1
|
Chen CW, Tseng YH, Kao CC, Ngo YG, Lee CY, Yang TY, Lin YH, Huang YK. Venous Segmental Flow Changes after Superficial Venous Intervention Demonstrating by Quantitative Phase-Contrast Magnetic Resonance Analysis: Preliminary Data from a Longitudinal Cohort Study. J Pers Med 2022; 12:jpm12061000. [PMID: 35743784 PMCID: PMC9224938 DOI: 10.3390/jpm12061000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022] Open
Abstract
The effects of superficial venous intervention on hemodynamics can be quantified using two-dimensional phase-contrast magnetic resonance imaging (2D PC-MRI). Twelve patients received pre- and postintervention 2D PC-MRI analysis using quantitative hemodynamic parameters. Fifteen healthy volunteers served as controls. The 2D PC-MRI results of the target limbs (limbs scheduled for intervention for venous reflux) differed from those of the controls in terms of stroke volume (SV), forward flow volume (FFV), absolute stroke volume (ASV), and mean flux (MF) in all venous segments. The velocity time integral (VTI) and mean velocity (MV) of the popliteal vein (PV) segments were similar between the target limbs and controls preoperatively. After intervention, the target limbs exhibited an increase in VTI and MV in the femoral vein (FV) and PV segments. We compared the target and nontreated limbs of the individual patients preoperatively and postoperatively to minimalize individual bias. All QFlow parameter ratios in the FV segment increased after venous intervention (VTI, p = 0.025; MV, p = 0.024). In the PV segment, FFV and ASV increased significantly (p = 0.035 and 0.024, respectively). After interventions, the volume (FFV and ASV) of the PV segment and the efficiency (VTI and MV) of the FV segment significantly increased.
Collapse
Affiliation(s)
- Chien-Wei Chen
- Department of Diagnostic Radiology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
| | - Yuan-Hsi Tseng
- Department of Obstetrics and Gynecology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Chih-Chen Kao
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Hospital, MOHW, Chiayi 61363, Taiwan
| | - Yeh Giin Ngo
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Department of Obstetrics and Gynecology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Chung-Yuan Lee
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Department of Obstetrics and Gynecology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Teng-Yao Yang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Cardiology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Yu-Hui Lin
- Cardiology, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
| | - Yao-Kuang Huang
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (C.-C.K.); (Y.G.N.); (C.-Y.L.); (T.-Y.Y.)
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Hospital, MOHW, Chiayi 61363, Taiwan
- Correspondence:
| |
Collapse
|
2
|
Lombardi P, Carr JC, Allen BD, Edelman RR. Updates in Magnetic Resonance Venous Imaging. Semin Intervent Radiol 2021; 38:202-208. [PMID: 34108807 DOI: 10.1055/s-0041-1729152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
For years, magnetic resonance angiography (MRA) has been a leading imaging modality in the assessment of venous disease involving the pelvis and lower extremities. Current advancement in noncontrast MRA techniques enables imaging of a larger subset of patients previously excluded due to allergy or renal insufficiency, allowing for preintervention assessment and planning. In this article, the current status of MR venography, with a focus on current advancements, will be presented. Protocols and parameters for MR venographic imaging of the pelvis and lower extremities, including contrast and noncontrast enhanced techniques, will be reviewed based on a recent literature review of applied MR venographic techniques. Finally, several disease-specific entities, including pelvic congestion and compression syndromes, will be discussed with a focus on imaging parameters that may best characterize these disease processes and optimize anatomical planning prior to intervention.
Collapse
Affiliation(s)
- Pamela Lombardi
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - James C Carr
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Bradley D Allen
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, Chicago, Illinois
| |
Collapse
|
3
|
Novel Diagnostic Options without Contrast Media or Radiation: Triggered Angiography Non-Contrast-Enhanced Sequence Magnetic Resonance Imaging in Treating Different Leg Venous Diseases. Diagnostics (Basel) 2020; 10:diagnostics10060355. [PMID: 32485855 PMCID: PMC7344462 DOI: 10.3390/diagnostics10060355] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Venous diseases in the lower extremities long lacked an objective diagnostic tool prior to the advent of the triggered angiography non-contrast-enhanced (TRANCE) technique. METHODS An observational study with retrospective data analysis. MATERIALS Between April 2017 and June 2019, 66 patients were evaluated for venous diseases through TRANCE-magnetic resonance imaging (MRI) and were grouped according to whether they had occlusive venous (OV) disease, a static venous ulcer (SU), or symptomatic varicose veins (VV). The clinical appliance of TRANCE-MRI was analysed by groups. RESULTS In total, 63 patients completed the study. TRANCE-MRI could identify venous thrombosis, including that of the abdominal and pelvic vessels, and it enabled the timely treatment of underlying diseases in patients with OV disease. TRANCE-MRI was statistically compared with the duplex scan, the gold standard to exclude deep vein thrombosis (DVT) in the legs, with regard to their abilities to detect venous thrombosis by using Cohen's kappa coefficient at a compatible value of 0.711. It could provide the occlusion degree of the peripheral artery for treating an SU. Finally, TRANCE-MRI can be used to outline all collateral veins and occult thrombi before treating symptomatic or recurrent VV to ensure a perfect surgical plan and to avoid complications. CONCLUSIONS TRANCE-MRI is an innovative tool in the treatment of versatile venous pathology in the lower extremities and is widely used for vascular diseases in our institution.
