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Janssen JP, Rose S, Kaya K, Terzis R, Hahnfeldt R, Gertz RJ, Goertz L, Iuga AI, Grunz JP, Kabbasch C, Rauen P, Persigehl T, Weiss K, Borggrefe J, Pennig L, Gietzen C. Non-contrast-enhanced MR-angiography of Extracranial Arteries in Acute Ischemic Stroke at 1.5 Tesla Using Relaxation-Enhanced Angiography Without Contrast and Triggering (REACT). Clin Neuroradiol 2024:10.1007/s00062-024-01458-4. [PMID: 39316116 DOI: 10.1007/s00062-024-01458-4] [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: 06/20/2024] [Accepted: 08/16/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE To evaluate a novel flow-independent sequence (Relaxation-Enhanced Angiography without Contrast and Triggering (REACT)) for imaging of the extracranial arteries in acute ischemic stroke (AIS) at 1.5 T. METHODS This retrospective single-center study included 47 AIS patients who received REACT (scan time: 3:01 min) and contrast-enhanced MRA (CE-MRA) of the extracranial arteries at 1.5 T in clinical routine. Two radiologists assessed scans for proximal internal carotid artery (ICA) stenosis, stated their diagnostic confidence and rated the image quality of cervical arteries, impact of artifacts and image noise. Apparent signal- and contrast-to-noise ratios (aSNR/aCNR) were measured for the common carotid artery and ICA. RESULTS REACT achieved a sensitivity of 95.0% and a specificity of 97.3% for ICA stenoses in high agreement with CE-MRA (κ = 0.83) with equal diagnostic confidence (p = 0.22). Image quality was rated higher for CE-MRA at the aortic arch (p = 0.002) and vertebral arteries (p < 0.001), whereas REACT provided superior results for the extracranial ICA (p = 0.008). Both sequences were only slightly affected by artifacts (p = 0.60), while image noise was more pronounced in CE-MRA (p < 0.001) in line with higher aSNR (p < 0.001) and aCNR (p < 0.001) values in REACT for all vessels. CONCLUSION Given its good diagnostic performance while yielding comparable image quality and scan time to CE-MRA, REACT may be suitable for the imaging of the extracranial arteries in acute ischemic stroke at 1.5 T.
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Affiliation(s)
- Jan P Janssen
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Sarah Rose
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kenan Kaya
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Robert Terzis
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Robert Hahnfeldt
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Roman J Gertz
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Lukas Goertz
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Andra-Iza Iuga
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jan-Peter Grunz
- University Hospital Wuerzburg, Institute for Diagnostic and Interventional Radiology, Wuerzburg, Germany
- University of Wisconsin-Madison, Madison, WI, USA
| | - Christoph Kabbasch
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Philip Rauen
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Thorsten Persigehl
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | | | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Lenhard Pennig
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
| | - Carsten Gietzen
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Institute for Diagnostic and Interventional Radiology, Kerpener Straße 62, 50937, Cologne, Germany
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Tachikawa Y, Maki Y, Ikeda K, Yoshikai H, Toyonari N, Hamano H, Chiwata N, Suzuyama K, Takahashi Y. Flow independent black blood imaging with a large FOV from the neck to the aortic arch: A feasibility study at 3 tesla. Magn Reson Imaging 2024; 108:77-85. [PMID: 38331052 DOI: 10.1016/j.mri.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/03/2024] [Accepted: 02/03/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To investigate the feasibility of obtaining black-blood imaging with a large FOV from the neck to the aortic arch at 3 T using a newly modified Relaxation-Enhanced Angiography without Contrast and Triggering for Black-Blood Imaging (REACT-BB). MATERIALS AND METHODS REACT-BB provides black-blood images by adjusting the inversion time (TI) in REACT to the null point of blood. The optimal TI for REACT-BB was investigated in 10 healthy volunteers with TI varied from 200 ms to 1400 ms. Contrast ratios were calculated between muscle and three branch arteries of the aortic arch. Additionally, a comparison between REACT-BB and MPRAGE involved evaluating the depiction of high-intensity plaques in 222 patients with stroke or transient ischemic attack. Measurements included plaque-to-muscle signal intensity ratios (PMR), plaque volumes, and carotid artery stenosis rates in 60 patients with high-intensity plaques in carotid arteries. RESULTS REACT-BB with TI = 850 ms produced the black-blood image with the best contrast between blood and background tissues. REACT-BB outperformed MPRAGE in depicting high-intensity plaques in the aortic arch (55.4% vs 45.5%) and exhibited superior overall image quality in visual assessment (3.31 ± 0.70 vs 2.89 ± 0.73; p < 0.05). Although the PMR of REACT-BB was significantly lower than MPRAGE (2.227 ± 0.601 vs 2.285 ± 0.662; P < 0.05), a strong positive correlation existed between REACT-BB and MPRAGE (ρ = 0.935; P < 0.05), and all high-intensity plaques that MPRAGE detected were clearly detected by REACT-BB. CONCLUSION REACT-BB provides black-blood images with uniformly suppressed fat and blood signals over a large FOV from the neck to the aortic arch with comparable or better high-signal plaque depiction than MPRAGE.
