MRA of abdominal vessels: technical advances

Emerging role of contrast-enhanced MRI in diagnosing vascular malformations

Vascular malformations comprise a diverse and rare group of lesions which generally pose a formidable treatment challenge. Requisite for optimal surgical planning are imaging modalities capable of delineating involved anatomy and malformation flow characteristics. In this regard, we and others have purported the advantages of contrast-enhanced MRI. Here, we review the current body of literature regarding the emerging of role of contrast enhanced MRI for the management of vascular malformations.

Viewing the effective k-space coverage of MR images: phantom experiments with fast Fourier transform

The purpose of this experimental study was to evaluate whether the effective k-space coverage of MR images can in principle be viewed after multidimensional Fourier transform back to k-space. A water-soaked sponge phantom providing homogeneous k-space pattern was imaged with different standard MR sequences, utilizing elliptic acquisitions, partial-Fourier acquisitions and elliptic filtering as imaging examples. The resulting MR images were Fourier-transformed to the spatial frequency domain (the k-space) to visualize their effective k-space coverage. These frequency domain images are named "backtransformed k-space images." For a quantitative assessment, the sponge phantom was imaged with three-dimensional partial-Fourier sequences while varying the partial acquisition parameters in slice and phase direction. By linear regression analysis, the k-space coverage as expected from the sequence menu parameters was compared to the effective k-space coverage as observed in the backtransformed k-space images. The k-space coverage of elliptic and partial-Fourier acquisitions became visible in the backtransformed k-space images, as well as the effect of elliptic filtering. The expected and the observed k-space coverage showed a highly significant correlation (r=.99, P<.001). In conclusion, the effective k-space coverage of MR images becomes visible when Fourier-transforming MR images of a sponge phantom back to k-space. This method could be used for several purposes including sequence parameter optimization, basic imaging research, and to enhance a visual understanding of k-space, especially in three-dimensional MR imaging.

Imaging in intestinal ischemic disorders

Intestinal ischemia and infarction are a heterogeneous group of diseases that have as their unifying theme hypoxia of the small bowel or colon. The incidence of bowel ischemia and infarction is on the rise for several reasons: the aging of the population, the ability of intensive care units to salvage critically ill patients, and heightened clinical awareness of these disorders. Improvements in diagnostic imaging techniques have greatly contributed to the earlier diagnosis of intestinal ischemia, which can have a positive influence on patient outcomes. In this article, role of radiology in the detection, differential diagnosis, and management of patients who have intestinal ischemia and infarction is discussed.

Three-dimensional contrast-enhanced magnetic-resonance angiography of the renal arteries: interindividual comparison of 0.2 mmol/kg gadobutrol at 1.5 T and 0.1 mmol/kg gadobenate dimeglumine at 3.0 T

The purpose was to evaluate the image quality of high-spatial resolution MRA of the renal arteries at 1.5 T after contrast-agent injection of 0.2 mmol/kg body weight (BW) in an interindividual comparison to 3.0 T after contrast-agent injection of 0.1 mmol/kg BW contrast agent (CA). After IRB approval and informed consent, 40 consecutive patients (25 men, 15 women; mean age 53.9 years) underwent MRA of the renal arteries either at a 1.5-T MR system with 0.2 mmol/kg BW gadobutrol or at a 3.0-T MR scanner with 0.1 mmol/kg BW gadobenate dimeglumine used as CA in a randomized order. A constant volume of 15 ml of these contrast agents was applied. The spatial resolution of the MRA sequences was 1.0 x 0.8 x 1.0 mm(3) at 1.5 T and 0.9 x 0.8 x 0.9 mm(3) at 3.0 T, which was achieved by using parallel imaging acceleration factors of 2 at 1.5 T and 3 at 3.0 T, respectively. Two radiologists blinded to the administered CA and the field strength assessed the image quality and the venous overlay for the aorta, the proximal and distal renal arteries independently on a four-point Likert-type scale. Phantom measurements were performed for a standardized comparison of SNR at 1.5 T and 3.0 T. There was no significant difference (p > 0.05) between the image quality at 3.0 T with 0.1 mmol/kg BW gadobenate dimeglumine compared to the exams at 1.5 T with 0.2 mmol/kg BW gadobutrol. The median scores were between 3 and 4 (good to excellent vessel visualization) for the aorta (3 at 1.5 T/4 at 3.0 T for reader 1 and 2). For the proximal renal arteries, median scores were 3 for the left and right renal artery at 1.5 T for both readers. At 3.0 T, median scores were 3 (left proximal renal artery) and 4 (right proximal renal artery) for reader 1 and 3 (left/right) for reader 2 at 3.0 T. For the distal renal arteries, median scores were between 2 and 3 at both field strengths (moderate and good) for both readers. The kappa values for both field strengths were comparable and ranged between 0.571 (moderate) for the distal renal arteries and 0.905 (almost perfect) for the proximal renal arteries. In the phantom measurements, a 40% higher SNR was found for the measurements at 3 T with gadobenate dimeglumine. High-spatial resolution renal MRA at 3.0 T with 0.1 mmol/kg BW gadobenate dimeglumine yields at least equal image quality compared with renal MRA at 1.5 T with 0.2 mmol/kg BW gadobutrol.

Abdominal and Pelvic MR Angiography

Currently, 3T MR scanners hold 10% of the market with rising market share. Angiographic exams in particular benefit directly from the higher field strength. The theoretically doubled signal-to-noise ratio at 3T allows for abdominal magnetic-resonance angiography (MRA) exams with submillimeter spatial resolution with acquisition times of less than 20 seconds. Because of altered longitudinal relaxation times, MRA exams can be performed with a significantly reduced amount of contrast agents. This review describes the current technical concepts and outlines typical sequence parameters for abdominal and pelvic MRA. The choice of contrast agents for abdominal MRA is discussed in detail. This article also provides an outlook to new technical concepts that are already at the horizon of MRA.

Renal magnetic resonance angiography at 3.0 T: technical feasibility and clinical perspectives

The increased signal-to-noise ratio at 3.0 T holds promise for high-spatial resolution renal magnetic resonance angiography (MRA). Today, state-of-the-art renal MRA is feasible with submillimeter isotropic spatial resolution in less than 20 seconds acquisition time with sufficient signal-to-noise ratio. This article explains the fundamentals of 3.0-T imaging that are essential for renal MRA, with a focus on the clinical implications. Protocol and imaging recommendations are given based on the physical principles of 3.0-T imaging and underlined by current clinical cases. Apart from pure morphological imaging, the value of functional renal imaging such as renal flow measurements and renal perfusion measurements for a comprehensive 3.0-T renal MRA protocol is discussed.

Magnetic resonance angiography of chest and abdomen at 3 T

During the past decade, contrast-enhanced magnetic resonance angiography (CE-MRA) has been proven to be a powerful tool to visualize the thoracoabdominal vasculature and, consequently, has become a widely accepted noninvasive imaging modality. With the more recent introduction of high-field whole-body magnetic resonance scanners, a further improvement of diagnostic accuracy can be expected. General considerations for performing high-resolution CE-MRA at higher field strength include the benefits of higher signal-to-noise ratio and an improved contrast between vascular and background tissues. Although there are many positive attributes for performing CE-MRA at 3 T, there are also some tradeoffs, such as static magnetic field inhomogeneity and increase in specific absorption rate. This review describes the main technical innovations of advanced CE-MRA techniques at 3 T, illustrated by characteristic cases.