Collapse
|
4
|
Ludwig DR, Shetty AS, Broncano J, Bhalla S, Raptis CA. Magnetic Resonance Angiography of the Thoracic Vasculature: Technique and Applications. J Magn Reson Imaging 2020; 52:325-347. [PMID: 32061029 DOI: 10.1002/jmri.27067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance angiography (MRA) is a powerful clinical tool for evaluation of the thoracic vasculature. MRA can be performed on nearly any magnetic resonance imaging (MRI) scanner, and provides images of high diagnostic quality without the use of ionizing radiation. While computed tomographic angiography (CTA) is preferred in the evaluation of hemodynamically unstable patients, MRA represents an important tool for evaluation of the thoracic vasculature in stable patients. Contrast-enhanced MRA is generally performed unless there is a specific contraindication, as it shortens the duration of the exam and provides images of higher diagnostic quality than noncontrast MRA. However, intravenous contrast is often not required to obtain a diagnostic evaluation for most clinical indications. Indeed, a variety of noncontrast MRA techniques are used for thoracic imaging, often in conjunction with contrast-enhanced MRA, each of which has a differing degree of reliance on flowing blood to produce the desired vascular signal. In this article we review contrast-enhanced MRA, with a focus on contrast agents, methods of bolus timing, and considerations in imaging acquisition. Next, we cover the mechanism of contrast, strengths, and weaknesses of various noncontrast MRA techniques. Finally, we present an approach to protocol development and review representative protocols used at our institution for a variety of thoracic applications. Further attention will be devoted to additional techniques employed to address specific clinical questions, such as delayed contrast-enhanced imaging, provocative maneuvers, electrocardiogram and respiratory gating, and phase-contrast imaging. The purpose of this article is to review basic techniques and methodology in thoracic MRA, discuss an approach to protocol development, and illustrate commonly encountered pathology on thoracic MRA examinations. Level of Evidence 5 Technical Efficacy Stage 3.
Collapse
Affiliation(s)
- Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jordi Broncano
- Cardiothoracic Imaging Section, Health Time, Hospital de la Cruz Roja and San Juan de Dios, Cordoba, Spain
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
5
|
Kuo AH, Nagpal P, Ghoshhajra BB, Hedgire SS. Vascular magnetic resonance angiography techniques. Cardiovasc Diagn Ther 2019; 9:S28-S36. [PMID: 31559152 DOI: 10.21037/cdt.2019.06.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Magnetic resonance angiography (MRA) denotes a unique option for the evaluation of peripheral vasculature due to its noninvasive nature, lack of ionizing radiation exposure, potential for non-contrast examination, and ability for generating volumetric representations that showcase vascular pathology. The constant evolution of the available MRA techniques, however, makes understanding and determining an optimal imaging protocol difficult. Here we present a brief overview of the major MRA sequence options, their major weaknesses and strengths, and related imaging considerations. Understanding the technical underpinnings of the various MRA methods helps with recognition of common imaging issues and artifacts and rendering clinically relevant interpretations.
Collapse
Affiliation(s)
- Anderson H Kuo
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Prashant Nagpal
- Department of Radiology, University of Iowa/Carver College of Medicine, Iowa City, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sandeep S Hedgire
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| |
Collapse
|
6
|
|
7
|
Cavallo AU, Koktzoglou I, Edelman RR, Gilkeson R, Mihai G, Shin T, Rajagopalan S. Noncontrast Magnetic Resonance Angiography for the Diagnosis of Peripheral Vascular Disease. Circ Cardiovasc Imaging 2019; 12:e008844. [DOI: 10.1161/circimaging.118.008844] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Armando Ugo Cavallo
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
- Division of Diagnostic and Interventional Radiology, University Hospital Policlinico “Tor Vergata”, Roma, Italy (A.U.C.)
| | - Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL (I.K., R.R.E.)
- University of Chicago Pritzker School of Medicine, IL (I.K.)
| | - Robert R. Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL (I.K., R.R.E.)
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL (R.R.E.)
| | - Robert Gilkeson
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
| | - Georgeta Mihai
- Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA (G.M.)
| | - Taehoon Shin
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, South Korea (T.S.)
| | - Sanjay Rajagopalan
- Departments of Medicine and Radiology, University Hospitals, Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland OH (A.U.C., R.G., T.S., S.R.)
