Transcatheter cardiovascular interventions increasingly rely on advanced imaging. X-ray fluoroscopy provides excellent visualization of catheters and devices, but poor visualization of anatomy. In contrast, magnetic resonance imaging (MRI) provides excellent visualization of anatomy and can generate real-time imaging with frame rates similar to X-ray fluoroscopy. Realization of MRI as a primary imaging modality for cardiovascular interventions has been slow, largely because existing guidewires, catheters and other devices create imaging artifacts and can heat dangerously. Nonetheless, numerous clinical centers have started interventional cardiovascular magnetic resonance (iCMR) programs for invasive hemodynamic studies or electrophysiology procedures to leverage the clear advantages of MRI tissue characterization, to quantify cardiac chamber function and flow, and to avoid ionizing radiation exposure. Clinical implementation of more complex cardiovascular interventions has been challenging because catheters and other tools require re-engineering for safety and conspicuity in the iCMR environment. However, recent innovations in scanner and interventional device technology, in particular availability of high performance low-field MRI scanners could be the inflection point, enabling a new generation of iCMR procedures. In this review we review these technical considerations, summarize contemporary clinical iCMR experience, and consider potential future applications.

中文翻译：

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介入性心血管磁共振：最先进的

经导管心血管干预越来越依赖先进的成像技术。X 射线透视提供了导管和设备的良好可视化，但解剖结构的可视化较差。相比之下，磁共振成像 (MRI) 提供了出色的解剖可视化效果，并且可以生成帧速率类似于 X 射线透视的实时成像。MRI 作为心血管干预的主要成像方式的实现进展缓慢，主要是因为现有的导丝、导管和其他设备会产生成像伪影，并且可能会产生危险的热量。尽管如此，许多临床中心已经启动了介入性心血管磁共振 (iCMR) 项目，用于侵入性血流动力学研究或电生理学程序，以利用 MRI 组织表征的明显优势，量化心腔功能和流量，并避免电离辐射暴露。更复杂的心血管干预措施的临床实施一直具有挑战性，因为导管和其他工具需要重新设计，以确保 iCMR 环境中的安全性和显着性。然而，扫描仪和介入设备技术的最新创新，特别是高性能低场 MRI 扫描仪的可用性可能会成为拐点，从而实现新一代 iCMR 程序。在这篇综述中，我们回顾了这些技术考虑因素，总结了当代临床 iCMR 经验，并考虑了未来潜在的应用。