Triple contrast technique for black blood imaging with double inversion preparation

Assessment of Novel Anti-thrombotic Fusion Proteins for Inhibition of Stenosis in a Porcine Model of Arteriovenous Graft

BACKGROUND

Hemodialysis arteriovenous synthetic grafts (AVG) provide high volumetric blood flow rates shortly after surgical placement. However, stenosis often develops at the vein-graft anastomosis contributing to thrombosis and early graft failure. Two novel fusion proteins, ANV-6L15 and TAP-ANV, inhibit the tissue factor/factor VIIa coagulation complex and the factor Xa/factor Va complex, respectively. Each inhibitor domain is fused to an annexin V domain that targets the inhibitor activity to sites of vascular injury to locally inhibit thrombosis. This study's objective was to determine if these antithrombotic proteins are safe and effective in inhibiting AVG stenosis.

METHODS

A bolus of either TAP-ANV or ANV-6L15 fusion protein was administered intravenously immediately prior to surgical placement of a synthetic graft between the external jugular vein and common carotid artery in a porcine model. At surgery, the vein and artery were irrigated with the anti-thrombotic fusion protein. Control animals received intravenous heparin. At 4 weeks, MRI was performed to evaluate graft patency, the pigs were then euthanized and grafts and attached vessels were explanted for histomorphometric assessment of neointimal hyperplasia at the vein-graft anastomosis. Blood was collected at surgery, immediately after surgery and at euthanasia for serum metabolic panels and coagulation chemistries.

RESULTS

No acute thrombosis occurred in the control group or in either experimental group. No abnormal serum chemistries, activated clotting times or PT, PTT values were observed after treatment in experimental or control animals. However, at the vein-graft anastomosis, there was no difference between the control and experimental groups in cross-sectional lumen areas, as measured on MRI, and no difference in hyperplasia areas as determined by histomorphometry. These results suggest that local irrigation of TAP-ANV or ANV-6L15 intra-operatively was as effective in inhibiting acute graft thrombosis as intravenous administration of heparin, but failed to inhibit hyperplasia development and stenosis in AVG.

Accelerated 3D MERGE carotid imaging using compressed sensing with a hidden Markov tree model

PURPOSE

To determine the potential for accelerated 3D carotid magnetic resonance imaging (MRI) using wavelet based compressed sensing (CS) with a hidden Markov tree (HMT) model.

MATERIALS AND METHODS

We retrospectively applied HMT model-based CS and conventional CS to 3D carotid MRI data with 0.7 mm isotropic resolution from six subjects with known carotid stenosis (12 carotids). We applied a wavelet-tree model learned from a training database of carotid images to improve CS reconstruction. Quantitative endpoints such as lumen area, wall area, mean and maximum wall thickness, plaque calcification, and necrotic core area were measured and compared using Bland-Altman analysis along with image quality.

RESULTS

Rate-4.5 acceleration with HMT model-based CS provided image quality comparable to that of rate-3 acceleration with conventional CS and fully sampled reference reconstructions. Morphological measurements made on rate-4.5 HMT model-based CS reconstructions were in good agreement with measurements made on fully sampled reference images. There was no significant bias or correlation between mean and difference of measurements when comparing rate 4.5 HMT model-based CS with fully sampled reference images.

CONCLUSION

HMT model-based CS can potentially be used to accelerate clinical carotid MRI by a factor of 4.5 without impacting diagnostic quality or quantitative endpoints.

CINE turbo spin echo imaging

High-resolution turbo spin echo (TSE) images have demonstrated important details of carotid artery morphology; however, it is evident that pulsatile blood and wall motion related to the cardiac cycle are still significant sources of image degradation. Although ECG gating can reduce artifacts due to cardiac-induced pulsations, gating is rarely used because it lengthens the acquisition time and can cause image degradation due to nonconstant repetition time. This work introduces a relatively simple method of converting a conventional TSE acquisition into a retrospectively ECG-correlated cineTSE sequence. The cineTSE sequence generates a full sequence of ECG-correlated images at each slice location throughout the cardiac cycle in the same scan time that is conventionally used by standard TSE sequences to produce a single image at each slice location. The cineTSE images exhibit reduced pulsatile artifacts associated with a gated sequence but without the increased scan time or associated nonconstant repetition time effects.

