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Coolen BF, Calcagno C, van Ooij P, Fayad ZA, Strijkers GJ, Nederveen AJ. Vessel wall characterization using quantitative MRI: what's in a number? MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:201-222. [PMID: 28808823 PMCID: PMC5813061 DOI: 10.1007/s10334-017-0644-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 12/15/2022]
Abstract
The past decade has witnessed the rapid development of new MRI technology for vessel wall imaging. Today, with advances in MRI hardware and pulse sequences, quantitative MRI of the vessel wall represents a real alternative to conventional qualitative imaging, which is hindered by significant intra- and inter-observer variability. Quantitative MRI can measure several important morphological and functional characteristics of the vessel wall. This review provides a detailed introduction to novel quantitative MRI methods for measuring vessel wall dimensions, plaque composition and permeability, endothelial shear stress and wall stiffness. Together, these methods show the versatility of non-invasive quantitative MRI for probing vascular disease at several stages. These quantitative MRI biomarkers can play an important role in the context of both treatment response monitoring and risk prediction. Given the rapid developments in scan acceleration techniques and novel image reconstruction, we foresee the possibility of integrating the acquisition of multiple quantitative vessel wall parameters within a single scan session.
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Affiliation(s)
- Bram F Coolen
- Department of Biomedical Engineering and Physics, Academic Medical Center, PO BOX 22660, 1100 DD, Amsterdam, The Netherlands. .,Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Claudia Calcagno
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pim van Ooij
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Zahi A Fayad
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Academic Medical Center, PO BOX 22660, 1100 DD, Amsterdam, The Netherlands
| | - Aart J Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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Alkhalil M, Biasiolli L, Chai JT, Galassi F, Li L, Darby C, Halliday A, Hands L, Magee T, Perkins J, Sideso E, Jezzard P, Robson MD, Handa A, Choudhury RP. Quantification of carotid plaque lipid content with magnetic resonance T2 mapping in patients undergoing carotid endarterectomy. PLoS One 2017; 12:e0181668. [PMID: 28746385 PMCID: PMC5528883 DOI: 10.1371/journal.pone.0181668] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/05/2017] [Indexed: 12/13/2022] Open
Abstract
Background and purpose Techniques to stratify subgroups of patients with asymptomatic carotid artery disease are urgently needed to guide decisions on optimal treatment. Reliance on estimates of % luminal stenosis has not been effective, perhaps because that approach entirely disregards potentially important information on the pathological process in the wall of the artery. Methods Since plaque lipid is a key determinant of plaque behaviour we used a newly validated, high-sensitivity T2-mapping MR technique for a systematic survey of the quantity and distribution of plaque lipid in patients undergoing endarterectomy. Lipid percentage was quantified in 50 carotid endarterectomy patients. Lipid distribution was tested, using two imaging indices (contribution of the largest lipid deposit towards total lipid (LLD %) and a newly-developed LAI ‘lipid aggregation index’). Results The bifurcation contained maximal lipid volume. Lipid percentage was higher in symptomatic vs. asymptomatic patients with degree of stenosis (DS ≥ 50%) and in the total cohort (P = 0.013 and P = 0.005, respectively). Both LLD % and LAI was higher in symptomatic patients (P = 0.028 and P = 0.018, respectively), suggesting that for a given plaque lipid volume, coalesced deposits were more likely to be associated with symptomatic events. There was no correlation between plaque volume or lipid content and degree of luminal stenosis measured on ultrasound duplex (r = -0.09, P = 0.53 and r = -0.05, P = 0.75), respectively. However, there was a strong correlation in lipid between left and right carotid arteries (r = 0.5, P <0.0001, respectively). Conclusions Plaque lipid content and distribution is associated with symptomatic status of the carotid plaque. Importantly, plaque lipid content was not related to the degree of luminal stenosis assessed by ultrasound. Determination of plaque lipid content may prove useful for stratification of asymptomatic patients, including selection of optimal invasive treatments.
