X-ray Fused With Magnetic Resonance Imaging to Guide Endomyocardial Biopsy of a Right Ventricular Mass.

BACKGROUND A patient with a history of cancer in remission and congestive heart failure with no acute symptoms presented for a follow-up echocardiogram. The scan revealed a new echodense mass filling his right ventricular apex. An endomyocardial biopsy guided by x-ray fused with magnetic resonance (MR) imaging (XFM) was performed. This case report outlines the steps of XFM image preparation involving MR image acquisition, processing, and coregistration with x-ray fluoroscopy. DISCUSSION In cases of focal pathology or cardiac masses, endomyocardial biopsy can be challenging because x-ray fluoroscopy guidance offers limited visualization of soft-tissue structures. XFM overcomes this issue by overlaying high-resolution MR images onto x-ray fluoroscopy images. CONCLUSION This case report illustrates the clinical use of XFM for endomyocardial biopsy of an apical right ventricular mass and provides a practical, step-by-step description of MR image acquisition, processing, and coregistration with fluoroscopy, as performed by the MR technologist.