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Zanardo M, Sardanelli F, Rainford L, Monti CB, Murray JG, Secchi F, Cradock A. Technique and protocols for cardiothoracic time-resolved contrast-enhanced magnetic resonance angiography sequences: a systematic review. Clin Radiol 2020; 76:156.e9-156.e18. [PMID: 33008622 DOI: 10.1016/j.crad.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022]
Abstract
AIM To review contrast medium administration protocols used for cardiothoracic applications of time-resolved, contrast-enhanced magnetic resonance angiography (MRA) sequences. MATERIALS AND METHODS A systematic search of the literature (Medline/EMBASE) was performed to identify articles utilising time-resolved MRA sequences, focusing on type of sequence, adopted technical parameters, contrast agent (CA) issues, and acquisition workflow. Study design, year of publication, population, magnetic field strength, type, dose, and injection parameters of CA, as well as technical parameters of time-resolved MRA sequences were extracted. RESULTS Of 117 retrieved articles, 16 matched the inclusion criteria. The study design was prospective in 9/16 (56%) articles, and study population ranged from 5 to 185 patients, for a total of 506 patients who underwent cardiothoracic time-resolved MRA. Magnetic field strength was 1.5 T in 13/16 (81%), and 3 T in 3/16 (19%) articles. The administered CA was gadobutrol (Gadovist) in 6/16 (37%) articles, gadopentetate dimeglumine (Magnevist) in 5/16 (31%), gadobenate dimeglumine (MultiHance) in 2/16 (13%), gadodiamide (Omniscan) in 2/16 (13%), gadofosveset trisodium (Ablavar, previously Vasovist) in 1/16 (6%). CA showed highly variable doses among studies: fixed amount or based on patient body weight (0.02-0.2 mmol/kg) and was injected with a flow rate ranging 1-5 ml/s. Sequences were TWIST in 13/16 (81%), TRICKS in 2/16 (13%), and CENTRA 1/16 articles (6%). CONCLUSION Time-resolved MRA sequences were adopted in different clinical settings with a large spectrum of technical approaches, mostly in association with different CA dose, type, and injection method. Further studies in relation to specific clinical indications are warranted to provide a common standardised acquisition protocol.
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Affiliation(s)
- M Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy.
| | - F Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - L Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - C B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - J G Murray
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - F Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - A Cradock
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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Three-Dimensional Free-Breathing Whole-Heart Coronary Magnetic Resonance Angiography at 1.5 T: Gadobutrol-Enhanced Gradient-Echo Acquisition Sequence Versus Non-Contrast-Enhanced Steady-State Free Precession Sequence. J Comput Assist Tomogr 2019; 43:919-925. [PMID: 31738205 DOI: 10.1097/rct.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to compare gadobutrol-enhanced gradient-echo sequence (GRE) acquisition with T2-prepared non-contrast-enhanced steady-state free precession (SSFP) in coronary magnetic resonance angiography at 1.5 T. METHODS Twenty-one subjects successfully completed GRE and SSFP acquisition. Signal-to-noise ratio (SNR), contrast-to-noise ratio, image quality, sharpness, visibility, length, and lumen diameter of vessels were analyzed by 2 experienced radiologists. RESULTS The SNR at whole left circumflex artery, left main artery, and proximal left descending artery (LAD) was significantly higher in SSFP acquisition (P < 0.05). The SNR of distal LAD was slightly higher in GRE acquisition (P < 0.05). The contrast-to-noise ratio at distal LAD, proximal and distal RCA were significantly higher with GRE acquisition (P < 0.05). CONCLUSIONS Double-dose gadobutrol-enhanced GRE and unenhanced SSFP coronary magnetic resonance angiography at 1.5 T have their own characteristics, and the combined use of the 2 methods may be taken into consideration.
