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Elsaid NMH, Peters DC, Galiana G, Sinusas AJ. Clinical physiology: the crucial role of MRI in evaluation of peripheral artery disease. Am J Physiol Heart Circ Physiol 2024; 326:H1304-H1323. [PMID: 38517227 DOI: 10.1152/ajpheart.00533.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 03/23/2024]
Abstract
Peripheral artery disease (PAD) is a common vascular disease that primarily affects the lower limbs and is defined by the constriction or blockage of peripheral arteries and may involve microvascular dysfunction and tissue injury. Patients with diabetes have more prominent disease of microcirculation and develop peripheral neuropathy, autonomic dysfunction, and medial vascular calcification. Early and accurate diagnosis of PAD and disease characterization are essential for personalized management and therapy planning. Magnetic resonance imaging (MRI) provides excellent soft tissue contrast and multiplanar imaging capabilities and is useful as a noninvasive imaging tool in the comprehensive physiological assessment of PAD. This review provides an overview of the current state of the art of MRI in the evaluation and characterization of PAD, including an analysis of the many applicable MR imaging techniques, describing the advantages and disadvantages of each approach. We also present recent developments, future clinical applications, and future MRI directions in assessing PAD. The development of new MR imaging technologies and applications in preclinical models with translation to clinical research holds considerable potential for improving the understanding of the pathophysiology of PAD and clinical applications for improving diagnostic precision, risk stratification, and treatment outcomes in patients with PAD.
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Affiliation(s)
- Nahla M H Elsaid
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Dana C Peters
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
| | - Gigi Galiana
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
| | - Albert J Sinusas
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, United States
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
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Ristow I, Riedel C, Lenz A, Well L, Adam G, Panuccio G, Kölbel T, Bannas P. Current Imaging Strategies in Patients with Abdominal Aortic Aneurysms. ROFO-FORTSCHR RONTG 2024; 196:52-61. [PMID: 37699431 DOI: 10.1055/a-2119-6448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND An abdominal aortic aneurysm (AAA) is defined as a localized dilatation of the abdominal aorta of ≥ 3 cm. With a prevalence of 4-8 %, AAA is one of the most common vascular diseases in Western society. Radiological imaging is an elementary component in the diagnosis, monitoring, and treatment planning of AAA patients. METHOD This is a narrative review article on preoperative imaging strategies of AAA, incorporating expert opinions based on the current literature and standard-of-care practices from our own center. Examples are provided to illustrate clinical cases from our institution. RESULTS AND CONCLUSION Radiological imaging plays a pivotal role in the initial diagnosis and monitoring of patients with AAA. Ultrasound is the mainstay imaging modality for AAA screening and surveillance. Contrast-enhanced CT angiography is currently considered the gold standard for preoperative imaging and image-based treatment planning in AAA repair. New non-contrast MR angiography techniques are robustly applicable and allow precise determination of aortic diameters, which is of critical importance, particularly with regard to current diameter-based surgical treatment guidelines. 3D imaging with multiplanar reformation and automatic centerline positioning enables more accurate assessment of the maximum aortic diameter. Modern imaging techniques such as 4D flow MRI have the potential to further improve individualized risk stratification in patients with AAA. KEY POINTS · Ultrasound is the mainstay imaging modality for AAA screening and monitoring. · Contrast-enhanced CT angiography is the gold standard for preoperative imaging in AAA repair. · Non-contrast MR angiography allows for accurate monitoring of aortic diameters in AAA patients. · Measurement of aortic diameters is more accurate with 3D-CT/MRI compared to ultrasound. · Research seeks new quantitative imaging biomarkers for AAA risk stratification, e. g., using 4D flow MRI.
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Affiliation(s)
- Inka Ristow
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Riedel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lennart Well
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hosadurg N, Kramer CM. Magnetic Resonance Imaging Techniques in Peripheral Arterial Disease. Adv Wound Care (New Rochelle) 2023; 12:611-625. [PMID: 37058352 PMCID: PMC10468560 DOI: 10.1089/wound.2022.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/12/2023] [Indexed: 04/15/2023] Open
Abstract
Significance: Peripheral arterial disease (PAD) leads to a significant burden of morbidity and impaired quality of life globally. Diabetes is a significant risk factor accelerating the development of PAD with an associated increase in the risk of chronic wounds, tissue, and limb loss. Various magnetic resonance imaging (MRI) techniques are being increasingly acknowledged as useful methods of accurately assessing PAD. Recent Advances: Conventionally utilized MRI techniques for assessing macrovascular disease have included contrast enhanced magnetic resonance angiography (MRA), noncontrast time of flight MRA, and phase contrast MRI, but have significant limitations. In recent years, novel noncontrast MRI methods assessing skeletal muscle perfusion and metabolism such as arterial spin labeling (ASL), blood-oxygen-level dependent (BOLD) imaging, and chemical exchange saturation transfer (CEST) have emerged. Critical Issues: Conventional non-MRI (such as ankle-brachial index, arterial duplex ultrasonography, and computed tomographic angiography) and MRI based modalities image the macrovasculature. The underlying mechanisms of PAD that result in clinical manifestations are, however, complex, and imaging modalities that can assess the interaction between impaired blood flow, microvascular tissue perfusion, and muscular metabolism are necessary. Future Directions: Further development and clinical validation of noncontrast MRI methods assessing skeletal muscle perfusion and metabolism, such as ASL, BOLD, CEST, intravoxel incoherent motion microperfusion, and techniques that assess plaque composition, are advancing this field. These modalities can provide useful prognostic data and help in reliable surveillance of outcomes after interventions.
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Affiliation(s)
- Nisha Hosadurg
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher M. Kramer
- Department of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
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Panda A, Francois CJ, Bookwalter CA, Chaturvedi A, Collins JD, Leiner T, Rajiah PS. Non-Contrast Magnetic Resonance Angiography: Techniques, Principles, and Applications. Magn Reson Imaging Clin N Am 2023; 31:337-360. [PMID: 37414465 DOI: 10.1016/j.mric.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Several non-contrast magnetic resonance angiography (MRA) techniques have been developed, providing an attractive alternative to contrast-enhanced MRA and a radiation-free alternative to computed tomography (CT) CT angiography. This review describes the physical principles, limitations, and clinical applications of bright-blood (BB) non-contrast MRA techniques. The principles of BB MRA techniques can be broadly divided into (a) flow-independent MRA, (b) blood-inflow-based MRA, (c) cardiac phase dependent, flow-based MRA, (d) velocity sensitive MRA, and (e) arterial spin-labeling MRA. The review also includes emerging multi-contrast MRA techniques that provide simultaneous BB and black-blood images for combined luminal and vessel wall evaluation.
