The present application relates to interventional guidewires, and, more particularly, to such guidewires for use with interventional magnetic resonance imaging.
Interventional Magnetic Resonance Imaging (“iMRI”) has increased in interest during the last decade due to Magnetic Resonance (“MR”) compatible instruments, the development of rapid imaging techniques and automatic instrument tracking techniques.
For MR guidance of vascular interventions to be safe, the interventionalist must be able to visualize the tip location and distal shaft of the MRI compatible guidewire relative to the vascular system and surrounding anatomy. A number of instrument visualization approaches under MRI have been developed including both passive and active techniques. Passive visualization techniques rely on the creation of susceptibility artifacts to enhance the device (e.g., catheter) appearance by using contrast agents or ferromagnetic materials. Active visualization relies on supplemental hardware embedded into a catheter body, such as a Radio Frequency (“RF”) antenna to receive the RF signal during MRI (Susil R C, Yeung C J, Atalar E, “Intravascular extended sensitivity (IVES) MR imaging antennas.” Magnetic Resonance in Medicine, 2003; 50(2): 383-390). However, none of these techniques provides satisfactory results in terms of both instrument tip and shaft visualization at the same time. Visualization of the shaft only is not enough to advance a guidewire through tortuous vessels due to the risk of puncturing vessel walls and visualization of a single point is not sufficient for steering an active guidewire in complex vessel territory (Atalar E, Kraitchman D L, Carkhuff B, Lesho J, Ocali O, Solaiyappan M, Guttman M A, Charles H K, Jr. Catheter-tracking FOV MR Fluoroscopy. Magnetic Resonance in Medicine 1998; 40(6):865-872). Patent publication number WO 2009/088936 provides the ability to visualize the shaft separately from the tip, but it requires separate channels for both the tip and the shaft, which is costly and more difficult to manufacture.
Magnetic Resonance Imaging (MRI) is one of the most important clinical imaging modalities. A significant advantage of using MRI in clinical procedures is that imaging via MR is conducted only using a strong homogenous magnetic field and radio frequency energy pulses, without the use of harmful ionizing radiation, such as with the use of X-ray angiography. Also, MRI utilizes Nuclear Magnetic Resonance principles with gradient coil elements to provide spatial encoding, resulting in the ability to perform 3-D human body imaging with high soft tissue contrast (Lauterbur P C. NMR Imaging in Biomedicine. Cell Biophysics 1986; 9(1-2): 211-214; Lai C M, Lauterbur P C. True Three-Dimensional Image Reconstruction by Nuclear Magnetic Resonance Zeugmatography. Physics in Medicine and Biology 1981; 26(5):851-856; Kramer D M, Schneider J s, Rudin A M, Lauterbur P C. True Three-Dimensional Nuclear Magnetic Resonance Zeugmatographic Images of a Human Brain. Neuroradiology 981;21(5):239-244). MRI allows one to obtain information about various physical parameters such as flow, motion, magnetic susceptibility and temperature (Axel L. Blood Flow Effects in Magnetic Resonance Imaging. Magnetic resonance Annual 1986;237-244; Henkelman R M, Stains/ G J, Graham S J. Magnetization Transfer in MRI: A review. NMR Biomedicine 2001; 14(2):57-64; Dickenson R J, Hall A S, Hind A J, Young I R. Measurement of Changes in Tissue Temperature using MR Imaging. Journal of Computer Assisted Tomography 1986;10(3):468-472). Because of this, MRI has a wide variety of both diagnostic and therapeutic imaging applications both in the clinical and research environment. When MRI was initially introduced in the clinical environment, it was used for only diagnostic imaging purposes with almost no consideration for use in therapeutic procedures (Webb W R, Gamsu G, Stark D D, Moon K L, Jr., Moore E H. Evaluation of Magnetic Resonance Sequences in Imaging Mediastinal Tumors. American Journal of Roentgenology 1984; 143(4):723-727; Belli P, Romani M, Magistrelli A, Masetti R, Pastore G, Costantini M. Diagnostic Imaging of Breast Implants: Role of MRI. Rays 2002; 27(4):259-277). Reasons for this can be attributed to the lack of sequences designed for interventional MRI such as sequences for real-time device tracking, sequences that provide image contrast that correlate directly to therapy performance, high-speed sequences that allow real-time imaging with sufficient contrast and resolution and the lack of dedicated and optimized hardware for interventional applications.
