Voxel sensitivity function description of flow-induced signal loss in MR imaging: implications for black-blood MR angiography with turbo spin-echo sequences

Evaluation of High Intracranial Plaque Prevalence in Type 2 Diabetes Using Vessel Wall Imaging on 7 T Magnetic Resonance Imaging

BACKGROUND

While type 2 diabetes (T2D) is a major risk for ischemic stroke, the associated vessel wall characteristics remain essentially unknown. This study aimed to clarify intracranial vascular changes on three-dimensional vessel wall imaging (3D-VWI) using fast spin echo by employing 7Tesla (7T) magnetic resonance imaging (MRI) in T2D patients without advanced atherosclerosis as compared to healthy controls.

METHODS

In 48 T2D patients and 35 healthy controls, the prevalence of cerebral small vessel diseases and intracranial plaques were evaluated by 3D-VWI with 7T MRI.

RESULTS

The prevalence rate of lacunar infarction was significantly higher in T2D than in controls (n = 8 in T2D vs. n = 0 in control, p = 0.011). The mean number of intracranial plaques in both anterior and posterior circulation of each subject was significantly larger in T2D than in controls (2.23 in T2D vs. 0.94 in control, p < 0.01). In T2D patients, gender was associated with the presence of intracranial plaques.

CONCLUSION

This is the first study to demonstrate the high prevalence of intracranial plaque in T2D patients with neither confirmed atherosclerotic disease nor symptoms by performing intracranial 3D-VWI employing 7TMRI. Investigation of intracranial VWI with 7T MRI is expected to provide novel insights allowing early intensive risk management for prevention of ischemic stroke in T2D patients.

Primary Multiparametric Quantitative Brain MRI: State-of-the-Art Relaxometric and Proton Density Mapping Techniques

This review on brain multiparametric quantitative MRI (MP-qMRI) focuses on the primary subset of quantitative MRI (qMRI) parameters that represent the mobile ("free") and bound ("motion-restricted") proton pools. Such primary parameters are the proton densities, relaxation times, and magnetization transfer parameters. Diffusion qMRI is also included because of its wide implementation in complete clinical MP-qMRI application. MP-qMRI advances were reviewed over the past 2 decades, with substantial progress observed toward accelerating image acquisition and increasing mapping accuracy. Areas that need further investigation and refinement are identified as follows: (a) the biologic underpinnings of qMRI parameter values and their changes with age and/or disease and (b) the theoretical limitations implicitly built into most qMRI mapping algorithms that do not distinguish between the different spatial scales of voxels versus spin packets, the central physical object of the Bloch theory. With rapidly improving image processing techniques and continuous advances in computer hardware, MP-qMRI has the potential for implementation in a wide range of clinical applications. Currently, three emerging MP-qMRI applications are synthetic MRI, macrostructural qMRI, and microstructural tissue modeling.

Image-Quality Assessment of 3D Intracranial Vessel Wall MRI Using DANTE or DANTE-CAIPI for Blood Suppression and Imaging Acceleration

BACKGROUND AND PURPOSE

3D intracranial vessel wall MRI techniques are time consuming and prone to artifacts, especially flow artifacts. Our aim was to compare the image quality of accelerated and flow-suppressed 3D intracranial vessel wall MR imaging techniques relative to conventional acquisitions.

MATERIALS AND METHODS

Consecutive patients undergoing MR imaging had conventional postcontrast 3D T1-sampling perfection with application-optimized contrasts by using different flip angle evolution (SPACE) and either postcontrast delay alternating with nutation for tailored excitation (DANTE) flow-suppressed or DANTE-controlled aliasing in parallel imaging results in higher acceleration (CAIPI) flow-suppressed and accelerated T1-SPACE sequences performed. The sequences were evaluated using 4- or 5-point Likert scales for overall image quality, SNR, extent/severity of artifacts, motion, blood suppression, sharpness, and lesion assessment. Quantitative assessment of lumen and wall-to-lumen contrast ratios was performed.

RESULTS

Eighty-nine patients were included. T1-DANTE-SPACE had significantly better qualitative ratings relative to T1-SPACE for image quality, SNR, artifact impact, arterial and venous suppression, and lesion assessment (P < .001 for each, respectively), with the exception of motion (P = .16). T1-DANTE-CAIPI-SPACE had significantly better image quality, lesion assessment, arterial and venous blood suppression, less artifact impact, and less motion compared with T1-SPACE (P < .001 for each, respectively). The SNR was higher with T1-SPACE compared with T1-DANTE-CAIPI-SPACE (P < .001). T1-DANTE-CAIPI-SPACE showed significantly worse lumen (P = .005) and wall-to-lumen contrast ratios (P = .001) compared with T1-SPACE, without a significant difference between T1-SPACE and T1-DANTE-SPACE. T1-DANTE-CAIPI-SPACE scan time was 5:11 minutes compared with 8:08 and 8:41 minutes for conventional T1-SPACE and T1-DANTE-SPACE, respectively.

CONCLUSIONS

Accelerated postcontrast T1-DANTE-CAIPI-SPACE had fewer image artifacts, less motion, improved blood suppression, and a shorter scan time, but lower qualitative and quantitative SNR ratings relative to conventional T1-SPACE intracranial vessel wall MR imaging. Postcontrast T1-DANTE-SPACE had superior SNR, blood suppression, higher image quality, and fewer image artifacts, but slightly longer scan times relative to T1-SPACE.

Reproducibility between three-dimensional turbo spin-echo and two-dimensional dual inversion recovery turbo spin-echo for coronary vessel wall imaging in Kawasaki disease

Magnetic resonance vessel wall imaging is desirable for evaluating Kawasaki disease (KD)-associated coronary arterial lesions. To evaluate the reproducibility of three-dimensional turbo spin-echo (3D-TSE) and two-dimensional dual inversion-recovery turbo spin-echo (2D-DIR-TSE) for coronary vessel wall imaging in KD. Ten patients were prospectively enrolled. Coronary vessel wall imaging with axial-slice orientation 3D-TSE and 2D-DIR-TSE were acquired for cross-sectional images in aneurysmal and normal regions. Lumen area (LA), wall area (WA), and normalized wall index (NWI) of cross-sectional images were measured in both regions. Reproducibility between 3D-TSE and 2D-DIR-TSE was evaluated via intraclass correlation coefficients (ICCs) and Bland–Altman plots. 48 points (aneurysmal, 27; normal, 21) were evaluated. There were high ICCs between 3D-TSE and 2D-DIR-TSE in LA (0.95) and WA (0.95). In aneurysmal regions, 95% limits of agreement were LA, WA, and NWI of − 29.9 to 30.4 mm², − 18.8 to 15.0 mm², and − 0.22 to 0.20, respectively. In normal regions, the 95% limits of agreement were LA, WA, and NWI of − 4.44 to 4.38 mm², − 3.51 to 4.30 mm², and − 0.14 to 0.16, respectively. No fixed and proportional biases between 3D-TSE and 2D-DIR-TSE images in aneurysmal and normal regions were noted. 3D-TSE was reproducible with conventional 2D-DIR-TSE for coronary vessel wall assessment on KD.