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Burkhardt BEU, Brown NK, Carberry JE, Velasco Forte MN, Byrne N, Greil G, Hussain T, Tandon A. Creating three dimensional models of the right ventricular outflow tract: influence of contrast, sequence, operator, and threshold. Int J Cardiovasc Imaging 2019; 35:2067-2076. [PMID: 31203535 DOI: 10.1007/s10554-019-01646-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/07/2019] [Indexed: 11/29/2022]
Abstract
The use of 3D printed models of the right ventricular outflow tract (RVOT) for surgical and interventional planning is growing and often requires image segmentation of cardiac magnetic resonance (CMR) images. Segmentation results may vary based on contrast, image sequence, signal threshold chosen by the operator, and manual post-processing. The purpose of this study was to determine potential biases and post-processing errors in image segmentation to enable informed decisions. Models of the RVOT and pulmonary arteries from twelve patients who had contrast enhanced CMR angiography with gadopentetate dimeglumine (GPD), gadofosveset trisodium (GFT), and a post-GFT inversion-recovery (IR) whole heart sequence were segmented, trimmed, and aligned by three operators. Geometric agreement and minimal RVOT diameters were compared between sequences and operators. To determine the contribution of threshold, interoperator variability was compared between models created by the same two operators using the same versus different thresholds. Geometric agreement by Dice between objects was high (intraoperator: 0.89-0.95; interoperator: 0.95-0.97), without differences between sequences. Minimal RVOT diameters differed on average by - 1.9 to - 1.3 mm (intraoperator) and by 0.4 to 1.4 mm (interoperator). The contribution of threshold to interoperator geometric agreement was not significant (same threshold: 0.96 ± 0.06, different threshold: 0.93 ± 0.05; p = 0.181), but minimal RVOT diameters were more variable with different versus constant thresholds (- 9.12% vs. 2.42%; p < 0.05). Thresholding does not significantly change interoperator variability for geometric agreement, but does for minimal RVOT diameter. Minimal RVOT diameters showed clinically relevant variation within and between operators.
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Affiliation(s)
- Barbara E U Burkhardt
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Pediatric Cardiology, Department of Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland.
| | - Nicholas K Brown
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jaclyn E Carberry
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | | | - Nicholas Byrne
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Gerald Greil
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tarique Hussain
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Animesh Tandon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Abstract
While imaging of the central venous system has traditionally been performed with conventional venography, MR venography (MRV) has emerged as an important modality as techniques and validation studies have evolved over time. While magnetic resonance angiography has a very robust representation in the literature, the proportion representing MRV is relatively sparse. The purpose of this article is to review the indications, techniques, and dedicated studies validating MRV of the central veins of the thorax.
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A non-invasive magnetic resonance imaging approach for assessment of real-time microcirculation dynamics. Sci Rep 2017; 7:7468. [PMID: 28784990 PMCID: PMC5547069 DOI: 10.1038/s41598-017-06983-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/21/2017] [Indexed: 11/17/2022] Open
Abstract
We present a novel, non-invasive magnetic resonance imaging (MRI) technique to assess real-time dynamic vasomodulation of the microvascular bed. Unlike existing perfusion imaging techniques, our method is sensitive only to blood volume and not flow velocity. Using graded gas challenges and a long-life, blood-pool T1-reducing agent gadofosveset, we can sensitively assess microvascular volume response in the liver, kidney cortex, and paraspinal muscle to vasoactive stimuli (i.e. hypercapnia, hypoxia, and hypercapnic hypoxia). Healthy adult rats were imaged on a 3 Tesla scanner and cycled through 10-minute gas intervals to elicit vasoconstriction followed by vasodilatation. Quantitative T1 relaxation time mapping was performed dynamically; heart rate and blood oxygen saturation were continuously monitored. Laser Doppler perfusion measurements confirmed MRI findings: dynamic changes in T1 corresponded with perfusion changes to graded gas challenges. Our new technique uncovered differential microvascular response to gas stimuli in different organs: for example, mild hypercapnia vasodilates the kidney cortex but constricts muscle vasculature. Finally, we present a gas challenge protocol that produces a consistent vasoactive response and can be used to assess vasomodulatory capacity. Our imaging approach to monitor real-time vasomodulation may be extended to other imaging modalities and is valuable for investigating diseases where microvascular health is compromised.
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Oliveira IS, Hedgire SS, Li W, Ganguli S, Prabhakar AM. Blood pool contrast agents for venous magnetic resonance imaging. Cardiovasc Diagn Ther 2016; 6:508-518. [PMID: 28123972 DOI: 10.21037/cdt.2016.12.05] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Imaging of the venous system plays a vital role in the diagnosis and management of a wide range of clinically significant disorders. There have been great advances in venous imaging techniques, culminating in the use of magnetic resonance venography (MRV). Although MRV has distinct advantages in anatomic and quantitative cross sectional imaging without ionizing radiation, there are well-known challenges in acquisition timing and contrast administration in patients with renal impairment. The latest advancement involves the addition of new contrast media agents, which have emerged as valuable alternatives in these difficult scenarios. In this review, we will focus on a group of specific contrast agents called blood pool agents and discuss their salient features and clinical applications.
