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Jagadeesan B, Tariq F, Nada A, Bhatti IA, Masood K, Siddiq F. Principles Behind 4D Time-Resolved MRA/Dynamic MRA in Neurovascular Imaging. Semin Roentgenol 2024; 59:191-202. [PMID: 38880517 DOI: 10.1053/j.ro.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/28/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Bharathi Jagadeesan
- Departments of Radiology, Neurology and Neurosurgery, University of Minnesota, Minneapolis, MN.
| | - Farzana Tariq
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
| | - Ayman Nada
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
| | - Ibrahim A Bhatti
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
| | - Kamran Masood
- Departments of Radiology, Neurology and Neurosurgery, University of Minnesota, Minneapolis, MN
| | - Farhan Siddiq
- Departments of Neurosurgery and Radiology, University of Missouri, Columbia, MO
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Koktzoglou I, Huang R, Ong AL, Aouad PJ, Aherne EA, Edelman RR. Feasibility of a sub-3-minute imaging strategy for ungated quiescent interval slice-selective MRA of the extracranial carotid arteries using radial k-space sampling and deep learning-based image processing. Magn Reson Med 2020; 84:825-837. [PMID: 31975432 DOI: 10.1002/mrm.28179] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/09/2019] [Accepted: 12/30/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To develop and test the feasibility of a sub-3-minute imaging strategy for non-contrast evaluation of the extracranial carotid arteries using ungated quiescent interval slice-selective (QISS) MRA, combining single-shot radial sampling with deep neural network-based image processing to optimize image quality. METHODS The extracranial carotid arteries of 12 human subjects were imaged at 3 T using ungated QISS MRA. In 7 healthy volunteers, the effects of radial and Cartesian k-space sampling, single-shot and multishot image acquisition (1.1-3.3 seconds/slice, 141-423 seconds/volume), and deep learning-based image processing were evaluated using segmental image quality scoring, arterial temporal SNR, arterial-to-background contrast and apparent contrast-to-noise ratio, and structural similarity index. Comparison of deep learning-based image processing was made with block matching and 3D filtering denoising. RESULTS Compared with Cartesian sampling, radial k-space sampling increased arterial temporal SNR 107% (P < .001) and improved image quality during 1-shot imaging (P < .05). The carotid arteries were depicted with similar image quality on the rapid 1-shot and much lengthier 3-shot radial QISS protocols (P = not significant), which was corroborated in patient studies. Deep learning-based image processing outperformed block matching and 3D filtering denoising in terms of structural similarity index (P < .001). Compared with original QISS source images, deep learning image processing provided 24% and 195% increases in arterial-to-background contrast (P < .001) and apparent contrast-to-noise ratio (P < .001), and provided source images that were preferred by radiologists (P < .001). CONCLUSION Rapid, sub-3-minute evaluation of the extracranial carotid arteries is feasible with ungated single-shot radial QISS, and benefits from the use of deep learning-based image processing to enhance source image quality.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois.,Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Rong Huang
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois
| | - Archie L Ong
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois.,Department of Neurology, NorthShore University HealthSystem, Evanston, Illinois
| | - Pascale J Aouad
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily A Aherne
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Koktzoglou I, Aherne EA, Walker MT, Meyer JR, Edelman RR. Ungated nonenhanced radial quiescent interval slice-selective (QISS) magnetic resonance angiography of the neck: Evaluation of image quality. J Magn Reson Imaging 2019; 50:1798-1807. [PMID: 31077477 DOI: 10.1002/jmri.26781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Standard-of-care time-of-flight (TOF) techniques for nonenhanced magnetic resonance angiography (NEMRA) of the carotid bifurcation and other cervical arteries often provide nondiagnostic image quality due to motion and flow artifacts. PURPOSE To perform an initial evaluation of an ungated radial quiescent-interval slice-selective (QISS) technique for NEMRA of the neck, in comparison