Semi-Automatic MRI Feature Assessment in Small- and Medium-Volume Benign Prostatic Hyperplasia after Prostatic Artery Embolization

(1) Background: To assess the treatment response of benign prostatic syndrome (BPS) following prostatic artery embolization (PAE) using a semi-automatic software analysis of magnetic resonance imaging (MRI) features and clinical indexes. (2) Methods: Prospective, monocenter study of MRI and clinical data of n = 27 patients with symptomatic BPS before and (1, 6, 12 months) after PAE. MRI analysis was performed using a dedicated semi-automatic software for segmentation of the central and the total gland (CG, TG), respectively; signal intensities (SIs) of T1-weighted (T1w), T2-weighted (T2w), and diffusion-weighted images (DWI), as well as intravesical prostatic protrusion (IPP) and prostatic volumes (CGV, TGV), were evaluated at each time point. The semi-automatic assessed TGV was compared to conventional TGV by an ellipse formula. International prostate symptom score (IPSS) and international consultation on incontinence questionnaire−urinary incontinence short form (ICIQ-UI SF) questionnaires were used as clinical indexes. Statistical testing in the form of ANOVA, pairwise comparisons using Bonferroni correction, and multiple linear correlations, were conducted using SPSS. (3) Results: TGV was significantly reduced one, six, and 12 months after PAE as assessed by the semi-automatic approach and conventional ellipse formula (p = 0.005; p = 0.025). CGV significantly decreased after one month (p = 0.038), but showed no significant differences six and 12 months after PAE (p = 0.191; p = 0.283). IPP at baseline was demonstrated by 25/27 patients (92.6%) with a significant decrease one, six, and 12 months after treatment (p = 0.028; p = 0.010; p = 0.008). Significant improvement in IPSS and ICIQ-UI SF (p = 0.002; p = 0.016) after one month correlated moderately with TGV reduction (p = 0.031; p = 0.05, correlation coefficients 0.52; 0.69). Apparent diffusion coefficient (ADC) values of CG significantly decreased one month after embolization (p < 0.001), while there were no significant differences in T1w and T2w SIs before and after treatment at each time point. (4) Conclusions: The semi-automatic approach is appropriate for the assessment of volumetric and morphological changes in prostate MRI following PAE, able to identify significantly different ADC values post-treatment without the need for manual identification of infarct areas. Semi-automatic measured TGV reduction is significant and comparable to the TGV calculated by the conventional ellipse formula, confirming the clinical response after PAE.

Vessel Wall Magnetic Resonance Imaging in Cerebrovascular Diseases

Cerebrovascular diseases are a leading cause of disability and death worldwide. The definition of stroke etiology is mandatory to predict outcome and guide therapeutic decisions. The diagnosis of pathological processes involving intracranial arteries is especially challenging, and the visualization of intracranial arteries’ vessel walls is not possible with routine imaging techniques. Vessel wall magnetic resonance imaging (VW-MRI) uses high-resolution, multiparametric MRI sequences to directly visualize intracranial arteries walls and their pathological alterations, allowing a better characterization of their pathology. VW-MRI demonstrated a wide range of clinical applications in acute cerebrovascular disease. Above all, it can be of great utility in the differential diagnosis of atherosclerotic and non-atherosclerotic intracranial vasculopathies. Additionally, it can be useful in the risk stratification of intracranial atherosclerotic lesions and to assess the risk of rupture of intracranial aneurysms. Recent advances in MRI technology made it more available, but larger studies are still needed to maximize its use in daily clinical practice.

Essentials for Interpreting Intracranial Vessel Wall MRI Results: State of the Art

Intracranial vessel wall (VW) MRI has become widely available in clinical practice, providing multiple uses for evaluation of neurovascular diseases. The Vessel Wall Imaging Study Group of the American Society of Neuroradiology has recently reported expert consensus recommendations for the clinical implementation of this technique. However, the complexity of the neurovascular system and caveats to the technique may challenge its application in clinical practice. The purpose of this article is to review concepts essential for accurate interpretation of intracranial VW MRI results. This knowledge is intended to improve diagnostic confidence and performance in the interpretation of VW MRI scans. © RSNA, 2021 Online supplemental material is available for this article.

Vessel wall MR imaging for the detection of intracranial inflammatory vasculopathies

Intracranial vasculopathies are routinely investigated by lumen-based modalities such as magnetic resonance angiography (MRA), computed tomography angiography (CTA), and digital subtraction angiography (DSA). These techniques are useful to analyze the vessel lumen, allowing to detect vessel stenosis or occlusion. However, the primum movins of the disease, i.e., an abnormal thickening of the vessel wall, remains within the arterial wall. The vasculopathy can moreover be present without always narrowing the lumen or modifying its regularity. Hence, there is a need to detect directly and analyze vessel wall abnormalities. Development of 3D high-resolution black blood sequences for intracranial vessel wall MR imaging (VW-MRI) enabled routine clinical applications not only vasculitis, but also of intracranial atherosclerotic disease (ICAD), intracranial dissections, reversible intracranial dissections, reversible cerebral vasoconstriction syndrome (RCVS), Moyamoya disease, and intracranial aneurysms. This high-resolution intracranial VW- MRI approach is increasingly used on a clinical basis at many centers to solve diagnostic problems, especially in patients with ischemic stroke or intracranial hemorrhage. An expert consensus Guideline from the American Society of Neuroradiology provides recommendations for clinical implementation of intracranial vessel wall MRI. There are several technical aspects needed to be considered when implementing VW-MRI in intracranial vessels, including flow suppression, both in blood and cerebrospinal fluid (CSF), spatial resolution and signal-to-noise ratio (SNR). In this article, we review the technical aspects of VW-MRI, and recommend applications for vascular diseases including non-occlusive intracranial vasculopathies, Moyamoya disease, and identifying culprit plaques. We also give a focus on the utility of VW-MRI for determining stroke etiology in adults and in children and young adults.

Vascular magnetic resonance angiography techniques

Magnetic resonance angiography (MRA) denotes a unique option for the evaluation of peripheral vasculature due to its noninvasive nature, lack of ionizing radiation exposure, potential for non-contrast examination, and ability for generating volumetric representations that showcase vascular pathology. The constant evolution of the available MRA techniques, however, makes understanding and determining an optimal imaging protocol difficult. Here we present a brief overview of the major MRA sequence options, their major weaknesses and strengths, and related imaging considerations. Understanding the technical underpinnings of the various MRA methods helps with recognition of common imaging issues and artifacts and rendering clinically relevant interpretations.

MR imaging findings of the prostate gland following prostate artery embolization: results from a prospective phase 2 study

PURPOSE

To assess changes in imaging and volume characteristics of the prostate gland by magnetic resonance (MR) following prostatic artery embolization (PAE) for benign prostate hyperplasia.