Improved blood suppression in three-dimensional (3D) fast spin-echo (FSE) vessel wall imaging using a combination of double inversion-recovery (DIR) and diffusion sensitizing gradient (DSG) preparations

PURPOSE

To provide improved blood suppression in three-dimensional inner-volume fast spin-echo (3D IV-FSE) carotid vessel wall imaging by using a hybrid preparation consisting of double inversion-recovery (DIR) and diffusion sensitizing gradients (DSG).

MATERIALS AND METHODS

Multicontrast black-blood MRI is widely used for vessel wall imaging and characterization of atherosclerotic plaque composition. Blood suppression is difficult when using 3D volumetric imaging techniques. DIR approaches do not provide robust blood suppression due to incomplete replacement of blood spins, and DSG approaches compromise vessel wall signal, reducing the lumen-wall contrast-to-noise ratio efficiency (CNR(eff)). In this work a hybrid DIR+DSG preparation is developed and optimized for blood suppression, vessel wall signal preservation, and vessel-wall contrast in 3D IV-FSE imaging. Cardiac gated T(1)-weighted carotid vessel wall images were acquired in five volunteers with 0.5 x 0.5 x 2.5 mm(3) spatial resolution in 80 seconds.

RESULTS

Data from healthy volunteers indicate that the proposed method yields a statistically significant (P < 0.01) improvement in blood suppression and lumen-wall CNR(eff) compared to standard DIR and standard DSG methods alone.

CONCLUSION

A combination of DIR and DSG preparations can provide improved blood suppression and lumen-wall CNR(eff) for 3D IV-FSE vessel wall imaging.

Diffusion-weighted imaging of human carotid artery using 2D single-shot interleaved multislice inner volume diffusion-weighted echo planar imaging (2D ss-IMIV-DWEPI) at 3T: diffusion measurement in atherosclerotic plaque

PURPOSE

To determine if 2D single-shot interleaved multislice inner volume diffusion-weighted echo planar imaging (ss-IMIV-DWEPI) can be used to obtain quantitative diffusion measurements that can assist in the identification of plaque components in the cervical carotid artery.

MATERIALS AND METHODS

The 2D ss-DWEPI sequence was combined with interleaved multislice inner volume region localization to obtain diffusion weighted images with 1 mm in-plane resolution and 2 mm slice thickness. Eleven subjects, six of whom have carotid plaque, were studied with this technique. The apparent diffusion coefficient (ADC) images were calculated using DW images with b = 10 s/mm(2) and b = 300 s/mm(2).

RESULTS

The mean ADC measurement in normal vessel wall of the 11 subjects was 1.28 +/- 0.09 x 10(-3) mm(2)/s. Six of the 11 subjects had carotid plaque and ADC measurements in plaque ranged from 0.29 to 0.87 x 10(-3) mm(2)/s. Of the 11 common carotid artery walls studied (33 images), at least partial visualization of the wall was obtained in all ADC images, more than 50% visualization in 82% (27/33 images), and full visualization in 18% (6/33 images).

CONCLUSION

2D ss-IMIV-DWEPI can perform diffusion-weighted carotid magnetic resonance imaging (MRI) in vivo with reasonably high spatial resolution (1 x 1 x 2 mm(3)). ADC values of the carotid wall and plaque are consistent with similar values obtained from ex vivo endarterectomy specimens. The spread in ADC values obtained from plaque indicate that this technique could form a basis for plaque component identification in conjunction with other MRI/MRA techniques.

Coil sensitivity estimation for optimal SNR reconstruction and intensity inhomogeneity correction in phased array MR imaging

Magnetic resonance (MR) images can be acquired by multiple receiver coil systems to improve signal-to-noise ratio (SNR) and to decrease acquisition time. The optimal SNR images can be reconstructed from the coil data when the coil sensitivities are known. In typical MR imaging studies, the information about coil sensitivity profiles is not available. In such cases the sum-of-squares (SoS) reconstruction algorithm is usually applied. The intensity of the SoS reconstructed image is modulated by a spatially variable function due to the non-uniformity of coil sensitivities. Additionally, the SoS images also have sub-optimal SNR and bias in image intensity. All these effects might introduce errors when quantitative analysis and/or tissue segmentation are performed on the SoS reconstructed images. In this paper, we present an iterative algorithm for coil sensitivity estimation and demonstrate its applicability for optimal SNR reconstruction and intensity inhomogeneity correction in phased array MR imaging.