| |
Collapse
|
8
|
Shin T, Qin Q, Park JY, Crawford RS, Rajagopalan S. Identification and reduction of image artifacts in non-contrast-enhanced velocity-selective peripheral angiography at 3T. Magn Reson Med 2016; 76:466-77. [PMID: 26308243 PMCID: PMC4769124 DOI: 10.1002/mrm.25870] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE To identify and reduce image artifacts in non-contrast-enhanced velocity-selective (VS) magnetization-prepared peripheral MR angiography (MRA) at 3T. METHODS To avoid signal loss in the arteries, double and quadruple refocused VS excitation pulse sequences were designed that were robust to a wide range of B0 and B1 offset. To suppress stripe artifact and background signal variation, we successively applied two VS preparations with excitation profiles shifted by half the period of the stripes. VS-MRA using single, double, and quadruple refocused VS preparations was tested in healthy subjects and a patient. RESULTS In the regions of large B0 and B1 offsets, arterial signal loss was yielded by single refocused VS preparation, but was avoided with double or quadruple refocused preparations. Compared with single VS preparation, the two consecutive preparations with shifted excitation profiles substantially reduced the stripe artifact and background signal variation, as demonstrated by increased mean and decreased standard deviation of relative contrast-to-noise ratio. The proposed VS-MRA identified multilevel disease in the femoral arteries of the patient, as validated by digital subtraction angiography. CONCLUSION Two multiple refocused VS magnetization preparations with shifted excitation profiles yield artifact-free peripheral angiograms at 3T. Magn Reson Med 76:466-477, 2016. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Taehoon Shin
- Department of Diagnostic Radiology and Nuclear Medicine, University
of Maryland, Baltimore, Maryland
| | - Qin Qin
- Department of Radiology, Johns Hopkins University, Baltimore,
Maryland
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy
Krieger Institute, Baltimore, Maryland
| | - Jang-Yeon Park
- Center for Neuroscience Imaging Research, Institute for Basic
Science, Suwon, South Korea
- Department of Biomedical Engineering, Sungkyunkwan University,
Suwon, South Korea
| | - Robert S. Crawford
- Division of Vascular and Endovascular Surgery, University of
Maryland, Baltimore, Maryland
| | - Sanjay Rajagopalan
- Division of Cardiovascular Medicine, University of Maryland,
Baltimore, Maryland
| |
Collapse
|
9
|
Zhang N, Fan Z, Luo N, Bi X, Zhao Y, An J, Liu J, Chen Z, Fan Z, Li D. Noncontrast MR angiography (MRA) of infragenual arteries using flow-sensitive dephasing (FSD)-prepared steady-state free precession (SSFP) at 3.0 Tesla: Comparison with contrast-enhanced MRA. J Magn Reson Imaging 2015; 43:364-72. [PMID: 26185106 DOI: 10.1002/jmri.25003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/26/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To evaluate the feasibility and diagnostic performance of flow-sensitive dephasing (FSD)-prepared steady-state free precession (SSFP) MR angiography (MRA) for imaging infragenual arteries at 3.0T, with contrast enhanced MR angiography (CE MRA) as reference. METHODS Twenty consecutive patients with suspicion of lower extremity arterial disease undergoing routine CE MRA were recruited. FSD MRA was performed at calf before CE MRA. Image quality and stenosis degree of infragenual arteries from both techniques were independently evaluated and compared. Six patients in this study underwent DSA examination. RESULTS Three undiagnostic segments were excluded with severe venous contamination in CE MRA. A total of 197 calf arterial segments images were analyzed. No significant difference existed in the relative signal intensity (rSI) of arterial segments between FSD MRA and CE MRA techniques (0.92 ± 0.09 versus 0.93 ± 0.05; P = 0.207). However, the subjective image quality score was slightly higher in FSD MRA (3.66 ± 0.81 versus 3.49 ± 0.87; P = 0.050). With CE MRA images as reference standard, slight overestimation existed in FSD MRA (2.19 ± 1.24 versus 2.09 ± 1.18; P = 0.019), with total agreement of 84.3% on the basis of all arterial segments. The sensitivity, specificity, negative predictive value, and positive predictive value of FSD MRA was 96.4%, 93.0%, 98.5%, and 84.1%. No significant difference in the stenosis degree score was detected between MRA (FSD MRA and CE MRA) and DSA (P > 0.05). CONCLUSION FSD MRA performed on at 3.0T without the use of contrast medium provides diagnostic images allowing for arterial stenosis assessment of calf arteries that was highly comparable with CE MRA. Moreover, venous contamination was less problematic with FSD MRA.
Collapse
Affiliation(s)
- Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nan Luo
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Bi
- Siemens Medical Solutions USA, Inc., Chicago, Illinois, USA
| | - Yike Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing An
- Siemens Healthcare, China, MR Collaborations NE Asia, Beijing, China
| | - Jiayi Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhong Chen
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhanming Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
10
|
Soliman H. Diagnostic accuracy of three-dimensional contrast-enhanced automatic moving-table MR angiography in patients with peripheral arterial occlusive disease in comparison with digital subtraction angiography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
11
|
Kwon KT, Kerr AB, Wu HH, Hu BS, Brittain JH, Nishimura DG. Non-contrast-enhanced peripheral angiography using a sliding interleaved cylinder acquisition. Magn Reson Med 2014; 74:727-38. [PMID: 25203505 DOI: 10.1002/mrm.25452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 11/07/2022]
Abstract
PURPOSE To develop a new sequence for non-contrast-enhanced peripheral angiography using a sliding interleaved cylinder (SLINCYL) acquisition. METHODS A venous saturation pulse was incorporated into a three-dimensional magnetization-prepared balanced steady-state free precession sequence for non-contrast-enhanced peripheral angiography to improve artery-vein contrast. The SLINCYL acquisition, which consists of a series of overlapped thin slabs for volumetric coverage similar to the original sliding interleaved ky (SLINKY) acquisition, was used to evenly distribute the venous-suppression effects over the field of view. In addition, the thin-slab-scan nature of SLINCYL and the centric-ordered sampling geometry of its readout trajectory were exploited to implement efficient fluid-suppression and parallel imaging schemes. The sequence was tested in healthy subjects and a patient. RESULTS Compared to a multiple overlapped thin slab acquisition, both SLINKY and SLINCYL suppressed the venetian blind artifacts and provided similar artery-vein contrast. However, SLINCYL achieved this with shorter scan times and less noticeable artifacts from k-space amplitude modulation than SLINKY. The fluid-suppression and parallel imaging schemes were also validated. A patient study using the SLINCYL-based sequence well identified stenoses at the superficial femoral arteries, which were also confirmed with digital subtraction angiography. CONCLUSION Non-contrast-enhanced angiography using SLINCYL can provide angiograms with improved artery-vein contrast in the lower extremities.
