Austin James Taylor1, Zion Tse1, Ehud Schmidt2, Matthew Miller1, Mable Fok1, and Kent Nilsson3
1Engineering, The University of Georgia, Athens, GA, United States, 2Department of Radiology, Brigham and Women's Hospital, Boston, MA, United States, 3Medicine, The University of Georgia, Athens, GA, United States
Synopsis
Catheter ablation is a common electrophysiological (EP) procedure to treat irregular heart rhythm conditions, such as atrial fibrillation. Catheter ablation can be assisted through the use of imaging coils under magnetic resonance imaging (MRI) which provides a roadmap for preoperative preparation and intraoperative catheter navigation. Intra-cardiac imaging coils allow for ablated lesions to be observed in real time with excellent soft tissue contrast, providing electrophysiologists better control over the result of the procedure. We present a novel catheter design which integrates a unique origami deployable mechanism for enabling parallel MR imaging in MRI guided EP procedures.Purpose
The
purpose of the work is to develop an expandable catheter structure for
deploying imaging coils inside the heart lumens for MRI-guided electrophysiological
(EP) studies. Approximately 750,000 people are hospitalized each year in the US
due to atrial fibrillation (AF) [1]. Intra-cardiac (IC) radiofrequency
ablation (RFA) treatment is a catheter-based minimally invasive procedure in
which abnormal tissue in the pulmonary veins is ablated to electrically
inactivate the sites causing the irregular heart rhythm. Roadmaps for
preoperative preparation and intraoperative catheter navigation can be provided
by multi-parametric MRI (e.g. T2-weighted and Late Gadolinium Enhancement
imaging). Through the use of an IC imaging coil, the ablated lesions can be
observed in real time with excellent soft tissue contrast and lesion
visualization, providing electrophysiologists better control over the result of
the procedure.
Invivo high element
receive-coil arrays have shown accelerated
imaging rates and enhanced image resolution [2]. This work integrates existing parallel MR
imaging technology with a highly expanding origami mechanical catheter
structure to achieve superior signal-to-noise ratio (SNR) IC MRI. This study presents
a novel catheter instrument with unique origami deployable mechanisms for enabling
intra-cardiac parallel MR imaging in MRI guided EP procedures.
Methods
The
ICMRI catheter deployable mechanism is modified from a previous catheter design
[3]. The new deployable mechanism
(Fig. 1a) contains multiple imaging coils to enable MR parallel imaging. The
coils were directly printed onto the catheter structure and fabricated with a
low-cost disposable design without the need of sterilization. The structure was
developed by micro-fabricating a 60 mm x 60 mm piece of biocompatible polycaprolactone
into an iso-area flasher origami pattern (Fig. 1b) , and contains an
approximately 10:1 deployed to stowed ratio. Four imaging coils were
constructed by printing square-shaped copper circuits in each corner of the
structure. Tuning and matching coils (Fig. 2a) were mounted to the catheter
structure, connected to the imaging coils, and wired to the proximal end of the
catheter through micro-coaxial cables. The embedded circuit was tuned at 127.7
MHz (3T Larmor frequency) with -7.81 dB and matched to 50 ohm through the use
of a network analyzer (Fig. 2b). As a result, the signal-to-noise ratio (SNR)
was intensified at the resonant frequency of the MRI scanner, providing increased
image resolution and soft tissue visualization. An optimal shape design was
determined by evaluating the geometric components, the mechanical strength of
the structure, along with the space necessary for storing tuning and matching
electronics.
Results
High contrast image quality was obtained with the
previous catheter design during ex-vivo swine left-ventricular (LV) and
left-atrial (LA) imaging. A 2-4 times SNR increment in MR images was acquired
using ICMRI versus Invivo array coils at distances of 5-8 cm from the coil, for
both T1-w GRE and T2-w TSE. A 4-16 times faster imaging time was demonstrated
with the ICMRI catheter, improving temporal efficiency.
Conclusion
The ICMRI catheter increases image resolution
and contrast visualization of soft tissue. The origami deployable catheter mechanism
allows for a low-cost disposable design where multiple imaging coils could be directly
printed on the catheter, potentially enhancing the imaging capabilities. The origami
design could also be applied to other medical applications that involve expandable
structures. In future work, the ICMRI catheter design for MR imaging and
MR-guided EP procedures will be evaluated through in vivo studies in swine
models.
Acknowledgements
This
material is based upon work supported by a NSF REU site program 1359095, AHA
10SDG261039, and UGA-GRU seed grantsReferences
[1] Center
for Disease Control. (2015). Atrial
Fibrillation. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_atrial_fibrillation.htm
[2] C. J. Hardy, R. D. Darrow, M.
Saranathan, R. O. Giaquinto, Y. Zhu, C. L. Dumoulin, et al., "Large field-of-view real-time MRI with a 32-channel
system," Magnetic resonance in
medicine, vol. 52, pp. 878-884, 2004.
[3] Y. Chen, T. T. Zion, W. Wang, R. Y.
Kwong, W. G. Stevenson, and E. J. Schmidt, "Intra-cardiac MR imaging &
MR-tracking catheter for improved MR-guided EP," Journal of Cardiovascular Magnetic Resonance, vol. 17, p. P237,
2015.