METHODS

With IRB approval, we analyzed prospectively acquired MR data of PAE patients at baseline and 6-month following treatment from 2015 to 2017. We reviewed prostate MRs looking for sequelae of embolization [changes in signal intensity and/or enhancement, infection/inflammation, infarction, edema, and change in intravesical prostatic protrusion (IPP)]. We calculated the total volume (TV) and central gland volumes (CGV) using DynaCAD^® and measured change in volumes. Analyses were performed using SPSS with p < 0.05 considered significant.

RESULTS

Forty-three patients (n = 43) met our inclusion criteria. 93% (30/43) and 100% (43/43) showed a decrease in TV and CGV at 6-months respectively. At baseline, median TV was 86 cc (range 29.4-232) and median CGV was 54.4 cc (range 12.9-165.5). Median decrease in TV was 18.2% (CI 13.3-27.2) (p = 0.0001) and median decrease in CGV was 26.7% (CI 20.4-35.9) (p = 0.0001). Thirty-seven percent (16/43) of patients had IPP at baseline; 100% showed a decrease in size of median lobe at follow-up. At 6-month follow-up, 33% (14/43) showed imaging features of infarction, 79% (34/43) had decrease in T2-signal intensity, and 51% (22/43) showed a decrease in enhancement. None had edema, peri-prostatic fat changes or infection/inflammation.

CONCLUSION

PAE causes a statistically significant reduction in the TV and CGV. There is also a reduction of the degree of IPP. Non-specific findings of infarction, decrease in T2-signal, and enhancement were also seen.

Vessel Wall MRI for Targeting Biopsies of Intracranial Vasculitis

Central nervous system vasculitides are elusive diseases that are challenging to diagnose because brain biopsies have high false-negative rates. We sought to test the ability of contrast-enhanced, high-resolution 3D vessel wall MR imaging to identify vascular inflammation and direct open biopsies of intracranial target vessels and adjacent brain parenchyma. Eight of 9 specimens revealed vascular inflammation. We conclude that vessel wall MR imaging can identify inflamed intracranial vessels, enabling precise localization of biopsy targets.

A Comparison of Black-blood T2 Mapping Sequences for Carotid Vessel Wall Imaging at 3T: An Assessment of Accuracy and Repeatability

Purpose:

This study is to compare the accuracy of four different black-blood T₂ mapping sequences in carotid vessel wall.

Methods:

Four different black-blood T₂ mapping sequences were developed and tested through phantom experiments and 17 healthy volunteers. The four sequences were: 1) double inversion-recovery (DIR) prepared 2D multi-echo spin-echo (MESE); 2) DIR-prepared 2D multi-echo fast spin-echo (MEFSE); 3) improved motion-sensitized driven-equilibrium (iMSDE) prepared 3D FSE and 4) iMSDE prepared 3D fast spoiled gradient echo (FSPGR). The concordance correlation coefficient and Bland–Altman statistics were used to compare the sequences with a gold-standard 2D MESE, without blood suppression in phantom studies. The volunteers were scanned twice to test the repeatability. Mean and standard deviation of vessel wall T₂, signal-to-noise (SNR), the coefficient of variance and interclass coefficient (ICC) of the two scans were compared.

Results:

The phantom study demonstrated that T₂ measurements had high concordance with respect to the gold-standard (all r values >0.9). In the volunteer study, the DIR 2D MEFSE had significantly higher T₂ values than the other three sequences (P < 0.01). There was no difference in T₂ measurements obtained using the other three sequences (P > 0.05). iMSDE 3D FSE had the highest SNR (P < 0.05) compared with the other three sequences. The 2D DIR MESE has the highest repeatability (ICC: 0.96, [95% CI: 0.88–0.99]).

Conclusion:

Although accurate T₂ measurements can be achieved in phantom by the four sequences, in vivo vessel wall T₂ quantification shows significant differences. The in vivo images can be influenced by multiple factors including black-blood preparation and acquisition method. Therefore, a careful choice of acquisition methods and analysis of the confounding factors are required for accurate in vivo carotid vessel wall T₂ measurements. From the settings in this study, the iMSDE prepared 3D FSE is preferred for the future volunteer/patient scans.

Vessel wall characterization using quantitative MRI: what's in a number?

The past decade has witnessed the rapid development of new MRI technology for vessel wall imaging. Today, with advances in MRI hardware and pulse sequences, quantitative MRI of the vessel wall represents a real alternative to conventional qualitative imaging, which is hindered by significant intra- and inter-observer variability. Quantitative MRI can measure several important morphological and functional characteristics of the vessel wall. This review provides a detailed introduction to novel quantitative MRI methods for measuring vessel wall dimensions, plaque composition and permeability, endothelial shear stress and wall stiffness. Together, these methods show the versatility of non-invasive quantitative MRI for probing vascular disease at several stages. These quantitative MRI biomarkers can play an important role in the context of both treatment response monitoring and risk prediction. Given the rapid developments in scan acceleration techniques and novel image reconstruction, we foresee the possibility of integrating the acquisition of multiple quantitative vessel wall parameters within a single scan session.

Breath-hold black blood quantitative T1rho imaging of liver using single shot fast spin echo acquisition

BACKGROUND

Liver fibrosis is a key feature in most chronic liver diseases. T1rho magnetic resonance imaging is a potentially important technique for noninvasive diagnosis, severity grading, and therapy monitoring of liver fibrosis. However, it remains challenging to perform robust T1rho quantification of liver on human subjects. One major reason is that the presence of rich blood signal in liver can cause artificially high T1rho measurement and makes T1rho quantification susceptible to motion.

METHODS

A pulse sequence based on single shot fast/turbo spin echo (SSFSE/SSTSE) acquisition, with theoretical analysis and simulation based on the extended phase graph (EPG) algorithm, was presented for breath-hold single slice quantitative T1rho imaging of liver with suppression of blood signal. The pulse sequence was evaluated in human subjects at 3.0 T with 500 Hz spinlock frequency and time-of-spinlock (TSL) 0, 10, 30 and 50 ms.

RESULTS

Human scan demonstrated that the entire T1rho data sets with four spinlock time can be acquired within a single breath-hold of 10 seconds with black blood effect. T1rho quantification with suppression of blood signal results in significantly reduced T1rho value of liver compared to the results without blood suppression.

CONCLUSIONS

A signal-to-noise ratio (SNR) efficient pulse sequence was reported for T1rho quantification of liver. The black blood effect, together with a short breath-hold, mitigates the risk of quantification errors as would occur in the conventional methods.

Isotropic 3D black blood MRI of abdominal aortic aneurysm wall and intraluminal thrombus

INTRODUCTION

The aortic wall and intraluminal thrombus (ILT) have been increasingly studied as potential markers of progressive disease with abdominal aortic aneurysms (AAAs). Our goal was to develop a high resolution, 3D black blood MR technique for AAA wall and ILT imaging within a clinically acceptable scan time.

