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van der Molen AJ, Dekkers IA, Geenen RWF, Bellin MF, Bertolotto M, Brismar TB, Correas JM, Heinz-Peer G, Mahnken AH, Quattrocchi CC, Radbruch A, Reimer P, Roditi G, Romanini L, Sebastià C, Stacul F, Clement O. Waiting times between examinations with intravascularly administered contrast media: a review of contrast media pharmacokinetics and updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 2024; 34:2512-2523. [PMID: 37823923 PMCID: PMC10957598 DOI: 10.1007/s00330-023-10085-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/04/2023] [Accepted: 07/07/2023] [Indexed: 10/13/2023]
Abstract
The pharmacokinetics of contrast media (CM) will determine how long safe waiting intervals between successive CT or MRI examinations should be. The Contrast Media Safety Committee has reviewed the data on pharmacokinetics of contrast media to suggest safe waiting intervals between successive contrast-enhanced imaging studies in relation to the renal function of the patient. CLINICAL RELEVANCE STATEMENT: Consider a waiting time between elective contrast-enhanced CT and (coronary) angiography with successive iodine-based contrast media administrations in patients with normal renal function (eGFR > 60 mL/min/1.73 m2) of optimally 12 h (near complete clearance of the previously administered iodine-based contrast media) and minimally 4 h (if clinical indication requires rapid follow-up). KEY POINTS: • Pharmacokinetics of contrast media will guide safe waiting times between successive administrations. • Safe waiting times increase with increasing renal insufficiency. • Iodine-based contrast media influence MRI signal intensities and gadolinium-based contrast agents influence CT attenuation.
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Affiliation(s)
- Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Marie-France Bellin
- Department of Radiology, University Paris Saclay, AP-HP, University Hospital Bicêtre, BioMaps, Le Kremlin-Bicêtre, France
| | | | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology, Unit of Radiology, Karolinska Institutet and Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Jean-Michel Correas
- AP-HP, Groupe Hospitalier Necker, DMU Imagina, Service de Radiologie, Université de Paris, Paris, France
| | | | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Marburg, Germany
| | | | - Alexander Radbruch
- Clinic for Diagnostic and Interventional Neuroradiology, University Clinic Bonn, and German Center for Neurodegenerative Diseases, DZNE, Bonn, Germany
| | - Peter Reimer
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, Klinikum Karlsruhe, Karlsruhe, Germany
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Carmen Sebastià
- Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Fulvio Stacul
- Department of Radiology, Ospedale Maggiore, Trieste, Italy
| | - Olivier Clement
- AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, Service de Radiologie, Université de Paris, 20 Rue LeBlanc, 75015, Paris, France.
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Liu K, Jiang L, Ruan J, Xia W, Huang H, Niu G, Yan S, Yin C. The Role of Dual Energy CT in Evaluating Hemorrhagic Complications at Different Stages After Thrombectomy. Front Neurol 2020; 11:583411. [PMID: 33117268 PMCID: PMC7575741 DOI: 10.3389/fneur.2020.583411] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/03/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Contrast media extravasation can mimic hemorrhage after endovascular thrombectomy (EVT). Dual energy CT (DECT) has the potential to distinguish hemorrhage from iodine contrast. Methods: We retrospectively examined clinical and radiological data from 106 consecutive acute ischemic stroke patients who received EVT and underwent DECT immediately and 24 h after EVT. Iodine overlay map, virtual non-contrast, and mixed images are reconstructed. Results: With the use of DECT, the proportion of all patients diagnosed with hemorrhagic transformation on mixed images immediately after EVT was reduced from 74.5% (79 of 106) to 10.4% (11 of 106), with a very poor consistency (κ = 0.076, p = 0.041). Correspondingly, hemorrhagic transformation on mixed images 24 h after EVT was reduced from 41.5% (44 of 106) to 30.2% (32 of 106), with a moderate consistency (κ = 0.757, p < 0.001). Conclusions: The use of DECT both immediately and 24 h after EVT changes the diagnosis of hemorrhagic transformation in a considerable proportion of acute ischemic stroke patients with EVT. This could affect decision making with respect to antithrombotic strategy.
