Karolinska, first in Sweden with simultaneous MRI and cardiac catheterisation

News

During the autumn, a new examination to diagnose heart disease has been initiated at Karolinska. The examination combines cardiac catheterisation with magnetic resonance imaging (MRI) by performing both examinations simultaneously, something Karolinska is the first in Sweden to do.

Several different methods can be used to diagnose heart disease. Magnetic resonance imaging (MRI) is often used to assess the anatomy and function of the heart, including the size of the chambers. Cardiac catheterisation is an invasive method of measuring the pressure and flow of the heart. Now, staff at Karolinska have introduced a way to combine these methods into one.

- What we wanted to do was to combine MRI with cardiac catheterisation to have two complementary “gold standard” examinations. We also wanted to use the MRI visualisation to guide the catheterisation itself, which is usually done with fluoroscopy," says Patrik Sundblad, a doctor at Clinical Physiology and one of the people who worked on implementing the method at Karolinska.

Better quality and without radiation

The advantages of guiding a cardiac catheterisation with MRI include avoiding exposure of the patient to X-rays, and a much better visualisation of the anatomy. Patrik Sundblad also says that the quality of cardiac catheterisation is improved with MRI as it provides very accurate flow measurements, and more locations can be measured.

Patrik Sundblad

- The examinations complement each other, and also enhance both of them. In addition, we save time by performing them at the same time, says Patrik Sundblad.

Challenges in the MRI environment

Working in an MRI environment is not straightforward as magnetic material cannot be used in the imaging room. Catheterisation is an invasive procedure and requires the insertion of a needle. The solution was to insert the needle in the adjacent room.

- Afterwards we insert a plastic tube into the vessel, and through this tube the catheter is inserted, which is also made of plastic. We then wheeled the patient into the imaging room and continued working with non-magnetic materials, including an MR-conditional guidewire that can be inserted into the catheter to make it more stable.

Drawing on knowledge from England

The examinations have now been successfully carried out on a couple of occasions at Karolinska, for the first time in Sweden.

- In London they have been working in this way for a while and we have visited them to bring the method to Karolinska. Later we have been in contact with them during the implementation.

The challenge right now is to reduce the examination time, which is currently two hours, to one hour.

- The time used is then the same as for a normal cardiac catheterisation, but we get all the information from the MRI as well. For patients who must undergo both examinations, it will be a big time-saver, says Patrik Sundblad.

FACTS

Both magnetic resonance imaging (MRI) and cardiac catheterisation are used as advanced diagnostic tools for heart disease.

MRI is used to assess the anatomy, function, and size of the heart chambers.

Cardiac catheterisation is an invasive method that measures pressure and flow in the heart chambers, which change with different diseases. With this new method, the examinations are combined, and the catheterisation is guided by MRI instead of fluoroscopy. The information from both methods is enhanced and results are available at the same time, while the patient is avoiding exposure of to X-rays.

The introduction of the method is a collaboration between ME Clinical Physiology, ME Cardiology, ME Radiology and the PAH Centre. The team working on this method development is Patrik Sundblad (Physician), Monika Nguyen (Biomedical Analyst, BMA), Mikaela Korpysz (BMA), Michael Melin (Physician), Viktoria Skott (BMA), Goran Abdula (Physician), Sofie Embro (BMA) and Sven Petersson (Physicist).