Magnetic Resonance Navigation for Targeted Embolization in a Two-Level Bifurcation Phantom NING LI, 1,2 YUTING JIANG, 2,3 ROSALIE PLANTEFE ` VE, 2 FRANCOIS MICHAUD, 2,3 ZEYNAB NOSRATI, 4 CHARLES TREMBLAY, 1 KATAYOUN SAATCHI, 4 URS O. HA ¨ FELI, 4 SAMUEL KADOURY, 1,2 GERALD MORAN, 5 FLORIAN JOLY, 6 SYLVAIN MARTEL, 1 and GILLES SOULEZ 2,3 1 Polytechnique Montre´al, Chemin de Polytechnique, 2500 Chemin de Polytechnique, Montre´al, QC 28 H3T 1J4, Canada; 2 Laboratory of Clinical Image Processing, Le Centre de recherche du CHUM (CRCHUM), 900 Rue Saint-Denis, Montre´al, QC H2X 0A9, Canada; 3 Department of Radiology, Radiation-Oncology and Nuclear Medicine and Institute of Biomedical Engineering, Universite´ de Montre´al, 2900 Boulevard E ´ douard-Montpetit, Montre´al, QC H3T 1J4, Canada; 4 University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; 5 Siemens Canada, Oakville, ON, Canada; and 6 INRIA Paris, 2 rue Simone Iff, 75012 Paris, France (Received 30 January 2019; accepted 28 June 2019; published online 9 July 2019) Associate Editor Jane Grande-Allen oversaw the review of this article. Abstract—This work combines a particle injection system with our proposed magnetic resonance navigation (MRN) sequence with the intention of validating MRN in a two-bifurcation phantom for endovascular treatment of hepatocellular carci- noma (HCC). A theoretical physical model used to calculate the most appropriate size of the magnetic drug-eluting bead (MDEB, 200 lm) aggregates was proposed. The aggregates were injected into the phantom by a dedicated particle injector while a trigger signal was automatically sent to the MRI to start MRN which consists of interleaved tracking and steering sequences. When the main branch of the phantom was parallel to B 0 , the aggregate distribution ratio in the (left–left, left– right, right–left and right–right divisions was obtained with results of 8, 68, 24 and 0% respectively at baseline (no MRN) and increased to 84%, 100, 84 and 92% (p < 0.001, p = 0.004, p < 0.001, p < 0.001) after implementing our MRN protocol. When the main branch was perpendicular to B 0 , the right-left branch, having the smallest baseline distribu- tion rate of 0%, reached 80% (p < 0.001) after applying MRN. Moreover, the success rate of MRN was always more than 92% at the 1st bifurcation in the experiments above. Keywords—Magnetic resonance navigation, Two-bifurca- tions navigation, Hepatocellular carcinoma, Embolization. ABBREVIATIONS DEB Drug-eluting bead HCC Hepatocellular carcinoma MRI Magnetic resonance imaging MRN Magnetic resonance navigation MDEB Magnetic drug-eluting bead TACE Trans-catheter arterial chemoembolization INTRODUCTION Liver cancer is the third most frequent cause of cancer-related deaths worldwide, among which, hepa- tocellular carcinoma (HCC), the most common type of this disease, makes up approximately 80–90% of all cases of primary liver cancer in the United States. 1,37 Surgical resection, liver transplantation and tran- scatheter arterial chemoembolization (TACE) are three therapeutic choices used to treat HCC. 16,23,43 Surgical resection is generally associated with better prognoses. However, poor liver function and/or the disease’s severity prevent more than 70% of the patients to be eligible for surgical resection. 2 Liver transplantation eligibility is also limited. Recent re- ports published on the website of the U.S. Department of Health & Human Services (OPTN) have shown that among those patients who are eligible and placed in the waiting list, only about 40–50% of them will undergo liver transplantation per year. Meanwhile, TACE, a palliative treatment, has a wider range of applications. It is not only suitable for patients with intermediate stage HCC ineligible for surgery or transplantation, but can also be used as a temporary treatment to Address correspondence to Gilles Soulez, Laboratory of Clinical Image Processing, Le Centre de recherche du CHUM (CRCHUM), 900 Rue Saint-Denis, Montre´al, QC H2X 0A9, Canada. Electronic mail: gilles.soulez.chum@ssss.gouv.qc.ca Annals of Biomedical Engineering, Vol. 47, No. 12, December 2019 (Ó 2019) pp. 2402–2415 https://doi.org/10.1007/s10439-019-02317-x BIOMEDICAL ENGINEERING SOCIETY 0090-6964/19/1200-2402/0 Ó 2019 Biomedical Engineering Society 2402