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Affiliation(s)
- Ananya Panda
- Department of Radiology, All India Institute of Medical Sciences, Jodhpur, India
| | | | | | - Abhishek Chaturvedi
- Department of Radiology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Tim Leiner
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Lebenatus A, Tesch K, Rudolph W, Naujokat H, Koktzoglou I, Edelman RR, Graessner J, Jansen O, Salehi Ravesh M. Evaluation of Lower Leg Arteries and Fibular Perforators before Microsurgical Fibular Transfer Using Noncontrast-Enhanced Quiescent-Interval Slice-Selective (QISS) Magnetic Resonance Angiography. J Clin Med 2023; 12:1634. [PMID: 36836170 PMCID: PMC9964888 DOI: 10.3390/jcm12041634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
(1) Background: Preoperative imaging of the lower leg arteries is essential for planning fibular grafting. The aim of this study was to evaluate the feasibility and clinical value of non-contrast-enhanced (CE) Quiescent-Interval Slice-Selective (QISS)-magnetic resonance angiography (MRA) for reliably visualizing the anatomy and patency of the lower leg arteries and for preoperatively determining the presence, number, and location of fibular perforators. (2) Methods: The anatomy and stenoses of the lower leg arteries and the presence, number, and location of fibular perforators were determined in fifty patients with oral and maxillofacial tumors. Postoperative outcomes of patients after fibula grafting were correlated with preoperative imaging, demographic, and clinical parameters. (3) Results: A regular three-vessel supply was present in 87% of the 100 legs. QISS-MRA was able to accurately assign the branching pattern in patients with aberrant anatomy. Fibular perforators were found in 87% of legs. More than 94% of the lower leg arteries had no relevant stenoses. Fibular grafting was performed in 50% of patients with a 92% success rate. (4) Conclusions: QISS-MRA has the potential to be used as a preoperative non-CE MRA technique for the diagnosis and detection of anatomic variants of lower leg arteries and their pathologies, as well as for the assessment of fibular perforators.
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Affiliation(s)
- Annett Lebenatus
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Karolin Tesch
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Wiebke Rudolph
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
- Pritzker School of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Robert R. Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL 60201, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | | | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
| | - Mona Salehi Ravesh
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany
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Non-contrast MR angiography of pelvic arterial vasculature using the Quiescent interval slice selective (QISS) sequence. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1023-1030. [PMID: 36781568 DOI: 10.1007/s10554-023-02798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 02/15/2023]
Abstract
To evaluate Quiescent Interval Slice Selective (QISS) balanced steady-state free precession (bSSFP) and QISS fast low-angle shot (FLASH) sequences for non-contrast Magnetic Resonance Angiography (MRA) of iliac arteries regarding image quality and diagnostic confidence in order to establish these sequences in daily clinical practice. A prospective study of healthy subjects (n = 10) was performed. All subjects underwent the QISS MRI protocol with bSSFP und FLASH sequences. Vessel contrast-to-background ratio (VCBR) were measured in pre-defined vessel segments. Image quality and diagnostic confidence was assessed using a Likert scale (five-point scale). Inter-reader agreement was determined using Cohen's kappa coefficient (κ). Ten healthy subjects (median age 29 years, IQR: 26.25 to 30 years) were included in this prospective study. Median MR examination time was 2:05 min (IQR 1:58 to 2:16) for QISS bSSFP and 4:11 min (IQR 3:57 to 4:32) for QISS FLASH. Both sequences revealed good VCBR in all examined vessel segments. VCBR (muscle tissue) were marginally higher for FLASH sequences (e.g., 0.82 vs. 0.78 in the right femoral artery, p = 0.035*), while bSSFP sequence showed significantly higher VCBR (fat tissue) in the majority of examined arterials vessels (e.g., 0.78 vs. 0.62 in right femoral artery, p = 0.001*). The image quality and diagnostic confidence of both sequences were rated as good to excellent. Moderate to good inter-reader agreement was found. QISS MRA using bSSFP and FLASH sequences are diagnostic for visualization of iliac arterial vasculature. The QISS bSSFP sequence might offer advantages due to the markedly shorter exam time and superior visualization of smaller vessels. The QISS FLASH sequence seems to be a robust alternative for non-contrast MRA since it is less sensitive to magnetic field inhomogeneities.
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Non-contrast magnetic resonance angiography/venography techniques: what are my options? Pediatr Radiol 2022; 52:271-284. [PMID: 33893543 DOI: 10.1007/s00247-021-05067-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/07/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
Non-contrast magnetic resonance (MR) angiography and MR venography techniques are gaining popularity for vascular imaging because they are faster, more forgiving and less costly compared with contrast-enhanced MR angiography. Non-contrast MR angiography also avoids gadolinium deposition, which is especially important in imaging children. Non-contrast MR angiography has an array of specific applications for numerous clinical indications. This review summarizes the non-contrast MR angiography methods and their relative advantages and disadvantages. The paper also guides the reader on which technique to consider when determining the optimal imaging modality for each individual patient.
