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Zhao DL, Li RY, Li C, Chen XH, Yu JW, Zhang Y, Ju S. Assessment of the degree of arterial stenosis in intracranial atherosclerosis using 3D high-resolution MRI: comparison with time-of-flight MRA, contrast-enhanced MRA, and DSA. Clin Radiol 2023; 78:e63-70. [PMID: 36307233 DOI: 10.1016/j.crad.2022.08.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 01/18/2023]
Abstract
AIM To compare the accuracy of three-dimensional (3D) high-resolution (HR) magnetic resonance imaging (MRI), time-of-flight magnetic resonance angiography (TOF-MRA), contrast-enhanced magnetic resonance angiography (CE-MRA), and digital subtraction angiography (DSA) in measuring the degree of stenosis in intracranial atherosclerosis. MATERIALS AND METHODS All patients with intracranial artery ischaemic events underwent HR-MRI, TOF-MRA, and CE-MRA analysis, and some of these patients underwent DSA examination. The correlation between different methods for measuring the degree of lumen stenosis was analysed. The accuracy of HR-MRI, TOF-MRA, and CE-MRA was evaluated and compared with that of DSA. RESULTS A total of 189 arterial stenoses were identified in 93 patients. Of these, 72 patients with 142 arterial stenoses underwent DSA examination. A very strong correlation between HR-MRI and CE-MRA measurements was shown (r=0.839, p<0.0001). The correlation between HR-MRI and TOF-MRA measurements was strong (r=0.720, p<0.0001). A very strong correlation between HR-MRI and DSA measurements was found (r=0.864, p<0.0001), and a similar correlation was observed between CE-MRA, and DSA measurements (r=0.843, p<0.0001). The correlation between TOF-MRA and DSA measurements was strong (r=0.686, p<0.0001). There was substantial agreement between HR-MRI and DSA measurements (K = 0.772) and between CE-MRA, and DSA measurements (K = 0.734) that was slightly higher than the agreement between TOF-MRA and DSA measurements (K = 0.636). CONCLUSION HR-MRI can accurately measure stenosis (especially for moderate and severe stenosis) in intracranial atherosclerosis by direct visualisation of the vessel lumen and steno-occlusive plaque.
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Timms L, Zhou T, Lyu Y, Qiao J, Mishra V, Lahoud RM, Jayaraman GV, Allegretti AS, Drew D, Seethamraju RT, Harisinghani M, Sridhar S. Ferumoxytol-enhanced ultrashort TE MRA and quantitative morphometry of the human kidney vasculature. Abdom Radiol (NY) 2021; 46:3288-300. [PMID: 33666735 DOI: 10.1007/s00261-021-02984-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the feasibility of Quantitative Ultrashort-Time-to-Echo Contrast-Enhanced (QUTE-CE) MRA using ferumoxytol as a contrast agent for abdominal angiography in the kidney. METHODS Four subjects underwent ferumoxytol-enhanced MRA with the 3D UTE Spiral VIBE WIP sequence at 3 T. Image quality metrics were quantified, specifically the blood Signal-to-Noise Ratio (SNR), blood-tissue Contrast-to-Noise Ratio (CNR) and Intraluminal Signal Heterogeneity (ISH) from both the aorta and inferior vena cava (IVC). Morphometric analysis of the vessels was performed using manual approach and semi-automatic approach using Vascular Modeling ToolKit (VMTK). Image quality and branching order were compared between QUTE-CE MRA and the Gadolinium (Gd) CEMRA reference image. RESULTS QUTE-CE MRA provides a bright blood snapshot that delineates arteries and veins equally in the same scan. The maximum SNR and CNR values were 3,282 ± 1,218 and 1,295 ± 580, respectively - significantly higher than available literature values using other CEMRA techniques. QUTE-CE MRA had lower ISH and depicted higher vessel branching order (7th vs 3rd) within the kidney compared to a standard dynamic clinical Gd CEMRA scan. Morphometric analysis yielded quantitative results for the total kidney volume, total cyst volume and for diameters of the branching arterial network down to the 7th branch. Vessel curvature was significantly increased (p < 0.001) in the presence of a renal cyst compared to equivalent vessels in normal kidney regions. CONCLUSION QUTE-CE MRA is feasible for kidney angiography, providing greater detail of kidney vasculature, enabling quantitative morphometric analysis of the abdominal and intra-renal vessels and yielding metrics relevant to vascular diseases while using a contrast agent ferumoxytol that is safe for CKD patients.