METHODS

Twenty two patients with AAAs (maximal diameter 4.3±1.0cm), along with five healthy volunteers, were imaged at 3T with a 3D T1-weighted fast-spin-echo sequence using variable flip angle trains (SPACE) with a preparation pulse (DANTE) for suppressing blood signal. Volunteers and ten patients were also scanned with SPACE alone for comparison purposes. The signal to noise ratio (SNR) and the aortic wall/ILT to lumen contrast to noise ratio (CNR) were measured. Qualitative image scores (1-4 scale) assessing the inner lumen and outer wall boundaries of AAA were performed by two blinded reviewers. In patients with ILT, the ratio of ILT signal intensity (ILTSI) over psoas muscle SI (MuscleSI) was calculated, and the signal heterogeneity of ILT was quantified as standard deviation (SD) over the mean.

RESULTS

All subjects were imaged successfully with an average scan time of 7.8±0.7minutes. The DANTE preparation pulse for blood suppression substantially reduced flow artifacts in SPACE with lower lumen SNR (8.8 vs. 21.4, p<0.001) and improved the wall/ILT to lumen CNR (9.9 vs. 6.3, p<0.001) in patients. Qualitative assessment showed improved visualization of lumen boundaries (73% higher scores on average, p=0.01) and comparable visualization of outer wall boundary (p>0.05). ILT was present in ten patients, with relatively high signal and a wide SD (average ILTSI/MuscleSI 1.42±0.48 (range 0.75-2.11)) and with SD/mean of 27.7%±6.6% (range 19.6%-39.4%).

CONCLUSION

High resolution, 3D black blood MRI of AAAs can be achieved in a clinical accepted scan time with reduction of flow artifacts using the DANTE preparation pulse. Signal characteristics of ILT can be quantified and may be used for improved patient-specific risk stratification.

Technical recommendations for the use of carotid duplex ultrasound for the assessment of extracranial blood flow

Duplex ultrasound is an evolving technology that allows the assessment of volumetric blood flow in the carotid and vertebral arteries during a range of interventions along the spectrum of health and chronic disease. Duplex ultrasound can provide high-resolution diameter and velocity information in real-time and is noninvasive with minimal risks or contraindications. However, this ultrasound approach is a specialized technique requiring intensive training and stringent control of multiple complex settings; results are highly operator-dependent, and analysis approaches are inconsistent. Importantly, therefore, methodological differences can invalidate comparisons between different imaging modalities and studies; such methodological errors have potential to discredit study findings completely. The task of this review is to provide the first comprehensive, user-friendly technical guideline for the application of duplex ultrasound in measuring extracranial blood flow in human research. An update on recent developments in the use of edge-detection software for offline analysis is highlighted, and suggestions for future directions in this field are provided. These recommendations are presented in an attempt to standardize measurements across research groups and, hence, ultimately to improve the accuracy and reproducibility of measuring extracranial blood flow both within subjects and between groups.

Improved black-blood imaging using DANTE-SPACE for simultaneous carotid and intracranial vessel wall evaluation

PURPOSE

The purpose of this study was to develop a three-dimensional black blood imaging method for simultaneously evaluating the carotid and intracranial arterial vessel walls with high spatial resolution and excellent blood suppression with and without contrast enhancement.

METHODS

The delay alternating with nutation for tailored excitation (DANTE) preparation module was incorporated into three-dimensional variable flip angle turbo spin echo (SPACE) sequence to improve blood signal suppression. Simulations and phantom studies were performed to quantify image contrast variations induced by DANTE. DANTE-SPACE, SPACE, and two-dimensional turbo spin echo were compared for apparent signal-to-noise ratio, contrast-to-noise ratio, and morphometric measurements in 14 healthy subjects. Preliminary clinical validation was performed in six symptomatic patients.

RESULTS

Apparent residual luminal blood was observed in five (pre-contrast) and nine (post-contrast) subjects with SPACE and only two (post-contrast) subjects with DANTE-SPACE. DANTE-SPACE showed 31% (pre-contrast) and 100% (post-contrast) improvement in wall-to-blood contrast-to-noise ratio over SPACE. Vessel wall area measured from SPACE was significantly larger than that from DANTE-SPACE due to possible residual blood signal contamination. DANTE-SPACE showed the potential to detect vessel wall dissection and identify plaque components in patients.

CONCLUSION

DANTE-SPACE significantly improved arterial and venous blood suppression compared with SPACE. Simultaneous high-resolution carotid and intracranial vessel wall imaging to potentially identify plaque components was feasible with a scan time under 6 min. Magn Reson Med 75:2286-2294, 2016. © 2015 Wiley Periodicals, Inc.

Tracking of mesenchymal stem cells labeled with gadolinium diethylenetriamine pentaacetic acid by 7T magnetic resonance imaging in a model of cerebral ischemia

Progress in the development of stem cell and gene therapy requires repeatable and non-invasive techniques to monitor the survival and integration of stem cells in vivo with a high temporal and spatial resolution. The purpose of the present study was to examine the feasibility of using the standard contrast agent gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) to label rat mesenchymal stem cells (MSCs) for stem cell tracking. MSCs, obtained from the bilateral femora of rats, were cultured and propagated. The non-liposomal lipid transfection reagent effectene was then used to induce the intracellular uptake of Gd-DTPA. Electron microscopy was used to detect the distribution of Gd-DTPA particles in the MSCs. The labeling efficiency of the Gd-DTPA particles in the MSCs was determined using spectrophotometry, and MTT and trypan blue exclusion assays were used to evaluate the viability and proliferation of the labeled MSCs. T1-weighted magnetic resonance imaging (MRI) was used to observe the labeled cells in vitro and in the rat brain. Gd-DTPA particles were detected inside the MSCs using transmission electron microscopy and a high labeling efficiency was observed. No difference was observed in cell viability or proliferation between the labeled and unlabeled MSCs (P>0.05). In the in vitro T1-weighted MRI and in the rat brain, a high signal intensity was observed in the labeled MSCs. The T1-weighted imaging of the labeled cells revealed a significantly higher signal intensity compared with that of the unlabeled cells (P<0.05) and the T1 values were significantly lower. The function of the labeled MSCs demonstrated no change following Gd-DTPA labeling, with no evident adverse effect on cell viability or proliferation. Therefore, a change in MR signal intensity was detected in vitro and in vivo, suggesting Gd-DTPA can be used to label MSCs for MRI tracking.

Assessment of middle cerebral artery diameter during hypocapnia and hypercapnia in humans using ultra-high-field MRI

In the evaluation of cerebrovascular CO2 reactivity measurements, it is often assumed that the diameter of the large intracranial arteries insonated by transcranial Doppler remains unaffected by changes in arterial CO2 partial pressure. However, the strong cerebral vasodilatory capacity of CO2 challenges this assumption, suggesting that there should be some changes in diameter, even if very small. Data from previous studies on effects of CO2 on cerebral artery diameter [middle cerebral artery (MCA)] have been inconsistent. In this study, we examined 10 healthy subjects (5 women, 5 men, age 21-30 yr). High-resolution (0.2 mm in-plane) MRI scans at 7 Tesla were used for direct observation of the MCA diameter during hypocapnia, -1 kPa (-7.5 mmHg), normocapnia, 0 kPa (0 mmHg), and two levels of hypercapnia, +1 and +2 kPa (7.5 and 15 mmHg), with respect to baseline. The vessel lumen was manually delineated by two independent observers. The results showed that the MCA diameter increased by 6.8 ± 2.9% in response to 2 kPa end-tidal P(CO2) (PET(CO2)) above baseline. However, no significant changes in diameter were observed at the -1 kPa (-1.2 ± 2.4%), and +1 kPa (+1.4 ± 3.2%) levels relative to normocapnia. The nonlinear response of the MCA diameter to CO2 was fitted as a continuous calibration curve. Cerebral blood flow changes measured by transcranial Doppler could be corrected by this calibration curve using concomitant PET(CO2) measurements. In conclusion, the MCA diameter remains constant during small deviations of the PET(CO2) from normocapnia, but increases at higher PET(CO2) values.