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Affiliation(s)
- Irai S Oliveira
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandeep S Hedgire
- Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Weier Li
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Suvranu Ganguli
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand M Prabhakar
- Department of Radiology, Division of Cardiovascular Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Schnell S, Smith DA, Barker AJ, Entezari P, Honarmand AR, Carr ML, Malaisrie SC, McCarthy PM, Collins J, Carr JC, Markl M. Altered aortic shape in bicuspid aortic valve relatives influences blood flow patterns. Eur Heart J Cardiovasc Imaging 2016; 17:1239-1247. [PMID: 27461208 DOI: 10.1093/ehjci/jew149] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/23/2016] [Indexed: 12/25/2022] Open
Abstract
AIMS Bicuspid aortic valve (BAV) is known to exhibit familial inheritance and is associated with aortopathy and altered aortic haemodynamics. However, it remains unclear whether BAV-related aortopathy can be inherited independently of valve morphology. METHODS AND RESULTS Four-dimensional flow magnetic resonance imaging for the in vivo assessment of thoracic aortic 3D blood flow was performed in 24 BAV relatives with trileaflet aortic valves (age = 40 ± 14 years) and 15 healthy controls (age = 37 ± 10 years). Data analysis included aortic dimensions, shape (round/gothic/cubic), and 3D blood flow characteristics (semi-quantitative vortex/helix grading and peak velocities). Cubic and gothic aortic shapes were markedly more prevalent in BAV relatives compared with controls (38 vs. 7%). Ascending aorta (AAo) vortex flow in BAV relatives was significantly increased compared with controls (grading = 1.5 ± 1.0 vs. 0.6 ± 0.9, P = 0.015). Aortic haemodynamics were influenced by aortic shape: peak velocities were reduced for gothic aortas vs. round aortas (P = 0.003); vortex flow was increased for cubic aortas in the AAo (P < 0.001) and aortic arch (P = 0.004); vortex and helix flows were elevated for gothic aortas in the AAo and descending aorta (P = 0.003, P = 0.029). Logistic regression demonstrated significant associations of shape with severity of vortex flow in AAo (P < 0.001) and aortic arch (P = 0.016) in BAV relatives. CONCLUSION BAV relatives expressed altered aortic shape and increased vortex flow despite the absence of valvular disease or aortic dilatation. These data suggest a heritable component of BAV-related aortopathy affecting aortic shape and aberrant blood flow, independent of valve morphology.
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Affiliation(s)
- Susanne Schnell
- Department of Radiology, Northwestern University, 737 N. Michigan Avenue, Suite 1600, Chicago, IL 60611, USA
| | - Danielle A Smith
- Division of Cardiac Surgery, Northwestern University, 201 E. Huron Street, Galter 11-140, Chicago, IL 60611, USA
| | - Alex J Barker
- Department of Radiology, Northwestern University, 737 N. Michigan Avenue, Suite 1600, Chicago, IL 60611, USA
| | - Pegah Entezari
- Department of Radiology, Northwestern University, 737 N. Michigan Avenue, Suite 1600, Chicago, IL 60611, USA
| | - Amir R Honarmand
- Department of Radiology, Northwestern University, 737 N. Michigan Avenue, Suite 1600, Chicago, IL 60611, USA
| | - Maria L Carr
- Department of Radiology, Northwestern University, 737 N. Michigan Avenue, Suite 1600, Chicago, IL 60611, USA
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University, 201 E. Huron Street, Galter 11-140, Chicago, IL 60611, USA
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Northwestern University, 201 E. Huron Street, Galter 11-140, Chicago, IL 60611, USA
| | - Jeremy Collins
- Department of Radiology, Northwestern University, 737 N. Michigan Avenue, Suite 1600, Chicago, IL 60611, USA
| | - James C Carr
- Department of Radiology, Northwestern University, 737 N. Michigan Avenue, Suite 1600, Chicago, IL 60611, USA
| | - Michael Markl
- Department of Radiology, Northwestern University, 737 N. Michigan Avenue, Suite 1600, Chicago, IL 60611, USA.,Department Biomedical Engineering, McCormick School of Engineering, Northwestern University, 2145 Sheridan Road, Evanston, IL 60208, USA
