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Kayano S, Ota H, Sato Y, Endo T, Niizuma K, Suzuki I, Kawamura T, Takase K. Carotid computed tomography angiography after cobalt-based alloy carotid artery stenting using ultra-high-resolution computed tomography with model-based iterative reconstruction. Radiol Case Rep 2021; 16:3721-3728. [PMID: 34630807 PMCID: PMC8493515 DOI: 10.1016/j.radcr.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 11/25/2022] Open
Abstract
In conventional carotid computed tomographic angiography, the artifacts of the stent vary depending on the structure and characteristics of the alloy type. Cobalt-based alloy stents have been reported to exhibit high artifacts, and accurate evaluation of the internal lumen can be difficult. Recently, ultra-high-resolution computed tomography scanner systems have become available for clinical practice. The primary features of this computed tomography scanner are a 0.25-mm detector row width and a 1024 × 1024 matrix. We report a case-series of carotid artery stenting using a cobalt-based alloy stent scanned by an ultra-high-resolution computed tomography scanner system and model-based iterative reconstruction. We also report that the combination of the ultra-high-resolution computed tomography scanner system with model-based iterative reconstruction would be useful to evaluate vessel patency after placement of a cobalt-based alloy stent.
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Affiliation(s)
- Shingo Kayano
- Department of Radiological Technology, Tohoku University Hospital, 1 1 Seiryo machi, Aoba ku, Sendai, Miyagi 980-8574, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshimichi Sato
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Ichiro Suzuki
- Department of Neurosurgery, Hachinohe City Hospital, Hachinohe, Japan
| | - Tsuyoshi Kawamura
- Department of Neurosurgery, Hachinohe City Hospital, Hachinohe, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Tomura N, Kokubun M, Horiuchi K, Watanabe Z. Comparison of TOF-MRA and silent scan-MRA in depicting cerebral arteries in patients with Moyamoya disease. Acta Radiol 2019; 60:1321-1328. [PMID: 30682891 DOI: 10.1177/0284185118824782] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Noriaki Tomura
- Department of Neuroradiology, Radiology, and Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
| | - Mika Kokubun
- Department of Neuroradiology, Radiology, and Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
| | - Kazuomi Horiuchi
- Department of Neuroradiology, Radiology, and Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
| | - Zenichiro Watanabe
- Department of Neuroradiology, Radiology, and Neurosurgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
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Heinrich A, Güttler FV, Schlesies F, Aschenbach R, Eckardt N, Teichgräber UKM. In vitro stent assessment by MRI: visibility of lumen and artifacts for 27 modern stents. ACTA ACUST UNITED AC 2017; 62:565-573. [DOI: 10.1515/bmt-2016-0008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 09/01/2016] [Indexed: 11/15/2022]
Abstract
AbstractPurpose:The purpose of this study was to measure artifacts and visibility of lumen for modern and most commonly used stents in vascular interventions according to a standardized test method of the American Society for Testing and Materials (ASTM).Materials and methods:Twenty-four peripheral self-expanding nitinol stents and three stainless steel stents with diameters between 5 and 8 mm and lengths between 30 and 250 mm from seven different manufacturers were compared on a 1.5T and a 3T magnetic resonance (MR) scanner. The visualization of lumen and artifacts was measured according to ASTM F2119 for a turbo spin echo (TSE) [repetition time(TR)/echo time (TE) 500/26 ms] and a gradient echo (GRE) (TR/TE 100/15 ms) sequence. The stents were placed parallel and perpendicular to the radio frequency field (BResults:There were large differences in visibility of the lumen for the stent models. The visualization of the lumen varies between 0% and 93% (perpendicular to BConclusion:Reliable stent lumen visualization is possible for Misago, Supera, Tigris, and Viabahn stents, if their axis is perpendicular to B
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Gitsioudis G, Fortner P, Stuber M, Missiou A, Andre F, Müller OJ, Katus HA, Korosoglou G. Off-resonance magnetic resonance angiography improves visualization of in-stent lumen in peripheral nitinol stents compared to conventional T1-weighted acquisitions: an in vitro comparison study. Int J Cardiovasc Imaging 2016; 32:1645-1655. [PMID: 27535040 DOI: 10.1007/s10554-016-0955-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Abstract
