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Journal of Cardiovascular Magnetic Resonance

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Open Access 01-12-2017 | Research

Feasibility of real-time MR thermal dose mapping for predicting radiofrequency ablation outcome in the myocardium in vivo

Authors: Solenn Toupin, Pierre Bour, Matthieu Lepetit-Coiffé, Valéry Ozenne, Baudouin Denis de Senneville, Rainer Schneider, Alexis Vaussy, Arnaud Chaumeil, Hubert Cochet, Frédéric Sacher, Pierre Jaïs, Bruno Quesson

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

Abstract

Background

Clinical treatment of cardiac arrhythmia by radiofrequency ablation (RFA) currently lacks quantitative and precise visualization of lesion formation in the myocardium during the procedure. This study aims at evaluating thermal dose (TD) imaging obtained from real-time magnetic resonance (MR) thermometry on the heart as a relevant indicator of the thermal lesion extent.

Methods

MR temperature mapping based on the Proton Resonance Frequency Shift (PRFS) method was performed at 1.5 T on the heart, with 4 to 5 slices acquired per heartbeat. Respiratory motion was compensated using navigator-based slice tracking. Residual in-plane motion and related magnetic susceptibility artifacts were corrected online. The standard deviation of temperature was measured on healthy volunteers (N = 5) in both ventricles. On animals, the MR-compatible catheter was positioned and visualized in the left ventricle (LV) using a bSSFP pulse sequence with active catheter tracking. Twelve MR-guided RFA were performed on three sheep in vivo at various locations in left ventricle (LV). The dimensions of the thermal lesions measured on thermal dose images, on 3D T1-weighted (T1-w) images acquired immediately after the ablation and at gross pathology were correlated.

Results

MR thermometry uncertainty was 1.5 °C on average over more than 96% of the pixels covering the left and right ventricles, on each volunteer. On animals, catheter repositioning in the LV with active slice tracking was successfully performed and each ablation could be monitored in real-time by MR thermometry and thermal dosimetry. Thermal lesion dimensions on TD maps were found to be highly correlated with those observed on post-ablation T1-w images (R = 0.87) that also correlated (R = 0.89) with measurements at gross pathology.

Conclusions

Quantitative TD mapping from real-time rapid CMR thermometry during catheter-based RFA is feasible. It provides a direct assessment of the lesion extent in the myocardium with precision in the range of one millimeter. Real-time MR thermometry and thermal dosimetry may improve safety and efficacy of the RFA procedure by offering a reliable indicator of therapy outcome during the procedure.

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Tanner H, Hindricks G, Volkmer M, Furniss S, KüHlkamp V, Lacroix D, De Chillou C, Almendral J, Caponi D, Kuck K-H, Kottkamp H. Catheter Ablation of Recurrent Scar-Related Ventricular Tachycardia Using Electroanatomical Mapping and Irrigated Ablation Technology: Results of the Prospective Multicenter Euro-VT-Study. J Cardiovasc Electrophysiol. 2010;21:47–53.CrossRefPubMed

Weerasooriya R, Khairy P, Litalien J, Macle L, Hocini M, Sacher F, Lellouche N, Knecht S, Wright M, Nault I, Miyazaki S, Scavee C, Clementy J, Haissaguerre M, Jais P. Catheter Ablation for Atrial Fibrillation. J Am Coll Cardiol. 2011;57:160–6.CrossRefPubMed

Eick OJ. Temperature controlled radiofrequency ablation. Indian Pacing Electrophysiol J. 2002;2:66.PubMedPubMedCentral

Cappato R, Calkins H, Chen S-A, Davies W, Iesaka Y, Kalman J, Kim Y-H, Klein G, Natale A, Packer D, Skanes A, Ambrogi F, Biganzoli E. Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2010;3:32–8.CrossRefPubMed

Seror O, Lepetit-Coiffé M, Le Bail B, de Senneville BD, Trillaud H, Moonen C, Quesson B. Real time monitoring of radiofrequency ablation based on MR thermometry and thermal dose in the pig liver in vivo. Eur Radiol. 2008;18:408–16.CrossRefPubMed

Holbrook AB, Santos JM, Kaye E, Rieke V, Pauly KB. Real-time MR thermometry for monitoring HIFU ablations of the liver. Magn Reson Med. 2010;63:365–73.CrossRefPubMedPubMedCentral

Ramsay E, Mougenot C, Köhler M, Bronskill M, Klotz L, Haider MA, Chopra R. MR thermometry in the human prostate gland at 3.0 T for transurethral ultrasound therapy: Prostate MR Thermometry at 3 T. J Magn Reson Imaging. 2013;38:1564–71.CrossRefPubMedPubMedCentral