Optimization of improved motion-sensitized driven-equilibrium (iMSDE) blood suppression for carotid artery wall imaging

BACKGROUND

Improved motion-sensitized driven-equilibrium (iMSDE) preparations have been successfully used in carotid artery wall imaging to achieve blood suppression, but it causes notable signal loss, mostly due to inherent T2 decay, eddy current effects and B1 + inhomogeneity. In this study, we investigate the signal to noise ratio (SNR) and blood suppression performance of iMSDE using composite RF pulses and sinusoidal gradients. Optimized first moment (m1) values for iMSDE prepared T1- and T2- weighted (T1- and T2-w) imaging are presented.

METHODS

Twelve healthy volunteers and six patients with carotid artery disease underwent iMSDE and double inversion recovery (DIR) prepared T1- and T2-w fast spin echo (FSE) MRI of the carotid arteries. Modified iMSDE module using composite RF pulses and sinusoidal gradients were evaluated with a range of m1. SNR of adjacent muscle, vessel wall and the lumen were reported. The optimized iMSDE module was also tested in a 3D variable flip angle FSE (CUBE) acquisition.

RESULTS

The SNR of muscle was highest using sinusoidal gradients, and the relative improvement over the trapezoidal gradient increased with higher m1 (p<0.001). Optimal SNR was observed using an iMSDE preparation scheme containing two 180° composite pulses and standard 90° and -90° pulses (p=0.151). iMSDE produced better blood suppression relative to DIR preparations even with a small m1 of 487 mT*ms2/m (p<0.001). In T1-w iMSDE, there was a SNR decrease and an increased T2 weighting with increasing m1. In T2-w iMSDE, by matching the effective echo time (TE), the SNR was equivalent when m1 was <= 1518 mT*ms2/m, however, higher m1 values (2278 - 3108 mT*ms2/m) reduced the SNR. In the patient study, iMSDE improved blood suppression but reduced vessel wall CNR efficiency in both T1-w and T2-w imaging. iMSDE also effectively suppressed residual flow artifacts in the CUBE acquisition.

CONCLUSIONS

iMSDE preparation achieved better blood suppression than DIR preparation with reduced vessel wall CNR efficiency in T1-w and T2-w images. The optimized m1s are 487 mT*ms2/m for T1-w imaging and 1518 mT*ms2/m for T2-w imaging. Composite 180° refocusing pulses and sinusoidal gradients improve SNR performance. iMSDE further improves the inherent blood suppression of CUBE.

3D high-resolution contrast enhanced MRI of carotid atheroma--a technical update

OBJECTIVE

Development of a fast 3D high-resolution magnetic resonance imaging (MRI) protocol for improved carotid artery plaque imaging.

METHODS

Two patients with carotid atherosclerosis disease underwent 3D high-resolution MRI which included time-of-flight and T1-weighted variable flip angle, fast-spin-echo (FSE) imaging, pre- and post-intravenous gadolinium-based contrast agent administration.

RESULTS

Good quality images with intrinsic blood suppression were obtained pre- and post-contrast administration using a 3D FSE sequence. The plaque burden, lipid core volume, hemorrhage volume and fibrous cap thickness were well determined.

CONCLUSIONS

3D high-resolution MR imaging of carotid plaque using TOF and 3D FSE can achieve high isotropic resolution, large coverage, and excellent image quality within a short acquisition time.

Improved T2 mapping accuracy with dual-echo turbo spin echo: effect of phase encoding profile orders

Turbo spin echo (TSE) pulse sequences have been applied to estimate T(2) relaxation times in clinically feasible scan times. However, T(2) estimations using TSE pulse sequences has been shown to differ considerable from reference standard sequences due to several sources of error. The purpose of this work was to apply voxel-sensitivity formalism to correct for one such source of error introduced by differing phase encoding profile orders with dual-echo TSE pulse sequences. The American College of Radiology phantom and the brains of two healthy volunteers were imaged using dual-echo TSE as well as 32-echo spin-echo acquisitions and T(2) estimations from uncorrected and voxel-sensitivity formalism-corrected dual-echo TSE and 32-echo acquisitions were compared. In all regions of the brain and the majority of the analyses of the American College of Radiology phantom, voxel-sensitivity formalism correction resulted in considerable improvements in dual-echo TSE T(2) estimation compared with the 32-echo acquisition, with improvements in T(2) value accuracy ranging from 5.2% to 18.6%.

Assessment of carotid stenosis using three-dimensional T2-weighted dark blood imaging: Initial experience

PURPOSE

To evaluate the use of a T2-weighted SPACE sequence (T2w-SPACE) to assess carotid stenosis via several methods and compare its performance with contrast-enhanced magnetic resonance angiography (ceMRA).

MATERIALS AND METHODS

Fifteen patients with carotid atherosclerosis underwent dark blood (DB)-MRI using a 3D turbo spin echo with variable flip angles sequence (T2w-SPACE) and ceMRA. Images were coregistered and evaluated by two observers. Comparisons were made for luminal diameter, luminal area, degree of luminal stenosis (NASCET: North American Symptomatic Endarterectomy Trial; ECST: European Carotid Surgery Trial, and area stenosis), and vessel wall area. Degree of NASCET stenosis was clinically classified as mild (<50%), moderate (50%-69%), or severe (>69%).

RESULTS

Excellent agreement was seen between ceMRA and T2w-SPACE and between observers for assessment of lumen diameter, lumen area, vessel wall area, and degree of NASCET stenosis (r > 0.80, P < 0.001). ECST stenosis was consistently higher than NASCET stenosis (48 ± 14% vs. 24 ± 22%, P < 0.001). Area stenosis (72 ± 2%) was significantly higher (P < 0.001) than both ESCT and NASCET stenosis.

CONCLUSION

DB-MRI of carotid arteries using T2w-SPACE is clinically feasible. It provides accurate measurements of lumen size and degree of stenosis in comparison with ceMRA and offers a more reproducible measure of ECST stenosis than ceMRA.