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Affiliation(s)
- Mohammad Alkhalil
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Luca Biasiolli
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Joshua T. Chai
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Francesca Galassi
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Linqing Li
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Christopher Darby
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Alison Halliday
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Linda Hands
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Timothy Magee
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Jeremy Perkins
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Ed Sideso
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Peter Jezzard
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Matthew D. Robson
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ashok Handa
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Robin P. Choudhury
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Black-blood T2* mapping with delay alternating with nutation for tailored excitation. Magn Reson Imaging 2017; 40:91-97. [DOI: 10.1016/j.mri.2017.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/17/2017] [Accepted: 04/20/2017] [Indexed: 02/05/2023]
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Yuan J, Usman A, Reid SA, King KF, Patterson AJ, Gillard JH, Graves MJ. Three-dimensional black-blood multi-contrast carotid imaging using compressed sensing: a repeatability study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:183-190. [PMID: 28653214 PMCID: PMC5813054 DOI: 10.1007/s10334-017-0640-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/09/2017] [Accepted: 06/16/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this work is to evaluate the repeatability of a compressed sensing (CS) accelerated multi-contrast carotid protocol at 3 T. MATERIALS AND METHODS Twelve volunteers and eight patients with carotid disease were scanned on a 3 T MRI scanner using a CS accelerated 3-D black-blood multi-contrast protocol which comprises T 1w, T 2w and PDw without CS, and with a CS factor of 1.5 and 2.0. The volunteers were scanned twice, the lumen/wall area and wall thickness were measured for each scan. Eight patients were scanned once, the inter/intra-observer reproducibility of the measurements was calculated. RESULTS In the repeated volunteer scans, the interclass correlation coefficient (ICC) for the wall area measurement using a CS factor of 1.5 in PDw, T 1w and T 2w were 0.95, 0.81, and 0.97, respectively. The ICC for lumen area measurement using a CS factor of 1.5 in PDw, T 1w and T 2w were 0.96, 0.92, and 0.96, respectively. In patients, the ICC for inter/intra-observer measurements of lumen/wall area, and wall thickness were all above 0.81 in all sequences. CONCLUSION The results show a CS accelerated 3-D black-blood multi-contrast protocol is a robust and reproducible method for carotid imaging. Future protocol design could use CS to reduce the scanning time.
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Affiliation(s)
- Jianmin Yuan
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Level 5, Box 218, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK.
| | - Ammara Usman
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Level 5, Box 218, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK
| | | | | | - Andrew J Patterson
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jonathan H Gillard
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Level 5, Box 218, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Martin J Graves
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Level 5, Box 218, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0QQ, UK
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Yuan J, Makris G, Patterson A, Usman A, Das T, Priest A, Teng Z, Hilborne S, Prudencio D, Gillard J, Graves M. Relationship between carotid plaque surface morphology and perfusion: a 3D DCE-MRI study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:191-199. [PMID: 28455630 PMCID: PMC5813060 DOI: 10.1007/s10334-017-0621-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 12/02/2022]
Abstract
Objective This study aims to explore the relationship between plaque surface morphology and neovascularization using a high temporal and spatial resolution 4D contrast-enhanced MRI/MRA sequence. Materials and methods Twenty one patients with either recent symptoms or a carotid artery stenosis ≥40% were recruited in this study. Plaque surface morphology and luminal stenosis were determined from the arterial phase MRA images. Carotid neovascularization was evaluated by a previously validated pharmacokinetic (PK) modeling approach. Ktrans (transfer constant) and vp (partial plasma volume) were calculated in both the adventitia and plaque. Results Image acquisition and analysis was successfully performed in 28 arteries. Mean luminal stenosis was 44% (range 11–82%). Both adventitial and plaque Ktrans in ulcerated/irregular plaques were significantly higher than smooth plaques (0.079 ± 0.018 vs. 0.064 ± 0.011 min−1, p = 0.02; 0.065 ± 0.013 vs. 0.055 ± 0.010 min−1, p = 0.03, respectively). Positive correlations between adventitial Ktrans and vp against stenosis were observed (r = 0.44, p = 0.02; r = 0.55, p = 0.01, respectively). Conclusion This study demonstrates the feasibility of using a single sequence to acquire both high resolution 4D CE-MRA and DCE-MRI to evaluate both plaque surface morphology and function. The results demonstrate significant relationships between lumen surface morphology and neovascularization.