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Heit JJ, Christensen S, Mlynash M, Marks MP, Faizy TD, Lansberg MG, Wintermark M, Bammer R, Albers GW. MR perfusion imaging: Half-dose gadolinium is half the quality. J Neuroimaging 2021; 31:1014-1019. [PMID: 34002424 DOI: 10.1111/jon.12879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Patients with acute ischemic stroke due to a large vessel occlusion (AIS-LVO) undergo emergent neuroimaging triage for thrombectomy treatment. MRI is often utilized for this evaluation, and cerebral magnetic resonance perfusion (MRP) imaging is used to identify the presence of the salvageable penumbra. To determine if dose reduction is feasible, we assessed whether a half-dose reduction in gadobenate provided sufficient MRP quality in AIS-LVO patients. METHODS A prospective observational study of all patients presenting to our neurovascular referral center with AIS-LVO was performed. MRP was done with a half-dose of gadolinium (0.1 ml/kg body weight) over a period of 10 months. MRP images were compared to a consecutive historical cohort of full-dose gadolinium (0.2 ml/kg body weight) MRP studies and rated for image quality (poor, borderline, or good) that determined thrombectomy eligibility. RESULTS Fifty-four half-dose and 127 full-dose patients were included. No differences in patient demographics or stroke presentation details were identified. MRP quality differed between half- and full-dose scans (p < 0.001), which were rated as poor (40.7% vs. 6.3%), borderline (18.5% vs. 26.8%), and good quality (40.7% vs. 66.9%), respectively. MRP image quality was then dichotomized into poor and sufficient (borderline and good) quality groups; half-dose studies were more likely to have poor quality compared to full-dose studies (40.7% vs. 6.3%; p < 0.001). CONCLUSIONS Half-dose gadolinium administration for MRP in AIS-LVO patients results in poor image quality in a substantial number of studies. MR cerebral perfusion performed with half-dose gadolinium may adversely affect stroke patient triage for thrombectomy.
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Affiliation(s)
- Jeremy J Heit
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Soren Christensen
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Michael Mlynash
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Michael P Marks
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Tobias D Faizy
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Maarten G Lansberg
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Max Wintermark
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Roland Bammer
- Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Gregory W Albers
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
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Abstract
Multimodal MR imaging provides valuable information in the management of patients with acute ischemic stroke (AIS), with diagnostic, therapeutic, and prognostic implications. MR imaging plays a critical role in treatment decision making for (1) thrombolytic treatment of AIS patients with unknown symptom-onset and (2) endovascular treatment of patients with large vessel occlusion presenting beyond 6 hours from the symptom onset. MR imaging provides the most accurate information for detection of ischemic brain and is invaluable for differentiating AIS from stroke mimics.
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Christensen S, Amukotuwa S, Lansberg MG, Kemp S, Heit JJ, Mlynash M, Marks MP, Albers GW, Bammer R. Comparison of Tmax values between full- and half-dose gadolinium perfusion studies. J Cereb Blood Flow Metab 2021; 41:336-341. [PMID: 32208802 PMCID: PMC8370009 DOI: 10.1177/0271678x20914537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AHA guidelines recommend use of perfusion imaging for patient selection in the 6-24 h window. Recently, the safety of gadolinium-based contrast agents for MR perfusion imaging has been questioned based on findings that gadolinium accumulates in brain tissue. Regulatory bodies have recommended to limit the use of gadolinium-based contrast agents where possible. Focusing specifically on the time to maximum of the tissue residue function (Tmax) parameter, used in DAWN and DEFUSE 3, we hypothesized that half-dose scans would yield a similar Tmax delay pattern to full-dose scans. We prospectively recruited 10 acute ischemic stroke patients imaged with two perfusion scans at their follow-up visit, one with a standard dose gadolinium followed by a half-dose injection a median of 7 min apart. The brain was parcellated into a grid of 3 × 3 regions and the mean of the difference in Tmax between the 3 × 3 regions on the half- and full-dose Tmax maps was 0.1 s (iqr 0.38 s). The fraction of brain tissue that differed by no more than ±1 s was 93.7%. In patients with normal or modest Tmax delays, half-dose gadolinium appears to provide comparable Tmax measurements to those of full-dose scans.