with 2D TOF and contrast-enhanced magnetic resonance angiography (CEMRA). STUDY TYPE Retrospective. POPULATION Sixty patients referred for neck MR angiography. FIELD STRENGTH/SEQUENCE Ungated radial QISS at 3T. ASSESSMENT Three radiologists scored image quality of 18 arterial segments using a 4-point scale (1, nondiagnostic; 2, fair; 3, good; 4, excellent), and two radiologists graded proximal internal carotid stenosis using five categories (<50%, 50-69%, 70-99%, occlusion, nondiagnostic). STATISTICAL TESTS Friedman tests with post-hoc Wilcoxon signed-rank tests; unweighted Gwet's AC1 statistic; tests for equality of proportions. RESULTS Ungated radial QISS provided image quality that significantly exceeded 2D TOF (mean scores of 2.7 vs. 2.0, 2.7 vs. 2.2, and 2.9 vs. 2.3; P < 0.001, all comparisons), while CEMRA provided the best image quality (mean scores of 3.6, 3.7, and 3.5 for the three reviewers). Interrater agreement of image quality scores was substantial for CEMRA (AC1 = 0.70, P < 0.001), and moderate for QISS (AC1 = 0.43, P < 0.001) and TOF (AC1 = 0.41, P < 0.001). Compared with TOF, QISS NEMRA provided a significantly higher percentage of diagnostic segments for all three reviewers (91.0% vs. 71.7%, 93.5% vs. 72.9%, 95.5% vs. 85.2%; P < 0.0001) and demonstrated better agreement with CEMRA for grading of proximal internal carotid stenosis (AC1 = 0.94 vs. 0.73 for reviewer 1, P < 0.05; AC1 = 0.89 vs. 0.68 for reviewer 2, P < 0.05). DATA CONCLUSION In this initial study, ungated radial QISS significantly outperformed 2D TOF for the evaluation of the neck arteries, with overall better image quality and more diagnostic arterial segments, and improved agreement with CEMRA for grading stenosis of the proximal internal carotid artery. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1798-1807.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Emily A Aherne
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew T Walker
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Joel R Meyer
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Wang L, Lv P, Yang S, Zeng M, Lin J. Assessment of thoracic vasculature in patients with central bronchogenic carcinoma by unenhanced magnetic resonance angiography: comparison between 2D free-breathing TrueFISP, 2D breath-hold TrueFISP and 3D respiratory-triggered SPACE. J Thorac Dis 2017; 9:1624-1633. [PMID: 28740677 DOI: 10.21037/jtd.2017.06.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Preoperative assessment of the integrity of major thoracic vessels in central bronchogenic carcinoma is vital for tumor staging and treatment planning. Contrast-enhanced CT is currently the first choice of modality for this purpose in clinical practice with limitations including exposure to ionizing radiation and the use of iodinated contrast material. MRI has been increasingly employed for the staging of lung cancer. More recently, unenhanced magnetic resonance angiography (MRA) which is totally non-invasive and contrast-free has been reported able to show thoracic vessels. This study was to compare image qualities of three unenhanced-MRAs and to evaluate accuracy of them in assessing thoracic vessel invasion by using contrast-enhanced CT as a reference standard. METHODS A total of 30 patients with central bronchogenic carcinoma confirmed by pathology were examined by CT and unenhanced MRA including 2D free-breathing (FB)-TrueFISP, breath-holding (BH)-TrueFISP and 3D respiratory-triggered (RT)-SPACE. Image qualities of pulmonary arteries and veins, thoracic aorta and vena cava were scored for each MRA sequence. Vessel to lung tissue signal contrast-to-noise ratio (CNR), vessel to tumor signal contrast ratio (VTR), and tumor to background signal contrast ratio (TBR) were calculated. On each method, vessel invasion was evaluated according to types of morphological relationships between the tumor and major vessels. RESULTS The three MRAs showed no significant difference in CNR (P=0.518) while TrueFISP MRAs were better than SPACE in terms of VTR (P=0.000) and image quality (P=0.002). Excellent consistency with CT was found for all three MRAs in assessment of the morphological relationships between tumors and major vessels (FB-TrueFISP: kappa =0.821; BH-TrueFISP: kappa =0.862; RT-SPACE: kappa =0.811). CONCLUSIONS Both TrueFISP and SPACE allow satisfactory visualization of major mediastinal and hilar vessels and are comparable to MDCT in assessment of vessel invasion in patients with central lung cancer. TrueFISP sequences are better than SPACE in regard to image quality and VTR.