To compare the value of inversion recovery with on-resonant water suppression (IRON) to conventional T1-weighted (T1w) MRA and computed tomography angiography (CTA) for visualization of peripheral nitinol stents. We visualized 14 different peripheral nitinol stents in vitro both using Gadolinium (Gd) and ultrasmall superparamagnetic iron nanoparticles (USPIOs) for conventional T1w and IRON-MRA using clinical grade 1.5T MR scanner and iodinated contrast material for CTA using a 256-slice CT scanner. Parameter assessment included signal- and contrast-to-noise ratio (S/CNR), relative in-stent signal and artificial lumen narrowing. X-ray angiography served as gold standard for diameter assessment. Gd-enhanced IRON-MRA exhibited highest in-stent SNR and CNR values compared to conventional T1w MRA (IRON (Gd/USPIO): SNR = 30 ± 3/21 ± 2, CNR = 23 ± 2/14 ± 1; T1w: SNR = 16 ± 1/14 ± 2, CNR = 12 ± 1/10 ± 1, all p < 0.05). Furthermore, IRON-MRA achieved highest relative in-stent signal both using Gd and USPIO (IRON (Gd/USPIO): 121 ± 8 %/103 ± 6 %; T1w: 73 ± 2 %/66 ± 4 %; CTA: 84 ± 6 %, all p < 0.05). However, artificial lumen narrowing appeared similar in all imaging protocols (IRON (Gd/USPIO): 21 ± 3 %/21 ± 2 %; T1w: 16 ± 4 %/17 ± 3 %; CTA: 19 ± 2 %, all p = NS). Finally, IRON-MRA provided improvement of the in-stent lumen visualization with an 'open-close-open' design, which revealed a complete in-stent signal loss in T1w MRA. IRON-MRA improves in-stent visualization in vitro compared to conventional T1w MRA and CTA. In light of the in vitro results with Gd-enhanced IRON-MRA, the clinical implementation of such an approach appears promising.
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Affiliation(s)
- Gitsios Gitsioudis
- Clinic of Internal Medicine, Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Philipp Fortner
- Clinic of Internal Medicine, Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Matthias Stuber
- Russell H. Morgan Department of Radiology and Radiological Sciences, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Biomedical Imaging (CIBM), University Hospital Lausanne, Lausanne, Switzerland
| | - Anna Missiou
- Clinic of Internal Medicine, Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Florian Andre
- Clinic of Internal Medicine, Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Oliver J Müller
- Clinic of Internal Medicine, Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Clinic of Internal Medicine, Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Grigorios Korosoglou
- Clinic of Internal Medicine, Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Chiang CH, Tseng YC, Chen AC, Huang YL, Chen DYT, Chen CJ, Lin YK, Hsu HL. In vitro comparison of intracranial stent visibility using various concentrations of gadolinium contrast agent under 1.5 T and 3 T MR angiography. J Neurointerv Surg 2016; 9:399-404. [DOI: 10.1136/neurintsurg-2016-012490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/12/2016] [Accepted: 07/21/2016] [Indexed: 11/03/2022]
Abstract
Background and purposeMR angiography (MRA) is an increasingly used evaluation method following intracranial stenting. However, the various artifacts created by the stent limit this technique. The purpose of this study was to investigate the effects of various concentrations of gadolinium contrast agent on the visibility and signal characteristics of two stents using the a contrast enhanced MRA technique.Material and methodTwo intracranial stents (Enterprise and Helistent) were placed in polyvinyl chloride tubes as vascular phantoms. They were filled with six different doses of gadolinium contrast agent (1.0, 2.0, 4.0, 6.0, 8.0, and 10.0 mmol/L dimeglumine gadopentetate, respectively) and imaged using 3 T and 1.5 T MR systems. Relative in-stent signal (RIS) was calculated and artificial luminal narrowing (ALN) was obtained using pixel by pixel analysis.ResultThe Enterprise stent, performed in both 1.5 T and 3 T MR systems, showed mean RIS values much less than those for the Helistent for all different doses of gadolinium solution. Increased gadolinium concentration resulted in a gradual reduction in RIS values in the Enterprise group. Also, ALN in the Enterprise group showed no or little change with various gadolinium doses.ConclusionsThe Enterprise stent demonstrated good luminal visibility regardless of gadolinium concentration. The relative in-stent signals were more predictable in the Enterprise stent with various doses of gadolinium. Therefore, the Enterprise stent has been shown to provide better in-stent visibility compared with the Helistent using various gadolinium doses.