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Koktzoglou I, Huang R, Edelman RR. Quantitative time-of-flight MR angiography for simultaneous luminal and hemodynamic evaluation of the intracranial arteries. Magn Reson Med 2022; 87:150-162. [PMID: 34374455 PMCID: PMC8616782 DOI: 10.1002/mrm.28969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To report a quantitative time-of-flight (qTOF) MRA technique for simultaneous luminal and hemodynamic evaluation of the intracranial arteries. METHODS Implemented using a thin overlapping slab 3D stack-of-stars based 3-echo FLASH readout, qTOF was tested in a flow phantom and for imaging the intracranial arteries of 10 human subjects at 3 Tesla. Display of the intracranial arteries with qTOF was compared to resolution-matched and scan time-matched standard Cartesian 3D time-of-flight (TOF) MRA, whereas quantification of mean blood flow velocity with qTOF, done using a computer vision-based inter-echo image analysis procedure, was compared to 3D phase contrast MRA. Arterial-to-background contrast-to-noise ratio was measured, and intraclass correlation coefficient was used to evaluate agreement of flow velocities. RESULTS For resolution-matched protocols of similar scan time, qTOF portrayed the intracranial arteries with good morphological correlation with standard Cartesian TOF, and both techniques provided superior contrast-to-noise ratio and arterial delineation compared to phase contrast (20.6 ± 3.0 and 37.8 ± 8.7 vs. 11.5 ± 2.2, P < .001, both comparisons). With respect to phase contrast, qTOF showed excellent agreement for measuring mean flow velocity in the flow phantom (intraclass correlation coefficient = 0.981, P < .001) and good agreement in the intracranial arteries (intraclass correlation coefficient = 0.700, P < .001). Stack-of-stars data sampling used with qTOF eliminated oblique in-plane flow misregistration artifacts that were seen with standard Cartesian TOF. CONCLUSION qTOF is a new 3D MRA technique for simultaneous luminal and hemodynamic evaluation of the intracranial arteries that provides significantly greater contrast-to-noise ratio efficiency than phase contrast and eliminates misregistration artifacts from oblique in-plane blood flow that occur with standard 3D TOF.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL,Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Rong Huang
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL
| | - Robert R. Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL,Northwestern University Feinberg School of Medicine, Chicago, IL
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Verma M, Pandey NN, Singh V, Jagia P. A meta-analysis of the diagnostic performance of quiescent-interval-single-shot magnetic resonance angiography in peripheral arterial disease. Eur Radiol 2021; 32:2393-2403. [PMID: 34766201 DOI: 10.1007/s00330-021-08349-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/30/2021] [Accepted: 09/20/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate by meta-analysis the diagnostic accuracy of non-contrast quiescent-interval-single-shot (QISS) magnetic resonance angiography (MRA) in patients with peripheral arterial disease (PAD) using digital subtraction angiography (DSA) or contrast-enhanced magnetic resonance angiography (CE-MRA) as reference standard. METHODS This study was performed and reported according to the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. A systematic literature search of MEDLINE, Embase and Scopus was done for studies reporting the diagnostic accuracy of QISS in PAD published up to 31 May 2021. The pooled sensitivity, specificity and diagnostic accuracy of QISS were calculated on a per-segment basis for the entire arterial tree. RESULTS Seventeen studies including 459 patients were found eligible for the meta-analysis. There was significant heterogeneity among studies as depicted by chi-square test (p = 0.02) and moderate heterogeneity by I2 statistic (I2: 69 [95% CI: 30-100]). The pooled sensitivity and specificity of QISS on a per-segment basis with DSA/CE-MRA as reference standard was 0.88 (95% CI: 0.85-0.91) and 0.94 (95% CI: 0.92-0.96) respectively. The area under hierarchical summary receiver-operating characteristic reflected a high accuracy of 0.96 (95% CI: 0.94-0.98). There was a low likelihood of publication bias as indicated by Deeks' funnel plot. CONCLUSIONS The present meta-analysis has consolidated the evidence that QISS has high accuracy for identifying as well as excluding arterial stenosis/occlusions in patients with symptoms of PAD. It can thus be considered the test of choice in patients with renal failure and in "at-risk patients" including pregnant women and patients with contrast allergy. KEY POINTS • The pooled sensitivity and specificity of QISS magnetic resonance angiography on a per-segment basis with DSA or contrast-enhanced MRA as reference standard are 88% and 94% respectively. • The diagnostic accuracy of QISS in patients with peripheral arterial disease as reflected by area under hierarchical summary receiver-operating characteristic is high (0.96 (95% CI: 0.94-0.98)). • There is moderate to significant heterogeneity among studies as depicted by I2 statistic and chi-square test.
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Affiliation(s)
- Mansi Verma
- All India Institute of Medical Sciences, Department of Cardiovascular Radiology and Endovascular Interventions, New Delhi, 110029, India
| | - Niraj Nirmal Pandey
- All India Institute of Medical Sciences, Department of Cardiovascular Radiology and Endovascular Interventions, New Delhi, 110029, India
| | - Vishwajeet Singh
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Priya Jagia
- All India Institute of Medical Sciences, Department of Cardiovascular Radiology and Endovascular Interventions, New Delhi, 110029, India.
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Breen MA, Hassan MM, Johnston P, Upton J, Bixby SD. Quantification of popliteal artery narrowing with QISS MRA during active ankle plantarflexion in healthy, asymptomatic volunteers and its potential application in the diagnosis of popliteal artery entrapment syndrome (PAES). Skeletal Radiol 2021; 50:2091-2102. [PMID: 33797565 DOI: 10.1007/s00256-021-03751-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/27/2021] [Accepted: 02/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the degree of narrowing of the popliteal artery during active ankle plantar flexion in healthy volunteers using a non-contrast quiescent-interval single-shot (QISS) magnetic resonance angiography (MRA) technique. MATERIALS AND METHODS Following IRB approval, 10 healthy volunteers were recruited and following informed consent underwent QISS MRA of the lower extremity at rest and during ankle plantarflexion. Two pediatric musculoskeletal radiologists independently reviewed MR images in random order and recorded a number of subjective and objective anatomic variables including branch pattern, proximity of vessel to bony structures, gastrocnemius bulk, and presence of accessory muscle. Arterial narrowing with plantarflexion was recorded by a subjective assessment of 3D reconstructions (negligible or non-negligible) and objectively by measuring the narrowest diameter during plantarflexion and at rest. Agreement between reader scores was assessed using the concordance correlation coefficient (CCC) for continuous variables, and kappa and the proportion of agreement for categorical variables. RESULTS Mean reduction in arterial diameter during plantar flexion was 17.1% (min 1.9%, max 64.1%, SD 16.7%) for reader 1 and 17.2% (min 1.7%, max 50.0%, SD 14.3%.) for reader 2 with high agreement between readers: CCC = 0.92 and CI = 0.82, 0.96. Arterial narrowing was described subjectively as "non-negligible" in 7/20 legs by reader 1 and 5/20 legs by reader 2 with proportion of agreement = 0.90, CI (0.77, 1.00). CONCLUSION We observed a wide range of popliteal arterial narrowing with plantarflexion in asymptomatic volunteers. Larger studies, for which QISS is well suited, may be invaluable for distinguishing physiologic from pathologic arterial narrowing in patients with suspected popliteal artery entrapment syndrome (PAES).