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Affiliation(s)
- Yoshihiko Tachikawa
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan.
| | - Yasunori Maki
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
| | - Kento Ikeda
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
| | - Hikaru Yoshikai
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
| | - Nobuyuki Toyonari
- Department of Radiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-ku, Kumamoto 862-0962, Japan
| | - Hiroshi Hamano
- Philips Japan, Philips Building, 2-13-37 Kohnan, Minato-ku, Tokyo 108-8507, Japan
| | - Naoya Chiwata
- Division of Radiological Technology, Department of Medical Technology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
| | - Kenji Suzuyama
- Department of Neurosurgery, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
| | - Yukihiko Takahashi
- Department of Radiology, Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga 847-8588, Japan
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Dekker HM, Stroomberg GJ, Van der Molen AJ, Prokop M. Review of strategies to reduce the contamination of the water environment by gadolinium-based contrast agents. Insights Imaging 2024; 15:62. [PMID: 38411847 PMCID: PMC10899148 DOI: 10.1186/s13244-024-01626-7] [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: 09/14/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
Gadolinium-based contrast agents (GBCA) are essential for diagnostic MRI examinations. GBCA are only used in small quantities on a per-patient basis; however, the acquisition of contrast-enhanced MRI examinations worldwide results in the use of many thousands of litres of GBCA per year. Data shows that these GBCA are present in sewage water, surface water, and drinking water in many regions of the world. Therefore, there is growing concern regarding the environmental impact of GBCA because of their ubiquitous presence in the aquatic environment. To address the problem of GBCA in the water system as a whole, collaboration is necessary between all stakeholders, including the producers of GBCA, medical professionals and importantly, the consumers of drinking water, i.e. the patients. This paper aims to make healthcare professionals aware of the opportunity to take the lead in making informed decisions about the use of GBCA and provides an overview of the different options for action.In this paper, we first provide a summary on the metabolism and clinical use of GBCA, then the environmental fate and observations of GBCA, followed by measures to reduce the use of GBCA. The environmental impact of GBCA can be reduced by (1) measures focusing on the application of GBCA by means of weight-based contrast volume reduction, GBCA with higher relaxivity per mmol of Gd, contrast-enhancing sequences, and post-processing; and (2) measures that reduce the waste of GBCA, including the use of bulk packaging and collecting residues of GBCA at the point of application.Critical relevance statement This review aims to make healthcare professionals aware of the environmental impact of GBCA and the opportunity for them to take the lead in making informed decisions about GBCA use and the different options to reduce its environmental burden.Key points• Gadolinium-based contrast agents are found in sources of drinking water and constitute an environmental risk.• Radiologists have a wide spectrum of options to reduce GBCA use without compromising diagnostic quality.• Radiology can become more sustainable by adopting such measures in clinical practice.
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Affiliation(s)
- Helena M Dekker
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Gerard J Stroomberg
- RIWA-Rijn - Association of River Water Works, Groenendael 6, 3439 LV, Nieuwegein, The Netherlands
| | - Aart J Van der Molen
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Zeilinger MG, Giese D, Schmidt M, May MS, Janka R, Heiss R, Ammon F, Achenbach S, Uder M, Treutlein C. Highly accelerated, Dixon-based non-contrast MR angiography versus high-pitch CT angiography. LA RADIOLOGIA MEDICA 2024; 129:268-279. [PMID: 38017228 PMCID: PMC10879221 DOI: 10.1007/s11547-023-01752-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To compare a novel, non-contrast, flow-independent, 3D isotropic magnetic resonance angiography (MRA) sequence that combines respiration compensation, electrocardiogram (ECG)-triggering, undersampling, and Dixon water-fat separation with an ECG-triggered aortic high-pitch computed tomography angiography (CTA) of the aorta. MATERIALS AND METHODS Twenty-five patients with recent CTA were scheduled for non-contrast MRA on a 3 T MRI. Aortic diameters and cross-sectional areas were measured on MRA and CTA using semiautomatic measurement tools at 11 aortic levels. Image quality was assessed independently by two radiologists on predefined aortic levels, including myocardium, proximal aortic branches, pulmonary veins and arteries, and the inferior (IVC) and superior vena cava (SVC). Image quality was assessed on a 5-point Likert scale. RESULTS All datasets showed diagnostic image quality. Visual grading was similar for MRA and CTA regarding overall image quality (0.71), systemic arterial image quality (p = 0.07-0.91) and pulmonary artery image quality (p = 0.05). Both readers favored MRA for SVC and IVC, while CTA was preferred for pulmonary veins (all p < 0.05). No significant difference was observed in aortic diameters or cross-sectional areas between native MRA and contrast-enhanced CTA (p = 0.08-0.94). CONCLUSION The proposed non-contrast MRA enables robust imaging of the aorta, its proximal branches and the pulmonary arteries and great veins with image quality and aortic diameters and cross-sectional areas comparable to that of CTA. Moreover, this technique represents a suitable free-breathing alternative, without the use of contrast agents or ionizing radiation. Therefore, it is especially suitable for patients requiring repetitive imaging.
