磁共振介入成像及其临床应用进展

doi:10.16150/j.1671-2870.2024.02.002

摘要/Abstract

摘要：

介入治疗在神经、血管和乳腺等手术中广泛使用。在影像学检查引导下，机器人辅助的介入治疗可以有效提高介入治疗的精准性和安全性，已成为当前介入手术的重要发展方向。与其他介入成像方法相比，磁共振介入成像（interventional magnetic resonance imaging, i-MRI）具有高软组织对比度、多对比度、可定量成像、无电离辐射等优点，在介入治疗的引导中具有巨大优势。然而，磁共振成像（magnetic resonance imaging，MRI）的成像速度相对较慢，对介入器械的兼容性要求高，是当前i-MRI引导治疗中面临的主要挑战。得益于快速i-MRI以及磁兼容介入设备等技术的发展，i-MRI在神经介入、心血管介入、前列腺介入以及乳腺介入等临床手术中发挥了重要的作用。本文总结i-MRI技术的发展现状及i-MRI的临床应用现状，分析i-MRI目前所面临的成像速度慢和时空分辨率难以平衡等挑战，并对i-MRI在多模态成像、实时MRI以及i-MRI引导下的介入机器人手术等方面的发展机遇进行展望。

关键词: 磁共振介入成像, 影像引导, 介入治疗, 临床应用

Abstract:

Interventional therapy has been widely used in surgeries involving neurology, vasculature, and breasts.Image-guided, robot-assisted interventional therapy significantly enhances surgical precision and safety, emerging as a critical trend in modern interventional surgery. Among various interventional imaging methods, interventional magnetic resonance imaging (i-MRI) stands out due to its excellent soft tissue differentiation, diverse imaging contrasts, ability to yield quantitative data, and no ionizing radiation. However, the challenges facing MRI-guided therapy include the relatively low speed of imaging and the stringent compatibility demands of interventional devices. Advance in the rapid i-MRI techniques and MR-compatible equipment have propelled i-MRI to a pivotal role in clinical applications, encompassing neurological, cardiovascular, prostate, and breast interventions. This review initially provides an overview of the current i-MRI landscape. It then consolidates the application of i-MRI in multiple medical interventions, offering illustrative examples. The article further delves into the obstacles posed by i-MRI, specifically slow imaging speed and the delicate spatiotemporal resolution balance. Ultimately, it envisages the growth potential of i-MRI in multimodal imaging, real-time MRI, and i-MRI-guided interventional robotic surgery.

Key words: Interventional magnetic resonance imaging, Image guidance, Interventional therapy, Clinical applications

中图分类号:

R815
R445.2

冯原, 何钊, 孙青芳, 孙伯民, 严福华, 杨广中. 磁共振介入成像及其临床应用进展[J]. 诊断学理论与实践, 2024, 23(02): 108-113.

FENG Yuan, HE Zhao, SUN Qingfang, SUN Bomin, YAN Fuhua, YANG Guangzhong. Advances in interventional magnetic resonance imaging and its clinical applications[J]. Journal of Diagnostics Concepts & Practice, 2024, 23(02): 108-113.

图/表 1

表1

i-MRI的临床应用

作者	应用场景	磁共振	实时成像	序列	TR/TE (ms)	空间分辨率 (mm³)	成像时间
He, et al ^[19]	脑组织介入(人体标本)	3.0T封闭式	是	3D GRE radial	4.58/1.76	1.00 $×$ 1.00 $×$ 3.00	0.73 s
He, et al ^[25]	脑穿刺活检	1.0T开放式	是	2D T1W-FFE	25/6.91	1.29 $×$ 1.30 $×$ 6.00	2.9 s
Lu, et al ^[26]	脑胶质瘤切除	3.0T移动式	否	3D T1W-MPRAGE	2 530/2.98	1.00 $×$ 1.00 $×$ 1.00	20 min
Larson, et al ^[11]	DBS电极植入	1.5T封闭式	否	3D TSE	2 000/80	1.00 $×$ 1.13 $×$ 1.50	54 s
Razavi, et al ^[12]	心脏导管术	1.5T	是	2D bSSFP	2.9/1.45	/	0.1 s
Overduin, et al ^[30]	前列腺穿刺	3.0T封闭式	是	2D bSSFP	4.16/2.03	1.88 $×$ 1.88 $×$ 5.00	0.33 s
Josan, et al ^[37]	前列腺肿瘤冷冻消融	0.5T开放式	是	2D T1W FSE	300/10.5	/	20 s
Spick, et al ^[34]	乳腺穿刺	1.5T	否	FLASH-3D	11/4.76	0.70 $×$ 0.70 $×$ 3.00	58 s
Hynynen, et al ^[13]	乳腺纤维肿瘤超声消融	1.5T封闭式	是	2D Fast spoiled gradient-echo	27.3/13.5	0.63 $×$ 1.25 $×$ 3.00	3.6 s

