The percutaneous revascularization of chronic total occlusions represents a major challenge to interventional cardiologists. Procedural success is currently limited by the inadequate soft-tissue contrast of x-ray fluoroscopy and the inability to visualize the position and orientation of a revascularization device with respect to the lesion and the vessel wall. In this thesis methods are developed that enable the percutaneous revascularization of occlusive lesions to be guided using magnetic resonance (MR) imaging. Unlike x-rays, MR has excellent soft-tissue contrast and this can be exploited to provide valuable information regarding the composition and geometry of the lesion. The first method is a robust and redundant technique for determining the position and orientation of a catheter inside an MR scanner. The technique uses phase information introduced into the MR signal by a small receive coil located at the distal tip of the catheter. The technique is developed theoretically and is demonstrated with a feasibility experiment. A forward-looking intravascular imaging catheter is then presented that is capable of acquiring of high-resolution MR images of occlusive lesions and the vessel wall in front of the catheter. The imaging catheter consists of two orthogonal receive coils located at the distal tip of the catheter. The use of the imaging catheter is demonstrated in phantoms and in vivo. A third method enables active visualization of MR compatible guidewires. The method utilizes a catheter-based pick-up coil that is magnetically coupled to the guidewire. The proposed technique enables one to concentrate all active components on a catheter thereby facilitating the use of safety features. Complete characterization is presented theoretically and validated experimentally. In addition, the use of a practical catheter device is demonstrated in an in situ environment. Finally, future work required for the development of an integrated catheter-based device for the MR-guided revascularization of chronic total occlusions is discussed.

The percutaneous revascularization of chronic total occlusions represents a major challenge to interventional cardiologists. Procedural success is currently limited by the inadequate soft-tissue contrast of x-ray fluoroscopy and the inability to visualize the position and orientation of a revascularization device with respect to the lesion and the vessel wall. In this thesis methods are developed that enable the percutaneous revascularization of occlusive lesions to be guided using magnetic resonance (MR) imaging. Unlike x-rays, MR has excellent soft-tissue contrast and this can be exploited to provide valuable information regarding the composition and geometry of the lesion. The first method is a robust and redundant technique for determining the position and orientation of a catheter inside an MR scanner. The technique uses phase information introduced into the MR signal by a small receive coil located at the distal tip of the catheter. The technique is developed theoretically and is demonstrated with a feasibility experiment. A forward-looking intravascular imaging catheter is then presented that is capable of acquiring of high-resolution MR images of occlusive lesions and the vessel wall in front of the catheter. The imaging catheter consists of two orthogonal receive coils located at the distal tip of the catheter. The use of the imaging catheter is demonstrated in phantoms and in vivo. A third method enables active visualization of MR compatible guidewires. The method utilizes a catheter-based pick-up coil that is magnetically coupled to the guidewire. The proposed technique enables one to concentrate all active components on a catheter thereby facilitating the use of safety features. Complete characterization is presented theoretically and validated experimentally. In addition, the use of a practical catheter device is demonstrated in an in situ environment. Finally, future work required for the development of an integrated catheter-based device for the MR-guided revascularization of chronic total occlusions is discussed.