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Part 2 - Coronary angiography with gadofosveset trisodium: a prospective intra-subject comparison for dose optimization for 100 % efficiency imaging. BMC Cardiovasc Disord 2016; 16:58. [PMID: 27004532 PMCID: PMC4804531 DOI: 10.1186/s12872-015-0152-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Three tesla (3T) coronary magnetic resonance angiography (MRA) may be optimized using gadolinium-based contrast agents (GBCA) such as gadofosveset trisodium. The goal of this study was to evaluate if there is a qualitative or quantitative improvement in the coronary arteries with variation in contrast dose. Methods Twenty-eight healthy volunteers were prospectively recruited for coronary MRA at 3T using a steady state injection technique for 3D radial whole-heart image acquisition with retrospective respiratory self-gating (ClinicalTrials.gov identifier: NCT01853592). Nineteen volunteers completed both single- and double-dose imaging instances (0.03 and 0.06 mmol/kg, respectively). Intra-individual comparison of image quality was assessed by measurement of apparent signal/contrast-to-noise ratio (aSNR/aCNR) and subjective evaluation of image quality by 2 independent reviewers. Results The average duration of coronary MRA acquisition was 7.2 ± 1.2 min. There was significantly higher (60 %, p < 0.001) aSNR of the aorta and right/left ventricle for the double dose compared to single dose injection scheme and aSNR of the coronary arteries increased by 70 % (p < 0.001) for the double dose injection. aCNR increased by +55 % and +60 % in the ventricles and coronary arteries, respectively (p < 0.001). Overall segmental artery visualization for single dose was possible 47 % of the time, which improved to 60 % with double dose (p = 0.019), predominantly driven by improvements in more distal segment visualization (+40 % improvement in mid arterial segments, p = 0.013). Conclusions Gadofosveset trisodium dose of 0.06 mmol/kg significantly quantitatively and qualitatively improves the coronary artery image quality compared to 0.03 mmol/kg at 3T for moderate duration (6–8 min) steady state contrast enhanced coronary MRA.
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Dose Reduction in Contrast-Enhanced Cervical MR Angiography: Field Strength Dependency of Vascular Signal Intensity, Contrast Administration, and Arteriographic Quality. AJR Am J Roentgenol 2015; 204:W701-6. [DOI: 10.2214/ajr.14.13435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Jah-Kabba AMBM, Kukuk GM, Hadizadeh DR, Träber F, Koscielny A, Kabba MS, Verrel F, Schild HH, Willinek WA. Mapping of autogenous saphenous veins as an imaging adjunct to peripheral MR angiography in patients with peripheral arterial occlusive disease and peripheral bypass grafting: prospective comparison with ultrasound and intraoperative findings. PLoS One 2014; 9:e112340. [PMID: 25405867 PMCID: PMC4236072 DOI: 10.1371/journal.pone.0112340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 10/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mapping of the great saphenous vein is very important for planning of peripheral and coronary bypass surgery. This study investigated mapping of the great saphenous vein as an adjunct to peripheral MR angiography using a blood pool contrast agent in patients who were referred for evaluation of peripheral arterial occlusive disease and bypass surgery. METHODS 38 patients with peripheral arterial occlusive disease (21 men; mean age: 71 years, range, 44-88 years) underwent peripheral MR angiography using the blood pool contrast agent Gadofosveset trisodium. Apart from primary arterial assessment images were evaluated in order to determine great saphenous vein diameters at three levels: below the saphenofemoral junction, mid thigh and 10 cm above the knee joint (usability: diameter range: >3 and <10 mm at one level and >3.5 and <10 mm at a neighboring level). Duplex ultrasound was performed by an independent examiner providing diameter measurements at the same levels. Additionally, vessel usability was determined intraoperatively by the vascular surgeon during subsequent bypass surgery. RESULTS Mean venous diameters for MR angiography/duplex ultrasound were 5.4±2.6/5.5±2.8 mm (level 1), 4.7±2.7/4.6±2.9 mm (level 2) and 4.4±2.2/4.5±2.3 mm (level 3), respectively, without significant differences between the modalities (P = 0.207/0.806/0.518). Subsequent surgery was performed in 27/38 patients. A suitable saphenous vein was diagnosed in 25 and non-usability was diagnosed in 2 of the 27 patients based on MR angiography/duplex ultrasound, respectively. Usability was confirmed by intraoperative assessment in all of the 24 patients that received a venous bypass graft in subsequent bypass surgery. In 1 case, in which the great saphenous vein was assessed as useable by both MR angiography and duplex ultrasound, it was not used during subsequent bypass surgery due to the patients clinical condition and comorbidities. CONCLUSION Simultaneous mapping of the great saphenous vein as an imaging adjunct to peripheral MR angiography with a blood pool contrast agent is an alternative to additive duplex ultrasound in patients undergoing subsequent peripheral bypass grafting.
