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Konta N, Shibukawa S, Horie T, Niwa T, Obara M, Okazaki T, Kawamura Y, Miyati T. Turbo spin-echo-based enhanced acceleration-selective arterial spin labeling without electrocardiography or peripheral pulse unit triggering and contrast enhancement for lower extremity MRA. Magn Reson Imaging 2024; 110:43-50. [PMID: 38604346 DOI: 10.1016/j.mri.2024.04.008] [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: 01/23/2024] [Revised: 03/28/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Lower extremity magnetic resonance angiography (MRA) without electrocardiography (ECG) or peripheral pulse unit (PPU) triggering and contrast enhancement is beneficial for diagnosing peripheral arterial disease (PAD) while avoiding synchronization failure and nephrogenic systemic fibrosis. This study aimed to compare the diagnostic performance of turbo spin-echo-based enhanced acceleration-selective arterial spin labeling (eAccASL) (TSE-Acc) of the lower extremities with that of turbo field-echo-based eAccASL (TFE-Acc) and triggered angiography non-contrast enhanced (TRANCE). METHODS Nine healthy volunteers and a patient with PAD were examined on a 3.0 Tesla magnetic resonance imaging (MRI) system. The artery-to-muscle signal intensity ratio (SIR) and contrast-to-noise ratio (CNR) were calculated. The arterial visibility (1: poor, 4: excellent) and artifact contamination (1: severe, 4: no) were independently assessed by two radiologists. Phase-contrast MRI and digital subtraction angiography were referenced in a patient with PAD. Friedman's test and a post-hoc test according to the Bonferroni-adjusted Wilcoxon signed-rank test were used for the SIR, CNR, and visual assessment. p < 0.05 was considered statistically significant. RESULTS No significant differences in nearly all the SIRs were observed among the three MRA methods. Higher CNRs were observed with TSE-Acc than those with TFE-Acc (anterior tibial artery, p = 0.014; peroneal artery, p = 0.029; and posterior tibial artery, p = 0.014) in distal arterial segments; however, no significant differences were observed upon comparison with TRANCE (all p > 0.05). The arterial visibility scores exhibited similar trends as the CNRs. The artifact contamination scores with TSE-Acc were significantly lower (but within an acceptable level) compared to those with TFE-Acc. In the patient with PAD, the sluggish peripheral arteries were better visualized using TSE-Acc than those using TFE-Acc, and the collateral and stenosis arteries were better visualized using TSE-Acc than those using TRANCE. CONCLUSION Peripheral arterial visualization was better with TSE-Acc than that with TFE-Acc in lower extremity MRA without ECG or PPU triggering and contrast enhancement, which was comparable with TRANCE as the reference standard. Furthermore, TSE-Acc may propose satisfactory diagnostic performance for diagnosing PAD in patients with arrhythmia and chronic kidney disease.
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Affiliation(s)
- Natsuo Konta
- Department of Radiology, Tokai University Hospital, Kanagawa, Japan; Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan.