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Affiliation(s)
- Martin Georg Zeilinger
- Institute of Radiology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Daniel Giese
- Institute of Radiology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Magnetic Resonance, Siemens Healthcare, Erlangen, Germany
| | | | - Matthias Stefan May
- Institute of Radiology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rolf Janka
- Institute of Radiology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Fabian Ammon
- Institute of Radiology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Institute of Cardiology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Achenbach
- Institute of Cardiology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Treutlein
- Institute of Radiology, University Hospital of Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Dux-Santoy L, Rodríguez-Palomares JF, Teixidó-Turà G, Garrido-Oliver J, Carrasco-Poves A, Morales-Galán A, Ruiz-Muñoz A, Casas G, Valente F, Galian-Gay L, Fernández-Galera R, Oliveró R, Cuéllar-Calabria H, Roque A, Burcet G, Barrabés JA, Ferreira-González I, Guala A. Three-dimensional aortic geometry mapping via registration of non-gated contrast-enhanced or gated and respiratory-navigated MR angiographies. J Cardiovasc Magn Reson 2024; 26:100992. [PMID: 38211655 PMCID: PMC11211222 DOI: 10.1016/j.jocmr.2024.100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The measurement of aortic dimensions and their evolution are key in the management of patients with aortic diseases. Manual assessment, the current guideline-recommended method and clinical standard, is subjective, poorly reproducible, and time-consuming, limiting the capacity to track aortic growth in everyday practice. Aortic geometry mapping (AGM) via image registration of serial computed tomography angiograms outperforms manual assessment, providing accurate and reproducible 3D maps of aortic diameter and growth rate. This observational study aimed to evaluate the accuracy and reproducibility of AGM on non-gated contrast-enhanced (CE-) and cardiac- and respiratory-gated (GN-) magnetic resonance angiographies (MRA). METHODS Patients with thoracic aortic disease followed with serial CE-MRA (n = 30) or GN-MRA (n = 15) acquired at least 1 year apart were retrospectively and consecutively identified. Two independent observers measured aortic diameters and growth rates (GR) manually at several thoracic aorta reference levels and with AGM. Agreement between manual and AGM measurements and their inter-observer reproducibility were compared. Reproducibility for aortic diameter and GR maps assessed with AGM was obtained. RESULTS Mean follow-up was 3.8 ± 2.3 years for CE- and 2.7 ± 1.6 years for GN-MRA. AGM was feasible in the 93% of CE-MRA pairs and in the 100% of GN-MRA pairs. Manual and AGM diameters showed excellent agreement and inter-observer reproducibility (ICC>0.9) at all anatomical levels. Agreement between manual and AGM GR was more limited, both in the aortic root by GN-MRA (ICC=0.47) and in the thoracic aorta, where higher accuracy was obtained with GN- than with CE-MRA (ICC=0.55 vs 0.43). The inter-observer reproducibility of GR by AGM was superior compared to manual assessment, both with CE- (thoracic: ICC= 0.91 vs 0.51) and GN-MRA (root: ICC=0.84 vs 0.52; thoracic: ICC=0.93 vs 0.60). AGM-based 3D aortic size and growth maps were highly reproducible (median ICC >0.9 for diameters and >0.80 for GR). CONCLUSION Mapping aortic diameter and growth on MRA via 3D image registration is feasible, accurate and outperforms the current manual clinical standard. This technique could broaden the possibilities of clinical and research evaluation of patients with aortic thoracic diseases.
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Affiliation(s)
| | - Jose F Rodríguez-Palomares
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Gisela Teixidó-Turà
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juan Garrido-Oliver
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alejandro Carrasco-Poves
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | - Aroa Ruiz-Muñoz
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | - Guillem Casas
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Filipa Valente
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Galian-Gay
- CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Ruperto Oliveró
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Hug Cuéllar-Calabria
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Albert Roque
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gemma Burcet
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - José A Barrabés
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ignacio Ferreira-González
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Epidemiología y Salud Pública, CIBERESP, Instituto de Salud Carlos III, Madrid, Spain.