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Affiliation(s)
- Jianmin Yuan
- Department of Radiology, University of Cambridge, Cambridge, UK.
| | - Gregory Makris
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Andrew Patterson
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ammara Usman
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Tilak Das
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrew Priest
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Sarah Hilborne
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Dario Prudencio
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Martin Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Xie G, Chen H, He X, Liang J, Deng W, He Z, Ye Y, Yang Q, Bi X, Liu X, Li D, Fan Z. Black-blood thrombus imaging (BTI): a contrast-free cardiovascular magnetic resonance approach for the diagnosis of non-acute deep vein thrombosis. J Cardiovasc Magn Reson 2017; 19:4. [PMID: 28095878 PMCID: PMC5242043 DOI: 10.1186/s12968-016-0320-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/23/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Deep vein thrombosis (DVT) is a common but elusive illness that can result in long-term disability or death. Accurate detection of thrombosis and assessment of its size and distribution are critical for treatment decision-making. In the present study, we sought to develop and evaluate a cardiovascular magnetic resonance (CMR) black-blood thrombus imaging (BTI) technique, based on delay alternating with nutation for tailored excitation black-blood preparation and variable flip angle turbo-spin-echo readout, for the diagnosis of non-acute DVT. METHODS: This prospective study was approved by institutional review board and informed consent obtained from all subjects. BTI was first conducted in 11 healthy subjects for parameter optimization and then conducted in 18 non-acute DVT patients to evaluate its diagnostic performance. Two clinically used CMR techniques, contrast-enhanced CMR venography (CE-MRV) and three dimensional magnetization prepared rapid acquisition gradient echo (MPRAGE), were also conducted in all patients for comparison. All images obtained from patients were analyzed on a per-segment basis. Using the consensus diagnosis of CE-MRV as the reference, the sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV), and accuracy (ACC) of BTI and MPRAGE as well as their diagnostic agreement with CE-MRV were calculated. Besides, diagnostic confidence and interreader diagnostic agreement were evaluated for all three techniques. RESULTS BTI with optimized parameters effectively nulled the venous blood flow signal and allowed directly visualizing the thrombus within the black-blood lumen. Higher SE (90.4% vs 67.6%), SP (99.0% vs. 97.4%), PPV (95.4% vs. 85.6%), NPV (97.8% vs 92.9%) and ACC (97.4% vs. 91.8%) were obtained by BTI in comparison with MPRAGE. Good diagnostic confidence and excellent diagnostic and interreader agreements were achieved by BTI, which were superior to MPRAGE on detecting the chronic thrombus. CONCLUSION BTI allows direct visualization of non-acute DVT within the dark venous lumen and has the potential to be a reliable diagnostic tool without the use of contrast medium.
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Affiliation(s)
- Guoxi Xie
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, CAS, Guangdong, 518055 China
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Pacific Theatres Building, Suite 800, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| | - Hanwei Chen
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong 511400 China
| | - Xueping He
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong 511400 China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405 China
| | - Jianke Liang
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong 511400 China
| | - Wei Deng
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong 511400 China
| | - Zhuonan He
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong 511400 China
| | - Yufeng Ye
- Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong 511400 China
| | - Qi Yang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Pacific Theatres Building, Suite 800, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
- Department of Radiology, Xuanwu Hospital, Beijing, 100053 China
| | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, CA 90048 USA
| | - Xin Liu
- Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, CAS, Guangdong, 518055 China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Pacific Theatres Building, Suite 800, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Pacific Theatres Building, Suite 800, 8700 Beverly Blvd, Los Angeles, CA 90048 USA
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Liem MI, Kennedy F, Bonati LH, van der Lugt A, Coolen BF, Nederveen AJ, Jager HR, Brown MM, Nederkoorn PJ. Investigations of Carotid Stenosis to Identify Vulnerable Atherosclerotic Plaque and Determine Individual Stroke Risk. Circ J 2017; 81:1246-1253. [DOI: 10.1253/circj.cj-16-1284] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Fiona Kennedy