Collapse
Affiliation(s)
- Kie Tae Kwon
- Department of Electrical Engineering, Magnetic Resonance Systems Research Laboratory, Stanford University, Stanford, California, USA
| | - Adam B Kerr
- Department of Electrical Engineering, Magnetic Resonance Systems Research Laboratory, Stanford University, Stanford, California, USA
| | - Holden H Wu
- Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, California, USA
| | - Bob S Hu
- Department of Electrical Engineering, Magnetic Resonance Systems Research Laboratory, Stanford University, Stanford, California, USA.,Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Jean H Brittain
- Department of Radiology, University of Wisconsin-Madison, Wisconsin, USA
| | - Dwight G Nishimura
- Department of Electrical Engineering, Magnetic Resonance Systems Research Laboratory, Stanford University, Stanford, California, USA
| |
Collapse
|
12
|
Okuaki T, Ishimoto T, Miyati T, Kobayashi S, Ishihara M, Kawakami M, Ogino T, Van Cauteren M. Separate pulmonary artery and vein magnetic resonance angiography by use of an arterial spin labeling method. Radiol Phys Technol 2014; 7:352-7. [PMID: 24906451 DOI: 10.1007/s12194-014-0272-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 05/18/2014] [Accepted: 05/18/2014] [Indexed: 12/01/2022]
Abstract
A separate pulmonary vein (PV) is difficult to depict with the commonly used bright-blood magnetic resonance angiography method. Until now, no study has described the depiction of peripheral PVs without the artery. Our purpose in this study was to develop an arterial spin labeling (ASL)-based magnetic resonance angiography sequence to depict the pulmonary artery (PA) and vein separately. We developed such a sequence by using two inversion recovery pulses. The first pulse was non-selective, and the second pulse was selective and was applied to the aorta and heart. All studies were conducted on a 1.5-T clinical magnetic resonance system with six different inversion times for seven healthy volunteers. For evaluation, we categorized the inversion times by using visual scoring. Then, we used the magnitude image to evaluate the PA, and we used the real image to evaluate the PV. For the PA, an inversion time of 300 ms had the lowest score (1.43), and the score changed with increasing times; an inversion time of 1,100 ms had the highest score (3.85). For the PV, an inversion time of 300 ms had the highest score (2.68), and the score decreased with increasing times. The results indicated that the PA and vein could be depicted separately by the use of an ASL-based magnetic resonance angiography method. The optimal inversion times for the PV and artery were 300 and 1,100 ms, respectively.
Collapse
Affiliation(s)
- Tomoyuki Okuaki
- Philips Healthcare, 2-13-37 Kohnan, Minato-ku, Tokyo, 108-8507, Japan,
| | | | | | | | | | | | | | | |
Collapse
|
13
|
|
14
|
Koktzoglou I, Mistretta CA, Giri S, Dunkle EE, Amin P, Edelman RR. Simultaneous static and cine nonenhanced MR angiography using radial sampling and highly constrained back projection reconstruction. Magn Reson Med 2013; 72:1079-86. [PMID: 24407879 DOI: 10.1002/mrm.25008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 09/12/2013] [Accepted: 09/28/2013] [Indexed: 11/06/2022]
Abstract
PURPOSE To describe a pulse sequence for simultaneous static and cine nonenhanced magnetic resonance angiography (NEMRA) of the peripheral arteries. METHODS The peripheral arteries of 10 volunteers and 6 patients with peripheral arterial disease (PAD) were imaged with the proposed cine NEMRA sequence on a 1.5 Tesla (T) system. The impact of multi-shot imaging and highly constrained back projection (HYPR) reconstruction was examined. The propagation rate of signal along the length of the arterial tree in the cine nonenhanced MR angiograms was quantified. RESULTS The cine NEMRA sequence simultaneously provided a static MR angiogram showing vascular anatomy as well as a cine display of arterial pulse wave propagation along the entire length of the peripheral arteries. Multi-shot cine NEMRA improved temporal resolution and reduced image artifacts. HYPR reconstruction improved image quality when temporal reconstruction footprints shorter than 100 ms were used (P < 0.001). Pulse wave propagation within the arterial tree as displayed by cine NEMRA was slower in patients with PAD than in volunteers. CONCLUSION Simultaneous static and cine NEMRA of the peripheral arteries is feasible. Multi-shot acquisition and HYPR reconstruction can be used to improve arterial conspicuity and temporal resolution.
Collapse
Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA; The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | | | | | | | | |
Collapse
|
15
|
Shin T, Hu BS, Nishimura DG. Off-resonance-robust velocity-selective magnetization preparation for non-contrast-enhanced peripheral MR angiography. Magn Reson Med 2013; 70:1229-40. [PMID: 23192893 PMCID: PMC3594489 DOI: 10.1002/mrm.24561] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/23/2012] [Accepted: 10/24/2012] [Indexed: 11/09/2022]
Abstract
PURPOSE To develop a new velocity-selective (VS) excitation pulse sequence which is robust to field inhomogeneity, and demonstrate its application to non-contrast-enhanced peripheral MR angiography (MRA). METHODS The off-resonance-robust VS saturation pulse is designed by incorporating 180° refocusing pulses into the k-space-based reference design and tailoring sequence parameters in a velocity region of interest. The VS saturation pulse is used as magnetization preparation for non-contrast-enhanced peripheral MRA to suppress background tissues but not arterial blood based on their velocities. Non-contrast-enhanced peripheral MRA using the proposed VS preparation was tested in healthy volunteers and a patient with arterial stenosis. RESULTS Calf angiograms obtained using the new VS preparation show more uniform background suppression than the reference VS preparation, as demonstrated by larger mean values and smaller standard deviations of artery-to-vein and artery-to-muscle contrast-to-noise ratios (71.0 ± 11.4 and 75.3 ± 12.1 versus 61.7 ± 22.7 and 58.5 ± 27.8). Two-station peripheral MRA using the new VS preparation identifies stenosis of the femoral and popliteal arteries in the patient, as validated by digital subtraction angiography. CONCLUSION Non-contrast-enhanced MRA using the new VS magnetization preparation can reliably provide high angiographic contrast in the lower extremities with significantly improved immunity to field inhomogeneity.
