MRI-guided percutaneous transhepatic cholangiodrainage: feasibility study in a porcine model

BACKGROUND AND STUDY AIMS: MRI-guided procedures combine high-quality imaging with lack of radiation. Percutaneous transhepatic cholangiodrainage under real-time MRI guidance (MRI-PTCD) seems promising, allowing targeted puncture and avoiding multiple blind passes and use of contrast, which are associated with standard PTCD's heaviest complications.

PATIENTS AND METHODS: Aim of this study was to investigate the feasibility of MRI-PTCD in three outbred piglets. Obstructive cholestasis was induced by common bile duct ligation. Two days later, MRI-PTCD was performed (open MRI, 1.0 Tesla) with prototype MRI-compatible accessories. Visualization was achieved with a balanced steady-state free precession real-time sequence (bSSFP: 0.75 frames/s, TR/TE [ms]: 7.2/3.6; flip angle: 45°; 200 × 200 matrix size; resolution: 1.3 × 1.3 mm(2), slice thickness: 7 mm). Cannulation of the bile ducts was followed by placement of Yamakawa drainages.

RESULTS: Twelve punctures were performed (four per animal, 10/12 successful); in 2/10 the bile ducts could not be cannulated. Animal survival was 100% and no significant complications occurred.

CONCLUSIONS: Initial data show that MRI-PTCD can be successfully performed. This may lead to establishment of a new optimized PTCD technique compared to the standard approach under fluoroscopy.