- UCL Stroke Research Centre, Institute of Neurology, University College London
| | | | | | | | | | - Hans R. Jager
- UCL Stroke Research Centre, Institute of Neurology, University College London
| | - Martin M. Brown
- UCL Stroke Research Centre, Institute of Neurology, University College London
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Alkhalil M, Chai JT, Choudhury RP. Plaque imaging to refine indications for emerging lipid-lowering drugs. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2017; 3:58-67. [PMID: 27816944 PMCID: PMC5841877 DOI: 10.1093/ehjcvp/pvw034] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/27/2016] [Accepted: 10/27/2016] [Indexed: 12/13/2022]
Abstract
Statins have been effective in reducing adverse cardiovascular events. Their benefits have been proportional to the level of plasma LDL-cholesterol reduction and seem to extend to patients with 'normal' levels of cholesterol at outset. Statins are also inexpensive and have a favourable side-effect profile. As a result, they are used widely (almost indiscriminately) in patients with atherosclerotic vascular disease, and in those at risk of disease. Next generation lipid-modifying drugs seem unlikely to offer the same simplicity of application. The recent trials of new classes of lipid modifying drugs underline the need for a risk stratification tool which is not based on patients' category of diagnosis (for example, post-myocardial infarction) but based on the characterization of disease in that individual patient. Mechanistic staging, a process that matches the target of the drug action with an identifiable disease characteristic, may offer an opportunity to achieve more precise intervention. The upshots of this targeted approach will be greater efficacy, requiring smaller clinical trials to demonstrate effectiveness; a reduced number needed to treat to yield benefits and more cost-effective prescribing. This will be important, as purchasers require ever more rigorous demonstration of both efficacy and cost-effectiveness. In this context, we will discuss available pharmacological strategies of lipid reduction in anti-atherosclerotic treatment and how plaque imaging techniques may provide an ideal method in stratifying patients for new lipid-modifying drugs.
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Affiliation(s)
- Mohammad Alkhalil
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Joshua T Chai
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Robin P Choudhury
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Oxford Acute Vascular Imaging Centre (AVIC), Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Quantification of Lipid-Rich Core in Carotid Atherosclerosis Using Magnetic Resonance T 2 Mapping: Relation to Clinical Presentation. JACC Cardiovasc Imaging 2016; 10:747-756. [PMID: 27743954 PMCID: PMC5502905 DOI: 10.1016/j.jcmg.2016.06.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/07/2016] [Accepted: 06/15/2016] [Indexed: 11/23/2022]
Abstract
Objectives The aim of this study was to: 1) provide tissue validation of quantitative T2 mapping to measure plaque lipid content; and 2) investigate whether this technique could discern differences in plaque characteristics between symptom-related and non–symptom-related carotid plaques. Background Noninvasive plaque lipid quantification is appealing both for stratification in treatment selection and as a possible predictor of future plaque rupture. However, current cardiovascular magnetic resonance (CMR) methods are insensitive, require a coalesced mass of lipid core, and rely on multicontrast acquisition with contrast media and extensive post-processing. Methods Patients scheduled for carotid endarterectomy were recruited for 3-T carotid CMR before surgery. Lipid area was derived from segmented T2 maps and compared directly to plaque lipid defined by histology. Results Lipid area (%) on T2 mapping and histology showed excellent correlation, both by individual slices (R = 0.85, p < 0.001) and plaque average (R = 0.83, p < 0.001). Lipid area (%) on T2 maps was significantly higher in symptomatic compared with asymptomatic plaques (31.5 ± 3.7% vs. 15.8 ± 3.1%; p = 0.005) despite similar degrees of carotid stenosis and only modest difference in plaque volume (128.0 ± 6.0 mm3 symptomatic vs. 105.6 ± 9.4 mm3 asymptomatic; p = 0.04). Receiver-operating characteristic analysis showed that T2 mapping has a good ability to discriminate between symptomatic and asymptomatic plaques with 67% sensitivity and 91% specificity (area under the curve: 0.79; p = 0.012). Conclusions CMR T2 mapping distinguishes different plaque components and accurately quantifies plaque lipid content noninvasively. Compared with asymptomatic plaques, greater lipid content was found in symptomatic plaques despite similar degree of luminal stenosis and only modest difference in plaque volumes. This new technique may find a role in determining optimum treatment (e.g., providing an indication for intensive lipid lowering or by informing decisions of stents vs. surgery).