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Affiliation(s)
- Keqin Liu
- Department of Neurology, Hangzhou First Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Jiang
- Department of Neurology, Hangzhou First Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jie Ruan
- Department of Neurology, Hangzhou First Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenqing Xia
- Department of Neurology, Hangzhou First Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huan Huang
- Department of Neurology, Hangzhou First Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guozhong Niu
- Department of Neurology, Hangzhou First Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, School of Medicine, The 2nd Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Congguo Yin
- Department of Neurology, Hangzhou First Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Almqvist H, Almqvist NS, Holmin S, Mazya MV. Dual-Energy CT Follow-Up After Stroke Thrombolysis Alters Assessment of Hemorrhagic Complications. Front Neurol 2020; 11:357. [PMID: 32508735 PMCID: PMC7249255 DOI: 10.3389/fneur.2020.00357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/14/2020] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose: We aimed to determine whether dual-energy CT (DECT) follow-up can differentiate contrast staining (CS) from intracranial hemorrhage (ICH) in stroke patients treated with intravenous thrombolysis (IVT), who had undergone acute stroke imaging using CT angiography (CTA), and CT perfusion (CTP). Materials and Methods: Between November 2012 and January 2018, 168 patients at our comprehensive stroke center underwent DECT follow-up within 36 h after IVT and acute CTA with or without CTP but did not receive intra-arterial imaging or treatment. Two independent readers evaluated plain monochromatic CT (pCT) alone and compared this with a second reading of a combined DECT approach using pCT and water- and iodine-weighted images, establishing and grading the ICH diagnosis, per Heidelberg and Safe Implementation of Treatments in Stroke Monitoring Study (SITS-MOST) classifications. Results: On pCT alone within 36 h, 31/168 (18.5%) patients had findings diagnosed as ICH. Using combined DECT (cDECT) changed ICH diagnosis to “CS only” in 3/168 (1.8%) patients, constituting 3/31 (9.7%) of cases with initially pCT-diagnosed ICH. These three cases had pCT diagnoses of one SAH, one minor, and one more extensive petechial hemorrhage (hemorrhagic infarction types 1 and 2), respectively. pCT alone had a 100% sensitivity, 98% specificity, 90% positive predictive value (PPV), 100% negative predictive value (NPV), and 98% accuracy for any ICH, compared to the cDECT. Inter-reader agreement for ICH classification using pCT compared to DECT was weighted kappa 0.92 (95% CI 0.87–0.98) vs. 0.91 (0.85–0.95). Conclusion: Compared to pCT, DECT within 36 h after IV thrombolysis for acute ischemic stroke, changes the radiological diagnosis of post-treatment ICH to “CS only” in a small proportion of patients. Studies are warranted of whether the altered radiological reports have an impact on patient management, for example initiation timing of antithrombotic secondary prevention.
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Affiliation(s)
- Håkan Almqvist
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurovascular Diseases, Karolinska University Hospital, Stockholm, Sweden
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Almqvist H, Holmin S, Mazya MV. Dual energy CT after stroke thrombectomy alters assessment of hemorrhagic complications. Neurology 2019; 93:e1068-e1075. [DOI: 10.1212/wnl.0000000000008093] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/16/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo determine whether dual energy CT with a combined approach (cDECT) using a plain noncontrast monochromatic CT (pCT), a water-weighted image after iodine removal, and an iodine-weighted image changes the diagnosis and classification of intracranial hemorrhage (ICH) after endovascular thrombectomy (EVT) in acute ischemic stroke compared to a pCT image alone without separate water and iodine weighting.MethodDuring 2012 to 2016, 372 patients at our comprehensive stroke center underwent DECT scans within 36 hours after EVT. Two readers evaluated pCT compared to a second reading with cDECT, establishing the diagnosis of ICH and grading it per the Heidelberg and Safe Implementation of Thrombolysis in Stroke–Monitoring Study (SITS-MOST) classifications.ResultUsing cDECT changed the ICH diagnosis to contrast staining only in 34% (52 of 152), modified the ICH grade in 10% (15 of 152), and diagnosed initially undetected ICH in 2% (5 of 220). pCT alone had 95% sensitivity, 80% specificity, 66% positive predictive value, 98% negative predictive value, and 85% accuracy for ICH compared to cDECT. Interreader agreement on the presence of ICH increased with cDECT compared to pCT (Cohen κ = 0.77 [95% confidence interval 0.69–0.84] vs 0.68 [0.61–0.76]).ConclusioncDECT within 36 hours after EVT changes the radiologic report regarding posttreatment ICH in a considerable proportion of patients undergoing EVT compared to pCT alone. This could affect decision-making regarding monitoring, secondary prevention, and prognostication. The cDECT scan could improve the interpretation consistency of high-attenuating changes on post-EVT images.