McDannold N, Tempany CM, Fennessy FM, So MJ, Rybicki FJ, Stewart EA, Jolesz FA, Hynynen K. Uterine leiomyomas: MR imaging–based thermometry and thermal dosimetry during focused ultrasound thermal ablation 1. Radiology. 2006;240:263–72.CrossRefPubMedPubMedCentral

de Senneville BD, Mougenot C, Quesson B, Dragonu I, Grenier N, Moonen CTW. MR thermometry for monitoring tumor ablation. Eur Radiol. 2007;17:2401–10.CrossRefPubMed

10.

Lipsman N, Schwartz ML, Huang Y, Lee L, Sankar T, Chapman M, Hynynen K, Lozano AM. MR-guided focused ultrasound thalamotomy for essential tremor: a proof-of-concept study. Lancet Neurol. 2013;12:462–8.CrossRefPubMed

11.

Sapareto SA, Dewey WC. Thermal dose determination in cancer theray. Int Contact Lens Clin. 1989;16:340–6.CrossRef

12.

Kolandaivelu A, Zviman MM, Castro V, Lardo AC, Berger RD, Halperin HR. Noninvasive assessment of tissue heating during cardiac radiofrequency ablation using MRI thermography. Circ Arrhythm Electrophysiol. 2010;3:521–9.CrossRefPubMedPubMedCentral

13.

de Senneville BD, Roujol S, Jaïs P, Moonen CTW, Herigault G, Quesson B. Feasibility of fast MR-thermometry during cardiac radiofrequency ablation: Feasibility Of Fast Mr-Thermometry During Cardiac Rf Ablation. NMR Biomed. 2012;25:556–62.CrossRefPubMed

14.

Ozenne V, Toupin S, Bour P, de Senneville BD, Lepetit-Coiffé M, Boissenin M, Benois-Pineau J, Hansen MS, Inati SJ, Govari A, others: Improved cardiac magnetic resonance thermometry and dosimetry for monitoring lesion formation during catheter ablation. Magn Reson Med 2016. Advance online publication.doi:10.1002/mrm.26158.

15.

Grissom WA, Rieke V, Holbrook AB, Medan Y, Lustig M, Santos J, McConnell MV, Pauly KB. Hybrid referenceless and multibaseline subtraction MR thermometry for monitoring thermal therapies in moving organs. Med Phys. 2010;37:5014.CrossRefPubMedPubMedCentral

16.

de Senneville BD, Ries M, Maclair G, Moonen C. MR-Guided Thermotherapy of Abdominal Organs Using a Robust PCA-Based Motion Descriptor. IEEE Trans Med Imaging. 2011;30:1987–95.CrossRefPubMed

17.

Vergara GR, Vijayakumar S, Kholmovski EG, Blauer JJE, Guttman MA, Gloschat C, Payne G, Vij K, Akoum NW, Daccarett M, McGann CJ, MacLeod RS, Marrouche NF. Real-time magnetic resonance imaging–guided radiofrequency atrial ablation and visualization of lesion formation at 3 Tesla. Heart Rhythm. 2011;8:295–303.CrossRefPubMed

18.

Hey S, Cernicanu A, de Senneville BD, Roujol S, Ries M, Jaïs P, Moonen CTW, Quesson B. Towards optimized MR thermometry of the human heart at 3 T: CARDIAC MR THERMOMETRY AT 3 T. NMR Biomed. 2012;25:35–43.CrossRefPubMed

19.

Köhler MO, Denis de Senneville B, Quesson B, Moonen CTW, Ries M. Spectrally selective pencil-beam navigator for motion compensation of MR-guided high-intensity focused ultrasound therapy of abdominal organs. Magn Reson Med. 2011;66:102–11.CrossRefPubMed

20.

Hansen MS, Sørensen TS. Gadgetron: An open source framework for medical image reconstruction: Gadgetron. Magn Reson Med. 2013;69:1768–76.CrossRefPubMed

21.

Denis de Senneville B, El Hamidi A, Moonen C. A Direct PCA-Based Approach for Real-Time Description of Physiological Organ Deformations. IEEE Trans Med Imaging. 2015;34:974–82.CrossRefPubMed

22.

Roujol S, Ries M, Quesson B, Moonen C, Denis de Senneville B. Real-time MR-thermometry and dosimetry for interventional guidance on abdominal organs. Magn Reson Med. 2010;63:1080–7.CrossRefPubMed

23.