Collapse
Affiliation(s)
- Taehoon Shin
- Department of Electrical Engineering, Stanford University, Stanford, California
| | - Bob S. Hu
- Department of Electrical Engineering, Stanford University, Stanford, California
- Palo Alto Medical Foundation, Palo Alto, California
- Heart Vista Inc., Palo Alto, California
| | - Dwight G. Nishimura
- Department of Electrical Engineering, Stanford University, Stanford, California
| |
Collapse
|
16
|
Shin T, Worters PW, Hu BS, Nishimura DG. Non-contrast-enhanced renal and abdominal MR angiography using velocity-selective inversion preparation. Magn Reson Med 2013; 69:1268-75. [PMID: 22711643 PMCID: PMC3449049 DOI: 10.1002/mrm.24356] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 04/14/2012] [Accepted: 05/08/2012] [Indexed: 01/15/2023]
Abstract
Non-contrast-enhanced MR angiography is a promising alternative to the established contrast-enhanced approach as it reduces patient discomfort and examination costs and avoids the risk of nephrogenic systemic fibrosis. Inflow-sensitive slab-selective inversion recovery imaging has been used with great promise, particularly for abdominal applications, but has limited craniocaudal coverage due to inflow time constraints. In this work, a new non-contrast-enhanced MR angiography method using velocity-selective inversion preparation is developed and applied to renal and abdominal angiography. Based on the excitation k-space formalism and Shinnar-Le-Roux transform, a velocity-selective excitation pulse is designed that inverts stationary tissues and venous blood while preserving inferiorly flowing arterial blood. As the magnetization of the arterial blood in the abdominal aorta and iliac arteries is well preserved during the magnetization preparation, artery visualization over a large abdominal field of view is achievable with an inversion delay time that is chosen for optimal background suppression. Healthy volunteer tests demonstrate that the proposed method significantly increases the extent of visible arteries compared with the slab-selective approach, covering renal arteries through iliac arteries over a craniocaudal field of view of 340 mm.
Collapse
Affiliation(s)
- Taehoon Shin
- Department of Electrical Engineering, Stanford University, Stanford, California 94305, USA.
| | | | | | | |
Collapse
|
17
|
Wheaton AJ, Miyazaki M. Non-contrast enhanced MR angiography: Physical principles. J Magn Reson Imaging 2012; 36:286-304. [DOI: 10.1002/jmri.23641] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
18
|
Miyazaki M, Akahane M. Non-contrast enhanced MR angiography: established techniques. J Magn Reson Imaging 2012; 35:1-19. [PMID: 22173999 DOI: 10.1002/jmri.22789] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Until recently, time-of-flight (TOF) and phase contrast (PC) were the only non-contrast MR angiography (NC-MRA) techniques practically used in clinical. In the decade, NC-MRA have been gained a revival of an interest among the MR researchers and scientists, in part because of safety concerns related to the possible link between gadolinium-based contrast agents and nephrogenic systemic fibrosis (NSF). This article introduces other established NC-MRA techniques, such as ECG-gated partial Fourier fast spin echo (FSE) and balanced steady-state free precession (bSSFP), both with and without arterial spin labeling. Then, the article focuses on two main applications: peripheral run-off and renal MRA. Recently, both applications have achieved remarkable advancements and have become a viable clinical option as an alternative to contrast-enhanced (CE)-MRA. In addition, developments on the horizon including whole body MRA applications and further advancement at 3 Tesla are discussed.
Collapse
Affiliation(s)
- Mitsue Miyazaki
- Toshiba Medical Research Institute USA, Vernon Hills, Illinois 60061, USA.
| | | |
Collapse
|
19
|
Abstract
The association between gadolinium-based contrast agents and neprogenic systemic fibrosis has helped propel noncontrast angiography techniques to center stage in the MR evaluation of vascular disease, especially in individuals with intrinsic renal diseases. Although balanced steady-state free precession, phase contrast, and time-of-flight sequences are currently being revisited and improved, new noncontrast angiographic methods have been created and are under development: ECG-gated 3D partial-Fourier fast spin echo (FSE) and 3D variable flip angle FSE (SPACE). All of these are attempts to develop noncontrast methods that offer equal or superior vascular diagnosis as compared with contrast-enhanced MR angiography.