Cationic Gd-DTPA liposomes for highly efficient labeling of mesenchymal stem cells and cell tracking with MRI

In the current study cell labeling was performed with water-soluble gadolinium (Gd)-DTPA containing liposomes, to allow for cell tracking by MRI. Liposomes were used to assure a highly concentrated intracellular build up of Gd, aiming to overcome the relatively low MRI sensitivity of Gd (compared to T2 contrast agents). Liposomes were positively charged (cationic) to facilitate uptake by binding to anionic charges in the cell membrane of bone marrow-derived mesenchymal stem cells (MSCs). We determined the cellular Gd load by variations in labeling time (1, 4, and 24 h) and liposome concentration (125, 250, 500, 1000 μM lipid), closely monitoring effects on cell viability, proliferation rate, and differentiation ability. Labeling was both time and dose dependent. Labeling for 4 h was most efficient regarding the combination of processing time and final cellular Gd uptake. Labeling for 4 h with low-dose concentration (125 μM lipid, corresponding to 52 ± 3 μM Gd) yielded an intracellular load of 30 ± 2.5 pg Gd cell(-1), without any effects on cell viability, proliferation, and cell differentiation. Gd liposomes, colabeled with fluorescent dyes, exhibited a prolonged cellular retention, with an endosomal distribution pattern. In vitro assay over 20 days demonstrated a drop in the average Gd load per cell, as a result of mitosis. However, there was no significant change in the sum of the Gd load in all daughter cells at endpoint (20 days), indicating an excellent cellular retention of Gd. MSCs labeled with Gd liposomes were imaged with MRI at both 1.5T and 3.0T, resulting in excellent visualization both in vitro and in vivo. Prolonged in vivo imaging of 500,000 Gd-labeled cells was possible for at least 2 weeks (3.0T). In conclusion, Gd-loaded cationic liposomes (125 μM lipid) are an excellent candidate to label cells, without detrimental effects on cell viability, proliferation, and differentiation, and can be visualized by MRI.

Post-interventional three-dimensional dark blood MRI in the adult with congenital heart disease

BACKGROUND

Investigate a novel three-dimensional (3D) turbo spin echo (TSE) magnetic resonance imaging (MRI) sequence to assess stented segments in adults with congenital heart disease (CHD) after transcatheter intervention.

METHODS

Adults with CHD referred for computed tomography (CT) after transcatheter intervention underwent MR exam with a 3D respiratory gated TSE sequence. Data obtained at the time of the study included type of CHD, radiation dose, length of time between exams, and luminal diameters of stented segments from each exam. Continuous variables were analyzed using Student'st and Bland-Altman plots performed to analyze measurements obtained from both examinations.

RESULTS

Eleven patients underwent both examinations. Type of defects included coarctation of the aorta (n=6) and tetralogy of Fallot. Average radiation dose was 19.6 mSv and average time between CT and MRI was 99 ± 160 days. Luminal diameters of stented vessels correlated closely between TSE MRI and CT (r(2)=.85) with a bias toward overestimation with MRI (mean 22.4 ± 4.3mm and 20.9 ± 3.7 mm, p<.01).

CONCLUSION

This novel 3D respiratory gated TSE MR technique provides a feasible method to reduce metallic artifact and improve visualization of stented segments and surrounding anatomic structures without exposure to radiation.

Carotid arterial wall MRI at 3T using 3D variable-flip-angle turbo spin-echo (TSE) with flow-sensitive dephasing (FSD)

PURPOSE

To evaluate the effectiveness of flow-sensitive dephasing (FSD) magnetization preparation in improving blood signal suppression of three-dimensional (3D) turbo spin-echo (TSE) sequence (SPACE) for isotropic high-spatial-resolution carotid arterial wall imaging at 3T.

MATERIALS AND METHODS

The FSD-prepared SPACE sequence (FSD-SPACE) was implemented by adding two identical FSD gradient pulses right before and after the first refocusing 180 degrees -pulse of the SPACE sequence in all three orthogonal directions. Nine healthy volunteers were imaged at 3T with SPACE, FSD-SPACE, and multislice T2-weighted 2D TSE coupled with saturation band (SB-TSE). Apparent carotid wall-lumen contrast-to-noise ratio (aCNR(w-l)) and apparent lumen area (aLA) at the locations with residual-blood (rb) signal shown on SPACE images were compared between SPACE and FSD-SPACE. Carotid aCNR(w-l) and lumen (LA) and wall area (WA) measured from FSD-SPACE were compared to those measured from SB-TSE.

RESULTS

Plaque-mimicking flow artifacts identified in seven carotids on SPACE images were eliminated on FSD-SPACE images. The FSD preparation resulted in slightly reduced aCNR(w-l) (P = 0.025), but significantly improved aCNR between the wall and rb regions (P < 0.001) and larger aLA (P < 0.001). Compared to SB-TSE, FSD-SPACE offered comparable aCNR(w-l) with much higher spatial resolution, shorter imaging time, and larger artery coverage. The LA and WA measurements from the two techniques were in good agreement based on intraclasss correlation coefficient (0.988 and 0.949, respectively; P < 0.001) and Bland-Altman analyses.

CONCLUSION

FSD-SPACE is a time-efficient 3D imaging technique for carotid arterial wall with superior spatial resolution and blood signal suppression.

Ghost magnetic resonance angiography

Traditional methods for magnetic resonance angiography (MRA) involve the radiofrequency excitation of vascular spins within a selected region of tissue, followed by gradient localization and imaging of those spins within that same region. Signals that unfaithfully localize within the imaging volume, so-called "ghost artifacts", have historically been considered undesirable since they degrade image quality and every effort is made to suppress them. To the contrary, we hypothesized that these ghost artifacts could be manipulated to create detailed angiograms of the human body. In this initial demonstration of the method, which we call "Ghost MRA," we show that the human arterial system can be depicted with exquisite anatomic detail and near total suppression of background signal. Moreover, unlike alternative unenhanced methods, Ghost MRA can be acquired without the need for cardiac synchronization.

[Magnetic resonance imaging of stents: quantitative in vitro examination at 3 Tesla]

PURPOSE

The aim of this study was to qualitatively and quantitatively study MR artifacts of various stents on the basis of in vitro experiments. We were particularly interested whether sequence type and orientation of the stent with respect to the static magnetic field influences the artifact.

MATERIAL AND METHODS

We examined 18 stents of different material (nitinol, stainless steel, cobalt alloy), different design of the stent meshes (AccuLink, OmniLink, DynaLink, Xact, Protoge, Wallstent Monorail), different diameter (5-10mm) and different length (18-58 mm) with a turbo spin echo (TSE), a 2D-fast low angle shot (FLASH) and a 3D-FLASH sequence. The MR images were examined qualitatively with respect to possible artifacts. Furthermore we examined the MR data quantitatively: The contrast-noise-ratio (CNR) was determined both within the stent and outside (within the tube); based on these values we calculated the transparency factor P, furthermore we calculated the apparent vascular lumen within the tube and within the stent.

RESULTS

The stents made of stainless steel and cobalt alloy displayed severe susceptibility artifacts. Therefore the vessel lumen within the stent could not be assessed. The nitinol stents showed different artifact patterns: The AccuLink and DynaLink stents showed less artifacts compared to the Xact and Protoge stents. Besides the susceptibility artifacts we found artifacts due to RF shielding by the stent mesh, particularly in TSE sequences.

