 75% is presented over conventional intravascular coil configurations where the matching circuit and low‐noise amplifier are placed at the proximal end. Therefore, designing devices for intravascular applications capable of generating high signal‐to‐noise ratio images becomes more feasible, also allowing for significant reductions in scan time. Magn Reson Med, 2012.