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Affiliation(s)
- Søren Christensen
- Stanford Stroke Center, Stanford University School of Medicine,
Stanford, CA, USA
| | - Shalini Amukotuwa
- Diagnostic Imaging, Monash Health, Clayton, Australia
- Department of Radiology, Barwon Health, Geelong, Australia
| | - Maarten G Lansberg
- Stanford Stroke Center, Stanford University School of Medicine,
Stanford, CA, USA
| | - Stephanie Kemp
- Stanford Stroke Center, Stanford University School of Medicine,
Stanford, CA, USA
| | - Jeremy J Heit
- Diagnostic and Interventional Neuroradiology Department,
Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Mlynash
- Stanford Stroke Center, Stanford University School of Medicine,
Stanford, CA, USA
| | - Michael P Marks
- Diagnostic and Interventional Neuroradiology Department,
Stanford University School of Medicine, Stanford, CA, USA
| | - Greg W Albers
- Department of Radiology, Barwon Health, Geelong, Australia
- Greg W Albers, Stanford Stroke Center, 780
Welch Rd, Palo Alto, CA 94304, USA.
| | - Roland Bammer
- Department of Radiology, University of Melbourne, Parkville,
Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Dhundass S, Savatovsky J, Duron L, Fahed R, Escalard S, Obadia M, Zuber K, Metten MA, Mejdoubi M, Blanc R, Sadik J, Collin A, Lecler A. Improved detection and characterization of arterial occlusion in acute ischemic stroke using contrast enhanced MRA. J Neuroradiol 2020; 47:278-83. [DOI: 10.1016/j.neurad.2019.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 11/20/2022]
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Nael K, Drummond J, Costa AB, De Leacy RA, Fung MM, Mocco J. Differential Subsampling with Cartesian Ordering for Ultrafast High-Resolution MRA in the Assessment of Intracranial Aneurysms. J Neuroimaging 2019; 30:40-44. [PMID: 31721362 DOI: 10.1111/jon.12677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the feasibility of an ultrafast whole head contrast-enhanced MRA (CE-MRA) in morphometric assessment of intracranial aneurysms in comparison to routinely used time-of-flight (TOF)-MRA. METHODS In this prospective single institutional study, patients with known untreated intracranial aneurysm underwent MRA. Routine multislab TOF-MRA was obtained with a 3D voxel sizes of .6 × .6 × 1 (6-minute acquisition time). CE-MRA of whole head was obtained using Differential Subsampling with Cartesian Ordering (DISCO) and 2D Auto-calibrating Reconstruction for Cartesian imaging with a 3D voxel-sizes of .75 × .75 × 1 mm3 during a 6-second temporal resolution. Morphometric features of intracranial aneurysms, including size, aneurysm sac morphology, and the presence of intraluminal thrombosis, were assessed on both techniques. Statistical analysis was performed using a combination of Kappa test, Bland-Altman, and correlation coefficient analysis. RESULTS A total of 34 aneurysms in 28 patients were included. Aneurysm size measurements (mean ± SD) were similar between DISCO-MRA (4.1 ± 2.3 mm) and TOF-MRA (4.3 ± 2.8 mm) (P = .27). Bland-Altman analysis showed a mean difference of .4 mm and there was excellent correlation r = .91 (95% CI: .87-.96). In six aneurysms (17.6%), TOF-MRA was nonconfidant to exclude intraluminal thrombosis. In seven aneurysms (20%), TOF-MRA was unable or nonconfidant in depicting aneurysm sac morphology. CONCLUSIONS Described ultrafast high spatial-resolution MRA is superior to routinely used TOF-MRA in assessment of morphometric features of intracranial aneurysms, such as intraluminal thrombosis and aneurysm morphology, and is obtained in a fraction of the time (6 seconds).