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Carotid artery stents on CT angiography: In vitro comparison of different stent designs and sizes using 16-, 64- and 320-row CT scanners. J Neuroradiol 2014; 41:259-68. [DOI: 10.1016/j.neurad.2013.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 10/08/2013] [Accepted: 10/22/2013] [Indexed: 11/18/2022]
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Cho WS, Kim SS, Lee SJ, Kim SH. The effectiveness of 3T time-of-flight magnetic resonance angiography for follow-up evaluations after the stent-assisted coil embolization of cerebral aneurysms. Acta Radiol 2014; 55:604-13. [PMID: 24003259 DOI: 10.1177/0284185113502335] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Artifacts introduced by stents limit the value of magnetic resonance (MR) imaging as a follow-up modality after the stent-assisted coil embolization of cerebral aneurysms. PURPOSE To investigate the usefulness of 3 Tesla (3T) time-of-flight (TOF) MR angiography (MRA) for the follow-up evaluation. MATERIAL AND METHODS Twenty-two aneurysms of 20 patients treated with stent-assisted coil embolization were followed up with 3T TOF MRA and digital subtraction angiography (DSA) with three-dimensional rotational angiography (3DRA). The status of coiled aneurysms was compared with 3T TOF MRA and DSA with 3DRA in terms of complete occlusion, residual neck, and residual aneurysm. TOF MRA at 3T was performed 1 day before DSA with 3DRA, with a mean follow-up period of 20.1 ± 10.8 months. RESULTS Twenty (90.9%) of 22 cases were concordant between the two modalities. The degree of agreement and correlation between them were high (κ=0.771, P<0.001; r=0.832 and P<0.001). When evaluating the status of residual neck, the sensitivity was 80% (4/5 cases); specificity was not available because there were no cases of complete occlusion. For the status of residual aneurysm, the sensitivity and specificity were 94.1% (16/17 cases) and 100% (all 5 cases), respectively. CONCLUSION TOF MRA at 3T with source images could be useful as a non-invasive follow-up modality after the stent-assisted coil embolization of cerebral aneurysms. Further study with a larger patient sample is needed to confirm the effectiveness of 3T TOF MRA.
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Affiliation(s)
- Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sam Soo Kim
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Sung Hun Kim
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
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Lettau M, Bendszus M, Hähnel S. Angiographic CT: In vitro comparison of different carotid artery stents using two different angiography systems. J Neuroradiol 2013; 40:348-54. [DOI: 10.1016/j.neurad.2013.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 03/16/2013] [Accepted: 03/20/2013] [Indexed: 12/24/2022]
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Khan SN, Rapacchi S, Levi DS, Finn JP. Pediatric cardiovascular interventional devices: effect on CMR images at 1.5 and 3 Tesla. J Cardiovasc Magn Reson 2013; 15:54. [PMID: 23782716 PMCID: PMC3716898 DOI: 10.1186/1532-429x-15-54] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 06/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To predict the type and extent of CMR artifacts caused by commonly used pediatric trans-catheter devices at 1.5 T and 3 T as an aid to clinical planning and patient screening. METHODS Eleven commonly used interventional, catheter-based devices including stents, septal occluders, vascular plugs and embolization coils made from either stainless steel or nitinol were evaluated ex-vivo at both 1.5T and 3T. Pulse sequences and protocols commonly used for cardiovascular magnetic resonance (CMR) were evaluated, including 3D high-resolution MR angiography (MRA), time-resolved MRA, 2D balanced-SSFP cine and 2D phase-contrast gradient echo imaging (GRE). We defined the signal void amplification factor (F) as the ratio of signal void dimension to true device dimension. F1 and F2 were measured in the long axis and short axes respectively of the device. We defined F3 as the maximum extent of the off-resonance dark band artifact on SSFP measured in the B0direction. The effects of field strength, sequence type, orientation, flip angle and phase encode direction were tested. Clinical CMR images in 3 patients with various indwelling devices were reviewed for correlation with the in-vitro findings. RESULTS F1 and F2 were higher (p<0.05) at 3T than at 1.5T for all sequences except 3D-MRA. Stainless steel devices produced greater off-resonance artifact on SSFP compared to nitinol devices (p<0.05). Artifacts were most severe with the stainless steel Flipper detachable embolization coil (Cook Medical, Bloomington, IN), with F1 and F2 10 times greater than with stainless steel stents. The orientation of stents changed the size of off-resonance artifacts by up to two fold. Sequence type did influence the size of signal void or off-resonance artifact (p<0.05). Varying the flip angle and phase encode direction did not affect image artifact. CONCLUSION Stainless steel embolization coils render large zones of anatomy uninterpretable, consistent with predictions based on ex-vivo testing. Most other commonly used devices produce only mild artifact ex-vivo and are compatible with diagnostic quality in-vivo studies. Knowledge of ex-vivo device behavior can help predict the technical success or failure of CMR scans and may preempt the performance of costly, futile studies.
