Dynamic three-dimensional magnetic resonance abdominal angiography and perfusion: implementation and preliminary experience

Magnetization spoiling in radial FLASH contrast-enhanced MR digital subtraction angiography

PURPOSE

To increase the in-plane spatial resolution and image update rates of 2D magnetic resonance (MR) digital subtraction angiography (DSA) pulse sequences to 0.57 × 0.57 mm and 6 frames/sec, respectively, for intracranial vascular disease applications by developing a radial FLASH protocol and to characterize a new artifact, not previously described in the literature, which arises in the presence of such pulse sequences.

MATERIALS AND METHODS

The pulse sequence was optimized and artifacts were characterized using simulation and phantom studies. With Institutional Review Board (IRB) approval, the pulse sequence was used to acquire time-resolved images from healthy human volunteers and patients with x-ray DSA-confirmed intracranial vascular disease.

RESULTS

Artifacts were shown to derive from inhomogeneous spoiling due to the nature of radial waveforms. Gradient spoiling strategies were proposed to eliminate the observed artifact by balancing gradient moments across TR intervals. The resulting radial 2D MR DSA sequence (2.6 sec temporal footprint, 6 frames/sec with sliding window factor 16, 0.57 × 0.57 mm in-plane) demonstrated small vessel detail and corroborated x-ray DSA findings in intracranial vascular imaging studies.

CONCLUSION

Appropriate gradient spoiling in radial 2D MR DSA pulse sequences improves intracranial vascular depiction by eliminating circular banding artifacts. The proposed pulse sequence may provide a useful addition to clinically applied 2D MR DSA scans.

Accelerating time-resolved MRA with multiecho acquisition

A new four-dimensional magnetic resonance angiography (MRA) technique called contrast-enhanced angiography with multiecho and radial k-space is introduced, which accelerates the acquisition using multiecho while maintaining a high spatial resolution and increasing the signal-to-noise ratio (SNR). An acceleration factor of approximately 2 is achieved without parallel imaging or undersampling by multiecho (i.e., echo-planar imaging) acquisition. SNR is gained from (1) longer pulse repetition times, which allow more time for T(1) regrowth; (2) decreased specific absorption rate, which allows use of flip angles that maximize contrast at high field; and (3) minimized effects of a transient contrast bolus signal with a shorter temporal footprint. Simulations, phantom studies, and in vivo scans were performed. Contrast-enhanced angiography with multiecho and radial k-space can be combined with parallel imaging techniques such as Generalized Autocalibrating Partially Parallel Acquisitions (GRAPPA) to provide additional 2-fold acceleration in addition to higher SNR to trade off for parallel imaging. This technique can be useful in diagnosing vascular lesions where accurate dynamic information is necessary.

Radial sliding-window magnetic resonance angiography (MRA) with highly-constrained projection reconstruction (HYPR)

Sufficient temporal resolution is required to image the dynamics of blood flow, which may be critical for accurate diagnosis and treatment of various intracranial vascular diseases, such as arteriovenous malformations (AVMs) and aneurysms. Highly-constrained projection reconstruction (HYPR) has recently become a technique of interest for high-speed contrast-enhanced magnetic resonance angiography (CE-MRA). HYPR provides high frame rates by preferential weighting of radial projections while maintaining signal-to-noise ratio (SNR) by using a high SNR composite. An analysis was done to quantify the effects of HYPR on SNR, contrast-to-noise ratio (CNR), and temporal blur compared to the previously developed radial sliding-window technique using standard filtered backprojection or regridding methods. Computer simulations were performed to study the effects of HYPR processing on image error and the temporal information. Additionally, in vivo imaging was done on patients with angiographically confirmed AVMs to measure the effects of alteration of various HYPR parameters on SNR as well as the fidelity of the temporal information. The images were scored by an interventional radiologist in a blinded read and were compared with X-ray digital subtraction angiography (DSA). It was found that with the right choice of parameters, modest improvements in both SNR and dynamic information can be achieved as compared to radial sliding-window MRA.

Renal contrast-enhanced MR angiography: timing errors and accurate depiction of renal artery origins

PURPOSE

To investigate bolus timing artifacts that impair depiction of renal arteries at contrast material-enhanced magnetic resonance (MR) angiography and to determine the effect of contrast agent infusion rates on artifact generation.