Bing C, Staruch RM, Tillander M, Köhler MO, Mougenot C, Ylihautala M, et al. Drift correction for accurate PRF-shift MR thermometry during mild hyperthermia treatments with MR-HIFU. Int J Hyperthermia. 2016;32:673–87.

24.

Weidensteiner C, Quesson B, Caire-Gana B, Kerioui N, Rullier A, Trillaud H, Moonen CT. Real-time MR temperature mapping of rabbit liver in vivo during thermal ablation. Magn Reson Med. 2003;50:322–30.CrossRefPubMed

25.

Guttman M, Kolandaivelu A, Fink S, Halperin H, Herzka DA. Towards MRI-guided cardiac ablation procedures with no contrast agent: safety and efficacy considerations. J Cardiovasc Magn Reson. 2016;18 Suppl 1:213.CrossRef

26.

Ikeda A, Nakagawa H, Lambert H, Shah DC, Fonck E, Yulzari A, Sharma T, Pitha JV, Lazzara R, Jackman WM. Relationship Between Catheter Contact Force and Radiofrequency Lesion Size and Incidence of Steam Pop in the Beating Canine Heart: Electrogram Amplitude, Impedance, and Electrode Temperature Are Poor Predictors of Electrode-Tissue Contact Force and Lesion Size. Circ Arrhythm Electrophysiol. 2014;7:1174–80.CrossRefPubMed

27.

Dickfeld T, Kato R, Zviman M, Lai S, Meininger G, Lardo AC, Roguin A, Blumke D, Berger R, Calkins H, Halperin H. Characterization of Radiofrequency Ablation Lesions With Gadolinium-Enhanced Cardiovascular Magnetic Resonance Imaging. J Am Coll Cardiol. 2006;47:370–8.CrossRefPubMedPubMedCentral

28.

Celik H, Ramanan V, Barry J, Ghate S, Leber V, Oduneye S, Gu Y, Jamali M, Ghugre N, Stainsby JA, et al. Intrinsic contrast for characterization of acute radiofrequency ablation lesions. Circ Arrhythm Electrophysiol. 2014;7:718–27.CrossRefPubMed

29.

Kholmovski E, Ranjan R, Angel N, Vijayakumar S, Marrouche NF. Visibility of RF ablation lesions in native T1-weighted MRI reduces with time after ablation. J Cardiovasc Magn Reson. 2016;18 Suppl 1:196.CrossRef

30.

Lustig M, Donoho D, Pauly JM. Sparse MRI: The application of compressed sensing for rapid MR imaging. Magn Reson Med. 2007;58:1182–95.CrossRefPubMed

31.

Forman C, Piccini D, Grimm R, Hutter J, Hornegger J, Zenge MO. Reduction of respiratory motion artifacts for free-breathing whole-heart coronary MRA by weighted iterative reconstruction: Weighted Iterative Reconstruction for CMRA. Magn Reson Med. 2015;73:1885–95.CrossRefPubMed

32.

Dumoulin CL, Souza SP, Darrow RD. Real-time position monitoring of invasive devices using magnetic resonance. Magn Reson Med. 1993;29:411–5.CrossRefPubMed

33.

Wang P, Unal O. Motion-compensated real-time MR thermometry augmented by tracking coils: Real-time MR Thermometry. J Magn Reson Imaging. 2015;41:851–7.CrossRefPubMed

34.

Volland NA, Kholmovski EG, Parker DL, Hadley JR. Initial feasibility testing of limited field of view magnetic resonance thermometry using a local cardiac radiofrequency coil: Limited FOV MR Thermometry with Local Coil. Magn Reson Med. 2013;70:994–1004.CrossRefPubMed

35.

Ertürk MA, Sathyanarayana Hegde S, Bottomley PA. Radiofrequency Ablation, MR Thermometry, and High-Spatial-Resolution MR Parametric Imaging with a Single, Minimally Invasive Device. Radiology. 2016;281:927–32.

Title: Feasibility of real-time MR thermal dose mapping for predicting radiofrequency ablation outcome in the myocardium in vivo
Authors: Solenn Toupin
Pierre Bour
Matthieu Lepetit-Coiffé
Valéry Ozenne
Baudouin Denis de Senneville
Rainer Schneider
Alexis Vaussy
Arnaud Chaumeil
Hubert Cochet
Frédéric Sacher
Pierre Jaïs
Bruno Quesson
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-017-0323-0

At a glance: The STEP trials

Springer Medicine

Feasibility of real-time MR thermal dose mapping for predicting radiofrequency ablation outcome in the myocardium in vivo

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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