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Li H, Li B, Huang W, Dong L, Zhang J. Flow artifact removal in carotid wall imaging based on black and gray-blood dual-contrast images subtraction. Magn Reson Med 2016; 77:1612-1618. [PMID: 27018428 DOI: 10.1002/mrm.26218] [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: 10/22/2015] [Revised: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop and validate a dual-contrast image subtraction (DCIS) strategy for eliminating the flow artifacts in black-blood carotid MRI. METHODS Twelve patients with carotid stenosis and eight healthy volunteers were imaged using the black and gray-blood dual-contrast imaging based on the relaxation-enhanced compressed sensing three-dimensional motion-sensitizing driven equilibrium prepared rapid-gradient-echo (RECS-3D MERGE) sequence. Subtraction of black-blood images (BBIs) and gray-blood images (GBIs), together with a preweighting procedure, was performed to eliminate the residual blood signal in BBIs. A wavelet denoising procedure was applied to offset the noise amplification. In addition to the lumen signal-to-noise ratio (SNR) and wall-lumen contrast-to-noise ratio (CNR), the signal variance ratio (SVR) and contrast variance ratio (CVR) were also used to evaluate the blood suppression efficiency. RESULTS By choosing the weighting factor of one, the lumen SNR of DCIS images was approximately 1% of that of the original BBIs, and the CNR showed a 91.4% improvement as compared with the BBIs. The median of the lumen SVR decreased to zero, and the CVR increased to 123% of that of the BBIs. CONCLUSIONS DCIS is demonstrated to be an effective strategy for sufficiently removing the residual flow signal from black-blood carotid MRI. Magn Reson Med 77:1612-1618, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Hao Li
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Bo Li
- College of Engineering, Peking University, Beijing, China
| | - Wenjian Huang
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Li Dong
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jue Zhang
- Academy of Advanced Interdisciplinary Studies, Peking University, Beijing, China.,College of Engineering, Peking University, Beijing, China
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Yang H, Zhang X, Qin Q, Liu L, Wasserman BA, Qiao Y. Improved cerebrospinal fluid suppression for intracranial vessel wall MRI. J Magn Reson Imaging 2016; 44:665-72. [DOI: 10.1002/jmri.25211] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/10/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Huan Yang
- Shandong Medical Imaging Research Institute; Shandong University; Jinan Shandong China
| | - Xuefeng Zhang
- The Russell H. Morgan Department of Radiology and Radiological Sciences; The Johns Hopkins Hospital; Baltimore Maryland USA
- Department of Radiology; Inner Mongolia Autonomous Region People's Hospital; Hohhot Inner Mongolia China
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Sciences; The Johns Hopkins Hospital; Baltimore Maryland USA
- F.M. Kirby Research Center for Functional Brain Imaging; Kennedy Krieger Institute; Baltimore Maryland USA
| | - Li Liu
- The Russell H. Morgan Department of Radiology and Radiological Sciences; The Johns Hopkins Hospital; Baltimore Maryland USA
| | - Bruce A. Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences; The Johns Hopkins Hospital; Baltimore Maryland USA
| | - Ye Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences; The Johns Hopkins Hospital; Baltimore Maryland USA
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Isotropic 3D black blood MRI of abdominal aortic aneurysm wall and intraluminal thrombus. Magn Reson Imaging 2015; 34:18-25. [PMID: 26471514 DOI: 10.1016/j.mri.2015.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/07/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The aortic wall and intraluminal thrombus (ILT) have been increasingly studied as potential markers of progressive disease with abdominal aortic aneurysms (AAAs). Our goal was to develop a high resolution, 3D black blood MR technique for AAA wall and ILT imaging within a clinically acceptable scan time. METHODS Twenty two patients with AAAs (maximal diameter 4.3±1.0cm), along with five healthy volunteers, were imaged at 3T with a 3D T1-weighted fast-spin-echo sequence using variable flip angle trains (SPACE) with a preparation pulse (DANTE) for suppressing blood signal. Volunteers and