CONCLUSION

A MR control of patients after stenting is possible and may yield diagnostic information when using the AccuLink or DynaLink stents. However, it is important to make sure that the stent is MR safe for the field strength used for the examination.

Combining spin echoes with gradient echoes in the context of the global coherent free precession pulse sequence

To extend the signal longevity of magnetically excited spins in flowing fluids while in a state of global coherent free precession (GCFP), a refocusing radiofrequency (RF) pulse and bipolar gradient waveforms were combined with the GCFP sequence. The data demonstrate that RF refocusing in the presence of flowing blood is possible, but the improvement in signal amplitude depends on the static magnetic field homogeneity along the direction of motion and the displacement of the spins between the excitation and the RF refocusing pulse, as well as displacement during subsequent RF refocusing pulses. The least amount of phase dispersion and thus the longest lasting signal is obtained with the shortest echo spacing where only one line of data is recorded between two RF refocusing pulses. This approach was successfully used in a phantom and in vivo to image fast and slow blood flow. Depending on the experimental conditions, signal persistence is improved significantly compared to playing the same sequence without RF refocusing, but the improvement is limited by the product of blood flow velocity and the time between RF refocusing pulses.

High-resolution 3D arteriography of chronic total peripheral occlusions using a T1-W turbo spin-echo sequence with inner-volume imaging

Percutaneous revascularization of peripheral artery chronic total occlusion (CTO) is challenging under X-ray guidance without direct image feedback, due to poor visualization of the obstructed segment and underappreciation of vessel tortuosity. Operators are required to steer interventional devices relatively "blindly," and therefore procedural failure or perforation may occur. Alternatively, MRI may allow complete visualization of both patent and occluded arterial segments. We designed and implemented a 3D high-resolution, T(1)-weighted (T(1)-W) turbo spin-echo (TSE) MRI sequence with inner-volume (IV) imaging to enable detailed peripheral artery CTO imaging. Using this sequence, high-resolution volumes of interest (VOIs) around the vessel were achieved within 5-10 min. This imaging approach may be used for rapid pre- and postprocedural evaluations, and as a 3D roadmap that can be overlaid during real-time X-, MR-, or XMR-guided catheterization. Experiments were successfully performed on a carotid CTO model in swine ex vivo, and in peripheral arteries in normal volunteers and patients in vivo. Delineation of the vascular architecture, including contrast differences between the patent and occluded artery segments, and lesion morphology heterogeneity were visualized.

Differentiation of hepatocellular carcinoma and hepatic metastasis from cysts and hemangiomas with calculated T2 relaxation times and the T1/T2 relaxation times ratio

PURPOSE

To determine the diagnostic capability of the T1 and T2 relaxation times and the T1/T2 relaxation times ratio generated with the mixed turbo spin echo (mixed-TSE) pulse sequence, in order to discriminate between hepatocellular carcinoma (HCC)/metastases and hemangiomas/cysts.

MATERIALS AND METHODS

A retrospective review of 36 MR examinations implementing the mixed-TSE pulse sequence demonstrated 70 focal hepatic lesions. Quantitative MR algorithms were used to generate T1 and T2 relaxation times, and the T1/T2 relaxation times ratio for each lesion. A two-sample t-test compared mean T1 and T2 relaxation times, and the T1/T2 relaxation times ratio, by lesion type: carcinoma/metastases and hemangiomas/cysts. Sensitivity and specificity for discriminating carcinoma/metastases from hemangiomas/cysts with T2 relaxation time thresholds of 112 and 125 msec, as well as a ratio of T1/T2 relaxation times of 5.8, were calculated.

RESULTS

Using a T2 relaxation time threshold of 112 msec, 92% sensitivity and 100% specificity discriminating cysts/hemangiomas from HCC/liver metastasis was demonstrated. With a threshold of 125 msec, 96% sensitivity and 98% specificity was demonstrated. There was no correlation between calculated T1 relaxation times and type of lesion. Using a T1/T2 relaxation times ratio of 5.8, 100% sensitivity and specificity were demonstrated.

CONCLUSION

Although there is high sensitivity and specificity associated with the use of T2 relaxation times alone to discriminate carcinoma/metastases from hemangiomas/cysts, using the T1/T2 relaxation times ratio threshold of 5.8 allowed proper classification of all lesions.

Combined volumetric T1, T2 and secular-T2 quantitative MRI of the brain: age-related global changes (preliminary results)

The combined T1, T2 and secular-T2 pixel frequency distributions of 24 adult human brains were studied in vivo using a technique based on the mixed-TSE pulse sequence, dual-space clustering segmentation and histogram gaussian decomposition. Pixel frequency histograms of whole brains and the four principal brain compartments were studied comparatively and as function of age. For white matter, the position of the T1 peak correlates with age (R2 =.7868) when data are fitted to a quadratic polynomial. For gray matter, a weaker age correlation is found (R2 =.3687). T2 and secular-T2 results are indicative of a weaker correlation with age. The technique and preliminary results presented herein may be useful for characterizing normal as well as abnormal aging of the brain, and also for comparison with the results obtained with alternative quantitative MRI methodologies.

Characterization of human atherosclerotic plaques by intravascular magnetic resonance imaging

BACKGROUND

Development and validation of novel imaging modalities to assess the composition of human atherosclerotic plaques will improve the understanding of atheroma evolution and could facilitate evaluation of therapeutic strategies for plaque modification. Surface MRI can characterize tissue content of carotid but not deeper arteries. This study evaluated the usefulness of intravascular MRI (IVMRI) to discern the composition of human iliac arteries in vivo.

METHODS AND RESULTS

Initial studies validated IVMRI against histopathology of human atherosclerotic arteries ex vivo. A 0.030-inch-diameter IVMRI detector coil was advanced into isolated human aortoiliac arteries and coupled to a 1.5-T scanner. Information from combined T1-, moderate T2-, and proton-density-weighted images differentiated lipid, fibrous, and calcified components with favorable sensitivity and specificity and allowed accurate quantification of plaque size. The validated approach was then applied to image iliac arteries of 25 human subjects in vivo, and results were compared with those of intravascular ultrasound (IVUS). IVMRI readily visualized inner and outer plaque boundaries in all arteries, even those with extensive calcification that precluded IVUS interpretation. It also revealed the expected heterogeneity of atherosclerotic plaque content that was noted during ex vivo validation. Again, IVUS did not disclose this heterogeneity. The level of interobserver and intraobserver agreement in the interpretation of plaque composition was high for IVMRI but poor for IVUS.

CONCLUSIONS

IVMRI can reliably identify plaque composition and size in arteries deep within the body. Identification of plaque components by IVMRI in vivo has important implications for the understanding and modification of human atherosclerosis.

Lipid-rich atherosclerotic plaques detected by gadofluorine-enhanced in vivo magnetic resonance imaging

BACKGROUND

MRI of specific components in atherosclerotic plaque may provide information on plaque stability and its potential to rupture. We evaluated gadofluorine in atherosclerotic rabbits using a new MR sequence that allows plaque detection within 1 hour after injection and assessed enhancement in lipid-rich and non-lipid-rich plaques.