MATERIALS AND METHODS

Renal contrast-enhanced MR angiography was simulated for a variety of infusion schemes, assuming both correct and incorrect timing between data acquisition and contrast agent injection. In addition, the ethics committee approved the retrospective evaluation of clinical breath-hold renal contrast-enhanced MR angiographic studies obtained with automated detection of contrast agent arrival. Twenty-two studies were evaluated for their ability to depict the origin of renal arteries in patent vessels and for any signs of timing errors.

RESULTS

Simulations showed that a completely artifactual stenosis or an artifactual overestimation of an existing stenosis at the renal artery origin can be caused by timing errors of the order of 5 seconds in examinations performed with contrast agent infusion rates compatible with or higher than those of hand injections. Lower infusion rates make the studies more likely to accurately depict the origin of the renal arteries. In approximately one-third of all clinical examinations, different contrast agent uptake rates were detected on the left and right sides of the body, and thus allowed us to confirm that it is often impossible to optimize depiction of both renal arteries. In three renal arteries, a signal void was found at the origin in a patent vessel, and delayed contrast agent arrival was confirmed.

CONCLUSION

Computer simulations and clinical examinations showed that timing errors impair the accurate depiction of renal artery origins.

3D contrast-enhanced MR angiography

Safe, fast, accurate contrast arteriography can be obtained utilizing gadolinium (Gd) and 3D MR data acquisition for diagnosing vascular diseases. Optimizing contrast enhanced MRA (CE MRA), however, requires understanding the complex interplay between Gd injection timing, the Fourier mapping of 3D MR data acquisition and a multitude of parameters determining resolution, anatomic coverage, and sensitivity to motion artifacts. It is critical to time the bolus peak to coincide with central k-space data acquisition, which dominates image contrast. Oversampling the center of k-space allows reconstruction of multiple 3D acquisitions in rapid succession to time-resolve the passage of the contrast bolus. Parallel imaging increases resolution, shortens scan time and compresses the center of k-space into a shorter period of time, thereby minimizing motion and timing artifacts. Absence of ionizing radiation allows MRA to be repeated and combined with additional sequences to more fully characterize anatomy, flow, and physiology. Utilizing stepping table technology and thigh compression, whole body MRA is possible with a single contrast injection. As MR technology continues to advance, CE MRA becomes better and simpler to perform, increasing its efficacy in the diagnosis and management of vascular diseases.

Accelerated time-resolved 3D contrast-enhanced MR angiography at 3T: clinical experience in 31 patients

PURPOSE

To evaluate whether time-resolved 3D MR-angiography at 3T with a net acceleration factor of eight is applicable in clinical routine and to evaluate whether good image quality and a low artifact level can be achieved with a temporal update rate that allows for additional information on pathologies.

MATERIALS AND METHODS

Thirty-one consecutive patients underwent time-resolved 3D contrast-enhanced MR-angiography on a 3T system. Imaging consisted of accelerated 3D gradient echo sequences combining parallel imaging with an acceleration factor of four, partial Fourier acquisition along phase and slice encoding direction, and twofold temporal acceleration using view sharing. Data volumes representing the arterial and venous contrast phases were independently evaluated by two experienced radiologists by grading of image quality and artifact level on a 0-3 scale.

RESULTS

Time-resolved MR-angiography was successfully performed in all subjects without the need for contrast agent bolus timing. Excellent arterial (average score = 2.65 +/- 0.32) and good venous (average score = 2.56 +/- 0.28) diagnostic image quality and little image degrading due to artifacts (average score = 2.20 +/- 0.16) were confirmed by both independent readers (agreement in 65.2% of all evaluations). In 14 patients vascular pathologies were identified in the arterial phases. In eight examinations temporal resolution and depiction of contrast agent dynamics provided additional information about pathology.

