Postprocessing techniques for time-resolved contrast-enhanced MR angiography

Automatic algorithm for correcting motion artifacts in time-resolved two-dimensional magnetic resoance angiography using convex projections

Time-resolved contrast enhanced magnetic resonance angiography (MRA) may suffer from involuntary patient motion. It is noted that while MR signal change associated with motion is large in magnitude and has smooth phase variation in k-phase, signal change associated with vascular enhancement is small in magnitude and has rapid phase variation in k-space. Based upon this observation, a novel projection onto convex sets (POCS) algorithm is developed as an automatic iterative method to remove motion artifacts. The presented POCS algorithm consists of high-pass phase filtering and convex projections in both k-space and image space. Without input of detailed motion knowledge, motion effects are filtered out, while vasculature information is preserved. The proposed method can be effective for a large class of nonrigid motions, including through-plane motion. The algorithm is stable and converges quickly, usually within five iterations. A double-blind evaluation on a set of clinical MRA cases shows that a completely unsupervised version of the algorithm produces significantly better rank scores (P=0.038) when compared to angiograms produced manually by an experienced radiologist.

La perspective d’une étude dynamique des artères des membres inférieurs en IRM grâce à la séquence ECTRICKS

PURPOSE

This article presents a new MR angiography technique, Elliptic Centric Time Resolved Imaging on Contrast KineticS (ECTRICKS), which allows dynamic evaluation of the lower limb arteries opacification when venous return prevents adequate diagnostic evaluation of calf arteries.

PATIENTS AND METHODS

Comparative examinations could be compared. Additional arteries in 59 patients using a standard MRA technique and the ECTRICKS technique.

RESULTS

A total of 33 examinations could be compared. Additional arteries could be evaluated in 10% of our patient population using the ECTRICKS technique, and in 20% for our diabetic population. Arterial evaluation was better with the ECTRICKS technique in patients with diabetes and venous insufficiency.

CONCLUSION

ECTRICKS is a good complementary sequence for evaluation the calf arteries in patients with diabetes or early venous return.

Comparison of matched-filtered two-dimensional projection and elliptical centric-ordered three-dimensional contrast-enhanced magnetic resonance angiography

PURPOSE

To compare the image quality of matched-filtered two-dimensional projection magnetic resonance angiography (MRA) and elliptical centric-ordered (EC) three-dimensional MRA.

MATERIALS AND METHODS

Signal-to-noise ratios (SNRs) of matched-filtered two-dimensional projection and EC three-dimensional MRA are developed theoretically and compared by clinical studies, in which 10-20 mL of gadolinium (Gd) was injected at 1.5 mL/second. The artery-vein contrast in two-dimensional projection MRA was managed by manually selecting specific templates for the matched filters.

RESULTS

The SNR of matched-filtered two-dimensional projection MRA is superior to that of EC three-dimensional MRA for vessels wider than one pixel due to the integral effect. The artery-vein contrast can be managed flexibly in two-dimensional projection MRA by choosing different templates for the matched filter, while the artery-vein contrast in EC three-dimensional MRA is solely determined by the timing to start the acquisition.

CONCLUSION

Matched-filtered two-dimensional projection MRA provides comparable image quality and is a flexible alternative to EC three-dimensional MRA in applications where contrast timing is difficult and temporal information is of interest.

Adaptive subtraction as an aid in MR-guided placement of catheters and guidewires

PURPOSE

To demonstrate the utility of mask subtraction optimization in magnetic resonance (MR)-guided placement of catheters and guidewires.

MATERIALS AND METHODS

MR-guided positioning of magnetically prepared catheters and guidewires was done by dynamically imaging a single thick slab at two frames per second. Selective visualization of the prepared parts of the devices was achieved by the use of a conventional baseline subtraction technique and by the use of an adaptive subtraction technique. In the latter, the best reference image is automatically selected from a fixed or a sliding subset of hitherto acquired dynamic images. The efficacy of both approaches was compared by tracking experiments in a flow phantom and in the aortoiliac arteries of a pig.