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A comparison between gadofosveset trisodium and gadobenate dimeglumine for steady state MRA of the thoracic vasculature. BIOMED RESEARCH INTERNATIONAL 2014; 2014:625614. [PMID: 25061611 PMCID: PMC4100356 DOI: 10.1155/2014/625614] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/07/2014] [Accepted: 05/15/2014] [Indexed: 11/18/2022]
Abstract
Purpose. Retrospective comparison between gadofosveset trisodium and gadobenate dimeglumine steady state magnetic resonance angiography (SS-MRA) of the thoracic vasculature at 1.5T using signal-to-noise ratio (SNR) and vessel edge sharpness (ES) as markers of image quality. Materials and Methods. IRB approval was obtained. Twenty separate patients each underwent SS-MRA using high-resolution 3D ECG-triggered coronal IR-TFE at 1.5T approximately 3-4 minutes following 10 or 15 mL gadofosveset or 20 mL gadobenate. ROIs were placed in the right atrium, left ventricle, left atrium, ascending aorta, descending aorta, and right pulmonary artery to estimate SNR. Vessel ES was estimated as 20–80% rise distances from line intensity profiles in the left pulmonary vein, ascending aorta, and descending aorta. Data were analyzed using nonpaired Student's t-test (threshold for significance set at P < 0.05). Results. There was no significant difference in mean SNR for the gadofosveset or gadobenate groups (P values: 0.14 to 0.85). There was no significant difference in mean vessel ES for gadofosveset and gadobenate groups (P values: 0.17 to 0.78). Conclusion. High quality thoracic SS-MRA can be achieved with gadobenate dimeglumine, similar to that achieved with the blood pool agent gadofosveset trisodium provided that imaging is initiated quickly (3-4 min) after contrast injection.
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Jang J, Schmitt P, Kim BY, Choi HS, Jung SL, Ahn KJ, Kim I, Paek M, Kim BS. Non-contrast-enhanced 4D MR angiography with STAR spin labeling and variable flip angle sampling: a feasibility study for the assessment of Dural Arteriovenous Fistula. Neuroradiology 2014; 56:305-14. [PMID: 24526141 DOI: 10.1007/s00234-014-1336-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study aimed to evaluate the feasibility of non-contrast-enhanced 4D magnetic resonance angiography (NCE 4D MRA) with signal targeting with alternative radiofrequency (STAR) spin labeling and variable flip angle (VFA) sampling in the assessment of dural arteriovenous fistula (DAVF) in the transverse sinus. METHODS Nine patients underwent NCE 4D MRA for the evaluation of DAVF in the transverse sinus at 3 T. One patient was examined twice, once before and once after the interventional treatment. All patients also underwent digital subtraction angiography (DSA) and/or contrast-enhanced magnetic resonance angiography (CEMRA). For the acquisition of NCE 4D MRA, a STAR spin tagging method was used, and a VFA sampling was applied in the data readout module instead of a constant flip angle. Two readers evaluated the NCE 4D MRA data for the diagnosis of DAVF and its type with consensus. The results were compared with those from DSA and/or CEMRA. RESULTS All patients underwent NCE 4D MRA without any difficulty. Among seven patients with patent DAVFs, all cases showed an early visualization of the transverse sinus on NCE 4D MRA. Except for one case, the type of DAVF of NCE 4D MRA was agreed with that of reference standard study. Cortical venous reflux (CVR) was demonstrated in two cases out of three patients with CVR. CONCLUSION NCE 4D MRA with STAR tagging and VFA sampling is technically and clinically feasible and represents a promising technique for assessment of DAVF in the transverse sinus. Further technical developments should aim at improvements of spatial and temporal coverage.