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Affiliation(s)
- Kambiz Nael
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James Drummond
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anthony B Costa
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Reade A De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Roh HG, Kim EY, Kim IS, Lee HJ, Park JJ, Lee SB, Choi JW, Jeon YS, Park M, Kim SU, Kim HJ. A Novel Collateral Imaging Method Derived from Time-Resolved Dynamic Contrast-Enhanced MR Angiography in Acute Ischemic Stroke: A Pilot Study. AJNR Am J Neuroradiol 2019; 40:946-953. [PMID: 31097431 DOI: 10.3174/ajnr.a6068] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/12/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Assessment of the collateral status has been emphasized for appropriate treatment decisions in patients with acute ischemic stroke. The purpose of this study was to introduce a multiphase MRA collateral imaging method (collateral map) derived from time-resolved dynamic contrast-enhanced MRA and to verify the value of the multiphase MRA collateral map in acute ischemic stroke by comparing it with the multiphase collateral imaging method (MRP collateral map) derived from dynamic susceptibility contrast-enhanced MR perfusion. MATERIALS AND METHODS From a prospectively maintained registry of acute ischemic stroke, MR imaging data of patients with acute ischemic stroke caused by steno-occlusive lesions of the unilateral ICA and/or the M1 segment of the MCA were analyzed. We generated collateral maps using dynamic signals from dynamic contrast-enhanced MRA and DSC-MRP using a Matlab-based in-house program and graded the collateral scores of the multiphase MRA collateral map and the MRP collateral map independently. Interobserver reliabilities and intermethod agreement between both collateral maps for collateral grading were tested. RESULTS Seventy-one paired multiphase MRA and MRP collateral maps from 67 patients were analyzed. The interobserver reliabilities for collateral grading using multiphase MRA or MRP collateral maps were excellent (weighted κ = 0.964 and 0.956, respectively). The agreement between both collateral maps was also excellent (weighted κ = 0.884; 95% confidence interval, 0.819-0.949). CONCLUSIONS We demonstrated that the dynamic signals of dynamic contrast-enhanced MRA could be used to generate multiphase collateral images and showed the possibility of the multiphase MRA collateral map as a useful collateral imaging method in acute ischemic stroke.
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Affiliation(s)
- H G Roh
- From the Departments of Radiology (H.G.R., J.W.C.)
| | - E Y Kim
- Department of Radiology (E.Y.K.), Gachon University Gil Medical Center, Incheon, Korea
| | - I S Kim
- Siemens Healthineers Ltd (I.S.K.), Seoul, Korea
| | - H J Lee
- Departments of Neurosurgery (H.J.L., S.U.K.)
| | | | | | - J W Choi
- From the Departments of Radiology (H.G.R., J.W.C.)
| | - Y S Jeon
- Neurosurgery (Y.S.J.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - M Park
- Department of Radiology (M.P.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - S U Kim
- Departments of Neurosurgery (H.J.L., S.U.K.)
| | - H J Kim
- Radiology (H.J.K.), Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
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Colafati GS, Rossi E, Carducci C, Piga S, Voicu IP, Mastronuzzi A, Tomà P. Half-dose versus full-dose macrocyclic gadolinium at 3-T magnetic resonance imaging in paediatric bone and soft-tissue disease. Pediatr Radiol 2018; 48:1724-1735. [PMID: 30046901 DOI: 10.1007/s00247-018-4204-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/31/2018] [Accepted: 07/02/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Given the recent concerns about gadolinium-based contrast agent safety, dose reduction strategies are being investigated. OBJECTIVE To compare half-dose and standard full-dose gadoterate meglumine at 3-tesla (T) MRI in paediatric bone and soft-tissue diseases. MATERIALS AND METHODS We prospectively enrolled 45 children (age range 2.7 months to 17.5 years, median age 8.7 years, 49 total anatomical segments) with bone and soft-tissue diseases (neoplastic, inflammatory/infectious, ischaemic and vascular) imaged at 3-T MRI. Two consecutive half-doses of gadoterate meglumine (0.05 mmol/kg body weight) were administered. Two sets of post-contrast T1-weighted images were obtained, one after the first half dose and the other after the second half dose. For qualitative analysis, three radiologists, masked to the gadolinium dose, compared the diagnostic quality of the images. For quantitative analysis, we compared signal-to-noise ratio and contrast-to-noise ratio at half and full doses. RESULTS Signal-to-noise ratio and contrast-to-noise ratio did not vary significantly between the two groups. Qualitative analysis yielded excellent image quality in both post-contrast image datasets (Cohen κ=0.8). CONCLUSION In paediatric bone and soft-tissue 3-T MRI, it is feasible to halve the standard dose of gadoterate meglumine without losing image quality.
