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Endovascular Stents in Pulmonary Valve and Artery in Swine: Feasibility Study of MR Imaging–guided Deployment and Postinterventional Assessment¹

¹ From the Department of Radiology (T.K., M.S., C.B.H., G.A.K., O.M.W.) and the Division of Pediatric Cardiology (T.K., K.G., D. Turner, D. Teitel, P.M.), University of California San Francisco, 505 Parnassus Ave, L308, San Francisco, CA 94143-0628; Institute for Biomedical Engineering, Swiss Federal Institute of Technology and University of Zurich, Switzerland (O.M.W.); and Philips Medical Systems, Best, the Netherlands (A.J.M.). Received October 5, 2001; revision requested December 18; final revision received May 31, 2002; accepted July 10. Address correspondence to C.B.H. (e-mail: charles.higgins@radiology.ucsf.edu).

View larger version (151K): [in a new window]   Figure 1. Interventional MR imaging and angiography suite used in the present study. The two adjoining units are connected by a sliding table (arrow), which allows transport of a subject from one unit to the other without changing position.

View larger version (124K): [in a new window]   Figure 2. (Left) Oblique sagittal T1-weighted turbo field-echo MR image (3.9/1.3) and (right) balanced fast field-echo MR image (3.4/1.7) of the heart and great vessels. Note good contrast between guide wire and background anatomy on T1-weighted turbo field-echo image (arrows). Curvature information for the guide wire was obtained along the tortuous anatomy of the inferior vena cava, right atrium (RA), right ventricular outflow tract, and pulmonary artery by using a section thickness of 30 mm. Conversely, the corresponding electrocardiography-gated balanced fast field-echo image (section thickness, 5 mm) contains detailed anatomic information. RV = right ventricle, LA = left atrium, LV = left ventricle.

View larger version (173K): [in a new window]   Figure 3. Series of oblique transverse balanced fast field-echo MR images (3.4/1.7, 7-mm-thick sections). A, Image obtained through right ventricular outflow tract (RVO) and pulmonary artery (PA). Ao = aorta. B, Image shows guide wire and stent delivery system across pulmonary valve (arrow). C, Stent was released when tip of application system (arrowhead) was seen approximately 10 mm distal to the pulmonary valve (arrow). D, Image shows stent (arrow) immediately after deployment.

View larger version (88K): [in a new window]   Figure 4. Oblique coronal T1-weighted turbo field-echo MR images (3.9/1.3) of lung. Tip of balloon catheter was filled with either (left) air (arrow) or (right) 1% solution of gadodiamide (arrow). Visualization of air-filled balloon against low-signal-intensity background of lung was not possible. In contrast, gadodiamide-doped balloon was reliably visualized and helped confirm position of catheter tip in distal branch of pulmonary arteries.

View larger version (158K): [in a new window]   Figure 5. Multisection multiphase balanced fast field-echo image (3.4/1.7) shows postinterventional assessment of pulmonary artery and stent positioned across pulmonary valve. Depiction of wall of pulmonary artery adjacent to stent is partially superimposed by susceptibility artifacts of stent (signal void, arrow).

View larger version (155K): [in a new window]   Figure 6. Velocity-encoding cine MR images (15/3.8) of pulmonary artery. (Left) magnitude and (right) phase images were acquired orthogonal to nitinol stent in main pulmonary artery position. Presence of low-signal-intensity ring around pulmonary artery on magnitude image represents susceptibility artifacts derived from stent. High signal intensity within stent lumen on phase image is indicative of forward flow in pulmonary artery during systole.