表1

参考文献 37

[1]	CAMPBELL-WASHBURN A E, FARANESH A Z, LEDERMAN R J, et al. Magnetic resonance sequences and rapid acquisition for MR-guided interventions[J]. Magn Reson Imaging Clin N Am, 2015, 23(4):669-679.
[2]	SCHULZ T, PUCCINI S, SCHNEIDER J P, et al. Interventional and intraoperative MR: review and update of techniques and clinical experience[J]. Eur Radiol, 2004, 14(12):2212-2227. doi: 10.1007/s00330-004-2496-9 pmid: 15480689
[3]	MUELLER P R, STARK D D, SIMEONE J F, et al. MR-guided aspiration biopsy: needle design and clinical trials[J]. Radiology, 1986, 161(3):605-609. pmid: 3786706
[4]	VAN SONNENBERG E, HAJEK P, GYLYS-MORIN V, et al. A wire-sheath system for MR-guided biopsy and drainage: laboratory studies and experience in 10 patients[J]. AJR, 1988, 151(4):815-817.
[5]	MATSUMOTO R, SELIG A M, COLUCCI V M, et al. Interstitial Nd-Yag laser ablation in normal rabbit liver- trial to maximize the size of laser-induced lesions[J]. Lasers Surg Med, 1992, 12(6):650-658.
[6]	CLINE H E, SCHENCK J F, HYNYNEN K, et al. MR-guided focused ultrasound surgery[J]. J Comput Assist Tomogr, 1992, 16(6):956-965. pmid: 1430448
[7]	NIMSKY C, GANSLANDT O, VON KELLER B, et al. Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients[J]. Radiology, 2004, 233(1):67-78. pmid: 15317949
[8]	李麟荪, 张学彬. 我国介入放射学新里程碑——磁共振介入治疗[J]. 介入放射学杂志, 2019, 28(11):1015-1016.
	LI L S, ZHANG X B. A new milestone in interventional radiology in China: magnetic resonance-guided interventional therapy[J]. J Int Radiol, 2019, 28(11):1015-1016.
[9]	李成利. 磁共振介入应用与前景[J]. 介入放射学杂志, 2019, 28(11):1017-1019.
	LI C L. The clinical application and prospect of interventional MRI景[J]. J Int Radiol, 2019, 28(11):1017-1019.
[10]	SCHENCK J F, JOLESZ F A, ROEMER P B, et al. Superconducting open-configuration MR imaging system for image-guided therapy[J]. Radiology, 1995, 195(3):805-814. pmid: 7754014
[11]	LARSON P S, STARR P A, BATES G, et al. An optimized system for interventional magnetic resonance ima-ging-guided stereotactic surgery: preliminary evaluation of targeting accuracy[J]. Neurosurgery, 2012, 70(1 Suppl Ope-rative):95-103.
[12]	RAZAVI R, HILL D L, KEEVIL S F, et al. Cardiac cathe-terisation guided by MRI in children and adults with congenital heart disease[J]. Lancet, 2003, 362(9399):1877-1882.
[13]	HYNYNEN K, POMEROY O, SMITH D N, et al. MR imaging-guided focused ultrasound surgery of fibroadenomas in the breast: a feasibility study[J]. Radiology, 2001, 219(1):176-185. pmid: 11274554
[14]	LUSTIG M, DONOHO D L, SANTOS J M, et al. Compressed sensing MRI[J]. IEEE Signal Proc Mag, 2008, 25(2):72-82.
[15]	UNTERBERG-BUCHWALD C, RITTER C O, REUPKE V, et al. Targeted endomyocardial biopsy guided by real-time cardiovascular magnetic resonance[J]. J Cardiovasc Magn Reson, 2017, 19(1):45.
[16]	HE Z, ZHU Y N, QIU S, et al. Low-rank and framelet based sparsity decomposition for interventional MRI reconstruction[J]. IEEE Trans Biomed Eng, 2022, 69(7):2294-2304.
[17]	WANG G, YE J C, DE MAN B. Deep learning for tomographic image reconstruction[J]. Nat Mach Intell, 2020, 2(12):737-748.
[18]	LIANG D, CHENG J, KE Z, et al. Deep magnetic resonance image reconstruction: inverse problems meet neural networks[J]. IEEE Signal Process Mag, 2020, 37(1):141-151.
[19]	HE Z, ZHU Y N, CHEN Y, et al. A deep unrolled neural network for real-time MRI-guided brain intervention[J]. Nat Commun, 2023, 14(1):8257. doi: 10.1038/s41467-023-43966-w pmid: 38086851
[20]	REICHERT A, REISS S, KRAFFT A J, et al. Passive needle guide tracking with radial acquisition and phase-only cross-correlation[J]. Magn Reson Med, 2021, 85(2):1039-1046.