ten patients were also scanned with SPACE alone for comparison purposes. The signal to noise ratio (SNR) and the aortic wall/ILT to lumen contrast to noise ratio (CNR) were measured. Qualitative image scores (1-4 scale) assessing the inner lumen and outer wall boundaries of AAA were performed by two blinded reviewers. In patients with ILT, the ratio of ILT signal intensity (ILTSI) over psoas muscle SI (MuscleSI) was calculated, and the signal heterogeneity of ILT was quantified as standard deviation (SD) over the mean. RESULTS All subjects were imaged successfully with an average scan time of 7.8±0.7minutes. The DANTE preparation pulse for blood suppression substantially reduced flow artifacts in SPACE with lower lumen SNR (8.8 vs. 21.4, p<0.001) and improved the wall/ILT to lumen CNR (9.9 vs. 6.3, p<0.001) in patients. Qualitative assessment showed improved visualization of lumen boundaries (73% higher scores on average, p=0.01) and comparable visualization of outer wall boundary (p>0.05). ILT was present in ten patients, with relatively high signal and a wide SD (average ILTSI/MuscleSI 1.42±0.48 (range 0.75-2.11)) and with SD/mean of 27.7%±6.6% (range 19.6%-39.4%). CONCLUSION High resolution, 3D black blood MRI of AAAs can be achieved in a clinical accepted scan time with reduction of flow artifacts using the DANTE preparation pulse. Signal characteristics of ILT can be quantified and may be used for improved patient-specific risk stratification.
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Abstract
There has been significant progress made in 3-dimensional (3D) carotid plaque MR imaging techniques in recent years. Three-dimensional plaque imaging clearly represents the future in clinical use. With effective flow-suppression techniques, choices of different contrast weighting acquisitions, and time-efficient imaging approaches, 3D plaque imaging offers flexible imaging plane and view angle analysis, large coverage, multivascular beds capability, and even can be used in fast screening.
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Affiliation(s)
- Chun Yuan
- Vascular Imaging Lab, Department of Radiology, Bio-Molecular Imaging Center, University of Washington, Box 358050, 850 Republican Street, Seattle, WA 98109-4714, USA.
| | - Dennis L Parker
- Department of Radiology, Imaging & Neurosciences Center, Utah Center for Advanced Imaging Research (UCAIR), University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108, USA
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64
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Scan-Rescan Reproducibility of High Resolution Magnetic Resonance Imaging of Atherosclerotic Plaque in the Middle Cerebral Artery. PLoS One 2015; 10:e0134913. [PMID: 26247869 PMCID: PMC4527831 DOI: 10.1371/journal.pone.0134913] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/16/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the scan-rescan reproducibility of high-resolution magnetic resonance imaging (MRI) of middle cerebral artery (MCA) plaque, and calculate the number of subjects needed for future longitudinal clinical studies. Material and Methods Twenty two patients with MCA plaque were scanned twice by a T2-weighted fast-spin-echo sequence at 3T. Areas and volumes of MCA lumen, total vessel and plaque were quantified and compared between two repeated scans. Agreement and measurement error was quantified by intraclass correlation coefficient (ICC) and coefficient of variance (CV) as defined by standard deviation (SD) of pair wise difference / mean. Sample size needed to detect 5% to 20% changes in area/volume was calculated using 80% power and 5% significance level. Results There was no significant different between the area and volume measurements of two repeated scans (p>0.05) with good agreement (ICC range 0.97–0.98 for area and 0.99 for volume). Relatively small measurement errors were observed with CVs range 6.1%-11.8% for area quantification and 4.9%-8.0% for volume quantification. Volume measurements tended to have 19.7% to 32.2% smaller CVs compared with area measurements. Sample size calculation showed a group of 47 patients was sufficient to detect 5% to 10% changes in MCA area/volume. Conclusion High resolution MRI is feasible for quantifying intracranial plaque area and volume in longitudinal clinical studies with low scan-rescan variability. Volume measurement tends to be more reproducible compared with area measurements.