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Affiliation(s)
- Sarah N Khan
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206, USA
| | - Stanislas Rapacchi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206, USA
| | - Daniel S Levi
- Department of Pediatrics, Pediatric Cardiology, Mattel Children Hospital, University of California at Los Angeles, Los Angeles, California, USA
| | - J Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206, USA
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Lettau M, Bendszus M, Hähnel S. Angiographic CT: in vitro comparison of different carotid artery stents-does stent orientation matter? Neuroradiology 2013; 55:675-82. [PMID: 23411716 DOI: 10.1007/s00234-013-1152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/29/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Our aim was to evaluate the in vitro visualization of different carotid artery stents on angiographic CT (ACT). Of particular interest was the influence of stent orientation to the angiography system by measurement of artificial lumen narrowing (ALN) caused by the stent material within the stented vessel segment to determine whether ACT can be used to detect restenosis within the stent. METHODS ACT appearances of 17 carotid artery stents of different designs and sizes (4.0 to 11.0 mm) were investigated in vitro. Stents were placed in different orientations to the angiography system. Standard algorithm image reconstruction and stent-optimized algorithm image reconstruction was performed. For each stent, ALN was calculated. RESULTS With standard algorithm image reconstruction, ALN ranged from 19.0 to 43.6 %. With stent-optimized algorithm image reconstruction, ALN was significantly lower and ranged from 8.2 to 18.7 %. Stent struts could be visualized in all stents. Differences in ALN between the different stent orientations to the angiography system were not significant. CONCLUSION ACT evaluation of vessel patency after stent placement is possible but is impaired by ALN. Stent orientation of the stents to the angiography system did not significantly influence ALN. Stent-optimized algorithm image reconstruction decreases ALN but further research is required to define the visibility of in-stent stenosis depending on image reconstruction.
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Affiliation(s)
- Michael Lettau
- Division of Neuroradiology, Department of Neurosurgery, University of Freiburg Medical Center, Breisacher Str. 64, 79106 Freiburg, Germany.