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Affiliation(s)
- Lili Wang
- Department of Diagnostic Radiology, Shanghai Zhongshan Hospital, Shanghai Medical College of Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China.,Department of Radiology, Xiehe Hospital, Fujian Medical University, Fujian 350001, China
| | - Peng Lv
- Department of Diagnostic Radiology, Shanghai Zhongshan Hospital, Shanghai Medical College of Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Shuohui Yang
- Department of Diagnostic Radiology, Shanghai Zhongshan Hospital, Shanghai Medical College of Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Mengsu Zeng
- Department of Diagnostic Radiology, Shanghai Zhongshan Hospital, Shanghai Medical College of Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Jiang Lin
- Department of Diagnostic Radiology, Shanghai Zhongshan Hospital, Shanghai Medical College of Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China.,Institute of Functional and Molecular Medical Imaging of Fudan University, Shanghai 200040, China
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Yuan J, Usman A, Das T, Patterson AJ, Gillard JH, Graves MJ. Imaging Carotid Atherosclerosis Plaque Ulceration: Comparison of Advanced Imaging Modalities and Recent Developments. AJNR Am J Neuroradiol 2016; 38:664-671. [PMID: 28007772 DOI: 10.3174/ajnr.a5026] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Atherosclerosis remains the leading cause of long-term mortality and morbidity worldwide, despite remarkable advancement in its management. Vulnerable atherosclerotic plaques are principally responsible for thromboembolic events in various arterial territories such as carotid, coronary, and lower limb vessels. Carotid plaque ulceration is one of the key features associated with plaque vulnerability and is considered a notable indicator of previous plaque rupture and possible future cerebrovascular events. Multiple imaging modalities have been used to assess the degree of carotid plaque ulceration for diagnostic and research purposes. Early diagnosis and management of carotid artery disease could prevent further cerebrovascular events. In this review, we highlight the merits and limitations of various imaging techniques for identifying plaque ulceration.
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Affiliation(s)
- J Yuan
- From the Department of Radiology (J.Y., A.U., J.H.G., M.J.G.), University of Cambridge, Cambridge, UK
| | - A Usman
- From the Department of Radiology (J.Y., A.U., J.H.G., M.J.G.), University of Cambridge, Cambridge, UK
| | - T Das
- Department of Radiology (T.D., A.J.P., M.J.G.), Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - A J Patterson
- Department of Radiology (T.D., A.J.P., M.J.G.), Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - J H Gillard
- From the Department of Radiology (J.Y., A.U., J.H.G., M.J.G.), University of Cambridge, Cambridge, UK
| | - M J Graves
- From the Department of Radiology (J.Y., A.U., J.H.G., M.J.G.), University of Cambridge, Cambridge, UK.,Department of Radiology (T.D., A.J.P., M.J.G.), Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
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Koktzoglou I, Walker MT, Meyer JR, Murphy IG, Edelman RR. Nonenhanced hybridized arterial spin labeled magnetic resonance angiography of the extracranial carotid arteries using a fast low angle shot readout at 3 Tesla. J Cardiovasc Magn Reson 2016; 18:18. [PMID: 27067840 PMCID: PMC4828773 DOI: 10.1186/s12968-016-0238-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate ungated nonenhanced hybridized arterial spin labeling (hASL) magnetic resonance angiography (MRA) of the extracranial carotid arteries using a fast low angle shot (FLASH) readout at 3 Tesla. METHODS In this retrospective, institutional review board-approved and HIPAA-compliant study, we evaluated the image quality (4-point scale) of nonenhanced hASL MRA using a FLASH readout with respect to contrast-enhanced MRA (CEMRA) in 37 patients presenting with neurologic symptoms. Two certified neuroradiologists independently evaluated 407 arterial segments (11 per patient) for image quality. The presence of vascular pathology was determined by consensus reading. Gwet's AC1 was used to assess inter-rater agreement in image quality scores, and image quality scores were correlated with age and body mass index. Objective measurements of arterial lumen area and sharpness in the carotid arteries were compared to values obtained with CEMRA. Comparisons were also made