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L'ablation des tissus par hyperthermie locale guidée par IRM est une technique prometteuse pour le traitement du cancer et des arythmies cardiaques. L'IRM permet d'extraire en temps réel des informations anatomiques et thermiques des tissus. Cette thèse a pour objectif d'améliorer et d'étendre la méthodologie existante pour des interventions sur des organes mobiles comme le rein, le foie et le coeur. La première partie a été consacrée à l'introduction de l'imagerie rapide (jusqu'à 10-15 Hz) pour le guidage de l'intervention par IRM en temps réel. L'utilisation de cartes graphiques (GPGPU) a permis une accélération des calculs afin de satisfaire la contrainte de temps réel. Une précision, de l'ordre de 1°C dans les organes abdominaux et de 2-3°C dans le coeur, a été obtenue. Basé sur ces avancées, de nouveaux développements méthodologiques ont été proposés dans une seconde partie de cette thèse. L'estimation du mouvement basée sur une approche variationnelle a été améliorée pour gérer la présence de structures non persistantes et de fortes variations d'intensité dans les images. Un critère pour évaluer la qualité du mouvement estimé a été proposé et utilisé pour auto-calibrer notre algorithme d'estimation du mouvement. La méthode de correction des artefacts de thermométrie liés au mouvement, jusqu'ici restreinte aux mouvements périodiques, a été étendue à la gestion de mouvements spontanés. Enfin, un nouveau filtre temporel a été développé pour la réduction du bruit sur les cartographies de température. La procédure interventionnelle apparaît maintenant suffisamment mature pour le traitement des organes abdominaux et pour le transfert vers la clinique. Concernant le traitement des arythmies cardiaques, les méthodes ont été évaluées sur des sujets sains et dans le ventricule gauche. Par conséquent, la faisabilité de l'intervention dans les oreillettes mais aussi en présence d'arythmie devra être abordée. / MR-guided thermal ablation is a promising technique for the treatment of cancer and atrial fibrillation. MRI provides both anatomical and temperature information. The objective of this thesis is to extend and improve existing techniques for such interventions in mobile organs such as the kidney, the liver and the heart. A first part of this work focuses on the use of fast MRI (up to 10-15 Hz) for guiding the intervention in real time. This study demonstrated the potential of GPGPU programming as a solution to guarantee the real time condition for both MR-reconstruction and MR-thermometry. A precision in the range of 1°C and 2-3°C was obtained in abdominal organs and in the heart, respectively. Based on these advances, new methodological developments have been carried out in a second part of this thesis. New variational approaches have proposed to address the problem of motion estimation in presence of structures appearing transient and high intensity variations in images. A novel quality criterion to assess the motion estimation is proposed and used to autocalibrate our motion estimation algorithm. The correction of motion related magnetic susceptibility variation was extended to treat the special case of spontaneous motion. Finally, a novel temporal filter is proposed to reduce the noise of MR-thermometry measurements while controlling the bias introduced by the filtering process. As a conclusion, all main obstacles for MR-guided HIFU-ablation of abdominal organs have been addressed in in-vivo and ex-vivo studies, therefore clinical studies will now be realized. However, although promising results have been obtained for MR-guided RF-ablation in the heart, its feasibility in the atrium and in presence of arrhythmia still remains to be investigated.

Magnetic Resonance Imaging (MRI) provides unique advantages such as superior soft tissue contrast, true multiplanar imaging, variable contrast mechanisms, measurement of temperature changes, perfusion and diffusion, and no ionizing radiation. Despite considerable research efforts in the field of interventional MRI, numerous challenges remain including restricted access to the patient, high acoustic noise and a shortage of MRI-safe devices. Novel methods and devices are presented in this thesis with the primary objective of enabling effective MRI-guided interventions, particularly abdominal needle and common catheter-based endovascular interventions. Firstly, a set of MRI-safe devices (guidewires, micro guidewires, catheters and micro catheters) were developed with passive or inductively coupling resonant markers for MRI visualisation. Secondly, a method was implemented for wireless tracking and dynamic guidance of instruments. Thirdly, a framework of technologies was developed for in-room display, wireless MRI remote control and multi-user communication along with a dedicated user interface and imaging protocol. These implementations were assessed in regards to MRI-safety, performance and usability and evaluated for MRI-guided liver biopsies, balloon angioplasty procedures and also for mechanical thrombolysis. Flow phantoms, Thiel soft-embalmed human cadavers with partially re-established perfusion and a porcine model were used for in vitro, ex vivo and in vivo validation, respectively. The results demonstrate that these interventions are experimentally feasible and practical when using the presented developments: automated device tracking and equipment designed for MRI-guided interventions streamlined procedural workflow. Specifically, it was shown that fast and accurate needle placements along complex trajectories were feasible using a wireless interactive display and control device with a dedicated user interface for interventions. Moreover, safe and efficacious balloon angioplasties of the iliac artery were practical using the described framework of technologies along with a dedicated MRI protocol. Finally, it was demonstrated that these developments could be adapted and applied to MRI-guided endovascular mechanical thrombolysis of the middle cerebral artery. The technologies, described in this thesis have been shown to overcome many of the present limitations and should therefore be useful for enabling MRI-guided interventions while not further constraining the operating physician in an already complex environment. Nevertheless, it is acknowledged that many crucial issues remain to be solved in the field of iMRI and in the context of the presented research. In particular further device optimisations, improvements of the tracking implementation along with further in vivo evaluations are required before moving towards clinical evaluation. This thesis sets the groundwork for moving ahead with the eventual clinical realisation of optimised MRI-guided interventions.