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In Vivo Evaluation of Carotid Artery Stents Using Multi–Detector-Row Computed Tomography Angiography. J Comput Assist Tomogr 2013; 37:402-7. [DOI: 10.1097/rct.0b013e318289a9f9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Seok JH, Choi HS, Jung SL, Ahn KJ, Kim MJ, Shin YS, Kim BS. Artificial luminal narrowing on contrast-enhanced magnetic resonance angiograms on an occasion of stent-assisted coiling of intracranial aneurysm: in vitro comparison using two different stents with variable imaging parameters. Korean J Radiol 2012; 13:550-6. [PMID: 22977321 PMCID: PMC3435851 DOI: 10.3348/kjr.2012.13.5.550] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 03/15/2012] [Indexed: 11/15/2022] Open
Abstract
Objective Intracranial stenting for stent-assisted coiling of aneurysms requires adequate follow-up imaging. The aim of this in vitro study was to compare in-stent artificial luminal narrowing on contrast-enhanced MR angiograms (CE-MRA) when applying Neuroform® and Enterprise® stents for stent-assisted coiling. Materials and Methods Two intracranial nitinol stents (Enterprise® and Neuroform®) were placed in silicon tubes and then imaged at 3 T and 1.5 T by the use of a T1-weighted three-dimensional spoiled gradient-echo sequence with minimal TR and TE. CE-MRAs were obtained by using different imaging planes, voxel sizes, and bandwidths, and with or without parallel imaging. Artificial lumen narrowing (ALN) was calculated and the results were compared. Results Lower magnetic field strength, axial plane perpendicular to axis of stent, and wider bandwidth resulted in a lower ALN on CE-MRA for both stents. Larger voxel size resulted in lower ALN for Neuroform® stent. The parallel imaging acceleration factor did not affect ALN. The mean ALN was lower for Neuroform®, but it was not significant by a paired t test. Conclusion CE-MRA of the stented lumen of vascular phantom was partially impaired with ALN. Consequently, image plane orientation, magnetic field strength, bandwidth, and voxel size should be adjusted appropriately to reduce ALN.
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Affiliation(s)
- Jee Hyun Seok
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul 137-701, Korea
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In vitro stent lumen visualisation of various common and newly developed femoral artery stents using MR angiography at 1.5 and 3 tesla. Eur Radiol 2012; 23:588-95. [PMID: 22898936 DOI: 10.1007/s00330-012-2625-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/18/2012] [Accepted: 07/18/2012] [Indexed: 10/28/2022]
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Comparing different MR angiography strategies of carotid stents in a vascular flow model: toward stent-specific recommendations in MR follow-up. Neuroradiology 2010; 53:359-65. [PMID: 20721544 PMCID: PMC3077747 DOI: 10.1007/s00234-010-0753-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Accepted: 07/27/2010] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Carotid artery stenting (CAS) requires adequate follow-up imaging to assess complications such as in-stent stenosis or occlusion. Options include digital subtraction angiography, CT angiography, ultrasound, and MR angiography (MRA), which may offer a non-invasive option for CAS follow-up imaging. The aim of this study was to assess contrast-enhanced MRA (CE-MRA) and three-dimensional time-of-flight MRA (3D-TOF) for visualization of the in-stent lumen in different carotid stents. METHODS In this study, we compared CE-MRA and 3D-TOF of five different carotid stents (Guidant Acculink®, Cordis Precise®, Boston Wallstent®, Abbot Vascular Xact®, Cook Zilver®) in three diameters (4, 6, and 8 mm) using a vascular flow model at 3.0 T with the help of a recently developed carotid surface coil. Stent-related artifacts were objectively assessed by calculating artificial lumen narrowing (ALN) and relative in-stent signal (RIS). RESULTS RIS and ALN depended heavily on stent type, stent diameter, and the employed MR sequence. ALN and RIS were relatively favorable for Acculink®, Precise®, and Zilver® stents with both CE-MRA and 3D-TOF. CE-MRA provided better results for the Wallstent, while the Xact stent was difficult to visualize with both MRA protocols. CONCLUSION Both CE-MRA and 3D-TOF are viable options for depicting the in-stent lumen in carotid stents. For specific stents, 3D-TOF provided image quality comparable to CE-MRA and may thus be suitable for in vivo assessment. Development of stent-specific pathways for follow-up imaging seems advisable to address stent-related differences in image quality.
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Abstract
CT angiography can be used to evaluate carotid artery stenosis with high diagnostic safety. In contrast to the gold standard digital subtraction angiography (DSA) it is a non-invasive procedure which yields information regarding the degree of stenosis as well as information about plaque morphology. Due to multiple reconstruction planes in 3 levels in maximum intensity projections (MIP) and the possibility to perform volume rendering (VR) reconstruction more information about the extent of carotid disease can be acquired. Due to the bolus tracking technique optimum contrast medium enhancement of the carotid artery with simultaneous minimization of venous artifacts is possible.
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Affiliation(s)
- W Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Strasse 1, 66421, Homburg/Saar, Deutschland
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