Basic Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2015; 7(7): 415-422
Published online Jul 26, 2015. doi: 10.4330/wjc.v7.i7.415
Feasibility of real-time magnetic resonance imaging-guided endomyocardial biopsies: An in-vitro study
Dirk Lossnitzer, Sebastian A Seitz, Birgit Krautz, Bernhard Schnackenburg, Florian André, Grigorios Korosoglou, Hugo A Katus, Henning Steen
Dirk Lossnitzer, Sebastian A Seitz, Birgit Krautz, Florian André, Grigorios Korosoglou, Hugo A Katus, Henning Steen, Department of Cardiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
Bernhard Schnackenburg, Philips Medical Systems, 20099 Hamburg, Germany
Author contributions: Lossnitzer D, Seitz SA, Krautz B and André F performed the research; Lossnitzer D, Seitz SA and Steen H designed the research and wrote the paper; Schnackenburg B, Korosoglou G and Katus HA contributed to the new analytic tools and reviewing the paper.
Supported by The German Research Foundation (KA493/6_1).
Institutional review board statement: The study was not reviewed by the University of Heidelberg Institutional Review Board since there were no patients enrolled and only phantoms and explanted pig hearts which were bought by a regional butcher were used.
Institutional animal care and use committee: All procedures involving animals were reviewed and approved by the Institutional Animal Care and Use Committee of the Regierungspräsidium Karlsruhe Case Number 35-9185.81/G-79/12.
Conflict-of-interest statement: There were no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dirk Lossnitzer, MD, Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. dirk.lossnitzer@medma.uni-heidelberg.de
Telephone: +49-6221-650412 Fax: +49-3212-1067858
Received: January 16, 2015
Peer-review started: January 16, 2015
First decision: March 20, 2015
Revised: June 2, 2015
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: July 26, 2015
Processing time: 200 Days and 5.6 Hours
Abstract

AIM: To investigate if magnetic resonance (MR)-guided biopsy can improve the performance and safety of such procedures.

METHODS: A novel MR-compatible bioptome was evaluated in a series of in-vitro experiments in a 1.5T magnetic resonance imaging (MRI) system. The bioptome was inserted into explanted porcine and bovine hearts under real-time MR-guidance employing a steady state free precession sequence. The artifact produced by the metal element at the tip and the signal voids caused by the bioptome were visually tracked for navigation and allowed its constant and precise localization.

RESULTS: Cardiac structural elements and the target regions for the biopsy were clearly visible. Our method allowed a significantly better spatial visualization of the bioptoms tip compared to conventional X-ray guidance. The specific device design of the bioptome avoided inducible currents and therefore subsequent heating. The novel MR-compatible bioptome provided a superior cardiovascular magnetic resonance (imaging) soft-tissue visualization for MR-guided myocardial biopsies. Not at least the use of MRI guidance for endomyocardial biopsies completely avoided radiation exposure for both patients and interventionalists.

CONCLUSION: MRI-guided endomyocardial biopsies provide a better than conventional X-ray guided navigation and could therefore improve the specificity and reproducibility of cardiac biopsies in future studies.

Keywords: Endomyocardial biopsy; Cardiovascular magnetic resonance (imaging); Magnetic resonance imaging-guided interventions; Real-time imaging

Core tip: Myocardial biopsy is the method of choice for assessing tissue pathologies. Cardiac magnetic resonance imaging (MRI) provides a 3D visualization and discrimination of soft-tissue and could therefore enable a targeted specimen sampling. We developed a novel MR-compatible bioptome which was evaluated by in-vitro experiments in a 1.5T MRI system under real-time MR-guidance. MRI-guided endomyocardial biopsies provide a superior soft-tissue visualization, a better than conventional X-ray guided navigation and could therefore improve the specificity and reproducibility of cardiac biopsies in future studies. Not at least the use of MRI guidance for endomyocardial biopsies completely avoided radiation exposure for both patients and interventionalists.