Real-Time Magnetic Resonance Imaging Guidance Improves the Diagnostic Yield of Endomyocardial Biopsy

Authors: Toby Rogers, Kanishka Ratnayaka, Parag Karmarkar, Adrienne E. Campbell-Washburn, William H. Schenke, Jonathan R. Mazal, Ozgur Kocaturk, Anthony Z. Faranesh, Robert J. Lederman

Summary:

Diagnostic yield of endomyocardial biopsy is low, particularly in disease that affects the myocardium in a nonuniform distribution. The authors hypothesized that real-time MRI guidance could improve the yield through targeted biopsy of focal myocardial pathology. They tested this hypothesis in an animal model of focal myocardial pathology using intracoronary ethanol and microspheres. The authors compared real-time MRI-guided endomyocardial biopsy in swine using a custom actively visualized MRI bioptome against x-ray–guided biopsy using a commercial bioptome by skilled operators. Real-time MRI guidance significantly increased the diagnostic yield of endomyocardial biopsy.

Key Words

Endomyocardial biopsy; heart failure; interventional cardiovascular magnetic resonance imaging; myocarditis.

Citation: Toby Rogers, Kanishka Ratnayaka, Parag Karmarkar, Adrienne E. Campbell-Washburn, William H. Schenke, Jonathan R. Mazal, Ozgur Kocaturk, Anthony Z. Faranesh, Robert J. Lederman Real-Time Magnetic Resonance Imaging Guidance Improves the Diagnostic Yield of Endomyocardial Biopsy http://dx.doi.org/10.1016/j.jacbts.2016.05.007

Received: 19 April 2016, Revised: 13 May 2016, Accepted: 13 May 2016, Available online: 29 August 2016

Copyright: © 2016 Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Conclusions

Targeted endomyocardial biopsy is feasible in a large animal model using real-time MRI guidance. Compared with conventional x-ray fluoroscopy guidance, MRI significantly improves the diagnostic yield despite smaller specimen volumes. MRI-guided endomyocardial biopsy could be of particular value in disease processes that affect the myocardium in a nonuniform distribution.

Acknowledgments

The authors thank Katherine Lucas and Joni Taylor from the NHLBI Animal Surgery and Resources Core, and Daniela Malide from the NHLBI Light Microscopy Core Lab.

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