| | - Andrea Guala
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares, CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
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Wang R, Liu X, Yao J, Schoepf UJ, Griffith J, Wang J, Lian J, Jiang K, Song G, Xu L. The feasibility of relaxation-enhanced angiography without contrast and triggering for preprocedural planning of transcatheter aortic valve implantation. Front Cardiovasc Med 2023; 10:1284743. [PMID: 38179508 PMCID: PMC10766106 DOI: 10.3389/fcvm.2023.1284743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024] Open
Abstract
Background Cardiovascular MRI is advantageous in transcatheter aortic valve implantation (TAVI) planning. This study aimed to evaluate the feasibility of comprehensive non-contrast MRI [relaxation-enhanced angiography without contrast and triggering (REACT)] combined with a three-dimensional whole-heart MRI protocol for preprocedural planning of TAVI vs. computed tomography angiography (CTA). Methods Thirty patients with severe aortic stenosis were prospectively enrolled. The anatomical properties of the aortic root anatomy, including the perimeter and area of the virtual aortic valve annulus and coronary heights, were determined from 3D whole-heart MRI and cardiac CTA (CCTA) images, respectively. The diameters of the aorta (thoracic and abdominal aorta) and iliofemoral arteries were measured from REACT and aortic CTA (ACTA) images, respectively. A paired t-test was used to compare these two modalities. Bland-Altman plots were used to assess cardiovascular MRI and CTA measurements. Transcatheter heart valve (THV) sizing was performed based on CCTA measurements and compared with 3D whole-heart MRI measurements. The extent of annular calcification on 3D whole-heart MRI images was evaluated by a four-point grading scale and compared with CCTA data. Results All 30 patients completed CTA and cardiovascular MRI examinations, with the TAVI procedure being administered in 25 patients. The mean acquisition time of the comprehensive MRI protocol was 18 ± 3.2 min. There were no significant differences between ACTA and REACT data in regard to the diameters of aortic and iliofemoral arteries, including the ascending thoracic aorta (37 ± 4.6 mm vs. 37.7 ± 5.2 mm, p = 0.085), descending thoracic aorta (24.3 ± 2.8 mm vs. 24.3 ± 2.8 mm, p = 0.832), abdominal aorta (20.9 ± 2.5 mm vs. 20.8 ± 2.5 mm, p = 0.602), bilateral common iliac arteries (right: 8.36 ± 1.44 mm vs. 8.42 ± 1.27 mm, p = 0.590; left: 8.61 ± 1.71 mm vs. 8.86 ± 1.46 mm, p = 0.050), and bilateral femoral arteries (right: 6.77 ± 1.06 mm vs. 6.87 ± 1.00 mm, p = 0.157; left: 6.75 ± 1.02 mm vs. 6.90 ± 0.80 mm, p = 0.142). Both modalities showed similar aortic valve morphology and semi-quantitative valve calcification (all, p's > 0.05). Overall agreement for implanted THV was found in all 25 (100%) patients assessed with both modalities. Conclusion REACT combined with 3D whole-heart MRI enables reliable measurements of aortic root anatomy, annular calcification, and aorta and iliofemoral access in patients under evaluation for TAVI.
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Affiliation(s)
- Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinmin Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Yao
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - U. Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC, United States
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Joseph Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC, United States
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Jiayang Wang
- Center of Coronary Artery Surgery, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Ke Jiang
- Philips Healthcare, Beijing, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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7
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Gietzen C, Pennig L, von Stein J, Guthoff H, Weiss K, Gertz R, Thürbach I, Bunck AC, Maintz D, Baldus S, Ten Freyhaus H, Hohmann C, von Stein P. Thoracic aorta diameters in Marfan patients: Intraindividual comparison of 3D modified relaxation-enhanced angiography without contrast and triggering (REACT) with transthoracic echocardiography. Int J Cardiol 2023; 390:131203. [PMID: 37480997 DOI: 10.1016/j.ijcard.2023.131203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE To compare the measurement of aortic diameters using a novel flow-independent MR-Angiography (3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT)) and transthoracic echocardiography (TTE) in Marfan syndrome (MFS) patients. MATERIAL AND METHODS This retrospective, single-center analysis included 46 examinations of 32 MFS patients (mean age 37.5 ± 11.3 years, 17 women, no prior aortic surgery) who received TTE and 3D modified REACT (ECG- and respiratory-triggering, Compressed SENSE factor 9 for acceleration of image acquisition) of the thoracic aorta. Aortic diameters (sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AoA)) were independently measured by two cardiologists in TTE (leading-edge) and two radiologists in modified REACT (inner-edge, using multiplanar reconstruction). Intraclass correlation coefficient, Bland-Altman analyses, and Pearson's correlation (r) were used to assess agreement between observers and methods. RESULTS Interobserver correlation at the SV, STJ, and AoA were excellent for both, TTE (ICC = 0.95-0.98) and modified REACT (ICC = 0.99-1.00). There was no significant difference between TTE and modified REACT for diameters measured at the SV (39.24 ± 3.24 mm vs. 39.63 ± 3.76 mm; p = 0.26; r = 0.78) and the STJ (35.16 ± 4.47 mm vs. 35.37 ± 4.74 mm; p = 0.552; r = 0.87). AoA diameters determined by TTE were larger than in modified REACT (34.29 ± 5.31 mm vs. 30.65 ± 5.64 mm; p < 0.01; r = 0.74). The mean scan time of modified REACT was 05:06 min ± 02:47 min, depending on the patient's breathing frequency and heart rate. CONCLUSIONS Both TTE and modified REACT showed a strong correlation for all aortic levels; however, at the AoA, diameters were larger using TTE, mostly due to the limited field of view of the latter with measurements being closer to the aortic valve. Given the excellent interobserver correlation and the strong agreement with TTE, modified REACT represents an attractive method to depict the thoracic aorta in MFS patients.