| | - Shuhei Shibukawa
- Department of Radiological Technology, Juntendo University, Tokyo, Japan
| | - Tomohiko Horie
- Department of Radiology, Tokai University Hospital, Kanagawa, Japan
| | - Tetsu Niwa
- Department of Diagnostic Radiology, Tokai University School of Medicine, Kanagawa, Japan
| | | | - Takashi Okazaki
- Department of Diagnostic Radiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Yui Kawamura
- Department of Diagnostic Radiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Toshiaki Miyati
- Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
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Raczeck P, Fries P, Massmann A, Minko P, Frenzel F, Woerner T, Buecker A, Schneider GK. Diagnostic Performance of a Lower-dose Contrast-Enhanced 4D Dynamic MR Angiography of the Lower Extremities at 3 T Using Multisegmental Time-Resolved Maximum Intensity Projections. J Magn Reson Imaging 2021; 54:763-774. [PMID: 33825259 DOI: 10.1002/jmri.27631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND For peripheral artery disease (PAD), MR angiography (MRA) is a well-established diagnostic modality providing morphologic and dynamic information comparable to digital subtraction angiography (DSA). However, relatively large amounts of contrast agents are necessary to achieve this. PURPOSE To evaluate the diagnostic accuracy of time-resolved 4D MR-angiography with interleaved stochastic trajectories (TWIST-MRA) by using maximum intensity projections (MIPs) of dynamic images acquired with reduced doses of contrast agent. STUDY TYPE Retrospective. POPULATION Forty adult PAD patients yielding 1088 artery segments. FIELD STRENGTH/SEQUENCE A 3.0 T, time-resolved 4D MR-angiography with TWIST-MRA and MIP of dynamic images. ASSESSMENT DSA was available in 14 patients (256 artery segments) and used as reference standard. Three-segmental MIP reconstructions of TWIST-images after administration of 3 mL of gadolinium-based contrast agent (Gadoteridol/Prohance®, 0.5 M) per anatomical level (pelvis, thighs, and lower legs) yielded 256 artery segments for correlation between MRA and DSA. Three independent observers rated image quality (scale: 1 [nondiagnostic] to 4 [excellent]) and the degree of venous overlay (scale: 0 [none] to 2 [significant]) for all segments. Diagnostic accuracy for the detection of >50% stenosis and artery occlusion was calculated for all observers. STATISTICAL TESTS Binary classification test (sensitivity, specificity, positive/negative predictive values, diagnostic accuracy). Intraclass correlation coefficients (ICCs), logistic regression analysis with comparison of areas under the receiver-operating-characteristics (ROC) curves (AUCs) with the DeLong method. Bland-Altman-comparison. RESULTS High diagnostic performance was achieved for the detection of >50% stenosis (sensitivity 92.9% [84.3-99.9% (95%-CI)] and specificity 98.5% [95.7-99.8% (95%-CI)]) and artery occlusion (sensitivity 93.1% [77.2-99.2% (95%-CI)] and specificity 99.1% [96.9-99.9% (95%-CI)]). Inter-reader agreement was excellent with ICC values ranging from 0.95 to 1.0 for >50% artery stenosis and occlusion. Image quality was good to excellent for both readers (3.41 ± 0.72, 3.33 ± 0.65, and 3.38 ± 0.61 [mean ± SD]) with good correlation between observer ratings (ICC 0.71-0.81). No significant venous overlay was observed (0.06 ± 0.24, 0.23 ± 0.43 and 0.11 ± 0.45 [mean ± SD]). DATA CONCLUSION MIPs of dynamic TWIST-MRA offer a promising diagnostic alternative necessitating only reduced amounts (50%) of gadolinium-based contrast agents for the entire runoff vasculature. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Paul Raczeck
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Peter Fries
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Alexander Massmann
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Peter Minko
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Felix Frenzel
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Tobias Woerner
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Arno Buecker
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Guenther K Schneider
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
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Monroe JC, Lin C, Perkins SM, Han Y, Wong BJ, Motaganahalli RL, Roseguini BT. Leg heat therapy improves perceived physical function but does not enhance walking capacity or vascular function in patients with peripheral artery disease. J Appl Physiol (1985) 2020; 129:1279-1289. [PMID: 33002377 DOI: 10.1152/japplphysiol.00277.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A single session of leg heat therapy (HT) has been shown to elicit increases in leg blood flow and reduce blood pressure (BP) and the circulating levels of endothelin-1 (ET-1) in patients with symptomatic peripheral artery disease (PAD). We assessed whether 6 wk of supervised leg HT (3 times/wk) with water-circulating trousers perfused with water at 48°C improved 6-min walk distance in individuals with PAD compared with a sham treatment. Secondary outcomes included the assessment of leg vascular function, BP, quality of life, and serum ET-1 and nitrite plus nitrate (NOx) levels. Of 32 PAD patients randomized, 30 [age: 68 ± 8 yr; ankle-brachial index (ABI): 0.6 ± 0.1] completed the 3- and 6-wk follow-ups. Participants completed 98.7% of the treatment sessions. Compared with the sham treatment, exposure to HT did not improve 6-min walk distance, BP, popliteal artery reactive hyperemia, cutaneous microvascular reactivity, resting ABI, or serum NOx levels. The change from baseline to 6 wk in scores of the physical functioning subscale of the 36-item Short Form Health Survey was significantly higher in the HT group (control -6.9 ± 10 vs. HT 6.8 ± 15; 95% confidence interval: 2.5-24.3, P = 0.017). Similarly, the change in ET-1 levels after 6 wk was different between groups, with the HT group experiencing a 0.4 pg/mL decrease (95% confidence interval: -0.8-0.0, P = 0.03). These preliminary results indicate that leg HT may improve perceived physical function in symptomatic PAD patients. Additional, larger studies are needed to confirm these findings and determine the optimal treatment regimen for symptomatic PAD patients.NEW & NOTEWORTHY This is the first sham-controlled study to investigate the effects of leg heat therapy (HT) on walking performance, vascular function, and quality of life in patients with peripheral artery disease (PAD). Adherence to HT was high, and the treatment was well tolerated. Our findings revealed that HT applied with water-circulating trousers evokes a clinically meaningful increase in perceived physical function and reduces the serum concentration of the potent vasoconstrictor endothelin-1 in patients with PAD.