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Affiliation(s)
- Jinhee Jang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
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Dehkharghani S, Kang J, Saindane AM. Improved quality and diagnostic confidence achieved by use of dose-reduced gadolinium blood-pool agents for time-resolved intracranial MR angiography. AJNR Am J Neuroradiol 2013; 35:450-6. [PMID: 23969342 DOI: 10.3174/ajnr.a3693] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Time-resolved MRA with the use of bolus injection of paramagnetic agents has proved valuable in neurovascular imaging. Standard contrast agents have limited blood-pool residence times, motivating the development of highly protein-bound blood-pool agents with greater relaxivity and longer intravascular residence, affording improved image quality at lesser doses. This study represents the first comparison of blood-pool agents to standard agents in time-resolved cerebral MRA. MATERIALS AND METHODS One hundred datasets were acquired at 1.5 T by use of a standardized, time-resolved MRA protocol. Patients received either unit dosing of a standard extracellular agent at 0.1 mmol/kg or a blood-pool agent at 0.03 mmol/kg. Peak arterial and venous enhancement phases were identified and subsequently scored qualitatively by use of a 4-point Likert scale, with attention to 6 vascular segments: 1) intracranial ICA; 2) MCA M1; 3) MCA M2; 4) MCA M3; 5) deep cerebral veins; and 6) dural venous sinuses. RESULTS Fifty MR angiographies were acquired with each agent. No significant differences were found between agents in generation of uncontaminated arteriograms. Blood-pool agents, at 67% dose reduction, were of significantly greater quality across most vascular segments, including ICA (P = .019), M2 (P = .003), and M3 (P < .01). Superiority in the M1 segment approached significance (P = .059). Significantly better venographic quality was noted for deep venous structures (P = .016) with the use of blood-pool agents. CONCLUSIONS Blood-pool agents provide superior demonstration of most intracranial vessels in time-resolved MRA compared with standard agents, at reduced doses. The greater relaxation enhancement and more favorable dosing profile make blood-pool agents superior to standard agents for use in cerebral time-resolved MRA.
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Affiliation(s)
- S Dehkharghani
- From Neuroradiology Division, Department of Radiology and Imaging Sciences (S.D., A.M.S.), Emory University Hospital, Atlanta, Georgia
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Raman FS, Nacif MS, Cater G, Gai N, Jones J, Li D, Sibley CT, Liu S, Bluemke DA. 3.0-T whole-heart coronary magnetic resonance angiography: comparison of gadobenate dimeglumine and gadofosveset trisodium. Int J Cardiovasc Imaging 2013; 29:1085-94. [PMID: 23515949 PMCID: PMC3702681 DOI: 10.1007/s10554-013-0192-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 01/30/2013] [Indexed: 10/27/2022]
Abstract
Gadolinium enhanced coronary magnetic resonance angiography (MRA) at 3 T appears to be superior to non-contrast methods. Gadofosveset is an intravascular contrast agent that may be well suited to this application. The purpose of this study was to perform an intra-individual comparison of gadofosveset and gadobenate for coronary MRA at 3 T. In this prospective randomized study, 22 study subjects [8 (36%) male; 27.9 ± 6 years; BMI = 22.8 ± 2 kg/m(2)] underwent two studies using a contrast-enhanced inversion recovery three-dimensional fast low angle shot MRA at 3 T. The order of contrast agent administration was varied randomly, separated by an average of 30 ± 5 days, using either gadobenate dimeglumine (Gd-BOPTA; Bracco, 0.1 mmol/Kg) or gadofosveset trisodium (MS-325; Lantheus Med, 0.03 mmol/Kg). Acquisition time, signal-to-noise ratio (SNR) of coronary vessels and contrast-to-noise ratio (CNR) were evaluated. Of 308 coronary arteries and veins segment analyzed, overall SNR of coronary arteries and veins segments were not different for the two contrast agents (132 ± 79 for gadofosveset vs. 135 ± 78 for gadobenate, p = 0.69). Coronary artery CNR was greater for gadofosveset in comparison to gadobenate (73.5 ± 46.9 vs. 59.3 ± 75.7 respectively, p = 0.03). Gadofosveset-enhanced MRA images displayed better image quality than gadobenate-enhanced MRA images (2.77 ± 0.61 for gadofosveset vs. 2.11 ± 0.51, p < .001). Inter- and intra-reader variability was excellent (ICC > 0.90) for both contrast agents. Gadofosveset trisodium appears to show slightly better performance for coronary MRA at 3 T compared to gadobenate.
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Affiliation(s)
- Fabio S Raman
- Radiology and Imaging Sciences, National Institutes of Health of Clinical Center, 10 Center Drive, Building 10, Rm 1C355, Bethesda, MD 20892-1182, USA
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