Collapse
|
20
|
Haneder S, Attenberger UI, Riffel P, Henzler T, Schoenberg SO, Michaely HJ. Magnetic resonance angiography (MRA) of the calf station at 3.0 T: intraindividual comparison of non-enhanced ECG-gated flow-dependent MRA, continuous table movement MRA and time-resolved MRA. Eur Radiol 2011; 21:1452-61. [DOI: 10.1007/s00330-011-2063-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/04/2010] [Accepted: 12/13/2010] [Indexed: 12/01/2022]
|
21
|
Abstract
This article discusses the role of magnetic resonance angiography (MRA) in evaluating the pulmonary arterial system. For depiction of pulmonary arterial anatomy and morphology, MRA techniques are compared with CT angiography and digital subtraction x-ray angiography. Perfusion, flow, and function are emphasized, as the integrated MR examination offers a comprehensive assessment of vascular morphology and function. Advances in MR technology that improve spatial and temporal resolution and compensate for potential artifacts are reviewed as they pertain to pulmonary MRA. Current and emerging gadolinium contrast-enhanced and non-contrast-enhanced MRA techniques are discussed. The role of pulmonary MRA, clinical protocols, imaging findings, and interpretation pitfalls are reviewed for clinical indications.
Collapse
Affiliation(s)
- Elizabeth M Hecht
- Department of Radiology, New York University School of Medicine, 560 First Avenue, TCH-HW202, New York, NY 10016, USA.
| | | |
Collapse
|
22
|
|
23
|
Abstract
While nonenhanced magnetic resonance (MR) angiographic methods have been available since the earliest days of MR imaging, prolonged acquisition times and image artifacts have generally limited their use in favor of gadolinium-enhanced MR angiographic techniques. However, the combination of recent technical advances and new concerns about the safety of gadolinium-based contrast agents has spurred a resurgence of interest in methods that do not require exogenous contrast material. After a review of basic considerations in vascular imaging, the established methods for nonenhanced MR angiographic techniques, such as time of flight and phase contrast, are considered and their advantages and disadvantages are discussed. This article then focuses on new techniques that are becoming commercially available, such as electrocardiographically gated partial-Fourier fast spin-echo methods and balanced steady-state free precession imaging both with and without arterial spin labeling. Challenges facing these methods and possible solutions are considered. Since different imaging techniques rely on different mechanisms of image contrast, recommendations are offered for which strategies may work best for specific angiographic applications. Developments on the horizon include techniques that provide time-resolved imaging for assessment of flow dynamics by using nonenhanced approaches.
Collapse
Affiliation(s)
- Mitsue Miyazaki
- Department of MRI, Toshiba Medical Research Institute USA, 990 Corporate Woods Pkwy, Vernon Hills, IL 60061, USA.
| | | |
Collapse
|
24
|
Thompson RB, McVeigh ER. Real-time volumetric flow measurements with complex-difference MRI. Magn Reson Med 2004; 50:1248-55. [PMID: 14648573 PMCID: PMC2396256 DOI: 10.1002/mrm.10637] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Blood flow in large vessels can be noninvasively evaluated with phase-contrast (PC) MRI by encoding the spin velocity to the image phase. Conventional phase-difference processing of the flow-encoded image data yields velocity images. Complex-difference processing is an alternative to phase-difference methods, and has the advantage of eliminating signal from stationary spins. In this study, two acquisitions with differential flow encoding are subtracted to yield a single projection that contains signal from only those spins moving in the direction of the flow-encoding gradients. The increase in acquisition efficiency allows real-time flow imaging with a temporal window as short as two acquisition lengths (60 ms). Validation of the complex-difference method by comparison with conventional gated-segmented PC-MRI in a flow phantom yielded a correlation of r > 0.99. Peak arterial flow rates in the popliteal artery and desending aorta measured in vivo with the complex-difference method were 0.92 +/- 0.06 of the values measured with conventional PC imaging. Real-time in vivo volumetric flow imaging of transient flow events is also presented.
Collapse
Affiliation(s)
- Richard B Thompson
- Laboratory of Cardiac Energetics, National Institutes of Health, Bethesda, Maryland 20892, USA.
| | | |
Collapse
|
25
|
Miyazaki M, Takai H, Sugiura S, Wada H, Kuwahara R, Urata J. Peripheral MR angiography: separation of arteries from veins with flow-spoiled gradient pulses in electrocardiography-triggered three-dimensional half-Fourier fast spin-echo imaging. Radiology 2003; 227:890-6. [PMID: 12702824 DOI: 10.1148/radiol.2273020227] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The authors evaluated a nonenhanced magnetic resonance (MR) angiographic technique that allows separation of arteries from veins. In 15 healthy subjects, peripheral MR angiography was performed with readout flow-spoiled gradient pulses in electrocardiography-triggered three-dimensional half-Fourier fast spin-echo MR imaging. Appropriate flow-spoiled gradient pulses were measured and applied in the three-dimensional acquisition to differentiate arteries and veins in the peripheral vasculature. Subtraction of the diastolic bright-blood arteries from the systolic black-blood arteries allowed visualization of the arteries by cancelling the veins, which are constantly depicted as bright blood throughout the cardiac cycle. Stronger flow-spoiled gradient pulses improved the depiction of slow-flow arteries even in the distal foot and hand vessels.
