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                                            Safety Information Article
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       Guidewires 

Advances in interventional MR procedures have resulted in the need for guidewires that are acceptable for endovascular therapy, drainage procedures, and other similar applications. Conventional guidewires are made from stainless steel or Nitinol, materials known to be conductive. Accordingly, radiofrequency fields used for MR procedures may induce substantial currents in guidewires, leading to excessive temperature increases and potential injuries.

Liu, et al. (2000) studied the theoretical and experimental aspects of the RF heating resonance phenomenon of an endovascular guidewire. A Nitinol-based guidewire (Terumo, Tokyo, Japan) was inserted into a vessel phantom and imaged using 1.5-T and 0.2-T MR systems with continuous temperature monitoring at the guidewire tip. The guidewire was deployed in the phantom in a “straight” manner. Heating effects due to different experimental conditions were examined. A model was developed for the resonant current and the associated electric field produced by the guidewire acting as an antenna. Temperature increases of up to 17 degrees C were measured while imaging the guidewire at an off-center position in the 1.5-Tesla MR system. Power absorption produced by the resonating wire decreased as the repetition time was increased. No temperature rise was measured during MRI performed using the 0.2-Tesla MR system. Thus, considering the potential utility of low-field, open MR systems for MR-guided endovascular interventions, it is important to be aware of the safety of such applications for metallic guidewires and the potential hazards associated with using a guidewire with MR systems operating at higher static magnetic field strengths, including 3-Tesla.

An investigation conducted by Konings, et al. (2000) examined the radiofrequency (RF) heating of an endovascular guidewire frequently used in interventional MR procedures. A Terumo guidewire was partly immersed in an oblong saline bath to simulate an endovascular intervention. The temperature rise of the guidewire tip during MR imaging was measured using a Luxtron fluoroptic thermometry system. Starting from a baseline level of 26 degrees C, the tip of the guidewire reached temperatures up to 74 degrees C after 30 seconds of scanning using a 1.5-Tesla MR system. Touching the guidewire produced a skin burn.

The excessive heating of a linear conductor, like the guidewire that underwent evaluation, was explained by the resonating RF waves. According to Konings, et al. (2000), the capricious dependencies of this resonance phenomenon have potentially severe consequences for safety guidelines of interventional MR procedures involving guidewires.

Advances in guidewire designs reported by Kocaturk, et al. (2009) and Kramer, et al. (2009) have yielded guidewires that appear to be more acceptable for interventional MRI procedures with respect to both safety and visualization aspects.

REFERENCES

Buecker A. Safety of MRI-guided vascular interventions. Minim Invasive Ther Allied Technol 2006;15:65-70.

Etezadi-Amoli M, et al. Controlling radiofrequency-induced currents in guidewires using parallel transmit. Magn Reson Med 2014 [Epub ahead of print].

Johnston T, et al. Intraoperative MRI: Safety. Neurosurg Clin N Am 2009;20:147-53.

Kocaturk O, et al. Whole shaft visibility and mechanical performance for active MR catheters using copper-nitinol braided polymer tubes. J Cardiovasc Magn Reson 2009;11:29.

Konings MK, Bartels LW, Smits HJ, Bakker CJ. Heating around intravascular guidewires by resonating RF waves. J Magn Reson Imag 2000;12:79-85.

Kramer NA, et al. Preclinical evaluation of a novel fiber compound MR guidewire in vivo. Invest Radiol 2009;44:390-7.

Liu CY, et al. Safety of MRI-guided endovascular guidewire applications. Magn Reson Imaging 2000;12:75-8.

Shellock FG. Magnetic Resonance Procedures: Health Effects and Safety. CRC Press, LLC, Boca Raton, FL, 2001.

Sonmez M, et al. MRI active guidewire with an embedded temperature probe and providing a distinct tip signal to enhance clinical safety. J Cardiovasc Magn Reson 2012;14:38.

van den Bosch MR, et al. New method to monitor RF safety in MRI-guided interventions based on RF induced image artefacts. Med Phys 2010;37:814-21.

Wolska-Krawczyk M, et al. Heating and safety of a new MR-compatible guidewire prototype versus a standard nitinol guidewire. Radiol Phys Technol 2014;7:95-101.



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