[21]	OMARY R A, UNAL O, KOSCIELSKI D S, et al. Real-time MR imaging-guided passive catheter tracking with use of gadolinium-filled catheters[J]. J Vasc Interv Radiol, 2000, 11(8):1079-1085. doi: 10.1016/s1051-0443(07)61343-8 pmid: 10997475
[22]	WANG W. Magnetic Resonance-guided Active Catheter Tracking[J]. Magn Reson Imaging Clin N Am, 2015, 23(4):579-589. doi: 10.1016/j.mric.2015.05.009 pmid: 26499276
[23]	CHUBB H, HARRISON J L, WEISS S, et al. Development, preclinical validation, and clinical translation of a cardiac magnetic resonance - electrophysiology system with active catheter tracking for ablation of cardiac arrhythmia[J]. JACC Clin Electrophysiol, 2017, 3(2):89-103.
[24]	KETTENBACH J, KACHER D F, KANAN A R, et al. Intraoperative and interventional MRI: recommendations for a safe environment[J]. Minim Invasive Ther Allied Technol, 2006, 15(2):53-64. doi: 10.1080/13645700600640774 pmid: 16754187
[25]	HE X, LIU M, LIU C, et al. Real-time MR-guided brain biopsy using 1.0-T open MRI scanner[J]. Eur Radiol, 2019, 29(1):85-92. doi: 10.1007/s00330-018-5531-y pmid: 29948073
[26]	LU C Y, CHEN X L, CHEN X L, et al. Clinical application of 3.0 T intraoperative magnetic resonance combined with multimodal neuronavigation in resection of cerebral eloquent area glioma[J]. Medicine (Baltimore), 2018, 97(34):e11702.
[27]	OSTREM J L, ZIMAN N, GALIFIANAKIS N B, et al. Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson's disease[J]. J Neurosurg, 2016, 124(4):908-916. doi: 10.3171/2015.4.JNS15173 pmid: 26495947
[28]	KILBRIDE B F, NARSINH K H, JORDAN C D, et al. MRI-guided endovascular intervention: current methods and future potential[J]. Expert Rev Med Devices, 2022, 19(10):763-778. doi: 10.1080/17434440.2022.2141110 pmid: 36373162
[29]	MASOOM S N, SUNDARAM K M, GHANOUNI P, et al. Real-time MRI-guided prostate interventions[J]. Cancers (Basel), 2022, 14(8):1860.
[30]	OVERDUIN C G, HEIDKAMP J, ROTHGANG E, et al. Fast 3-T MR-guided transrectal prostate biopsy using an in-room tablet device for needle guide alignment: a feasibility study[J]. Eur Radiol, 2018, 28(11):4824-4831. doi: 10.1007/s00330-018-5497-9 pmid: 29789909
[31]	KLOTZ L, PAVLOVICH C P, CHIN J, et al. Magnetic resonance imaging-guided transurethral ultrasound ablation of prostate cancer[J]. J Urol, 2021, 205(3):769-779. doi: 10.1097/JU.0000000000001362 pmid: 33021440
[32]	LEHMAN C D, ISAACS C, SCHNALL M D, et al. Cancer yield of mammography, MR, and US in high-risk women: prospective multi-institution breast cancer screening study[J]. Radiology, 2007, 244(2):381-388. doi: 10.1148/radiol.2442060461 pmid: 17641362
[33]	LEE C H, DERSHAW D D, KOPANS D, et al. Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer[J]. J Am Coll Radiol, 2010, 7(1):18-27. doi: 10.1016/j.jacr.2009.09.022 pmid: 20129267
[34]	SPICK C, SCHERNTHANER M, PINKER K, et al. MR-guided vacuum-assisted breast biopsy of MRI-only lesions: a single center experience[J]. Eur Radiol, 2016, 26(11):3908-3916. pmid: 26984430
[35]	邢宁, 张爱莲, 王建东, 等. MRI引导下乳腺病灶真空辅助穿刺活检术的应用[J]. 中国介入影像与治疗学, 2014, 11(3):136-140.
	XING N, ZHANG A L, WANG J D, et al. Application of MRI-guided vacuum-assisted breast biopsy[J]. Chin J Interv Imag Ther, 2014, 11(3):136-140.
[36]	GIANFELICE D, KHIAT A, BOULANGER Y, et al. Feasibility of magnetic resonance imaging-guided focused ultrasound surgery as an adjunct to tamoxifen therapy in high-risk surgical patients with breast carcinoma[J]. J Vasc Interv Radiol, 2003, 14(10):1275-1282. pmid: 14551274
[37]	JOSAN S, BOULEY D M, VAN DEN BOSCH M, et al. MRI-guided cryoablation: In vivo assessment of focal canine prostate cryolesions[J]. J Magn Reson Imaging, 2009, 30(1):169-176. doi: 10.1002/jmri.21827 pmid: 19557805