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Affiliation(s)
- Micheál A Breen
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Mahad M Hassan
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Patrick Johnston
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Joseph Upton
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
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Navot B, Hecht EM, Lim RP, Edelman RR, Koktzoglou I. MR Angiography Series: Fundamentals of Non-Contrast-enhanced MR Angiography. Radiographics 2021; 41:E157-E158. [PMID: 34469213 DOI: 10.1148/rg.2021210141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Unlike CT angiography, which requires the use of contrast medium, MR angiography (MRA) can be performed without the use of contrast agents. This subfield of MRA is referred to as non-contrast-enhanced MRA (NC-MRA). While NC-MRA can be performed in many patients, it is especially useful in the imaging of pediatric and pregnant patients, as well as in patients with renal impairment. NC-MRA can also provide unique functional and hemodynamic information that is not obtainable with CT angiography or contrast-enhanced MRA. This module gives an overview of the predominant NC-MRA techniques that are currently available on modern clinical MRI systems, while also discussing some new and emerging topics in the field. This module is the second in a series created on behalf of the Society for Magnetic Resonance Angiography (SMRA), a group of researchers and clinicians who are passionate about the benefits of MRA but understand its challenges. The full digital presentation is available online. ©RSNA, 2021.
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Affiliation(s)
- Benjamin Navot
- From the Department of Radiology, Columbia University Irving Medical Center, 622 W 168th St, Ph1-301, New York, NY 10032 (B.N.); Department of Radiology, New York Presbyterian-Weill Cornell Medicine, New York, NY (E.M.H.); Department of Radiology, Austin Health, Heidelberg, Australia (R.P.L.); Departments of Radiology and Surgery, University of Melbourne, Melbourne, Australia (R.P.L.); Department of Radiology, NorthShore University HealthSystem, Evanston, Ill (R.R.E., I.K.); Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Ill (R.R.E.); and Department of Radiology, The University of Chicago Pritzker School of Medicine, Chicago, Ill (I.K.)
| | - Elizabeth M Hecht
- From the Department of Radiology, Columbia University Irving Medical Center, 622 W 168th St, Ph1-301, New York, NY 10032 (B.N.); Department of Radiology, New York Presbyterian-Weill Cornell Medicine, New York, NY (E.M.H.); Department of Radiology, Austin Health, Heidelberg, Australia (R.P.L.); Departments of Radiology and Surgery, University of Melbourne, Melbourne, Australia (R.P.L.); Department of Radiology, NorthShore University HealthSystem, Evanston, Ill (R.R.E., I.K.); Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Ill (R.R.E.); and Department of Radiology, The University of Chicago Pritzker School of Medicine, Chicago, Ill (I.K.)
| | - Ruth P Lim
- From the Department of Radiology, Columbia University Irving Medical Center, 622 W 168th St, Ph1-301, New York, NY 10032 (B.N.); Department of Radiology, New York Presbyterian-Weill Cornell Medicine, New York, NY (E.M.H.); Department of Radiology, Austin Health, Heidelberg, Australia (R.P.L.); Departments of Radiology and Surgery, University of Melbourne, Melbourne, Australia (R.P.L.); Department of Radiology, NorthShore University HealthSystem, Evanston, Ill (R.R.E., I.K.); Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Ill (R.R.E.); and Department of Radiology, The University of Chicago Pritzker School of Medicine, Chicago, Ill (I.K.)
| | - Robert R Edelman
- From the Department of Radiology, Columbia University Irving Medical Center, 622 W 168th St, Ph1-301, New York, NY 10032 (B.N.); Department of Radiology, New York Presbyterian-Weill Cornell Medicine, New York, NY (E.M.H.); Department of Radiology, Austin Health, Heidelberg, Australia (R.P.L.); Departments of Radiology and Surgery, University of Melbourne, Melbourne, Australia (R.P.L.); Department of Radiology, NorthShore University HealthSystem, Evanston, Ill (R.R.E., I.K.); Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Ill (R.R.E.); and Department of Radiology, The University of Chicago Pritzker School of Medicine, Chicago, Ill (I.K.)
| | - Ioannis Koktzoglou
- From the Department of Radiology, Columbia University Irving Medical Center, 622 W 168th St, Ph1-301, New York, NY 10032 (B.N.); Department of Radiology, New York Presbyterian-Weill Cornell Medicine, New York, NY (E.M.H.); Department of Radiology, Austin Health, Heidelberg, Australia (R.P.L.); Departments of Radiology and Surgery, University of Melbourne, Melbourne, Australia (R.P.L.); Department of Radiology, NorthShore University HealthSystem, Evanston, Ill (R.R.E., I.K.); Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Ill (R.R.E.); and Department of Radiology, The University of Chicago Pritzker School of Medicine, Chicago, Ill (I.K.)