Interventional magnetic resonance imaging (MRI) aims at performing minimally invasive percutaneous interventions, such as tumor ablations and biopsies, under MRI guidance. During such interventions, the acquired MR image planes are typically aligned to the surgical instrument (needle) axis and to surrounding anatomical structures of interest in order to efficiently monitor the advancement in real-time of the instrument inside the patient's body. Object tracking inside the MRI is expected to facilitate and accelerate MR-guided interventions by allowing to automatically align the image planes to the surgical instrument. In this PhD thesis, an image-based workflow is proposed and refined for automatic image plane alignment. An automatic tracking workflow was developed, performing detection and tracking of a passive marker directly in clinical real-time images. This tracking workflow is designed for fully automated image plane alignment, with minimization of tracking-dedicated time. Its main drawback is its inherent dependence on the slow clinical MRI update rate. First, the addition of motion estimation and prediction with a Kalman filter was investigated and improved the workflow tracking performance. Second, a complementary optical sensor was used for multi-sensor tracking in order to decouple the tracking update rate from the MR image acquisition rate. Performance of the workflow was evaluated with both computer simulations and experiments using an MR compatible testbed. Results show a high robustness of the multi-sensor tracking approach for dynamic image plane alignment, due to the combination of the individual strengths of each sensor.

En imagerie par résonance magnétique (IRM) interventionnelle, des interventions percutanées minimalement-invasives (biopsies, ablations de tumeurs,...) sont réalisées sous guidage IRM. Lors de l’intervention, les plans de coupe acquis sont alignés sur l’outil chirurgical et les régions anatomiques d’intérêt afin de surveiller la progression de l’outil dans le corps du patient en temps réel. Le suivi d’objets dans l’IRM facilite et accélère les interventions guidées par IRM en permettant d’aligner automatiquement les plans de coupe avec l’outil chirurgical. Dans cette thèse, un système d’alignement automatique des plans de coupe établi sur une séquence IRM clinique est développé. Celui-ci réalise automatiquement la détection et le suivi d’un marqueur passif directement dans les images IRM tout en minimisant le temps d’imagerie dédié à la détection. L’inconvénient principal de cette approche est sa dépendance au temps d’acquisition de la séquence IRM clinique utilisée. Dans un premier temps, les performances du suivi ont pu être améliorées grâce à l’estimation et la prédiction du mouvement suivi par un filtre de Kalman. Puis un capteur optique complémentaire a été ajouté pour réaliser un suivi multi-capteurs, découplant ainsi la fréquence de rafraichissement du suivi de la fréquence de rafraichissement des images IRM. La performance du système développé a été évaluée par des simulations et des expériences utilisant un banc d’essai compatible IRM. Les résultats montrent une bonne robustesse du suivi multi-capteurs pour l’alignement des plans de coupe grâce à la combinaison des qualités individuelles de chaque capteur. / Interventional magnetic resonance imaging (MRI) aims at performing minimally invasive percutaneous interventions, such as tumor ablations and biopsies, under MRI guidance. During such interventions, the acquired MR image planes are typically aligned to the surgical instrument (needle) axis and to surrounding anatomical structures of interest in order to efficiently monitor the advancement in real-time of the instrument inside the patient’s body. Object tracking inside the MRI is expected to facilitate and accelerate MR-guided interventions by allowing to automatically align the image planes to the surgical instrument. In this PhD thesis, an image-based workflow is proposed and refined for automatic image plane alignment. An automatic tracking workflow was developed, performing detection and tracking of a passive marker directly in clinical real-time images. This tracking workflow is designed for fully automated image plane alignment, with minimization of tracking-dedicated time. Its main drawback is its inherent dependence on the slow clinical MRI update rate. First, the addition of motion estimation and prediction with a Kalman filter was investigated and improved the workflow tracking performance. Second, a complementary optical sensor was used for multi-sensor tracking in order to decouple the tracking update rate from the MR image acquisition rate. Performance of the workflow was evaluated with both computer simulations and experiments using an MR compatible testbed. Results show a high robustness of the multi-sensor tracking approach for dynamic image plane alignment, due to the combination of the individual strengths of each sensor.