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Xie Y, Yang Q, Xie G, Pang J, Fan Z, Li D. Improved black-blood imaging using DANTE-SPACE for simultaneous carotid and intracranial vessel wall evaluation. Magn Reson Med 2015; 75:2286-94. [PMID: 26152900 DOI: 10.1002/mrm.25785] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this study was to develop a three-dimensional black blood imaging method for simultaneously evaluating the carotid and intracranial arterial vessel walls with high spatial resolution and excellent blood suppression with and without contrast enhancement. METHODS The delay alternating with nutation for tailored excitation (DANTE) preparation module was incorporated into three-dimensional variable flip angle turbo spin echo (SPACE) sequence to improve blood signal suppression. Simulations and phantom studies were performed to quantify image contrast variations induced by DANTE. DANTE-SPACE, SPACE, and two-dimensional turbo spin echo were compared for apparent signal-to-noise ratio, contrast-to-noise ratio, and morphometric measurements in 14 healthy subjects. Preliminary clinical validation was performed in six symptomatic patients. RESULTS Apparent residual luminal blood was observed in five (pre-contrast) and nine (post-contrast) subjects with SPACE and only two (post-contrast) subjects with DANTE-SPACE. DANTE-SPACE showed 31% (pre-contrast) and 100% (post-contrast) improvement in wall-to-blood contrast-to-noise ratio over SPACE. Vessel wall area measured from SPACE was significantly larger than that from DANTE-SPACE due to possible residual blood signal contamination. DANTE-SPACE showed the potential to detect vessel wall dissection and identify plaque components in patients. CONCLUSION DANTE-SPACE significantly improved arterial and venous blood suppression compared with SPACE. Simultaneous high-resolution carotid and intracranial vessel wall imaging to potentially identify plaque components was feasible with a scan time under 6 min. Magn Reson Med 75:2286-2294, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | - Qi Yang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guoxi Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Shenzhen Key Lab for MRI, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jianing Pang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
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Xie G, Zhang N, Xie Y, Nguyen C, Deng Z, Bi X, Fan Z, Liu X, Li D, Fan Z. DANTE-prepared three-dimensional FLASH: A fast isotropic-resolution MR approach to morphological evaluation of the peripheral arterial wall at 3 Tesla. J Magn Reson Imaging 2015; 43:343-51. [PMID: 26139414 DOI: 10.1002/jmri.24986] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/11/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To develop and assess a sequence using DANTE dark-blood preparation combined with FLASH readout (DANTE-FLASH) for rapid isotropic-resolution three-dimensional (3D) peripheral vessel wall imaging at 3 Tesla (T). METHODS Numerical simulations were first conducted to optimize imaging parameters for maximizing the wall-lumen contrast. The sequence, implemented at 3T, was then assessed in the bilateral superficial femoral arteries of eight healthy volunteers and three patients who were undergoing non-contrast-enhanced MRA due to known peripheral artery disease. Conventional 2D dark-blood turbo spin echo (DB-TSE) was performed as a reference in all subjects. Image quality on a 5-point scale, apparent wall signal-to-noise ratio, apparent wall-lumen contrast-to-noise ratio, wall thickness, wall area and lumen area were assessed or measured in all healthy subjects. Additionally, the agreement in the depiction of wall thickening or luminal stenosis between DANTE-FLASH and DB-TSE, or MRA was assessed using a 4-point scale in the patient study. RESULTS DANTE-FLASH allowed for a 30-cm-long coverage within 4 min, whereas DB-TSE took approximately 7 min for a 9-cm-long coverage. Good image quality was obtained by DANTE-FLASH (score > 3). The wall thickness, wall area, and lumen area were all comparable (t-test; P = 0.334, 0.224 and 0.136) and showed excellent agreement between DANTE-FLASH and DB-TSE (intra-class correlation = 0.81, 0.85, and 0.98). The atherosclerotic plaques and luminal stenosis identified by DANTE-FLASH were in accordance with the findings by 2D DB-TSE or MRA. CONCLUSION DANTE-FLASH is a 3D dark-blood MR sequence allowing for rapid isotropic-resolution imaging of the peripheral vessel wall at 3T.