DISCUSSION

Without the necessity for additional bolus timing, time-resolved 3D contrast-enhanced MR-angiography with imaging acceleration along both the spatial encoding direction and temporal domain revealed excellent diagnostic image quality in neurovascular and thoracic imaging. Despite the limited spatial resolution as compared to high-resolution imaging of the carotid artery bifurcation, the results demonstrate the applicability of contrast-enhanced MR-angiography in thoracic and abdominal MRA as well as cervical imaging with a temporal update rate allowing for additional information on pathologies. Future studies may include an evaluation of optimal trade-offs between spatial and temporal resolution, different acceleration factors and a comparison to the gold-standard for accuracy.

Simultaneous magnetic resonance gadolinium-enhanced 2D perfusion and 3D angiographic imaging

A method was implemented and tested that allows the simultaneous acquisition of magnetic resonance 2D slice selective perfusion and 3D angiographic data during a single bolus injection of a contrast agent. High quality contrast-enhanced perfusion images and angiograms of the lung, kidney and heart were obtained in healthy volunteers. Combined perfusion and angiography provided additional information with an acceptable increase in acquisition time. No image artifacts were attributed to the technique. The combined information may be useful in detecting, as well as characterizing, vascular abnormalities.

Time-resolved, undersampled projection reconstruction imaging for high-resolution CE-MRA of the distal runoff vessels

Imaging of the blood vessels below the knee using contrast-enhanced (CE) MRI is challenging due to the need to coordinate image acquisition and arrival of the contrast in the targeted vessels. Time-resolved acquisitions have been successful in consistently capturing images of the arterial phase of the bolus of contrast agent in the distal extremities. Although time-resolved exams are robust in this respect, higher spatial resolution for the depiction of tight stenoses and the small vessels in the lower leg is desirable. A modification to a high-spatial-resolution T(1)-weighted pulse sequence (projection reconstruction-time resolved imaging of contrast kinetics (PR-TRICKS)) that improves the through-plane spatial resolution by a factor of 2 and maintains a high frame rate is presented. The undersampled PR-TRICKS pulse sequence has been modified to double the spatial resolution in the slice direction by acquiring high-spatial-frequency slice data only after first pass of the bolus of contrast agent. The acquisition reported in the present work (PR-hyperTRICKS) has been used to image healthy volunteers and patients with known vascular disease. The temporal resolution was found to be beneficial in capturing arterial phase images in the presence of asymmetric filling of vessels.

Noninvasive assessment of portomesenteric venous thrombosis: current concepts and imaging strategies

Rapid, noninvasive imaging strategies, especially multidetector spiral CT and CT angiography (CTA) as well as gadolinium-enhanced MR angiography (MRA), have facilitated early diagnosis of splanchnic venous thrombosis, a potentially lethal cause of intestinal ischemia. Single breath-hold volumetric acquisitions permit superior temporal and contrast resolution while eliminating motion artifact and suppressing respiratory misregistration. Increased spatial resolution is aided by thinner slice collimation. These cross-sectional imaging techniques are becoming a preferred noninvasive alternative to conventional selective mesenteric angiography with delayed imaging for venous evaluation and should be considered the primary diagnostic modalities for evaluating patients with high clinical suspicion of nonsurgical mesenteric ischemia.

Carotid bifurcation: evaluation of time-resolved three-dimensional contrast-enhanced MR angiography

A magnetic resonance (MR) angiographic protocol was evaluated in the carotid bifurcation with use of a pulse sequence for time-resolved three-dimensional imaging of contrast material kinetics. The enhancement ratio, a quantitative measure of contrast enhancement, indicated that all studies included an image obtained near the peak of the intraarterial concentration of contrast agent (enhancement ratio, 90% +/- 9 [standard deviation]). Studies acquired at a higher frame rate (4.1-4.9 seconds) exhibited less venous enhancement (enhancement ratio, 25% +/- 16) than studies acquired with slower (6.0-9.6-second) frame rates (enhancement ratio, 46% +/- 25).

Current awareness

In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of NMR in biomedicine. Each bibliography is divided into 9 sections: 1 Books, Reviews ' Symposia; 2 General; 3 Technology; 4 Brain and Nerves; 5 Neuropathology; 6 Cancer; 7 Cardiac, Vascular and Respiratory Systems; 8 Liver, Kidney and Other Organs; 9 Muscle and Orthopaedic. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.