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Republished: Real-time MRI guidance for intra-arterial drug delivery in a patient with a brain tumor: technical note
  1. Michal Zawadzki1,
  2. Jerzy Walecki1,
  3. Boguslaw Kostkiewicz2,
  4. Kacper Kostyra2,
  5. Monica Smith Pearl3,4,
  6. Meiyappan Solaiyappan3,
  7. Piotr Walczak3,
  8. Miroslaw Janowski3
  1. 1Department of Radiology, Centre of Postgraduate Medical Education, Warsaw, Poland
  2. 2Department of Neurosurgery, Central Clinical Hospital of Ministry of the Interior and Administration, Warsaw, Poland
  3. 3Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
  4. 4Department of Radiology, Children’s National Medical Center, Washington, District of Columbia, USA
  1. Correspondence to Dr Miroslaw Janowski, Department of Radiology, Johns Hopkins University, Baltimore MD 21205, USA; mjanows1{at}


Patients suffering from malignant brain tumors are burdened with a grim prognosis. The blood brain barrier is considered a primary obstacle in therapeutic drug delivery to the brain. Intra-arterial (IA) delivery of therapeutic agents following osmotic BBB opening has been attempted for years, but high variability has limited its widespread implementation. It has been recently shown in animal studies that MRI is superior to X-ray for guiding IA infusions, as it allows direct visualization of the brain parenchyma perfused and facilitates predictable drug targeting. Moreover, PET imaging has revealed that IA, not intravenous, delivery of bevacizumab results in brain accumulation, providing strong rationale for utilizing the IA route. Here, we present our experience in a patient with recurrent butterfly glioblastoma enrolled in first-in-man MRI-guided neurointervention for targeted IA drug delivery.

  • MRI
  • brain
  • intervention
  • technique
  • malignant

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  • Republished with permission from BMJ Case Reports Published 27 January 2019; doi: 10.1136/bcr-2018-014469

  • Contributors MZ: planned treatment and performed procedure, analyzed data and edited manuscript. JW: planned treatment and edited manuscript. BK: planned treatment and edited manuscript. KK: planned treatment and took care of patient on daily basis. MSP and MS: prepared virtual reality visualization. PW: planned procedure, analyzed data, edited manuscript and prepared figures. MJ: planned treatment and performed procedure, analyzed data, drafted manuscript and approved its final form.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Central Clinical Hospital of Ministry of the Interior and Administration.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All imaging data can be shared on request.

  • Patient consent for publication Not required.