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Affiliation(s)
- Jacob C Monroe
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
| | - Chen Lin
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Susan M Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Yan Han
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brett J Wong
- Department of Kinesiology and Health, Georgia State University, Atlanta, Georgia
| | - Raghu L Motaganahalli
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Bruno T Roseguini
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana
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Englund EK, Langham MC. Quantitative and Dynamic MRI Measures of Peripheral Vascular Function. Front Physiol 2020; 11:120. [PMID: 32184733 PMCID: PMC7058683 DOI: 10.3389/fphys.2020.00120] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 02/03/2020] [Indexed: 12/31/2022] Open
Abstract
The endothelium regulates and mediates vascular homeostasis, allowing for dynamic changes of blood flow in response to mechanical and chemical stimuli. Endothelial dysfunction underlies many diseases and is purported to be the earliest pathologic change in the progression of atherosclerotic disease. Peripheral vascular function can be interrogated by measuring the response kinetics following induced ischemia or exercise. In the presence of endothelial dysfunction, there is a blunting and delay of the hyperemic response, which can be measured non-invasively using a variety of quantitative magnetic resonance imaging (MRI) methods. In this review, we summarize recent developments in non-contrast, proton MRI for dynamic quantification of blood flow and oxygenation. Methodologic description is provided for: blood oxygenation-level dependent (BOLD) signal that reflect combined effect of blood flow and capillary bed oxygen content; arterial spin labeling (ASL) for quantification of regional perfusion; phase contrast (PC) to quantify arterial flow waveforms and macrovascular blood flow velocity and rate; high-resolution MRI for luminal flow-mediated dilation; and dynamic MR oximetry to quantify oxygen saturation. Overall, results suggest that these dynamic and quantitative MRI methods can detect endothelial dysfunction both in the presence of overt cardiovascular disease (such as in patients with peripheral artery disease), as well as in sub-clinical settings (i.e., in chronic smokers, non-smokers exposed to e-cigarette aerosol, and as a function of age). Thus far, these tools have been relegated to the realm of research, used as biomarkers of disease progression and therapeutic response. With proper validation, MRI-measures of vascular function may ultimately be used to complement the standard clinical workup, providing additional insight into the optimal treatment strategy and evaluation of treatment efficacy.