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Affiliation(s)
- Guoxi Xie
- Shenzhen Key Lab for MRI, BCMIIS, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, China.,Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, China
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Christopher Nguyen
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Zixin Deng
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Xiaoming Bi
- MR R&D, Siemens Healthcare, Los Angeles, California, USA
| | - Zhanming Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, China
| | - Xin Liu
- Shenzhen Key Lab for MRI, BCMIIS, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
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Lavin B, Phinikaridou A, Henningsson M, Botnar RM. Current Development of Molecular Coronary Plaque Imaging using Magnetic Resonance Imaging towards Clinical Application. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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68
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Li L, Kong Y, Zaitsu Y, Matthews L, Palace J, Jezzard P. Structural imaging of the cervical spinal cord with suppressed CSF signal using DANTE pulse trains. Magn Reson Med 2014; 74:971-7. [DOI: 10.1002/mrm.25474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/11/2014] [Accepted: 09/05/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Linqing Li
- FMRIB Centre, Nuffield Department of Clinical Neurosciences; University of Oxford; Oxford United Kingdom
| | - Yazhuo Kong
- FMRIB Centre, Nuffield Department of Clinical Neurosciences; University of Oxford; Oxford United Kingdom
| | - Yuri Zaitsu
- FMRIB Centre, Nuffield Department of Clinical Neurosciences; University of Oxford; Oxford United Kingdom
| | - Lucy Matthews
- Nuffield Department of Clinical Neurosciences; University of Oxford; Oxford United Kingdom
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences; University of Oxford; Oxford United Kingdom
| | - Peter Jezzard
- FMRIB Centre, Nuffield Department of Clinical Neurosciences; University of Oxford; Oxford United Kingdom
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Zhu C, Graves MJ, Yuan J, Sadat U, Gillard JH, Patterson AJ. Optimization of improved motion-sensitized driven-equilibrium (iMSDE) blood suppression for carotid artery wall imaging. J Cardiovasc Magn Reson 2014; 16:61. [PMID: 25160911 PMCID: PMC4145260 DOI: 10.1186/s12968-014-0061-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 07/28/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Improved motion-sensitized driven-equilibrium (iMSDE) preparations have been successfully used in carotid artery wall imaging to achieve blood suppression, but it causes notable signal loss, mostly due to inherent T2 decay, eddy current effects and B1 + inhomogeneity. In this study, we investigate the signal to noise ratio (SNR) and blood suppression performance of iMSDE using composite RF pulses and sinusoidal gradients. Optimized first moment (m1) values for iMSDE prepared T1- and T2- weighted (T1- and T2-w) imaging are presented. METHODS Twelve healthy volunteers and six patients with carotid artery disease underwent iMSDE and double inversion recovery (DIR) prepared T1- and T2-w fast spin echo (FSE) MRI of the carotid arteries. Modified iMSDE module using composite RF pulses and sinusoidal gradients were evaluated with a range of m1. SNR of adjacent muscle, vessel wall and the lumen were reported. The optimized iMSDE module was also tested in a 3D variable flip angle FSE (CUBE) acquisition. RESULTS The SNR of muscle was highest using sinusoidal gradients, and the relative improvement over the trapezoidal gradient increased with higher m1 (p<0.001). Optimal SNR was observed using an iMSDE preparation scheme containing two 180° composite pulses and standard 90° and -90° pulses (p=0.151). iMSDE produced better blood suppression relative to DIR preparations even with a small m1 of 487 mT*ms2/m (p<0.001). In T1-w iMSDE, there was a SNR decrease and an increased T2 weighting with increasing m1. In T2-w iMSDE, by matching the effective echo time (TE), the SNR was equivalent when m1 was <= 1518 mT*ms2/m, however, higher m1 values (2278 - 3108 mT*ms2/m) reduced the SNR. In the patient study, iMSDE improved blood suppression but reduced vessel wall CNR efficiency in both T1-w and T2-w imaging. iMSDE also effectively suppressed residual flow artifacts in the CUBE acquisition. CONCLUSIONS iMSDE preparation achieved better blood suppression than DIR preparation with reduced vessel wall CNR efficiency in T1-w and T2-w images. The optimized m1s are 487 mT*ms2/m for T1-w imaging and 1518 mT*ms2/m for T2-w imaging. Composite 180° refocusing pulses and sinusoidal gradients improve SNR performance. iMSDE further improves the inherent blood suppression of CUBE.
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Affiliation(s)
- Chengcheng Zhu
- University Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Martin J Graves
- University Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Jianmin Yuan
- University Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Umar Sadat
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Jonathan H Gillard
- University Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Andrew J Patterson
- University Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK
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