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Affiliation(s)
- Carsten Gietzen
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jennifer von Stein
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henning Guthoff
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Roman Gertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Iris Thürbach
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander C Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henrik Ten Freyhaus
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christopher Hohmann
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp von Stein
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Betz LH, Dillman JR, Towbin AJ, Anton CG, Chavhan GB, Crotty EJ, Morin CE, Pace E, Sreedher G, Zhang B, Tkach JA. Respiratory-Triggered Flow-Independent Noncontrast Non-ECG-Gated MRV (REACT) Versus CE-MRV for Central Venous Evaluation in Children and Young Adults: A Six-Reader Study. AJR Am J Roentgenol 2023; 221:240-248. [PMID: 36946900 DOI: 10.2214/ajr.22.28893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND. Contrast-enhanced MRI is commonly used to evaluate thoracic central venous patency in children and young adults. A flow-independent noncontrast non-ECG-gated 3D MRA-MR venography (MRV) technique described in 2019 as "relaxation-enhanced angiography without contrast and triggering (REACT)" may facilitate such evaluation. OBJECTIVE. The purpose of our study was to compare image quality, diagnostic confidence, and interreader agreement between respiratory-triggered REACT and 3D Dixon-based contrast-enhanced MRV (CE-MRV) for evaluating thoracic central venous patency in children and young adults. METHODS. This retrospective study included 42 consecutive children and young adults who underwent MRI of the neck and chest to evaluate central venous patency between August 2019 and January 2021 (median age, 5.2 years; IQR, 1.4-15.1 years; 22 female patients and 20 male patients). Examinations included respiratory-triggered REACT and navigator-gated CE-MRV sequences based on the institution's standard-of-care protocol. Six pediatric radiologists from four different institutions independently reviewed REACT and CE-MRV sequences; they assessed overall image quality (scale, 1-5; 5 = excellent), diagnostic confidence (scale, 1-5; 5 = extremely confident), and presence of clinically relevant artifact(s). Readers classified seven major central vessels as normal or abnormal (e.g., narrowing, thrombosis, or occlusion). Analysis used Wilcoxon signed rank and McNemar tests and Fleiss kappa coefficients. RESULTS. The distribution of overall image quality scores was higher (p = .02) for REACT than for CE-MRV for one reader (both sequences: median score, 5). Image quality scores were not significantly different between the sequences for the remaining five readers (all p > .05). Diagnostic confidence scores and frequency of clinically relevant artifact(s) were not significantly different between sequences for any reader (all p > .05). Interreader agreement for vessel classification as normal or abnormal was similar between sequences for all seven vessels (REACT: κ = 0.37-0.81; CE-MRV: κ = 0.34-0.81). Pooling readers and vessels, 65.4% of vessels were normal by both sequences; 18.7%, abnormal by both sequences; 9.8%, abnormal by REACT only; and 6.1%, abnormal by CE-MRV only. CONCLUSION. Respiratory-triggered REACT, in comparison with CE-MRV, showed no significant difference in image quality (aside from for one of six readers), diagnostic confidence, or frequency of artifact(s), with similar interreader agreement for vessel classification as normal or abnormal. CLINICAL IMPACT. High-resolution 3D MRV performed without IV contrast material can be used to assess central venous patency in children and young adults.
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Affiliation(s)
- Lisa H Betz
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Christopher G Anton
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Eric J Crotty
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Erika Pace
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, England
| | | | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
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Isaak A, Mesropyan N, Hart C, Zhang S, Kravchenko D, Endler C, Katemann C, Weber O, Pieper CC, Kuetting D, Attenberger U, Dabir D, Luetkens JA. Non-contrast free-breathing 3D cardiovascular magnetic resonance angiography using REACT (relaxation-enhanced angiography without contrast) compared to contrast-enhanced steady-state magnetic resonance angiography in complex pediatric congenital heart disease at 3T. J Cardiovasc Magn Reson 2022; 24:55. [PMID: 36384752 PMCID: PMC9670549 DOI: 10.1186/s12968-022-00895-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To evaluate the great vessels in young children with complex congenital heart disease (CHD) using non-contrast cardiovascular magnetic resonance angiography (CMRA) based on three-dimensional relaxation-enhanced angiography without contrast (REACT) in comparison to contrast-enhanced steady-state CMRA. METHODS In this retrospective study from April to July 2021, respiratory- and electrocardiogram-gated native REACT CMRA was compared to contrast-enhanced single-phase steady-state CMRA in children with CHD who underwent CMRA at 3T under deep sedation. Vascular assessment included image quality (1 = non-diagnostic, 5 = excellent), vessel diameter, and diagnostic findings. For statistical analysis, paired t-test, Pearson correlation, Bland-Altman analysis, Wilcoxon test, and intraclass correlation coefficients (ICC) were applied. RESULTS Thirty-six young children with complex CHD (median 4 years, interquartile range, 2-5; 20 males) were included. Native REACT CMRA was obtained successfully in all patients (mean scan time: 4:22 ± 1:44 min). For all vessels assessed, diameters correlated strongly between both methods (Pearson r = 0.99; bias = 0.04 ± 0.61 mm) with high interobserver reproducibility (ICC: 0.99 for both CMRAs). Native REACT CMRA demonstrated comparable overall image quality to contrast-enhanced CMRA (3.9 ± 1.0 vs. 3.8 ± 0.9, P = 0.018). With REACT CMRA, better image quality was obtained at the ascending aorta (4.8 ± 0.5 vs. 4.3 ± 0.8, P < 0.001), coronary roots (e.g., left: 4.1 ± 1.0 vs. 3.3 ± 1.1, P = 0.001), and inferior vena cava (4.6 ± 0.5 vs. 3.2 ± 0.8, P < 0.001). In all patients, additional vascular findings were assessed equally with native REACT CMRA and the contrast-enhanced reference standard (n = 6). CONCLUSION In young children with complex CHD, REACT CMRA can provide gadolinium-free high image quality, accurate vascular measurements, and equivalent diagnostic quality compared to standard contrast-enhanced CMRA.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany.