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Saini BS, Darby JRT, Marini D, Portnoy S, Lock MC, Yin Soo J, Holman SL, Perumal SR, Wald RM, Windrim R, Macgowan CK, Kingdom JC, Morrison JL, Seed M. An MRI approach to assess placental function in healthy humans and sheep. J Physiol 2021; 599:2573-2602. [PMID: 33675040 DOI: 10.1113/jp281002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/15/2021] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Human placental function is evaluated using non-invasive Doppler ultrasound of umbilical and uterine artery pulsatility indices as measures of resistance in placental vascular beds, while measurement of placental oxygen consumption ( V O 2 ) is only possible during Caesarean delivery. This study shows the feasibility of using magnetic resonance imaging (MRI) in utero to measure blood flow and oxygen content in uterine and umbilical vessels to calculate oxygen delivery to and V O 2 by the gravid uterus, uteroplacenta and fetus. Normal late gestational human uteroplacental V O 2 by MRI was ∼4 ml min-1 kg-1 fetal weight, which was similar to our MRI measurements in sheep and to those previously measured using invasive techniques. Our MRI approach can quantify uteroplacental V O 2 , which involves the quantification of maternal- and fetal-placental blood flows, fetal oxygen delivery and V O 2 , and the oxygen gradient between uterine- and umbilical-venous blood, providing a comprehensive assessment of placental function with clinical potential. ABSTRACT It has not been feasible to perform routine clinical measurement of human placental oxygen consumption ( V O 2 ) and in vitro studies do not reflect true metabolism in utero. Here we propose an MRI method to non-invasively quantify in utero placental and fetal oxygen delivery ( D O 2 ) and V O 2 in healthy humans and sheep. Women (n = 20) and Merino sheep (n = 10; 23 sets of measurements) with singleton pregnancies underwent an MRI in late gestation (36 ± 2 weeks and 128 ± 9 days, respectively; mean ± SD). Blood flow (phase-contrast) and oxygen content (T1 and T2 relaxometry) were measured in the major uterine- and umbilical-placental vessels, allowing calculation of uteroplacental and fetal D O 2 and V O 2 . Maternal D O 2 (ml min-1 kg-1 fetus) to the gravid uterus was similar in humans and sheep (human = 54 ± 15, sheep = 53 ± 21, P = 0.854), while fetal D O 2 (human = 25 ± 4, sheep = 22 ± 5, P = 0.049) was slightly lower in sheep. Uteroplacental and fetal V O 2 (ml min-1 kg-1 fetus; uteroplacental: human = 4.1 ± 1.5, sheep = 3.5 ± 1.9, P = 0.281; fetus: human = 6.8 ± 1.3, sheep = 7.2 ± 1.7, P = 0.426) were similar between species. Late gestational uteroplacental:fetal V O 2 ratio did not change with age (human, P = 0.256; sheep, P = 0.121). Human umbilical blood flow (ml min-1 kg-1 fetus) decreased with advancing age (P = 0.008), while fetal V O 2 was preserved through an increase in oxygen extraction (P = 0.046). By contrast, sheep fetal V O 2 was preserved through stable umbilical flow (ml min-1 kg-1 ; P = 0.443) and oxygen extraction (P = 0.582). MRI derived measurements of uteroplacental and fetal V O 2 between humans and sheep were similar and in keeping with prior data obtained using invasive techniques. Taken together, these data confirm the reliability of our approach, which offers a novel clinical 'placental function test'.
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Affiliation(s)
- Brahmdeep S Saini
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Jack R T Darby
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Davide Marini
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Sharon Portnoy
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada
| | - Mitchell C Lock
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Jia Yin Soo
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Stacey L Holman
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Sunthara R Perumal
- Preclinical, Imaging and Research Laboratories, South Australian Health and Medical Research Institute, Adelaide, South Australia, 5086, Australia
| | - Rachel M Wald
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, M5G 2N2, Canada
| | - Rory Windrim
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1E2, Canada
| | - Christopher K Macgowan
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada.,Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1L7, Canada
| | - John C Kingdom
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1E2, Canada
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Mike Seed
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.,Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada.,Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1E2, Canada
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Kazemtash M, Harth M, Derwich W, Thalhammer A, Schmitz-Rixen T, Keese M. Quiescent-Interval Slice Selective Magnetic Resonance Angiography for Abdominal Aortic Aneurysm Treatment Planning. J Endovasc Ther 2021; 28:393-398. [PMID: 33478349 DOI: 10.1177/1526602821989341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Diagnostic imaging of Abdominal aortic aneurysm (AAA) almost exclusively employs CT angiography (CTA) involving X-ray exposure and contrast medium that may harm some patients. Quiescent-Interval Slice Selective MR (QISS-MR) depicts vascular anatomy without radiation or contrast medium. The diagnostic quality of QISS-MRA and CTA were compared in regard to length and diameter measurements in AAA patients. Suitability of QISS-MRA for AAA treatment planning was evaluated. MATERIALS AND METHODS The details of 30 patients with AAA who received both a QISS-MR and CTA for a known infrarenal AAA were obtained retrospectively that was approved by the local research ethics board. Two observers analyzed each dataset in terms of image quality and determined lumen diameter and length of 15 vessel segments. RESULTS Highly accurate agreement between the diagnostic scores from the two observers was achieved. There was no significant difference between CTA and QISS-MRA for all 15 measured vessels. Although information on calcification was lacking and intraluminal thrombus was visualized in only 25 patients out of 30 patients, a founded decision to carry out OR or EVAR was possible with both imaging modalities. CONCLUSION QISS-MRA presents a radiation and contrast free method for preoperative diagnostic AAA imaging. While QISS-MRA does not deliver exact information regarding calcification and thrombus formation, it does accurately allow measurement of vessel diameter and length. Therefore, it is potentially useful for EVAR planning in selected patients with impaired renal function.