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Affiliation(s)
- Giovanna Stefania Colafati
- Department of Imaging, Neuroradiology Unit, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Enrica Rossi
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Carducci
- Department of Imaging, Neuroradiology Unit, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Simone Piga
- Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ioan Paul Voicu
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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11
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Nam Y, Jang J, Park SY, Choi HS, Jung S, Ahn K, Kim B. Correlation-based perfusion mapping using time-resolved MR angiography: A feasibility study for patients with suspicions of steno-occlusive craniocervical arteries. Eur Radiol 2018; 28:4890-4899. [DOI: 10.1007/s00330-018-5468-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/13/2018] [Accepted: 04/09/2018] [Indexed: 10/16/2022]
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12
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Boujan T, Neuberger U, Pfaff J, Nagel S, Herweh C, Bendszus M, Möhlenbruch MA. Value of Contrast-Enhanced MRA versus Time-of-Flight MRA in Acute Ischemic Stroke MRI. AJNR Am J Neuroradiol 2018; 39:1710-1716. [PMID: 30115678 DOI: 10.3174/ajnr.a5771] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/17/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vessel imaging in acute ischemic stroke is essential to select patients with large-vessel occlusion for mechanical thrombectomy. Our aim was to compare the diagnostic accuracy of time-of-flight MR angiography and contrast-enhanced MR angiography for identification of vessel occlusion and collateral status in acute ischemic stroke. MATERIALS AND METHODS One hundred twenty-three patients with stroke with large-vessel occlusion before thrombectomy were included in this retrospective study. Before thrombectomy, 3T MR imaging, including conventional 3D TOF-MRA of the intracranial arteries and contrast-enhanced MRA of intra- and extracranial arteries, was performed. Both techniques were assessed independently by 2 neuroradiologists for location of the occlusion, imaging quality, and collateral status. Findings were compared, with subsequent DSA as the reference standard. RESULTS Both techniques had good interrater agreement of κ = 0.74 (95% CI, 0.66-0.83) for TOF-MRA and κ = 0.72 (95% CI, 0.63-0.80) for contrast-enhanced MRA. Occlusion localization differed significantly on TOF-MRA compared with DSA (P < .001), while no significant difference was observed between DSA and contrast-enhanced MRA (P = .75). Assessment of collaterals showed very good agreement between contrast-enhanced MRA and DSA (94.9% with P = .25), but only fair agreement between TOF-MRA and DSA (23.2% with P < .001). CONCLUSIONS Contrast-enhanced MRA offers better diagnostic accuracy than TOF-MRA in acute ischemic stroke. Contrast-enhanced MRA was superior in localizing vessel occlusion within a shorter acquisition time while providing a larger coverage, including extracranial vessels, and a more accurate assessment of collateral status. These results support inclusion of contrast-enhanced MRA in acute stroke MR imaging, perhaps making TOF-MRA superfluous.
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Affiliation(s)
- T Boujan
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - U Neuberger
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - J Pfaff
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - S Nagel
- Neurology (S.N.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - C Herweh
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - M Bendszus
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - M A Möhlenbruch
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
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Buller M, Karis JP. Introduction of a Dedicated Emergency Department MR Imaging Scanner at the Barrow Neurological Institute. AJNR Am J Neuroradiol 2017; 38:1480-1485. [PMID: 28495948 DOI: 10.3174/ajnr.a5210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/23/2017] [Indexed: 11/07/2022]
Abstract
Use of advanced imaging in the emergency department has been increasing in the United States during the past 2 decades. This trend has been most notable in CT, which has increased concern over the effects of increasing levels of medical ionizing radiation. MR imaging offers a safe, nonionizing alternative to CT and is diagnostically superior in many neurologic conditions encountered in the emergency department. Herein, we describe the process of developing and installing a dedicated MR imaging scanner in the Neuroscience Emergency Department at the Barrow Neurological Institute and its effects on neuroradiology and the emergency department in general.
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Affiliation(s)
- M Buller
- From the Neuroradiology Department, Barrow Neurological Institute, Phoenix, Arizona
| | - J P Karis
- From the Neuroradiology Department, Barrow Neurological Institute, Phoenix, Arizona.