Collapse
Affiliation(s)
- Mitsue Miyazaki
- MR Imaging Department, Toshiba Medical Research and Development Center, 1385 Shimoishigami, Otawara-city, Tochigi 324-8550, Japan.
| | | | | | | | | | | |
Collapse
|
26
|
Eiberg JP, Lundorf E, Thomsen C, Schroeder TV. Peripheral vascular surgery and magnetic resonance arteriography--a review. Eur J Vasc Endovasc Surg 2001; 22:396-402. [PMID: 11735175 DOI: 10.1053/ejvs.2001.1503] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to review the current status of lower limb MRA. DESIGN a literature review based predominantly on a MEDLINE database search of English-language publications from January 1991 to October 2000. MATERIALS AND METHODS twenty-eight articles, concerning non-enhanced MRA (13), gadolinium-enhanced MRA (14) or both (1), met the predefined requirement for quality. Results gadolinium-enhanced MRA (CE-MRA) seems to be more accurate, quicker and associated with fewer problems than non-enhanced (TOF) MRA. TOF-MRA has a sensitivity and specificity of 93% (range 64-100%) and 88% (range 57-100%) respectively, and CE-MRA presents values of 96% (range 71-100%) and 96% (63-100%), respectively, using conventional arteriography as the gold standard. Some articles report a substantial incidence of runoff vessels suitable for distal bypass visible on MRA but invisible on conventional arteriography. Gadolinium contrast is given intravenously and is generally well tolerated and has no known nephrotoxicity. CONCLUSION CE-MRA is accurate compared to conventional arteriography, has the potential to increase the limb salvage rate for selected patients, is non-invasive and well tolerated.
Collapse
Affiliation(s)
- J P Eiberg
- Department of Vascular Surgery RK, Rigshospitalet 3111, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | | | | | | |
Collapse
|
27
|
Shetty AN, Shirkhoda A, Bis KG, Ellwood R, Li D. 3D breath-hold contrast-enhanced MRA: a preliminary experience in aorta and iliac vascular disease. J Comput Assist Tomogr 1998; 22:179-85. [PMID: 9530376 DOI: 10.1097/00004728-199803000-00004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Our goal was to describe a 3D breath-hold (3D BH) contrast-enhanced MRA technique and apply the technique to patients with known or suspected aortic and iliac artery disease. METHOD A fat-suppressed 3D GRE pulse sequence was designed with a total of 16 partition encodings. This took < 24 s for data acquisition in the abdomen and pelvis and was easily achieved during a single breath-hold. The technique was applied to 26 patients who presented with either known or suspected abdominal aortic or iliac vascular diseases. For comparison, in 19 patients a 2D TOF MRA pulse sequence with a traveling saturation band was used. Angiographic correlation was made in 18 studies. RESULTS The 3D BH MRA was easily applicable in the evaluation of vascular anatomy and pathology. In three cases, it was superior to 2D TOF and conventional angiography for visualizing clot within the wall of an aneurysm in the abdominal aorta. In 20 cases, both MRA techniques overestimated the degree of stenosis in the lower peripheral vessels; however, this was more pronounced on 2D TOF. In five cases, the aneurysm wall was clearly defined by 3D BH MRA, whereas there was considerable signal loss in 2D TOF due to complex flow. With 3D BH MRA, the entire vessel territory both in abdominal aorta and in iliac vessels was visualized in all cases without signal falloff in the FOV. Breath-holding provided static images of the vessels that were free of blurring due to respiratory motion. CONCLUSION Preliminary experience suggests that 3D BH with its distinct advantage of speed may serve as a useful screening tool for patients who cannot have conventional angiography or tolerate a lengthy MR examination of the abdominal aorta and iliac arteries.
Collapse
Affiliation(s)
- A N Shetty
- Department of Radiology, William Beaumont Hospital, Royal Oak, MI 48073-6769, USA
| | | | | | | | | |
Collapse
|
28
|
Schmiedl UP, Yuan C, Nghiem HV, Winter TC, Freeny PC. MR angiography of the peripheral vasculature. Semin Ultrasound CT MR 1996; 17:404-11. [PMID: 8858778 DOI: 10.1016/s0887-2171(96)90026-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
MR angiography (MRA) for the evaluation of peripheral arterial occlusive disease is a rapidly evolving technique. Recent prospective clinical trials have indicated that MRA may play an important role in the evaluation of patients with peripheral arterial disease. This article discusses the pertinent technical aspects and limitations of peripheral MRA as well as some of the clinical data available.
Collapse
Affiliation(s)
- U P Schmiedl
- Department of Radiology, University of Washington, Seattle, USA
| | | | | | | | | |
Collapse
|
29
|
Laissy JP, Schouman-Claeys E. Time-of-flight magnetic resonance angiography of aorta and renal arteries: state-of-the-art. Eur J Radiol 1996; 21:201-11. [PMID: 8777911 DOI: 10.1016/0720-048x(95)00727-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J P Laissy
- Department of Radiology, Centre Hospitalier et Universitaire Bichat-Claude Bernard, Paris, France
| | | |
Collapse
|
30
|
Sivananthan UM, Ridgway JP, Bann K, Verma SP, Cullingworth J, Ward J, Rees MR. Fast magnetic resonance angiography using turbo-FLASH sequences in advanced aortoiliac disease. Br J Radiol 1993; 66:1103-10. [PMID: 8293253 DOI: 10.1259/0007-1285-66-792-1103] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A prospective study using contrast enhanced turbo-FLASH (Fast Low-Angle Shot) magnetic resonance (MR) angiography was performed to assess the arterial anatomy in patients who had advanced atherosclerotic aortoiliac disease. This new imaging sequence was employed in 17 patients and the results were compared with conventional abdominal aortography. MR angiography accurately detected all aortic occlusions (3/3), their sites and their extent. All nine iliac occlusions were correctly identified (sensitivity 100%, specificity of 90%). The sensitivity was 100% for stenosis of 50% or greater in the abdominal aorta, and the iliac and common femoral arteries. The degree of stenosis was overgraded in 20 of 51 lesions (39.2%). Mild stenosis was overgraded as moderate stenosis in 10 and as severe stenosis in three. Moderate stenosis was overgraded as severe stenosis in four. None of the mild or moderate stenoses resulted in areas of signal voids suggestive of occlusions. Three severe stenoses were seen as areas of signal voids (two iliac, one femoral). In the eight patients who had in total 10 aneurysmal dilatations of the aorta or the iliac arteries, MR angiography was superior in demonstrating the true extent of the aneurysms. We conclude that turbo-FLASH MR angiography has the potential to be a useful non-invasive imaging technique for patients with advanced aortoiliac disease.