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High-concentration iodinated contrast media for T1-weighted direct magnetic resonance arthrography. Clin Radiol 2018; 73:907.e1-907.e7. [DOI: 10.1016/j.crad.2018.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/23/2018] [Accepted: 05/09/2018] [Indexed: 11/23/2022]
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Nikoubashman O, Jablawi F, Dekeyzer S, Oros-Peusquens AM, Abbas Z, Lindemeyer J, Othman AE, Shah NJ, Wiesmann M. MRI Appearance of Intracerebral Iodinated Contrast Agents: Is It Possible to Distinguish Extravasated Contrast Agent from Hemorrhage? AJNR Am J Neuroradiol 2016; 37:1418-21. [PMID: 27032975 DOI: 10.3174/ajnr.a4755] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/14/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Hyperattenuated cerebral areas on postinterventional CT are a common finding after endovascular stroke treatment. There is uncertainty about the extent to which these hyperattenuated areas correspond to hemorrhage or contrast agent that extravasated into infarcted parenchyma during angiography. We evaluated whether it is possible to distinguish contrast extravasation from blood on MR imaging. MATERIALS AND METHODS We examined the influence of iodinated contrast agents on T1, T2, and T2* and magnetic susceptibility in a phantom model and an ex vivo animal model. We determined T1, T2, and T2* relaxation times and magnetic susceptibility of iopamidol and iopromide in dilutions of 1:1; 1:2; 1:4; 1:10; and 1:100 with physiologic saline solution. We then examined the appearance of intracerebral iopamidol on MR imaging in an ex vivo animal model. To this end, we injected iopamidol into the brain of a deceased swine. RESULTS Iopamidol and iopromide cause a negative susceptibility shift and T1, T2, and T2* shortening. The effects, however, become very small in dilutions of 1:10 and higher. Undiluted iopamidol, injected directly into the brain parenchyma, did not cause visually distinctive signal changes on T1-weighted spin-echo, T2-weighted turbo spin-echo, and T2*-weighted gradient recalled-echo imaging. CONCLUSIONS It is unlikely that iodinated contrast agents extravasated into infarcted brain parenchyma cause signal changes that mimic hemorrhage on T1WI, T2WI, and T2*WI. Our results imply that extravasated contrast agents can be distinguished from hemorrhage on MR imaging.
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Affiliation(s)
- O Nikoubashman
- Institute of Neuroscience and Medicine 4 (O.N., A.M. O.-P., Z.A., J.L., N.J.S.), Forschungszentrum Jülich GmbH, Jülich, Germany
| | | | - S Dekeyzer
- From the Departments of Neuroradiology (O.N., S.D., M.W.)
| | - A M Oros-Peusquens
- Institute of Neuroscience and Medicine 4 (O.N., A.M. O.-P., Z.A., J.L., N.J.S.), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Z Abbas
- Neurology (Z.A., N.J.S.), University Hospital Aachen, Aachen, Germany Institute of Neuroscience and Medicine 4 (O.N., A.M. O.-P., Z.A., J.L., N.J.S.), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - J Lindemeyer
- Institute of Neuroscience and Medicine 4 (O.N., A.M. O.-P., Z.A., J.L., N.J.S.), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - A E Othman
- Department of Radiology (A.E.O.), University Hospital Tübingen, Tübingen, Germany
| | - N J Shah
- Neurology (Z.A., N.J.S.), University Hospital Aachen, Aachen, Germany Institute of Neuroscience and Medicine 4 (O.N., A.M. O.-P., Z.A., J.L., N.J.S.), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - M Wiesmann
- From the Departments of Neuroradiology (O.N., S.D., M.W.)
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Sussman MS, Lindner U, Haider M, Kucharczyk W, Hlasny E, Trachtenberg J. Optimizing contrast agent concentration and spoiled gradient echo pulse sequence parameters for catheter visualization in MR-guided interventional procedures: an analytic solution. Magn Reson Med 2013; 70:333-40. [PMID: 23801423 DOI: 10.1002/mrm.24830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 11/09/2022]
Abstract
PURPOSE A critical requirement of MR-guided interventions is the visualization of an instrument (e.g., catheter, needle) during the procedure. One approach is to fill the instrument with a contrast agent. Previously, the optimization of contrast agent visualization was performed only empirically. In the present study, an analytic optimization of contrast agent SNR efficiency was performed for a spoiled gradient echo pulse sequence. METHODS Optimal flip angle, repetition time, echo time, and contrast agent concentration were derived analytically. The solution is valid for any contrast agent, provided the relationship between T1 , T2 , and doping concentration is known. RESULTS Phantom experiments validated the analytic optimization for Gd- and MnCl2 -based contrast agents. Results showed excellent agreement between experimentally predicted and theoretically observed magnetization behavior. In vivo experiments demonstrated optimized contrast agent visualization in brain, heart, and prostate applications. The results demonstrated the large SNR that can be achieved with analytic optimization. As a practical guideline, an 11% dilution of 500 mMol/L Gd-DTPA solution, repetition time ≈ 4 ms, echo time ≈ 1 ms, and θ ≈ 65° was found to provide a large SNR. CONCLUSION This study derived and validated a method for analytically optimizing contrast agent SNR efficiency. This information may be useful for visualizing instruments during MR-guided interventions.
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Affiliation(s)
- Marshall S Sussman
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada.