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Heiss WD, Zaro Weber O. Validation of MRI Determination of the Penumbra by PET Measurements in Ischemic Stroke. J Nucl Med 2016; 58:187-193. [PMID: 27879370 DOI: 10.2967/jnumed.116.185975] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 11/16/2022] Open
Abstract
The concept of the ischemic penumbra was formulated on the basis of animal experiments showing functional impairment and electrophysiologic disturbances with decreasing flow to the brain below defined values (the threshold for function) and irreversible tissue damage with blood supply further decreased (the threshold for infarction). The perfusion range between these thresholds was termed the "penumbra," and restitution of flow above the functional threshold was able to reverse the deficits without permanent damage. In further experiments, the dependency of the development of irreversible lesions on the interaction of the severity and the duration of critically reduced blood flow was established, proving that the lower the flow, the shorter the time for efficient reperfusion. As a consequence, infarction develops from the core of ischemia to the areas of less severe hypoperfusion. The translation of this experimental concept as the basis for the efficient treatment of stroke requires noninvasive methods with which regional flow and energy metabolism can be repeatedly investigated to demonstrate penumbra tissue, which can benefit from therapeutic interventions. PET allows the quantification of regional cerebral blood flow, the regional oxygen extraction fraction, and the regional metabolic rate for oxygen. With these variables, clear definitions of irreversible tissue damage and of critically hypoperfused but potentially salvageable tissue (i.e., the penumbra) in stroke patients can be achieved. However, PET is a research tool, and its complex logistics limit clinical routine applications. Perfusion-weighted or diffusion-weighted MRI is a widely applicable clinical tool, and the "mismatch" between perfusion-weighted and diffusion-weighted abnormalities serves as an indicator of the penumbra. However, comparative studies of perfusion-weighted or diffusion-weighted MRI and PET have indicated overestimation of the core of irreversible infarction as well as of the penumbra by the MRI modalities. Some of these discrepancies can be explained by the nonselective application of relative perfusion thresholds, which might be improved by more complex analytic procedures. The heterogeneity of the MRI signatures used for the definition of the mismatch are also responsible for disappointing results in the application of perfusion-weighted or diffusion-weighted MRI to the selection of patients for clinical trials. As long as validation of the mismatch selection paradigm is lacking, the use of this paradigm as a surrogate marker of outcome is limited.
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Cai J, Wu D, Mo Y, Wang A, Hu S, Ren L. Comparison of extracranial artery stenosis and cerebral blood flow, assessed by quantitative magnetic resonance, using digital subtraction angiography as the reference standard. Medicine (Baltimore) 2016; 95:e5370. [PMID: 27861368 PMCID: PMC5120925 DOI: 10.1097/md.0000000000005370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Extracranial arteriosclerosis usually indicates a high risk of ischemic stroke. In the past, a clinical decision following diagnosis was dependent on the percentage of vessel stenosis determined by an invasive technique. We aimed to develop a quantitative magnetic resonance (QMR) technique to evaluate artery structure and cerebral hemodynamics noninvasively.QMR and digital subtraction angiography (DSA) were performed in 67 patients with suspected cerebral vascular disease at our hospital. Accuracy, sensitivity, positive predictive values (PPVs), negative predictive values (NPVs), and Pearson correlation coefficient of QMR were calculated and compared for the detection and measurement of vascular stenoses using DSA as a gold standard. For patients with unilateral artery stenosis, quantitative cerebral blood flow (CBF) was measured by QMR in ipsilateral and contralateral hemispheres.Among 67 subjects (male 54, female 12), 201 stenoses were detected by QMR and DSA. QMR measuring the degree of stenosis and lesion length was in good correlation with the results obtained by DSA (r = 0.845, 0.721, respectively). As for artery stenosis, PPV and NPV of QMR were 89.55% and 95.71%, respectively. As for severe stenosis, sensitivity and specificity of QMR were 82.3% and 86.0% with DSA as a reference. For subjects with unilateral carotid stenosis, CBF in basal ganglia decreased significantly (P < 0.001) compared with the contralateral one in symptomatic and asymptomatic groups. For subjects with moderate stenosis (50-79%), CBF of temporal and basal ganglia was decreased compared with the contralateral ganglia. However, CBF in subjects with severe stenosis or occlusion in the basal ganglia was mildly elevated compared with the contralateral ganglia (P < 0.001).In our study, a good correlation was found between QMR and DSA when measuring artery stenosis and CBF. QMR may become an important method for measuring artery stenosis and cerebral hemodynamics in the future.