In recent years, efforts have been made to develop MRI as an interventional tool for image guided interventions by addressing the above mentioned challenges (Miles K. Diagnostic and Therapeutic Impact of MRI. Clinical Radiology 2002; 57(3):231-232; Jolesz F A, Blumenfeld S M. Interventional Use of Magnetic Resonance Imaging. Magnetic Resonance Quarterly 1994; 10(2):85-96; Jolesz FA. Interventional and Intraoperative MRI: A General Overview of the Field. Journal of Magnetic Resonance Imaging 1998; 8(1):3-7). Also, development of 1.5 T magnets with short bores that allow access to the groin area for catheter-based procedures, liquid crystal image displays that can be exposed to high magnetic fields, improvements in the hardware of the magnetic field gradient systems for additional gains in image acquisition speed, and the development of catheter based MRI antennas for localized intravascular signal reception, provide wide range of interventional MR Imaging applications.
MR guided interventions should be performed with devices free of ferromagnetic components, otherwise as one would encounter severe magnetic forces (induced displacement force and torque) on the device by the static magnetic field of the MR scanner and they would also cause image distortion due to the intrinsic susceptibility artifact (Shunk K A, Iima J A, Heldman A W Transesophageal magnetic resonant imaging. Magn Reson. Med 1999;41:722-726). However, MR compatible and safe devices are not enough to perform vascular interventions with MRI. The reliable visualization of these devices in relation to the surrounding tissue morphology is also required. In contrast to ultrasound, X-ray fluoroscopy, or computed tomography (CT), visualization of interventional instruments in MR has proven to be difficult. A number of approaches have been developed for depicting vascular instruments in an MR environment. They can be broadly grouped into two categories: passive and active visualization.
In passive visualization techniques, achieving adequate catheter contrast is based on enhancing the inherent signal void of an instrument as it displaces (spins) during insertion. Differences in magnetic susceptibility can be used to create large local losses in signal due to intra-voxel dephasing (Rubin D L, Ratner A V, Young S W. Magnetic susceptibility effects and their application in the development of new ferromagnetic catheters for magnetic resonance imaging. Invest radiol. 1990;25:1325-1332). The tip or body of passive catheters is composed of either ferromagnetic or paramagnetic sleeves that produce susceptibility artifacts. Incorporating multiple rings of paramagnetic dysprosium oxide (Dy2O3) along the instrument tip allows the catheter to be consistently visualized independently of orientation (Bakker C J, Hoogeveen R M, Hurtak W F, van Vaals J J, Viergever M A, Mali W P. MR-guided endovascular interventions: susceptibility based catheter and near real time imaging technique).
Susceptibility markers should have a high magnetic moment to induce an adequate artifact at a variety of scan techniques and tracking speeds. In other words, they must have sufficient contrast to noise ratio (CNR) with respect to the background in order to distinguish the device in thick slab images.
The advantage of using a passive marker is that circuit components and transmission lines are not required to visualize the catheter. This property of passive visualization techniques is important because it also eliminates electrical safety issues. However, this technique also has several disadvantages. First, it provides low spatial resolution. Second, it slows down the speed of the procedure compared to active tracking methods. And finally, a susceptibility artifact varies based on device orientation and magnetic field strength.
Active visualization relies on the incorporation of a miniature solenoid coil into the device itself (Dumoulin C L, Souza S p, Darrow R D. Real-time position monitoring of invasive devices using magnetic resonance. Magn Reson. Med. 1993;29:411-415; Ladd M E, Zimmerman G G, Mcklnnon G C, von Schulthess G K et al. Visualization of vascular guidewires using MR tracking. J Magn Reson Imaging 1998;8:251-253; Leung D A, debatin J F, Wildermuth S, McKinnon G C et al. Intravascular MR Tracking catheter: preliminary experimental evaluation. Am J roentgenol 1995; 164: 1265-1270). The coil is connected to the scanner via a transmission line such as a thin coaxial cable passing through the catheter and provides a robust signal, identifying the instrument location with high contrast. The tip of an active catheter can be visualized with high contrast by the incorporated coil on the tip.
A solenoid coil is basic form of loop antenna element in which the wire is coiled in a helical pattern to create a cylindrical shape. Solenoid micro coils can be connected to the MR systems through the use of coaxial or twisted pair transmission lines, which may serve both detuning and signal transduction purposes. Loop antenna signal sensitivity for small-loop receivers falls off very rapidly (l/r3, where r is the radial distance from the loop) (Balanis C A. Antenna theory. New York: John Wiley & Sons; 1997. p. 941). To improve longitudinal coverage, long-loop intravascular antennas were subsequently investigated (Atalar E, Bottomley P A, Ocali O, Correia L C, Kelemen M D, Lima J A, Zerhouni E A. High resolution intravascular MRI and MRS by using a catheter receiver coil. Magn Reson Med 1996;36:596-605). For these long, narrow loop receivers (in which the loop length is much greater than its width), sensitivity falls off as l/r2.