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Christopher Hart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Shuo Zhang
- Philips GmbH Market DACH, Hamburg, Germany
| | - Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | | | | | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Darius Dabir
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
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10
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Filomena D, Dresselaers T, Bogaert J. Role of Cardiovascular Magnetic Resonance to Assess Cardiovascular Inflammation. Front Cardiovasc Med 2022; 9:877364. [PMID: 35872907 PMCID: PMC9299360 DOI: 10.3389/fcvm.2022.877364] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/30/2022] [Indexed: 01/01/2023] Open
Abstract
Cardiovascular inflammatory diseases still represent a challenge for physicians. Inflammatory cardiomyopathy, pericarditis, and large vessels vasculitis can clinically mimic a wide spectrum of diseases. While the underlying etiologies are varied, the common physio-pathological process is characterized by vasodilation, exudation, leukocytes infiltration, cell damage, and fibrosis. Cardiovascular magnetic resonance (CMR) allows the visualization of some of these diagnostic targets. CMR provides not only morphological and functional assessment but also tissue catheterization revealing edema, hyperemia, tissue injury, and reparative fibrosis through T2 weighted images, early and late gadolinium enhancement, and parametric mapping techniques. Recent developments showed the role of CMR in the identification of ongoing inflammation also in other CV diseases like myocardial infarction, atherosclerosis, arrhythmogenic and hypertrophic cardiomyopathy. Future developments of CMR, aiming at the specific assessment of immune cell infiltration, will give deeper insight into cardiovascular inflammatory diseases.
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Affiliation(s)
- Domenico Filomena
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Dresselaers
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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11
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Hoyer UCI, Lennartz S, Abdullayev N, Fichter F, Jünger ST, Goertz L, Laukamp KR, Gertz RJ, Grunz JP, Hohmann C, Maintz D, Persigehl T, Kabbasch C, Borggrefe J, Weiss K, Pennig L. Imaging of the extracranial internal carotid artery in acute ischemic stroke: assessment of stenosis, plaques, and image quality using relaxation-enhanced angiography without contrast and triggering (REACT). Quant Imaging Med Surg 2022; 12:3640-3654. [PMID: 35782261 PMCID: PMC9246733 DOI: 10.21037/qims-21-1122] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/22/2022] [Indexed: 07/24/2023]
Abstract
BACKGROUND In stroke magnetic resonance imaging (MRI), contrast-enhanced magnetic resonance angiography (CE-MRA) is the clinical standard to depict extracranial arteries but native MRA techniques are of increased interest to facilitate clinical practice. The purpose of this study was to assess the detection of extracranial internal carotid artery (ICA) stenosis and plaques as well as the image quality of cervical carotid arteries between a novel flow-independent relaxation-enhanced angiography without contrast and triggering (REACT) sequence and CE-MRA in acute ischemic stroke (AIS). METHODS In this retrospective, single-center study, 105 consecutive patients (65.27±18.74 years, 63 males) were included, who received a standard stroke protocol at 3T in clinical routine including Compressed SENSE (CS) accelerated (factor 4) 3D isotropic REACT (fixed scan time: 02:46 min) and CS accelerated (factor 6) 3D isotropic CE-MRA. Three radiologists independently assessed scans for the presence of extracranial ICA stenosis and plaques (including hyper-/hypointense signal) with concomitant diagnostic confidence using 3-point scales (3= excellent). Vessel quality, artifacts, and image noise of extracranial carotid arteries were subjectively scored on 5-point scales (5= excellent/none). Wilcoxon tests were used for statistical comparison. RESULTS Considering CE-MRA as the standard of reference, REACT provided a sensitivity of 89.8% and specificity of 95.2% for any and of 93.5% and 95.8% for clinically relevant (≥50%) extracranial ICA stenosis and yielded a to CE-MRA comparable diagnostic confidence [mean ± standard deviation (SD), median (interquartile range): 2.8±0.5, 3 (3-3) vs. 2.7±0.5, 3 (2-3), P=0.03]. Using REACT, readers detected more plaques overall (n=57.3 vs. 47.7, P<0.001) and plaques of hyperintense signal (n=12.3 vs. 5.7, P=0.02) with higher diagnostic confidence [2.8±0.5, 3 (3-3) vs. 2.6±0.7, 3 (2-3), P<0.001] than CE-MRA. After analyzing a total of 1,260 segments, the vessel quality of all segments combined [4.61±0.66 vs. 4.58±0.68, 5 (4-5) vs. 5 (4-5), P=0.0299] and artifacts [4.51±0.70 vs. 4.44±0.73, 5 (4-5) vs. 5 (4-5), P>0.05] were comparable between the sequences with REACT showing a lower image noise [4.43±0.67 vs. 4.25±0.71, 5 (4-5) vs. 4 (4-5), P<0.001]. CONCLUSIONS Without the use of gadolinium-based contrast agents or triggering, REACT provides a high sensitivity and specificity for extracranial ICA stenosis and a potential improved depiction of adjacent plaques while yielding to CE-MRA comparable vessel quality in a large patient cohort with AIS.