RESULTS

Baseline subtraction produced adequate visualization of paramagnetic markers in the absence of subject motion and for fixed scan conditions. The sensitivity to subject motion and interactive modification of the scan parameters was greatly reduced by using adaptive subtraction. Adaptive subtraction images, other than conventional subtraction images, appeared to be insensitive to slow periodic motion, e.g., respiratory motion, and were only transiently affected by gross subject motion and interactive alterations of the scan parameters.

CONCLUSION

Adaptive subtraction is superior to baseline subtraction for guiding the manipulation of catheters and guidewires in the presence of gross and periodic subject motion and whenever scan parameters are modified in the course of a procedure.

Peripheral MR angiography

Peripheral arterial occlusive disease is a chronic and progressive disease with a reported incidence rate from 4.5% to 8.8% in men over 55 years of age. The diagnosis is usually made clinically, but for treatment planning and control, imaging of the peripheral arteries is required. Since its introduction in 1994, contrast-enhanced MR angiography has demonstrated a high diagnostic confidence and has replaced the invasive intra-arterial DSA, which is still the current gold standard for many different indications. For the peripheral arteries, clinical use of MR angiography was hampered for some years by the unsolved problem of the large imaging volume and the small diameter of the distal arteries. However, since the availability of ultra-fast high-gradient sequences and the possibility of moving-bed imaging, contrast-enhanced MR angiography, over the last few years, has shown its enormous potential and high accuracy in the diagnosis and follow-up of patients suffering from peripheral arterial occlusive disease. Exciting innovations in hardware and software allows very fast, very accurate, and very robust noninvasive imaging of the peripheral arteries, and both treatment planning as well as follow-up can be performed using contrast-enhanced MR angiography. The following review introduces the basic concepts of peripheral MR angiography--focusing on contrast enhanced imaging--and presents the different techniques as well as some potential limitations and how they could be solved. Finally, this article provides a look into the already-begun future of peripheral contrast-enhanced MR angiography with hybrid and combination techniques.

Deep venous thrombosis: diagnosis by using venous enhanced subtracted peak arterial MR venography versus conventional venography

PURPOSE

To assess diagnostic accuracy and interobserver variability at venous enhanced subtracted peak arterial (VESPA) magnetic resonance (MR) venography compared with those at conventional venography for the diagnosis of femoral and iliac deep venous thrombosis (DVT).

MATERIALS AND METHODS

A single anteroposterior maximum intensity projection (MIP) venogram of the femoral and iliac veins was constructed by using VESPA MR venography in 55 symptomatic patients suspected of having lower limb DVT. All patients also underwent conventional venography, results of which were used as the standard of reference. VESPA MR venograms were interpreted by two independent reviewers (reviewers A and B) who were unaware of other results. Sensitivity and specificity of VESPA MR venography for the diagnosis of thrombus in the femoral and iliac veins were calculated. Interobserver variability was calculated for these observations by using weighted kappa with equally spaced weights for positive, nondiagnostic, and negative studies. Nondiagnostic studies were reinterpreted separately by reviewer A on the basis of source data.

RESULTS

Sensitivity of VESPA MR venography for the femoral veins (20 of 20) and iliac veins (seven of seven) was 100% for both reviewers. Specificity was 100% (39 of 39 for reviewer A, 40 of 40 for reviewer B) for the iliac veins and 97% (31 of 32) for the femoral veins for both reviewers. Segments in which the VESPA MR venograms were nondiagnostic were excluded from this analysis. Interobserver variability as calculated by using weighted kappa for positive, negative, and nondiagnostic studies was 0.85 for femoral veins and 0.97 for iliac veins. Interpretation of the source data led to correct diagnosis in six of six cases in which the VESPA MR venograms were nondiagnostic.

CONCLUSION

VESPA MR venography yielded MIP venograms that were highly accurate for the diagnosis of DVT in femoral and iliac veins. Interpretation of the studies was also highly reproducible.