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Affiliation(s)
- Majid Kazemtash
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt/Main, Germany
| | - Marc Harth
- Department of Diagnostic and Interventional Radiology, J.W. Goethe University Hospital, Frankfurt/Main, Germany
| | - Wojciech Derwich
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt/Main, Germany
| | - Axel Thalhammer
- Department of Diagnostic and Interventional Radiology, J.W. Goethe University Hospital, Frankfurt/Main, Germany
| | - Thomas Schmitz-Rixen
- Department of Vascular and Endovascular Surgery, J.W. Goethe University Hospital, Frankfurt/Main, Germany
| | - Michael Keese
- Department of Vascular and Endovascular Surgery, University Hospital Mannheim, Germany
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Settecase F, Rayz VL. Advanced vascular imaging techniques. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:81-105. [DOI: 10.1016/b978-0-444-64034-5.00016-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Knobloch G, Lauff MT, Hanke M, Schwenke C, Hamm B, Wagner M. Non-contrast-enhanced MR-angiography (MRA) of lower extremity peripheral arterial disease at 3 tesla: Examination time and diagnostic performance of 2D quiescent-interval single-shot MRA vs. 3D fast spin-Echo MRA. Magn Reson Imaging 2020; 76:17-25. [PMID: 33157187 DOI: 10.1016/j.mri.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/24/2020] [Accepted: 10/31/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Non-contrast enhanced MRA is a promising diagnostic alternative to contrast-enhanced (CE-) MRA or CT in patients with lower extremity peripheral arterial disease (PAD) but potentially associated with prolonged examination times and inferior diagnostic performance. We aimed to compare examination times and diagnostic performance of non-contrast enhanced quiescent-interval slice-selective (QISS)-MRA and fast-spin-echo (FSE)-MRA at 3.0 T. MATERIALS AND METHODS Forty-five patients with PAD were recruited for this IRB approved prospective study. Subjects underwent lower extremity MRA with 1) QISS-MRA, 2) FSE-MRA, and 3) CE-MRA (continuous table movement MRA and time-resolved MRA of the calf), which served as the standard of reference. Scan times for each examination step and total examination times for each of the three techniques was determined. Image quality and degree of stenosis were rated by two readers on a 5-point Likert scale. Sensitivity, specificity and diagnostic accuracy for relevant (>50%) stenosis were calculated. RESULTS Median total examination time was 27:02 min for QISS-MRA (IQR, 25:13-31:01 min), 28:37 min for FSE-MRA (IQR, 25:51-33:12 min), and 31:22 min for CE-MRA (IQR, 26:41-33:23 min). Acquisition time for QISS-MRA was significantly longer compared to FSE-MRA and CE-MRA (p ≤ 0.0001), while time for localizers, scouts and planning of the MRA sequence was significantly shorter for QISS-MRA compared to FSE-MRA and CE-MRA (p ≤ 0.0001). QISS-MRA had significantly better image quality compared to FSE-MRA with less segments classified as non-diagnostic (Reader 1: 3% vs. 35%; Reader 2: 3% vs. 50%, p ≤ 0.0001). Overall, QISS-MRA showed significantly better diagnostic performance than FSE-MRA (sensitivity, 85% vs. 54%; specificity, 90% vs. 47%, diagnostic accuracy, 89% vs. 48%; p ≤ 0.0001). CONCLUSION Total examination time of QISS-MRA and FSE-MRA was comparable with a conventional CE-MRA protocol. QISS-MRA showed significantly higher diagnostic performance than FSE-MRA.
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Affiliation(s)
- Gesine Knobloch
- Department of Radiology, Charité - University Medicine Berlin, Germany.
| | - Marie-Teres Lauff
- Department of Radiology, Charité - University Medicine Berlin, Germany
| | - Moritz Hanke
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Bernd Hamm
- Department of Radiology, Charité - University Medicine Berlin, Germany
| | - Moritz Wagner
- Department of Radiology, Charité - University Medicine Berlin, Germany
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16
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Koktzoglou I, Huang R, Ong AL, Aouad PJ, Walker MT, Edelman RR. High spatial resolution whole-neck MR angiography using thin-slab stack-of-stars quiescent interval slice-selective acquisition. Magn Reson Med 2020; 84:3316-3324. [PMID: 32521094 DOI: 10.1002/mrm.28339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To report a 3D multi-echo thin-slab stack-of-stars (tsSOS) quiescent-interval slice-selective (QISS) strategy for high-resolution magnetic resonance angiography (MRA) of the entire neck in under seven minutes. METHODS The neck arteries of eight subjects were imaged at 3 Tesla. Multi-echo 3D tsSOS QISS using a FLASH readout was compared with 3D tsSOS FLASH, 2D QISS, 2D TOF, and 3D TOF. A root-mean-square (RMS) combination of echo time images was tested. Evaluation metrics included arterial signal-to-noise ratio (SNR), arterial-to-muscle contrast-to-noise ratio (CNR), and image quality. RESULTS 3D multi-echo tsSOS QISS using a RMS combination of echo time images increased SNR and CNR by 60% and 63% with respect to the reconstruction obtained with the shortest echo time. 3D tsSOS QISS showed superior CNR with respect to 3D tsSOS FLASH imaging, and more than 3-fold higher SNR and CNR with respect to 2D radial QISS when normalized for voxel size. 3D tsSOS QISS provided good to excellent image quality that exceeded the image quality of 2D QISS, 2D TOF, and 3D TOF (P < .05). CONCLUSION Whole-neck high-resolution nonenhanced MRA is feasible using 3D tsSOS QISS, and produced image quality that exceeded those of competing nonenhanced MRA protocols at 3 Tesla.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Rong Huang
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Archie L Ong
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.,Department of Neurology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Pascale J Aouad
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew T Walker
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
MR angiography is a flexible imaging technique enabling morphologic assessment of mesenteric arterial and venous vasculature. Conventional gadolinium-based contrast media and ferumoxytol are used as contrast agents. Ferumoxytol, an intravenous iron replacement therapy approved by the US Food and Drug Administration for iron deficiency anemia, is an effective and well tolerated blood pool contrast agent. The addition of 4D flow MR imaging enables a functional assessment of the arterial and venous vasculature; when coupled with a meal challenge, the severity of mesenteric arterial stenosis is well appreciated. Noncontrast MR angiographic techniques are useful for evaluating suspected mesenteric ischemia.
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18
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Pamminger M, Klug G, Kranewitter C, Reindl M, Reinstadler SJ, Henninger B, Tiller C, Holzknecht M, Kremser C, Bauer A, Jaschke W, Metzler B, Mayr A. Non-contrast MRI protocol for TAVI guidance: quiescent-interval single-shot angiography in comparison with contrast-enhanced CT. Eur Radiol 2020; 30:4847-4856. [PMID: 32318849 PMCID: PMC7431439 DOI: 10.1007/s00330-020-06832-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/07/2020] [Accepted: 03/25/2020] [Indexed: 12/18/2022]
Abstract
Objectives To prospectively compare unenhanced quiescent-interval single-shot MR angiography (QISS-MRA) with contrast-enhanced computed tomography angiography (CTA) for contrast-free guidance in transcatheter aortic valve intervention (TAVI). Methods Twenty-six patients (mean age 83 ± 5 years, 15 female [58%]) referred for TAVI evaluation underwent QISS-MRA for aortoiliofemoral access guidance and non-contrast three-dimensional (3D) “whole heart” MRI for prosthesis sizing on a 1.5-T system. Contrast-enhanced CTA was performed as imaging gold standard for TAVI planning. Image quality was assessed by a 4-point Likert scale; continuous MRA and CTA measurements were compared with regression and Bland-Altman analyses. Results QISS-MRA and CTA-based measurements of aortoiliofemoral vessel diameters correlated moderately to very strong (r = 0.572 to 0.851, all p ≤ 0.002) with good to excellent inter-observer reliability (intra-class correlation coefficient (ICC) = 0.862 to 0.999, all p < 0.0001) regarding QISS assessment. Mean diameters of the infrarenal aorta and iliofemoral vessels differed significantly (bias 0.37 to 0.98 mm, p = 0.041 to < 0.0001) between the two modalities. However, inter-method decision for transfemoral access route was comparable (κ = 0.866, p < 0.0001). Aortic root parameters assessed by 3D whole heart MRI strongly correlated (r = 0.679 to 0.887, all p ≤ 0.0001) to CTA measurements. Conclusion QISS-MRA provides contrast-free access route evaluation in TAVI patients with moderate to strong correlations compared with CTA and substantial inter-observer agreement. Despite some significant differences in minimal vessel diameters, inter-method agreement for transfemoral accessibility is strong. Combination with 3D whole heart MRI facilitates unenhanced TAVI guidance. Key Points • QISS-MRA and CTA inter-method agreement for transfemoral approach is strong. • QISS-MRA is a very good alternative to CTA and MRA especially in patients with Kidney Disease Outcomes Quality Initiativestages 4 and 5. • Combination of QISS-MRA and 3D “whole heart” MRI facilitates fully unenhanced TAVI guidance.