Combo acquisitions: balancing scan time reduction and image quality

Recently a new technique for the combined acquisition of multicontrast images, termed "combo acquisition," was introduced. In combo acquisitions, the three concepts of 1) variable acquisition parameters, 2) k-space data sharing, and 3) multicontrast imaging are systematically integrated to reduce MRI scan time and improve data utilization in a clinical setting. In this study, two-contrast and three-contrast spin-echo (SE) and turbo spin-echo (TSE) combo acquisition protocols that were designed and optimized in simulation experiments were implemented on a 1.5 T clinical scanner. Phantom and human brain data from volunteers and patients were acquired. Scan time reductions of 25-52% were achieved compared to standard acquisitions, largely confirming the simulation results. We evaluated the resulting images by quantitatively analyzing the preservation of contrast and the signal-to-noise ratio (SNR). In addition, data sets for 10 clinical cases obtained with TSE combo and corresponding standard acquisitions were graded by two experienced neuroradiologists in terms of the level of artifacts and image quality for comparison. Only minor image degradation with the combo scans was observed, indicating an inherent trade-off between scan time reduction and image quality. The specific aspects of combo acquisitions with respect to motion, flow, and k-space data weighting are discussed.

Comparison of gated and non-gated fast multislice black-blood carotid imaging using rapid extended coverage and inflow/outflow saturation techniques

PURPOSE

To comparatively analyze two fast in vivo multislice black-blood carotid artery vessel wall imaging techniques with and without cardiac gating.

MATERIALS AND METHODS

Eight subjects with carotid artery atherosclerosis, and four healthy subjects were studied using two black-blood multislice techniques: rapid extended coverage double inversion recovery (REX-DIR), and inflow/outflow saturation band (IOSB) rapid acquisition with relaxation enhancement (RARE) multislice acquisitions. Quantitative, qualitative, and morphometric analyses were performed on images.

RESULTS

Gating produced significantly lower values for the REX-DIR sequence with respect to signal intensity in muscle and the carotid artery wall, whereas it had no effect on flow suppression compared to non-gated images. For the IOSB sequences, gating had no significant effect on signal intensity of muscle and the carotid artery wall, but worsened flow suppression. REX-DIR and IOSB sequences were statistically different with respect to signal intensity of muscle (with REX-DIR sequences having lower values), while no statistical significance was observed for flow suppression and wall delineation. A morphologic analysis of the vessel wall and lumen comparing REX-DIR gated, IOSB gated, REX-DIR non-gated, and IOSB non-gated sequences revealed no significant differences between the acquisition techniques tested.

CONCLUSION

Non-gated sequences may be used instead of gated sequences in atherosclerotic vessel wall imaging without compromising image quality. This may shorten examination time and improve patient comfort.

Application of phase consistency to improve time efficiency and image quality in dual echo black-blood carotid angiography

There is a considerable similarity between proton density-weighted (PDw) and T2-weighted (T2w) images acquired by dual echo fast spin-echo (FSE) sequences. The similarity manifests itself not only in image space as correspondence between intensities of PDw and T2w images, but also in phase space as consistency between phases of PDw and T2w images. Methods for improving the imaging efficiency and image quality of dual echo FSE sequences based on this feature have been developed. The total scan time of dual echo FSE acquisition may be reduced by as much as 25% by incorporating an estimate of the image phase from a fully sampled PDw image when reconstructing partially sampled T2w images. The quality of T2w images acquired using phased array coils may be significantly improved by using the developed noise reduction reconstruction scheme, which is based on the correspondence between the PDw and T2w image intensities and the consistency between the PDw and T2w image phases. Studies of phantom and human subject MRI data were performed to evaluate the effectiveness of the techniques.