The opposed solenoid loop antenna is based on groups of helical loops separated by a gap region, with current driven in opposite directions in the helical loops on either side of the gap. The gap provides the small area of homogenous longitudinal magnetic field that makes it a good candidate for especially using as an imaging coil within and beyond the vessel wall. However, it has a small area of homogenous longitudinal coverage compared with the dipole antenna.
A dipole antenna for iMRI applications can be a simple coaxial transmission line with an extended inner conductor. Dipole antenna sensitivity falls off as l/r where r is the radial distance from the antenna center (Susil R C, Yeung C J, Atalar E, “Intravascular extended sensitivity (IVES) MR imaging antennas.” Magnetic Resonance in Medicine, 2003; 50(2): 383-390).
Dipole antenna sensitivity can be improved by increasing the insulation layer (insulation broadens the SNR distribution) and helical winding over the extended core inductor (winding allows for improved SNR near the tip of the antenna).
The present application discloses a guidewire for magnetic resonance imaging with a single channel design to reduce complexity, while maintaining conspicuous both tip and shaft visibility under MRI.
In one embodiment, a guidewire body includes an antenna formed from a MRI compatible metal rod and a helical coil coupled together. The helical coil can have multiple windings without a gap between the windings. The rod passes through the windings of the helical coil and is coupled to the helical coil using a conductive joint. The conductive joint can be at a distal end, a proximal end, or both ends of the helical coil. When at a distal end, the conductive joint forms a conductive tip of the guidewire. Insulation can be positioned between the rod and the windings of the helical coil. The configuration allows visibility of the antenna along the shaft of the rod, but signals are suppressed where the rod passes through the coil. Thus, the tip visibility is enhanced because the suppressed signals between the tip and the shaft of the rod create a gap between the two. The gap increases visibility as it is easier to distinguish the distal tip from the rest of the shaft profile.
In another embodiment, the conductive joint is a solder joint with a semispherical shape in order to maximize conductive surface area and increase the tip visibility.
In yet another embodiment, the rod diameter can be reduced as the rod enters the windings in order to increase room for additional insulation. The additional insulation further reduces signal reception by the rod in the area of the windings.
According to one embodiment, a guidewire for use with magnetic resonance imaging comprises an antenna formed from a combination of a rod and a helical coil. The coil defines an internal space, and the rod is positioned to extend axially through the internal space and is coupled to the coil using a conductive joint at an end of the rod. The conductive joint forms a tip of the guidewire. The guidewire has a null zone defined over an axial length between the conductive joint and a point proximal of the conductive joint. The null zone is operable to suppress signals received by a portion of the rod within the null zone, thereby producing a conspicuous distal tip signal.
The null zone can produce a spatial separation between the distal tip signal and the shaft signal. The coil can have windings that are adjacent to each other over an axial distance corresponding to at least the length of the null zone.
The guidewire can comprise a temperature sensor positioned in and axially movable relative to the guidewire. The temperature sensor can be configurable to monitor in real-time temperatures of interest along the guidewire. The temperature sensor can be configurable to measure for heating increases caused by defects in the guidewire. The guidewire can comprise a dedicated port formed in the guidewire into which a distal end of the temperature sensor is inserted.
A distal end portion of the guidewire can be curved, and the helical coil can have a corresponding preformed curved configuration without gaps between adjacent windings. The helical coil can be preformed of a shape memory alloy into the curved configuration.
The guidewire can comprise insulation in an annular region between the helical coil and the rod. The guidewire can comprise multiple layers of insulation separating the rod from the coil.
The foregoing and other objects, features, and advantages of the invention will become more apparent from the following detailed description, which proceeds with reference to the accompanying figures.
The current invention relates to the iMRI guidewires in which an antenna embedded into guidewire body is used for signal reception. A receiving antenna is positioned within the imaging volume that is used to detect the MR signal generated from the patient as the excited spins relax back into an equilibrium distribution. Embodiments described herein can be used for a clinical grade 0.035″ multi purpose guidewire that can offer both precise tip location and distal shaft visualization.