METHODS AND RESULTS

Twelve rabbits with aortic plaque and 6 controls underwent MRI before and up to 24 hours after gadofluorine injection (50 micromol/kg). Two T1-weighted, segmented gradient-echo sequences (TFL) were compared to enhance vessel wall delineation after injection: (1) an inversion-recovery prepulse (IR-TFL) or (2) a combination of inversion-recovery and diffusion-based flow suppression prepulses (IR-DIFF-TFL). With the use of IR-TFL at 1 hour after injection, the vessel wall was not delineated because of poor flow suppression; at 24 hours after injection, the enhancement was 37% (P<0.01). IR-DIFF-TFL showed significant enhancement after versus before contrast (1 hour: 164% [P<0.005]; 24 hours: 207% [P<0.001]). At 1 hour and 24 hours after injection, the contrast-to-noise ratio was higher with the use of IR-DIFF-TFL than with IR-TFL (1 hour: 13.0+/-7.7 versus -19.8+/-10.3 [P<0.001]; 24 hours: 15.2+/-5.9 versus 11.4+/-8.9, respectively [P=0.052]). There was no enhancement in the vessel wall after gadofluorine injection in the control group. A strong correlation was found (r2=0.87; P<0.001) between the lipid-rich areas in histological sections and signal intensity in corresponding MR images. This suggests a high affinity of gadofluorine for lipid-rich plaques.

CONCLUSIONS

Gadofluorine-enhanced MRI improves atherosclerotic plaque detection. The IR-DIFF-TFL method allows early detection of atherosclerotic plaque within 1 hour after gadofluorine injection.

MR imaging of atherosclerotic plaque

MRI is a powerful noninvasive imaging tool with high spatial resolution that continues to prove its value in determining atherosclerotic plaque size, volume, and tissue components. Multispectral MRI sequences have been validated to characterize atherosclerotic plaque components in animals; they have recently been applied to human aorta and carotid artery and are being used to identify the vulnerable plaque. The ability to measure wall thickness in human coronary artery wall has been realized. Future developments may allow plaque characterization in the coronary arteries with surface coil imaging, but intravascular MRI may play an important role in this regard. Novel contrast agents for identifying inflammation and thrombus within atherosclerotic plaque will aid in the identification of higher-risk atherosclerotic disease. Lastly, MRI has progressed to the point where it can be used in serial studies of atherosclerotic plaque progression and regression in the face of therapeutic intervention. MRI will continue to evolve an important role in imaging of atherosclerotic plaque.

Free-breathing black-blood coronary MR angiography: initial results

The authors developed a free-breathing black-blood coronary magnetic resonance (MR) angiographic technique with a potential for exclusive visualization of the coronary blood pool. Results with the MR angiographic technique were evaluated in eight healthy subjects and four patients with coronary disease identified at conventional angiography. This MR angiographic technique accurately depicted luminal disease in the patients and permitted visualization of extensive continuous segments of the native coronary tree in both the healthy subjects and the patients. Black-blood coronary MR angiography provides an alternative source of contrast enhancement.

Three-dimensional high-resolution fast spin-echo coronary magnetic resonance angiography

Due to SNR constraints, current "bright-blood" 3D coronary MRA approaches still suffer from limited spatial resolution when compared to conventional x-ray coronary angiography. Recent 2D fast spin-echo black-blood techniques maximize signal for coronary MRA at no loss in image spatial resolution. This suggests that the extension of black-blood coronary MRA with a 3D imaging technique would allow for a further signal increase, which may be traded for an improved spatial resolution. Therefore, a dual-inversion 3D fast spin-echo imaging sequence and real-time navigator technology were combined for high-resolution free-breathing black-blood coronary MRA. In-plane image resolution below 400 microm was obtained. Magn Reson Med 45:206-211, 2001.

Noninvasive coronary vessel wall and plaque imaging with magnetic resonance imaging

BACKGROUND

Conventional x-ray angiography frequently underestimates the true burden of atherosclerosis. Although intravascular ultrasound allows for imaging of coronary plaque, this invasive technique is inappropriate for screening or serial examinations. We therefore sought to develop a noninvasive free-breathing MR technique for coronary vessel wall imaging. We hypothesized that such an approach would allow for in vivo imaging of coronary atherosclerosis.

METHODS AND RESULTS

Ten subjects, including 5 healthy adult volunteers (aged 35+/-17 years, range 19 to 56 years) and 5 patients (aged 60+/-4 years, range 56 to 66 years) with x-ray-confirmed coronary artery disease (CAD), were studied with a T2-weighted, dual-inversion, fast spin-echo MR sequence. Multiple adjacent 5-mm cross-sectional images of the proximal right coronary artery were obtained with an in-plane resolution of 0.5x1.0 mm. A right hemidiaphragmatic navigator was used to facilitate free-breathing MR acquisition. Coronary vessel wall images were readily acquired in all subjects. Both coronary vessel wall thickness (1.5+/-0.2 versus 1.0+/-0.2 mm) and wall area (21.2+/-3.1 versus 13.7+/-4.2 mm(2)) were greater in patients with CAD (both P:<0.02 versus healthy adults).

CONCLUSIONS

In vivo free-breathing coronary vessel wall and plaque imaging with MR has been successfully implemented in humans. Coronary wall thickness and wall area were significantly greater in patients with angiographic CAD. The presented technique may have potential applications in patients with known or suspected atherosclerotic CAD or for serial evaluation after pharmacological intervention.

Noninvasive in vivo human coronary artery lumen and wall imaging using black-blood magnetic resonance imaging

BACKGROUND

High-resolution MRI has the potential to noninvasively image the human coronary artery wall and define the degree and nature of coronary artery disease. Coronary artery imaging by MR has been limited by artifacts related to blood flow and motion and by low spatial resolution.

METHODS AND RESULTS

We used a noninvasive black-blood (BB) MRI (BB-MR) method, free of motion and blood-flow artifacts, for high-resolution (down to 0.46 mm in-plane resolution and 3-mm slice thickness) imaging of the coronary artery lumen and wall. In vivo BB-MR of both normal and atherosclerotic human coronary arteries was performed in 13 subjects: 8 normal subjects and 5 patients with coronary artery disease. The average coronary wall thickness for each cross-sectional image was 0.75+/-0.17 mm (range, 0.55 to 1.0 mm) in the normal subjects. MR images of coronary arteries in patients with >/=40% stenosis as assessed by x-ray angiography showed localized wall thickness of 4.38+/-0.71 mm (range, 3.30 to 5.73 mm). The difference in maximum wall thickness between the normal subjects and patients was statistically significant (P<0.0001).

CONCLUSIONS

In vivo high-spatial-resolution BB-MR provides a unique new method to noninvasively image and assess the morphological features of human coronary arteries. This may allow the identification of atherosclerotic disease before it is symptomatic. Further studies are necessary to identify the different plaque components and to assess lesions in asymptomatic patients and their outcomes.