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Affiliation(s)
- Ulrike Cornelia Isabel Hoyer
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nuran Abdullayev
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Florian Fichter
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie T. Jünger
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roman Johannes Gertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Christopher Hohmann
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Borggrefe
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | | | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Deep Learning-Based Magnetic Resonance Imaging in Diagnosis and Treatment of Intracranial Aneurysm. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1683475. [PMID: 35734777 PMCID: PMC9208965 DOI: 10.1155/2022/1683475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022]
Abstract
This study was focused on the positioning of the intracranial aneurysm in the magnetic resonance imaging (MRI) images using the deep learning-based U-Net model, to realize the computer-aided diagnosis of the intracranial aneurysm. First, a network was established based on the three-dimensional (3D) U-Net model, and the collected image data were input into the network to realize the automatic location and segmentation of the aneurysm. The 3D convolutional neural network (CNN) network can extract the aneurysm blood vessels to locate and identify the areas of possible aneurysms. Next, 40 patients highly suspected of intracranial aneurysm were selected as research subjects, and they were subjected to magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) examinations. The results showed that based on the U-Net algorithm model, 40 patients' hemangiomas were completely contained in the labeling bounding box, one patient's hemangioma was at the edge of the labeling bounding box, and 4 patients' hemangiomas were outside the labeling box. The final accuracy coefficient was 88.9%, and it was in good agreement with the doctor's manual labelling results. Under the 3D CNN network test, the sensitivity, specificity, and accuracy of DSA for intracranial aneurysm were 91.46%, 86.01%, and 90.2%, respectively; the sensitivity, specificity, and accuracy of MRA for intracranial aneurysm were 95.87%, 100%, and 97.19%, respectively. In conclusion, the 3D CNN can successfully realize the positioning of intracranial aneurysm in MRA images, providing a certain theoretical basis for subsequent imaging diagnosis of aneurysm.
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Isaak A, Luetkens JA, Faron A, Endler C, Mesropyan N, Katemann C, Zhang S, Kupczyk P, Kuetting D, Attenberger U, Dabir D. Free-breathing non-contrast flow-independent cardiovascular magnetic resonance angiography using cardiac gated, magnetization-prepared 3D Dixon method: assessment of thoracic vasculature in congenital heart disease. J Cardiovasc Magn Reson 2021; 23:91. [PMID: 34275486 PMCID: PMC8287681 DOI: 10.1186/s12968-021-00788-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate a non-contrast respiratory- and electrocardiogram-gated 3D cardiovascular magnetic resonance angiography (CMRA) based on magnetization-prepared Dixon method (relaxation-enhanced angiography without contrast and triggering, REACT) for the assessment of the thoracic vasculature in congenital heart disease (CHD) patients. METHODS 70 patients with CHD (mean 28 years, range: 10-65 years) were retrospectively identified in this single-center study. REACT-CMRA was applied with respiratory- and cardiac-gating. Image quality (IQ) of REACT-CMRA was compared to standard non-gated multi-phase first-pass-CMRA and respiratory- and electrocardiogram-gated steady-state-CMRA. IQ of different vessels of interest (ascending aorta, left pulmonary artery, left superior pulmonary vein, right coronary ostium, coronary sinus) was independently assessed by two readers on a five-point Likert scale. Measurements of vessel diameters were performed in predefined anatomic landmarks (ascending aorta, left pulmonary artery, left superior pulmonary vein). Both readers assessed artifacts and vascular abnormalities. Friedman test, chi-squared test, and Bland-Altman method were used for statistical analysis. RESULTS Overall IQ score of REACT-CMRA was higher compared to first-pass-CMRA (3.5 ± 0.4 vs. 2.7 ± 0.4, P < 0.001) and did not differ from steady-state-CMRA (3.5 ± 0.4 vs. 3.5 ± 0.6, P = 0.99). Non-diagnostic IQ of the defined vessels of interest was observed less frequently on REACT-CMRA (1.7 %) compared to steady-state- (4.3 %, P = 0.046) or first-pass-CMRA (20.9 %, P < 0.001). Close agreements in vessel diameter measurements were observed between REACT-CMRA and steady-state-CMRA (e.g. ascending aorta, bias: 0.38 ± 1.0 mm, 95 % limits of agreement (LOA): - 1.62-2.38 mm). REACT-CMRA showed high intra- (bias: 0.04 ± 1.0 mm, 95 % LOA: - 1.9-2.0 mm) and interobserver (bias: 0.20 ± 1.1 mm, 95 % LOA: - 2.0-2.4 mm) agreements regarding vessel diameter measurements. Fat-water separation artifacts were observed in 11/70 (16 %) patients on REACT-CMRA but did not limit diagnostic utility. Six vascular abnormalities were detected on REACT-CMRA that were not seen on standard contrast-enhanced CMRA. CONCLUSIONS Non-contrast-enhanced cardiac-gated REACT-CMRA offers a high diagnostic quality for assessment of the thoracic vasculature in CHD patients.
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Affiliation(s)
- Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany.