with conventional nonenhanced 2D time-of-flight (TOF) MRA. RESULTS CEMRA provided the best image quality, while nonenhanced hASL FLASH MRA provided image quality that exceeded 2D TOF at the carotid bifurcation and in the internal and external carotid arteries. All nine vascular abnormalities of the carotid and intracranial arteries detected by CEMRA were depicted with hASL MRA, with no false positives. Inter-rater agreement of image quality scores was highest for CEMRA (AC1 = 0.87), followed by hASL (AC1 = 0.61) and TOF (AC1 = 0.43) (P < 0.001, all comparisons). With respect to CEMRA, agreement in cross-sectional lumen area was significantly better with hASL than TOF in the common carotid artery (intraclass correlation (ICC) = 0.90 versus 0.66; P < 0.05) and at the carotid bifurcation (ICC = 0.87 versus 0.54; P < 0.05). Nonenhanced hASL MRA provided superior arterial sharpness with respect to CEMRA and 2D TOF (P < 0.001). CONCLUSION Although inferior to CEMRA in terms of image quality and inter-rater agreement, hASL FLASH MRA offers an alternative to 2D TOF for the nonenhanced evaluation of the extracranial carotid arteries at 3 Tesla. Compared with 2D TOF, nonenhanced hASL FLASH MRA provides improved quantification of arterial cross-sectional area, vessel sharpness, inter-rater agreement and image quality.
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Affiliation(s)
- Ioannis Koktzoglou
- />Department of Radiology, NorthShore University HealthSystem, Evanston, USA
- />University of Chicago Pritzker School of Medicine, Chicago, USA
| | - Matthew T. Walker
- />Department of Radiology, NorthShore University HealthSystem, Evanston, USA
- />University of Chicago Pritzker School of Medicine, Chicago, USA
| | - Joel R. Meyer
- />Department of Radiology, NorthShore University HealthSystem, Evanston, USA
- />University of Chicago Pritzker School of Medicine, Chicago, USA
| | - Ian G. Murphy
- />Department of Radiology, NorthShore University HealthSystem, Evanston, USA
- />Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Robert R. Edelman
- />Department of Radiology, NorthShore University HealthSystem, Evanston, USA
- />Northwestern University Feinberg School of Medicine, Chicago, USA
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Braca JA, Bookland MJ, Heiferman DM, Loftus CM. Indications for Carotid Endarterectomy in Patients with Asymptomatic and Symptomatic Carotid Stenosis. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00074-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kramer M, Ellmann S, Allmendinger T, Eller A, Kammerer F, May MS, Baigger JF, Uder M, Lell MM. Computed Tomography Angiography of Carotid Arteries and Vertebrobasilar System: A Simulation Study for Radiation Dose Reduction. Medicine (Baltimore) 2015; 94:e1058. [PMID: 26131822 PMCID: PMC4504529 DOI: 10.1097/md.0000000000001058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Computed tomography angiography (CTA) of carotid arteries and vertebrobasilar system is a standardized procedure with excellent image quality, but radiation exposure remains a matter of concern. The aim of this study is to examine to what extent radiation dose can be lowered in relation to a standard protocol by simulating examinations with lower tube currents applying a dedicated software.Lower tube current was simulated by a dedicated noise insertion and reconstruction software (ReconCT). In a phantom study, true scans were performed with different dose protocols and compared to the results of simulated dose reductions of the same degree, respectively. In a patient study, 30 CTAs of supra-aortic vessels were reconstructed at a level of 100%, 75%, 50%, and 25% of the initial dose. Objective and subjective image analyses were performed.No significant noise differences between true scans and simulated scans of mimicked contrasted vessels were found. In the patient study, the quality scores of the 4 dose groups differed statistically significant; this difference vanished for the comparison of the 100% and 75% datasets after dichotomization into the categories of diagnostic and nondiagnostic image quality (P = .50).This study suggests an easy-to-implement method of simulating CTAs of carotid arteries and vertebrobasilar system with lower tube current for dose reduction by artificially adding noise to the original raw data. Lowering the radiation dose in a moderate extent to 75% of the original dose levels does not significantly alter the diagnostic image quality.
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