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Affiliation(s)
- Jingjing Cai
- Department of Neurology, The Affiliated College Shenzhen Second People's Hospital, Anhui Medical University, Hefei, Anhui province
- Department of Neurology, The First Affiliated Hospital of Shenzhen University
| | - Dan Wu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province
| | - Yongqian Mo
- Department of Neurology, The First Affiliated Hospital of Shenzhen University
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiyu Hu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University
| | - Lijie Ren
- Department of Neurology, The Affiliated College Shenzhen Second People's Hospital, Anhui Medical University, Hefei, Anhui province
- Department of Neurology, The First Affiliated Hospital of Shenzhen University
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Crisi G, Filice S, Erb G, Bozzetti F. Effectiveness of a high relaxivity contrast agent administered at half dose in dynamic susceptibility contrast MRI of brain gliomas. J Magn Reson Imaging 2016; 45:500-506. [PMID: 27373976 DOI: 10.1002/jmri.25370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/17/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To determine whether half of the approved dose of gadobenate dimeglumine (MultiHance) is as effective as a full dose of gadoterate meglumine (Dotarem) for qualitative and quantitative cerebral blood volume (CBV) perfusion evaluation at 3T in patients with brain gliomas. MATERIALS AND METHODS We enrolled 65 adult patients in an interindividual comparative study. Patients were randomized to one of two study arms: 33 patients received 0.1 mmol/kg body weight (bw) of gadoterate, 32 patients received 0.05 mmol/kg bw of gadobenate. The patients underwent identical examinations at 3T. Arterial input function (AIF), tissue function (TF), and the maximum tumor CBV (CBV_T) were obtained from each patient. The quality of the CBV maps were independently reviewed by two neuroradiologists blinded to the administered contrast agent. RESULTS The administration of a half dose of gadobenate led to a roughly 40% reduction in signal drop compared to that achieved with a full dose of gadoterate (P values for AIF and TF maximum and integral were <0.01); quantitative and qualitative assessment of CBV maps revealed no difference between contrast agents (P values for CBV_T of high- and low-grade gliomas, image quality evaluation were 0.87, 0.48, >0.65, respectively) CONCLUSION: The CBV maps obtained with a half dose gadobenate (0.05 mmol/kg bw) are of comparable diagnostic quality as the corresponding images acquired with a full dose of gadoterate (0.1 mmol/kg bw). LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:500-506.
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Affiliation(s)
- Girolamo Crisi
- Department of Neuroradiology, University Hospital of Parma, Parma, Italy
| | - Silvano Filice
- Department of Medical Physics, University Hospital of Parma, Parma, Italy
| | - Gunter Erb
- Bracco Group, Medical and Regulatory Affairs, Konstanz, Germany
| | - Francesca Bozzetti
- Department of Neuroradiology, University Hospital of Parma, Parma, Italy
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Balaji R. Time-resolved MR angiography in wake-up stroke: an innovative application of a proven technique. Acad Radiol 2015; 22:411-2. [PMID: 25753592 DOI: 10.1016/j.acra.2015.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Ravikanth Balaji
- Department Of Radiology, Apollo Specialty Hospital, #320, Padma Towers, Mount Road, CHENNAI, Tamil Nadu 600035, INDIA.
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Na DG, Sohn CH, Kim EY. Imaging-based management of acute ischemic stroke patients: current neuroradiological perspectives. Korean J Radiol 2015; 16:372-90. [PMID: 25741200 PMCID: PMC4347274 DOI: 10.3348/kjr.2015.16.2.372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/02/2014] [Indexed: 01/05/2023] Open
Abstract
Advances in imaging-based management of acute ischemic stroke now provide crucial information such as infarct core, ischemic penumbra/degree of collaterals, vessel occlusion, and thrombus that helps in the selection of the best candidates for reperfusion therapy. It also predicts thrombolytic efficacy and benefit or potential hazards from therapy. Thus, radiologists should be familiar with various imaging studies for patients with acute ischemic stroke and the applicability to clinical trials. This helps radiologists to obtain optimal rapid imaging as well as its accurate interpretation. This review is focused on imaging studies for acute ischemic stroke, including their roles in recent clinical trials and some guidelines to optimal interpretation.
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Affiliation(s)
- Dong Gyu Na
- Department of Neuroradiology, Head & Neck Radiology, Thyroid Radiology Human Medical Imaging & Intervention Center, Seoul 137-902, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
| | - Eung Yeop Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon 405-760, Korea
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Stalder AF, Schmidt M, Quick HH, Schlamann M, Maderwald S, Schmitt P, Wang Q, Nadar MS, Zenge MO. Highly undersampled contrast-enhanced MRA with iterative reconstruction: Integration in a clinical setting. Magn Reson Med 2014; 74:1652-60. [PMID: 25522299 DOI: 10.1002/mrm.25565] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/17/2014] [Accepted: 11/17/2014] [Indexed: 11/06/2022]
Abstract
PURPOSE To integrate, optimize, and evaluate a three-dimensional (3D) contrast-enhanced sparse MRA technique with iterative reconstruction on a standard clinical MR system. METHODS Data were acquired using a highly undersampled Cartesian spiral phyllotaxis sampling pattern and reconstructed directly on the MR system with an iterative SENSE technique. Undersampling, regularization, and number of iterations of the reconstruction were optimized and validated based on phantom experiments and patient data. Sparse MRA of the whole head (field of view: 265 × 232 × 179 mm(3) ) was investigated in 10 patient examinations. RESULTS High-quality images with 30-fold undersampling, resulting in 0.7 mm isotropic resolution within 10 s acquisition, were obtained. After optimization of the regularization factor and of the number of iterations of the reconstruction, it was possible to reconstruct images with excellent quality within six minutes per 3D volume. Initial results of sparse contrast-enhanced MRA (CEMRA) in 10 patients demonstrated high-quality whole-head first-pass MRA for both the arterial and venous contrast phases. CONCLUSION While sparse MRI techniques have not yet reached clinical routine, this study demonstrates the technical feasibility of high-quality sparse CEMRA of the whole head in a clinical setting. Sparse CEMRA has the potential to become a viable alternative where conventional CEMRA is too slow or does not provide sufficient spatial resolution.