In conventional conductive guidewires, there is a “hot spot” representing a portion of the device that reaches a greatest temperature located generally at the distal tip. In specific implementations as described herein, this “hot spot” is repositioned along the guidewire proximally of the distal tip. As a result, measuring a real time temperature increase from RF induced heating under MRI with a fiber optic temperature probe is easier. During typical use of a guidewire, the flexible distal tip is moved in ways such that it contacts surfaces (e.g., the surfaces of vessels, organs, etc.) frequently. If the hot spot is located at the distal tip, then the distal end of the fiber optic probe would need to be located at the distal tip. Typically, such a fiber optic has a GaAs crystal at its distal end, and this crystal would be subject to possible damage from the frequent contacts between the distal tip and adjacent surfaces. Further, a distal tip with an internal curvature might not allow the planar distal end of the probe to be placed as close to the distal tip as desired. Rather, it has been discovered that the hot spot can be positioned proximally of the distal tip, taking into account one or more of the following factors: the profile of the inner rod, the thickness of the insulation layer(s), the inner and outer diameters of the solenoid coil, the solenoid coil length and wire diameter, the solenoid coil insulation material(s), the soldering locations, etc., to achieve the desired results for different guidewire configurations.
As discussed above, in the various implementations, the coil is constructed to have a closed pitch configuration. Stated differently, the coil is constructed so that adjacent windings are not separated by gaps. As best shown in
Use of a guidewire with a closed pitch coil and the resulting null zone produces a received signal profile that is unique and allows the operator to easily distinguish the shaft signal from the tip signal. Referring to
The surface area of the solder and the ratio of the solenoid coil diameter to the inner rod diameter ratio are factors that affect resonant LC properties of the structure. In the described implementations, these properties are optimized for 0.035 in diameter guidewires, but the same principles can be applied to guidewires of different sizes and configurations.
In some applications, the distal portion of the guidewire is curved or “bent” rather than straight. For example, as shown in the image of
It has been discovered that through careful measurement and forming techniques, a closed pitch coil suitable for a curved distal portion can be formed. The final curved geometry is carefully measured, and a metal mold for a coil corresponding to the final curved geometry is made. By forming the coil from a shape memory metal alloy such as nitinol, the coil can be molded to the correct final curved geometry, yet with the ability to deform during installation. As the coil is finally positioned, it will assume the proper final curved geometry and no gaps between the winding will be present. The windings can be coated with parylene or other insulating material with a high dielectric constant.
Referring again to
In described implementations, the guidewire has a dedicated port through which a fiber optic temperature probe or similar device) can be advanced and withdrawn along the guidewire shaft during a procedure. This is especially useful in conducting testing, such as RF safety, before clinical use. During such a test, the guidewire is arranged in a phantom and subjected to heating while the probe is withdrawn (a temperature probe pullback test). Areas of thinner insulation or other discontinuities, which might not be discovered through a visual inspection, create conspicuous hot spots that are easy to discern on a graph similar to
In describing embodiments of the present invention illustrated in the drawings, specific terminology is employed for the sake of clarity. However, the invention is not intended to be limited to the specific terminology so selected. It is to be understood that each specific element includes all technical equivalents which operate in a similar manner to accomplish a similar purpose. The embodiments illustrated and discussed in this specification are intended only to teach those skilled in the art the best way known to the inventors at the time of filing to make and use the disclosed embodiments. The embodiments may be modified or varied, and elements added or omitted, without departing from the invention, as appreciated by those skilled in the art in light of the above teachings.
The disclosed methods, apparatus, and systems should not be construed as limiting in any way. Instead, the present disclosure is directed toward all novel and nonobvious features and aspects of the various disclosed embodiments, alone and in various combinations and subcombinations with one another. The disclosed methods, apparatus, and systems are not limited to any specific aspect or feature or combination thereof, nor do the disclosed embodiments require that any one or more specific advantages be present or problems be solved.
In view of the many possible embodiments to which the principles of the disclosed invention may be applied, it should be recognized that the illustrated embodiments are only preferred examples of the invention and should not be taken as limiting the scope of the invention. Rather, the scope of the invention is defined by the following claims. We therefore claim as our invention all that comes within the scope of these claims.
This application claims the benefit of U.S. Provisional Application No. 61/429,833, filed Jan. 5, 2011, which is incorporated herein by reference in its entirety.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US2012/020139 | 1/4/2012 | WO | 00 | 6/28/2013 |
Number | Date | Country | |
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61429833 | Jan 2011 | US |