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Optimal gadolinium concentration for direct MR arthrography at high field strength up to 7T: In vitro model. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2012.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sussman MS, Vidarsson L, Pauly JM, Cheng HLM. A technique for rapid single-echo spin-echo T2 mapping. Magn Reson Med 2011; 64:536-45. [PMID: 20665797 DOI: 10.1002/mrm.22454] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A rapid technique for mapping of T(2) relaxation times is presented. The method is based on the conventional single-echo spin echo approach but uses a much shorter pulse repetition time to accelerate data acquisition. The premise of the new method is the use of a constant difference between the echo time and pulse repetition time, which removes the conventional and restrictive requirement of pulse repetition time >> T(1). Theoretical and simulation investigations were performed to evaluate the criteria for accurate T(2) measurements. Measured T(2)s were shown to be within 1% error as long as the key criterion of pulse repetition time/T(2) > or =3 is met. Strictly, a second condition of echo time/T(1) << 1 is also required. However, violations of this condition were found to have minimal impact in most clinical scenarios. Validation was conducted in phantoms and in vivo T(2) mapping of healthy cartilage and brain. The proposed method offers all the advantages of single-echo spin echo imaging (e.g., immunity to stimulated echo effects, robustness to static field inhomogeneity, flexibility in the number and choice of echo times) in a considerably reduced amount of time and is readily implemented on any clinical scanner.
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Noordin S, Winalski CS, Shortkroff S, Mulkern RV. Factors affecting paramagnetic contrast enhancement in synovial fluid: effects of electrolytes, protein concentrations, and temperature on water proton relaxivities from Mn ions and Gd chelated contrast agents. Osteoarthritis Cartilage 2010; 18:964-70. [PMID: 20417287 DOI: 10.1016/j.joca.2010.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 01/29/2010] [Accepted: 03/26/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Protein and electrolyte concentration of synovial fluid (SF) varies with the type of underlying arthritis. These characteristics can be utilized by magnetic resonance technology to provide a potentially significant diagnostic modality through quantitative assessments of inherent water relaxation rates and their response to contrast agents. METHODS We evaluated the effect of a classic "in vitro" contrast agent, the Mn ion, and a common "in vivo" gadolinium based contrast agent, gadopentetate dimeglumine, on the water relaxation times of solutions with biochemical compositions simulating different types of arthritis along with similar studies of SF obtained from patients. RESULTS The results demonstrate how protein and electrolyte concentrations play a significant role in the response of water relaxation to the Mn ion but much less so to chelated gadolinium contrast agents used clinically. DISCUSSION A major challenge remains to develop paramagnetic agents with less toxicity than the Mn ion but with similar properties that can then serve as a tool to determine protein concentrations through imaging and thereby assist in the diagnosis of inflammatory arthrides and evaluation of therapeutic regimens.
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Affiliation(s)
- S Noordin
- Department of Orthopaedic Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
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Vandevenne JE, Vanhoenacker F, Mahachie John JM, Gelin G, Parizel PM. Fast MR arthrography using VIBE sequences to evaluate the rotator cuff. Skeletal Radiol 2009; 38:669-74. [PMID: 19294378 DOI: 10.1007/s00256-009-0677-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 02/17/2009] [Accepted: 02/27/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this paper was to evaluate if short volumetric interpolated breath-hold examination (VIBE) sequences can be used as a substitute for T1-weighted with fat saturation (T1-FS) sequences when performing magnetic resonance (MR) arthrography to diagnose rotator cuff tears. MATERIALS AND METHODS Eighty-two patients underwent direct MR arthrography of the shoulder joint using VIBE (acquisition time of 13 s) and T1-FS (acquisition time of 5 min) sequences in the axial and paracoronal plane on a 1.0-T MR unit. Two radiologists scored rotator cuff tendons on VIBE and T1-FS images separately as normal, small/large partial thickness and full thickness tears with or without geyser sign. T1-FS sequences were considered the gold standard. Surgical correlation was available in a small sample. RESULTS Sensitivity, specificity, and positive and negative predictive values of VIBE were greater than 92% for large articular-sided partial thickness and full thickness tears. For detecting fraying and articular-sided small partial thickness tears, these parameters were 55%, 94%, 94%, and 57%, respectively. The simple kappa value was 0.76, and the weighted kappa value was 0.86 for agreement between T1-FS and VIBE scores. All large partial and full thickness tears at surgery were correctly diagnosed using VIBE or T1-FS MR images. CONCLUSION Fast MR arthrography of the shoulder joint using VIBE sequences showed good concordance with the classically used T1-FS sequences for the appearance of the rotator cuff, in particular for large articular-sided partial thickness tears and for full thickness tears. Due to its very short acquisition time, VIBE may be especially useful when performing MR arthrography in claustrophobic patients or patients with a painful shoulder.
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Affiliation(s)
- Jan E Vandevenne
- Department of Radiology, Ziekenhuizen Oost-Limburg, Schiepse Bos 6, Genk 3600, Belgium.
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