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Affiliation(s)
- Erin K Englund
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Michael C Langham
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
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Wink C, Bassenge JP, Ferrazzi G, Schaeffter T, Schmitter S. 4D flow imaging with UNFOLD in a reduced FOV. Magn Reson Med 2019; 84:327-338. [PMID: 31873954 DOI: 10.1002/mrm.28120] [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: 07/04/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 11/08/2022]
Abstract
PURPOSE Two-dimensional selective excitation (2DRF) allows shortening 4D flow scan times by reducing the FOV, but the longer 2DRF pulse duration decreases the temporal resolution, yielding underestimated peak flow values. Multiple k-space lines per cardiac phase, nl ≥ 2, are commonly applied in 4D flow MRI to shorten the inherent long scan times. We demonstrate that 2DRF 4D flow with nl ≥ 2 can be easily combined with UNFOLD (UNaliasing by Fourier-encoding the Overlaps using the temporaL Dimension), a technique that allows regaining nominally the temporal resolution of the respective acquisition with nl = 1, to assure peak flow quantification. METHODS Two different 2DRF pulses with spiral k-space trajectories were designed and integrated into a 4D flow sequence. Flow phantom experiments and 7 healthy control 4D flow in vivo measurements, with and without UNFOLD reconstructions, were compared with conventional reconstruction and 1D slab-selective excitation (1DRF) by evaluating time-resolved flow curves, peak flow, peak velocity, blood flow volume per cardiac cycle, and spatial aliasing. RESULTS Applying UNFOLD to 4D flow imaging with 2DRF and reduced FOV increased the quantified in vivo peak flow values significantly by 3.7% ± 2.3% to 5.2% ± 2.4% (P < .05). Accordingly, the peak flow underestimation of 2DRF scans compared with conventional 1DRF scans decreased with UNFOLD. Finally, 2DRF combined with UNFOLD accelerated the 4D flow acquisition 3.5 ± 1.4 fold by reducing the FOV and increasing the effective temporal resolution by 6.7% compared with conventional 1D selective excitation, with 2 k-space lines per cardiac phase. CONCLUSION Two-dimensional selective excitation combined with UNFOLD allows limiting the FOV to shorten 4D flow scan times and compensates for the loss in temporal resolution with 2DRF (Δt = 64.8 ms) compared with 1DRF (Δt = 43.2 ms), yielding an effective resolution of Δteff = 40.5 ms to enhance peak flow quantification.
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Affiliation(s)
- Clarissa Wink
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany.,FG Medizintechnik, Technische Universität Berlin, Berlin, Germany
| | - Jean Pierre Bassenge
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany.,Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Giulio Ferrazzi
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Tobias Schaeffter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany.,FG Medizintechnik, Technische Universität Berlin, Berlin, Germany
| | - Sebastian Schmitter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
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6
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Cooper K, Majdalany BS, Kalva SP, Chandra A, Collins JD, Francois CJ, Ganguli S, Gornik HL, Kendi AT, Khaja MS, Minocha J, Norton PT, Obara P, Reis SP, Sutphin PD, Rybicki FJ. ACR Appropriateness Criteria ® Lower Extremity Arterial Revascularization-Post-Therapy Imaging. J Am Coll Radiol 2019; 15:S104-S115. [PMID: 29724414 DOI: 10.1016/j.jacr.2018.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 02/07/2023]
Abstract
Peripheral arterial disease (PAD) affects millions across the world and in the United States between 9% to 23% of all patients older than 55 years. The refinement of surgical techniques and evolution of endovascular approaches have improved the success rates of revascularization in patients afflicted by lower extremity PAD. However, restenosis or occlusion of previously treated vessels remains a pervasive issue in the postoperative setting. A variety of different imaging options are available to evaluate patients and are reviewed within the context of asymptomatic and symptomatic patients with PAD who have previously undergone endovascular or surgical revascularization. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Kyle Cooper
- Research Author, University of Michigan Health System, Ann Arbor, Michigan
| | - Bill S Majdalany
- Principal Author and Panel Vice-Chair, University of Michigan Health System, Ann Arbor, Michigan.
| | | | - Ankur Chandra
- Scripps Green Hospital, La Jolla, California; Society for Vascular Surgery
| | | | | | | | - Heather L Gornik
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; American College of Cardiology
| | | | | | - Jeet Minocha
- University of California, San Diego, San Diego, California
| | | | - Piotr Obara
- Loyola University Medical Center, Maywood, Illinois
| | | | | | - Frank J Rybicki
- Specialty Chair, Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada
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Whole-Body MR Imaging Including Angiography: Predicting Recurrent Events in Diabetics. Eur Radiol 2015; 26:1420-30. [DOI: 10.1007/s00330-015-3936-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/02/2015] [Accepted: 07/20/2015] [Indexed: 01/15/2023]
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8
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Chakfe N, Ohana M. Commentary on "MRI-derived arterial peak flow in peripheral arterial disease: towards a standardized measurement". Eur J Vasc Endovasc Surg 2014; 48:193. [PMID: 24935914 DOI: 10.1016/j.ejvs.2014.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 05/09/2014] [Indexed: 11/20/2022]
Affiliation(s)
- N Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
| | - M Ohana
- Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
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