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Affiliation(s)
- Mathias Pamminger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christof Kranewitter
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christian Kremser
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Werner Jaschke
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
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Free-Breathing Fast Low-Angle Shot Quiescent-Interval Slice-Selective Magnetic Resonance Angiography for Improved Detection of Vascular Stenoses in the Pelvis and Abdomen: Technical Development. Invest Radiol 2020; 54:752-756. [PMID: 31299678 DOI: 10.1097/rli.0000000000000592] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Balanced steady-state free precession-based quiescent-interval slice-selective (bSSFP QISS) magnetic resonance angiography (MRA) is accurate for the noncontrast evaluation of peripheral arterial disease (PAD); however, drawbacks include the need for breath-holding when imaging the abdomen and pelvis, and sensitivity to off-resonance artifacts. The purpose of this study was to evaluate the image quality and diagnostic accuracy in the pelvis and abdomen of free-breathing fast low-angle shot-based QISS (FLASH QISS) techniques in comparison to bSSFP QISS in patients with PAD, using computed tomographic angiography as the reference. MATERIALS AND METHODS Twenty-seven patients (69 ± 10 years, 17 men) with PAD were enrolled in this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant prospective study between April and December 2018. Patients underwent noncontrast MRA using standard bSSFP QISS and prototype free-breathing radial-FLASH and Cartesian-FLASH QISS at 3 T. A subset of patients (n = 22) also underwent computed tomographic angiography as the reference standard. Nine arterial segments per patient were evaluated spanning the abdomen, pelvis, and upper thigh regions. Objective (signal intensity ratio and relative standard deviation) and subjective image quality (4-point scale) and stenosis (>50%) were evaluated by 2 readers and compared using one-way analysis of variance, Wilcoxon, and McNemar tests, respectively. RESULTS A total of 179 vascular segments were available for analysis by all QISS techniques. No significant difference was observed among bSSFP, radial-FLASH, and Cartesian-FLASH QISS techniques in signal intensity ratio (P = 0.428) and relative standard deviation (P = 0.220). Radial-FLASH QISS demonstrated the best image quality (P < 0.0001) and the highest interreader agreement (κ = 0.721). The sensitivity values of bSSFP, radial-FLASH, and Cartesian-FLASH QISS for the detection of greater than 50% stenosis were 76.0%, 84.0%, and 80.0%, respectively, whereas specificity values were 97.6%, 94.0%, and 92.8%, respectively. Moreover, FLASH QISS consistently reduced off-resonance artifacts compared with bSSFP QISS. CONCLUSIONS Free-breathing FLASH QISS MRA techniques provide improved image quality and sensitivity, high specificity, and reduced off-resonance artifacts for vascular stenosis detection in the abdomen and pelvis.
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20
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Yoneyama M, Zhang S, Hu HH, Chong LR, Bardo D, Miller JH, Toyonari N, Katahira K, Katsumata Y, Pokorney A, Ng CK, Kouwenhoven M, Van Cauteren M. Free-breathing non-contrast-enhanced flow-independent MR angiography using magnetization-prepared 3D non-balanced dual-echo Dixon method: A feasibility study at 3 Tesla. Magn Reson Imaging 2019; 63:137-146. [DOI: 10.1016/j.mri.2019.08.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/18/2019] [Accepted: 08/15/2019] [Indexed: 11/30/2022]
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Peters S, Huhndorf M, Jensen-Kondering U, Larsen N, Koktzoglou I, Edelman RR, Graessner J, Both M, Jansen O, Salehi Ravesh M. Non-Contrast-Enhanced Carotid MRA: Clinical Evaluation of a Novel Ungated Radial Quiescent-Interval Slice-Selective MRA at 1.5T. AJNR Am J Neuroradiol 2019; 40:1529-1537. [PMID: 31395666 DOI: 10.3174/ajnr.a6171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/04/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Non-contrast-enhanced MRA techniques have experienced a renaissance due to the known correlation between the use of gadolinium-based contrast agents and the development of nephrogenic systemic fibrosis and the deposition of gadolinium in some brain regions. The purpose of this study was to assess the diagnostic performance of ungated non-contrast-enhanced radial quiescent-interval slice-selective MRA of the extracranial supra-aortic arteries in comparison with conventional contrast-enhanced MRA in patients with clinical suspicion of carotid stenosis. MATERIALS AND METHODS In this prospective study, both MRA pulse sequences were performed in 31 consecutive patients (median age, 68.8 years; 19 men). For the evaluation, the cervical arterial system was divided into 35 segments (right and left side). Three blinded reviewers separately evaluated these segments. An ordinal scoring system was used to assess the image quality of arterial segments and the stenosis grading of carotid arteries. RESULTS Overall venous contamination in quiescent-interval slice-selective MRA was rated as "none" by all readers in 84.9% of cases and in 8.1% of cases in contrast-enhanced MRA (P < .0001). The visualization quality of arterial segments was considered good to excellent in 40.2% for the quiescent-interval slice-selective MRA and in 52.2% for the contrast-enhanced MRA (P < .0001). The diagnostic accuracy of ungated quiescent-interval slice-selective MRA concerning the stenosis grading showed a total sensitivity and specificity of 85.7% and 90.0%, respectively. CONCLUSIONS Ungated quiescent-interval slice-selective MRA can be used clinically as an alternative to contrast-enhanced MRA without a significantly different image quality or diagnostic accuracy for the detection of carotid stenosis at 1.5T.