Collapse
Affiliation(s)
- U M Sivananthan
- Department of Cardiac Radiology, Killingbeck Hospital, Leeds, UK
| | | | | | | | | | | | | |
Collapse
|
31
|
Hatch WD, Pentecost MJ, Colletti PM, Weaver FA. Magnetic resonance imaging of a post-traumatic arteriovenous fistula in the lower extremity. Magn Reson Imaging 1991; 9:459-62. [PMID: 1881266 DOI: 10.1016/0730-725x(91)90435-o] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Currently, magnetic resonance (MR) is most useful as a means of providing distinct images of gross abnormalities in major blood vessels. While new advances and further refinements will continue, MR has proven its value as a convenient and effective diagnostic tool for the recognition and delineation of vascular abnormalities, such as acquired arteriovenous fistulae (AVFs). We report a case of a chronic, post-traumatic AVF, in which MR angiography provided excellent anatomic detail and angiographic correlation.
Collapse
Affiliation(s)
- W D Hatch
- Department of Radiology, Los Angeles County-University of Southern California Medical Center, 90033
| | | | | | | |
Collapse
|
32
|
Wendt RE, Nitz W, Morrisett JD, Hedrick TD. A technique for flow-enhanced magnetic resonance angiography of the lower extremities. Magn Reson Imaging 1990; 8:723-8. [PMID: 2266798 DOI: 10.1016/0730-725x(90)90007-o] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A two-dimensional, flow-enhanced gradient echo pulse sequence for nuclear magnetic resonance angiography is described. It employs interleaved, presaturated slices to acquire data efficiently on imagers which favor interleaved acquisition over sequential acquisition for multislice imaging. It is useful on any imagers when the effective TR is extended to enhance the sensitivity to slow flow. The technique was applied to the region from aortic bifurcation to the iliac bifurcations of three normal volunteers. The right and left common iliac arteries and veins, the separation of the external and internal iliac arteries, and secondary branches were clearly depicted.
Collapse
Affiliation(s)
- R E Wendt
- Department of Radiology, Baylor College of Medicine, Houston, Texas 77030
| | | | | | | |
Collapse
|
33
|
Mitchell DG, Carabasi A. Vascular applications of magnetic resonance imaging. Ann Vasc Surg 1989; 3:400-19. [PMID: 2688735 DOI: 10.1016/s0890-5096(06)60169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- D G Mitchell
- Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, Pennsylvania
| | | |
Collapse
|
34
|
Akins EW, Carmichael MJ, Hill JA, Mancuso AA. Preoperative evaluation of the thoracic aorta using MRI and angiography. Ann Thorac Surg 1987; 44:499-507. [PMID: 3675054 DOI: 10.1016/s0003-4975(10)62109-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The ability of ECG-gated magnetic resonance imaging (MRI) to evaluate disease of the thoracic aorta compared with angiography was prospectively assessed in 28 patients. MRI identified abnormalities in all patients, with confirmation at operation in 22 (79%) and by angiography alone in all 28. In 20 of the patients, MRI correctly diagnosed 20 of 21 aneurysms of the thoracic aorta (6 dissecting, 4 saccular, 10 fusiform), but 1 surgically proven fusiform aneurysm was categorized as an enlarged aortic dissection based on both MRI and angiographic findings. One dissection and 1 fusiform aneurysm were shown by MRI only. Coarctation of the aorta was identified in 4 patients. Ascending aortic enlargement and left ventricular hypertrophy were identified by MRI in 4 patients with aortic stenosis. In 7 patients (25%), MRI provided additional important information not shown by angiography and in 1 patient, the MRI findings resulted in a change in the surgical approach. In 14 of 28 patients (50%), angiography was necessary for definitive preoperative evaluation of the aortic valve, the coronary arteries, or the brachiocephalic vessels. MRI was a useful noninvasive supplement to angiography for the preoperative assessment of thoracic aortic disease.
Collapse
Affiliation(s)
- E W Akins
- Department of Radiology, Shands Hospital, University of Florida, Gainesville 32610
| | | | | | | |
Collapse
|
35
|
Twieg DB, Katz J, Peshock RM. A general treatment of NMR imaging with chemical shifts and motion. Magn Reson Med 1987; 5:32-46. [PMID: 3309543 DOI: 10.1002/mrm.1910050105] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A general treatment of nuclear magnetic resonance imaging (MRI) and spectroscopic imaging (MRSI), which takes into account the effects of chemical shift, motion, field inhomogeneity, and relaxation times, is presented. A graphical representation based on the k trajectory formalism which includes these effects is then developed for MRI and MRSI acquisition processes. These considerations should be useful in the study and design of flow-sensitive MRI and MRSI methods and the accurate prediction of motion artifacts in conventional MRI and MRSI techniques. We conclude by presenting examples illustrating applications of the general theory to specific MRSI and flow imaging methods.
Collapse
Affiliation(s)
- D B Twieg
- Department of Radiology, University of Texas Health Science Center, Dallas 75235
| | | | | |
Collapse
|
36
|
|