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Affiliation(s)
| | | | - Harald H Quick
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Germany.,High Field and Hybrid MR Imaging, University Hospital Essen, Germany
| | - Marc Schlamann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Germany
| | | | - Qiu Wang
- Siemens Corporate Technology, Princeton, New Jersey, USA
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Nael K, Mossadeghi B, Boutelier T, Kubal W, Krupinski EA, Dagher J, Villablanca JP. Bayesian estimation of cerebral perfusion using reduced-contrast-dose dynamic susceptibility contrast perfusion at 3T. AJNR Am J Neuroradiol 2014; 36:710-8. [PMID: 25430859 DOI: 10.3174/ajnr.a4184] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 10/19/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DSC perfusion has been increasingly used in conjunction with other contrast-enhanced MR applications and therefore there is need for contrast-dose reduction when feasible. The purpose of this study was to establish the feasibility of reduced-contrast-dose brain DSC perfusion by using a probabilistic Bayesian method and to compare the results with the commonly used singular value decomposition technique. MATERIALS AND METHODS Half-dose (0.05-mmol/kg) and full-dose (0.1-mmol/kg) DSC perfusion studies were prospectively performed in 20 patients (12 men; 34-70 years of age) by using a 3T MR imaging scanner and a gradient-EPI sequence (TR/TE, 1450/22 ms; flip angle, 90°). All DSC scans were processed with block circulant singular value decomposition and Bayesian probabilistic methods. SNR analysis was performed in both half-dose and full-dose groups. The CBF, CBV, and MTT maps from both full-dose and half-dose scans were evaluated qualitatively and quantitatively in both WM and GM on coregistered perfusion maps. Statistical analysis was performed by using a t test, regression, and Bland-Altman analysis. RESULTS The SNR was significantly (P < .0001) lower in the half-dose group with 32% and 40% reduction in GM and WM, respectively. In the half-dose group, the image-quality scores were significantly higher in Bayesian-derived CBV (P = .02) and MTT (P = .004) maps in comparison with block circulant singular value decomposition. Quantitative values of CBF, CBV, and MTT in Bayesian-processed data were comparable and without a statistically significant difference between the half-dose and full-dose groups. The block circulant singular value decomposition-derived half-dose perfusion values were significantly different from those of the full-dose group both in GM (CBF, P < .001; CBV, P = .02; MTT, P = .02) and WM (CBF, P < .001; CBV, P = .003; MTT, P = .01). CONCLUSIONS Reduced-contrast-dose (0.05-mmol/kg) DSC perfusion of the brain is feasible at 3T by using the Bayesian probabilistic method with quantitative results comparable with those of the full-dose protocol.
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Affiliation(s)
- K Nael
- From the Department of Medical Imaging (K.N., B.M., W.K., E.A.K., J.D.), University of Arizona, Tucson, Arizona
| | - B Mossadeghi
- From the Department of Medical Imaging (K.N., B.M., W.K., E.A.K., J.D.), University of Arizona, Tucson, Arizona
| | | | - W Kubal
- From the Department of Medical Imaging (K.N., B.M., W.K., E.A.K., J.D.), University of Arizona, Tucson, Arizona
| | - E A Krupinski
- From the Department of Medical Imaging (K.N., B.M., W.K., E.A.K., J.D.), University of Arizona, Tucson, Arizona
| | - J Dagher
- From the Department of Medical Imaging (K.N., B.M., W.K., E.A.K., J.D.), University of Arizona, Tucson, Arizona
| | - J P Villablanca
- Department of Radiological Sciences (J.P.V.), University of California, Los Angeles, Los Angeles, California
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