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Anton Faron
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Christoph Endler
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | | | | | - Patrick Kupczyk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Darius Dabir
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
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Pennig L, Lennartz S, Wagner A, Sokolowski M, Gajzler M, Ney S, Laukamp KR, Persigehl T, Bunck AC, Maintz D, Weiss K, Naehle CP, Doerner J. Clinical application of free-breathing 3D whole heart late gadolinium enhancement cardiovascular magnetic resonance with high isotropic spatial resolution using Compressed SENSE. J Cardiovasc Magn Reson 2020; 22:89. [PMID: 33327958 PMCID: PMC7745391 DOI: 10.1186/s12968-020-00673-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/15/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) represents the gold standard for assessment of myocardial viability. The purpose of this study was to investigate the clinical potential of Compressed SENSE (factor 5) accelerated free-breathing three-dimensional (3D) whole heart LGE with high isotropic spatial resolution (1.4 mm3 acquired voxel size) compared to standard breath-hold LGE imaging. METHODS This was a retrospective, single-center study of 70 consecutive patients (45.8 ± 18.1 years, 27 females; February-November 2019), who were referred for assessment of left ventricular myocardial viability and received free-breathing and breath-hold LGE sequences at 1.5 T in clinical routine. Two radiologists independently evaluated global and segmental LGE in terms of localization and transmural extent. Readers scored scans regarding image quality (IQ), artifacts, and diagnostic confidence (DC) using 5-point scales (1 non-diagnostic-5 excellent/none). Effects of heart rate and body mass index (BMI) on IQ, artifacts, and DC were evaluated with ordinal logistic regression analysis. RESULTS Global LGE (n = 33) was identical for both techniques. Using free-breathing LGE (average scan time: 04:33 ± 01:17 min), readers detected more hyperenhanced lesions (28.2% vs. 23.5%, P < .05) compared to breath-hold LGE (05:15 ± 01:23 min, P = .0104), pronounced at subepicardial localization and for 1-50% of transmural extent. For free-breathing LGE, readers graded scans with good/excellent IQ in 80.0%, with low-impact/no artifacts in 78.6%, and with good/high DC in 82.1% of cases. Elevated BMI was associated with increased artifacts (P = .0012) and decreased IQ (P = .0237). Increased heart rate negatively influenced artifacts (P = .0013) and DC (P = .0479) whereas IQ (P = .3025) was unimpaired. CONCLUSIONS In a clinical setting, free-breathing Compressed SENSE accelerated 3D high isotropic spatial resolution whole heart LGE provides good to excellent image quality in 80% of scans independent of heart rate while enabling improved depiction of small and particularly non-ischemic hyperenhanced lesions in a shorter scan time than standard breath-hold LGE.
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Affiliation(s)
- Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931, Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Marcel Sokolowski
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Matej Gajzler
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Svenja Ney
- Department III of Internal Medicine, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Department of Radiology, University Hospitals Cleveland Medical Center, 11000 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, 11000 Euclid Ave, Cleveland, OH, 44106, USA
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kilian Weiss
- Philips GmbH, Röntgenstraße 22, 22335, Hamburg, Germany
| | - Claas Philip Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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15
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Pennig L, Kabbasch C, Hoyer UCI, Lennartz S, Zopfs D, Goertz L, Laukamp KR, Wagner A, Grunz JP, Doerner J, Persigehl T, Weiss K, Borggrefe J. Relaxation-Enhanced Angiography Without Contrast and Triggering (REACT) for Fast Imaging of Extracranial Arteries in Acute Ischemic Stroke at 3 T. Clin Neuroradiol 2020; 31:815-826. [PMID: 33026511 PMCID: PMC8463375 DOI: 10.1007/s00062-020-00963-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
Purpose To evaluate a novel flow-independent 3D isotropic REACT sequence compared with CE-MRA for the imaging of extracranial arteries in acute ischemic stroke (AIS). Methods This was a retrospective study of 35 patients who underwent a stroke protocol at 3 T including REACT (fixed scan time: 2:46 min) and CE-MRA of the extracranial arteries. Three radiologists evaluated scans regarding vessel delineation, signal, and contrast and assessed overall image noise and artifacts using 5-point scales (5: excellent delineation/no artifacts). Apparent signal- and contrast-to-noise ratios (aSNR/aCNR) were measured for the common carotid artery (CCA), internal carotid artery (ICA, C1 segment), and vertebral artery (V2 segment). Two radiologists graded the degree of proximal ICA stenosis. Results Compared to REACT, CE-MRA showed better delineation for the CCA and ICA (C1 and C2 segments) (median 5, range 2–5 vs. 4, range 3–5; P < 0.05). For the ICA (C1 and C2 segments), REACT provided a higher signal (5, range 3–5; P < 0.05/4.5, range 3–5; P > 0.05 vs. 4, range 2–5) and contrast (5, range 3–5 vs. 4, range 2–5; P > 0.05) than CE-MRA. The remaining segments of the blood-supplying vessels showed equal medians. There was no significant difference regarding artifacts, whereas REACT provided significantly lower image noise (4, range 3–5 vs. 4 range 2–5; P < 0.05) with a higher aSNR (P < 0.05) and aCNR (P < 0.05) for all vessels combined. For clinically relevant (≥50%) ICA stenosis, REACT achieved a detection sensitivity of 93.75% and a specificity of 100%. Conclusion Given its fast acquisition, comparable image quality to CE-MRA and high sensitivity and specificity for the detection of ICA stenosis, REACT was proven to be a clinically applicable method to assess extracranial arteries in AIS. Electronic supplementary material The online version of this article (10.1007/s00062-020-00963-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Christoph Kabbasch
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ulrike Cornelia Isabel Hoyer
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Harvard Medical School, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Cologne, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Jan Borggrefe
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
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