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CMR-guidance of passively tracked endomyocardial biopsy in an in vivo porcine model

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Endomyocardial biopsy (EMB) is considered to be the diagnostic gold-standard in detection of myocardial-inflammation. EMB is usually conducted under fluoroscopy without any specific target information. Specific target-information provided by cardiovascular magnetic resonance (CMR) may improve specificity of EMB. The aim was to investigate feasibility and safety of CMR-guided and targeted EMB in a preclinical-model using passively-tracked devices. Procedures were performed on a MRI-System equipped with an Interventional Software-Platform for real-time imaging. Ex vivo experiments were conducted to optimize visibility of the guide-sheath. In vivo experiments were conducted in 2 pigs for technical feasibility assessment and in 4 pigs after acute myocardial infarction to test feasibility of guided and lesion targeted EMB. For anatomical real-time imaging a single-shot-balanced-SSFP-sequence was applied. Myocardial targets were identified under real-time imaging (single-shot-T2 (sshT2) and single-shot Late-Gadolinium-Enhancement (sshLGE) sequences). Ex vivo experiments demonstrated best visibility of continuously labelled guide-sheath. CMR-guided EMB was feasible in all cases without major complications. Likewise, lesion-targeting endomyocardial biopsy was feasible in two cases. Biopsies exhibited appropriate sizes and qualities. Real-time lesion sequences revealed comparable CNR values to clinical-protocols. Real-time imaging of lesions showed following signal- and contrast-to-noise ratios (SNR/CNR): SNR of sshT2- and sshLGE was 124 ± 35 and 67 ± 51 respectively, whereas CNR was 81 ± 30 and 57 ± 44. This study demonstrates feasibility and safety of CMR-guided and basically targeted EMB with passively-tracked devices. Signal-to-noise ratios of real-time sequences is non-inferior to standard sequences for lesion detection. CMR-guidance may improve diagnostic accuracy of EMB since CMR can detect myocardial-targets under real-time-imaging.

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The authors thank Juliane Geisler for excellent technical support.


Forschungskommsion of the medial faculty Düsseldorf (University of duesseldorf), Nr.: 142014. Grant of DFG (Deutsche Forschungsgemeinschaft); GRL B0-4264/1–1.

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Correspondence to F. Bönner.

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Animal experiments

All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted. An approval exists: Reference number—84-02.04.2012.A141.

Conflict of interest

S. Krueger: employee of Philips GmbH Innovative Technologies. S. Weiss: employee of Philips GmbH Innovative Technologies. B. Schnackenburg: employee of Philips GmbH Market DACH. K. Düring: CEO and Shareholder MaRVis Medical, Interventional. H. Clogenson: employee of MaRVis Medical, Interventional. Rest of the authors declare that they have no competing interests.

Human data acquisition

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The ethical board of Heinrich-Heine University Düsseldorf approved the human data acquisition: application number 4307. Informed consent was obtained from all individual participants included in the study.

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Behm, P., Gastl, M., Jahn, A. et al. CMR-guidance of passively tracked endomyocardial biopsy in an in vivo porcine model. Int J Cardiovasc Imaging 34, 1917–1926 (2018).

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