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Affiliation(s)
- S Peters
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - M Huhndorf
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - U Jensen-Kondering
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - N Larsen
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - I Koktzoglou
- Department of Radiology (I.K., R.R.E.), NorthShore University Health System, Evanston, Illinois.,University of Chicago Pritzker School of Medicine (I.K.), Chicago, Illinois
| | - R R Edelman
- Department of Radiology (I.K., R.R.E.), NorthShore University Health System, Evanston, Illinois.,Northwestern University Feinberg School of Medicine (R.R.E.), Chicago, Illinois
| | | | - M Both
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - O Jansen
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - M Salehi Ravesh
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
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Küstner T, Bustin A, Jaubert O, Neji R, Prieto C, Botnar R. 3D Cartesian fast interrupted steady-state (FISS) imaging. Magn Reson Med 2019; 82:1617-1630. [PMID: 31197881 PMCID: PMC6772102 DOI: 10.1002/mrm.27830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/24/2019] [Accepted: 05/07/2019] [Indexed: 11/11/2022]
Abstract
PURPOSE To enable intrinsic and efficient fat suppression in 3D Cartesian fast interrupted steady-state (FISS) acquisitions. METHODS A periodic interruption of the balanced steady-state free precession (bSSFP) readout train (FISS) has been previously proposed for 2D radial imaging. FISS modulates the bSSFP frequency response pattern in terms of shape, width and location of stop band (attenuated transverse magnetization). Depending on the FISS interruption rate, the stop band characteristic can be exploited to suppress the fat spectrum at 3.5 ppm, thus yielding intrinsic fat suppression. For conventional 2D Cartesian sampling, ghosting/aliasing artifacts along phase-encoding direction have been reported. In this work, we propose to extend FISS to 3D Cartesian imaging and report countermeasures for the previously observed ghosting/aliasing artifacts. Key parameters (dummy prepulses, spatial resolution, and interruption rate) are investigated to optimize fat suppression and image quality. FISS behavior is examined using extended phase graph simulations to recommend parametrizations which are validated in phantom and in vivo measurements on a 1.5T MRI scanner for 3 applications: upper thigh angiography, abdominal imaging, and free-running 5D CINE. RESULTS Using optimized parameters, 3D Cartesian FISS provides homogeneous and consistent fat suppression for all 3 applications. In upper thigh angiography, vessel structures can be recovered in FISS that are obscured in bSSFP. Fat suppression in free-running cardiac CINE resulted in less fat-related motion aliasing and yielded better image quality. CONCLUSION 3D Cartesian FISS is feasible and offers homogeneous intrinsic fat suppression for selected imaging parameters without the need for dedicated preparation pulses, making it a promising candidate for free-running fat-suppressed imaging.
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Affiliation(s)
- Thomas Küstner
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Aurélien Bustin
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Olivier Jaubert
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom.,MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom.,Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - René Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom.,Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
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Cavallo AU, Koktzoglou I, Edelman RR, Gilkeson R, Mihai G, Shin T, Rajagopalan S. Noncontrast Magnetic Resonance Angiography for the Diagnosis of Peripheral Vascular Disease. Circ Cardiovasc Imaging 2019; 12:e008844. [DOI: 10.1161/circimaging.118.008844] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Armando Ugo Cavallo
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
- Division of Diagnostic and Interventional Radiology, University Hospital Policlinico “Tor Vergata”, Roma, Italy (A.U.C.)
| | - Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL (I.K., R.R.E.)
- University of Chicago Pritzker School of Medicine, IL (I.K.)
| | - Robert R. Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL (I.K., R.R.E.)
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (R.R.E.)
| | - Robert Gilkeson
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
| | - Georgeta Mihai
- Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA (G.M.)
| | - Taehoon Shin
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, South Korea (T.S.)
| | - Sanjay Rajagopalan
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
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Bisla JK, Saranathan M, Martin DR, Arif-Tiwari H, Kalb BT. MR Imaging Evaluation of the Kidneys in Patients with Reduced Kidney Function. Magn Reson Imaging Clin N Am 2019; 27:45-57. [DOI: 10.1016/j.mric.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Saini A, Wallace A, Albadawi H, Naidu S, Alzubaidi S, Knuttinen MG, Panda A, Oklu R. Quiescent-Interval Single-Shot Magnetic Resonance Angiography. Diagnostics (Basel) 2018; 8:diagnostics8040084. [PMID: 30567304 PMCID: PMC6315503 DOI: 10.3390/diagnostics8040084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/15/2018] [Accepted: 12/15/2018] [Indexed: 01/22/2023] Open
Abstract
Lower extremity peripheral arterial disease (PAD) is a chronic, debilitating disease with a significant global burden. A number of diagnostic imaging techniques exist, including computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CEMRA), to aid in PAD diagnosis and subsequent treatment planning. Due to concerns of renal toxicity or nephrogenic systemic fibrosis (NSF) for iodinated and gadolinium-based contrasts, respectively, a number of non-enhanced MRA (NEMRA) protocols are being increasingly used in PAD diagnosis. These techniques, including time of flight and phase contrast MRA, have previously demonstrated poor image quality, long acquisition times, and/or susceptibility to artifacts when compared to existing contrast-enhanced techniques. In recent years, Quiescent-Interval Single-Shot (QISS) MRA has been developed to overcome these limitations in NEMRA methods, with promising results. Here, we review the various screening and diagnostic tests currently used for PAD. The various NEMRA protocols are discussed, followed by a comprehensive review of the literature on QISS MRA to date. A particular emphasis is placed on QISS MRA feasibility studies and studies comparing the diagnostic accuracy and image quality of QISS MRA versus other diagnostic imaging techniques in PAD.
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Affiliation(s)
- Aman Saini
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Alex Wallace
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Hassan Albadawi
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Sailendra Naidu
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Sadeer Alzubaidi
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - M Grace Knuttinen
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Anshuman Panda
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, Arizona 85054, USA.
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