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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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Desjardins B, Hanley M, Steigner ML, Aghayev A, Azene EM, Bennett SJ, Chandra A, Hedgire SS, Lo BM, Mauro DM, Ptak T, Singh-Bhinder N, Suranyi PS, Verma N, Dill KE. ACR Appropriateness Criteria® Suspected Upper Extremity Deep Vein Thrombosis. J Am Coll Radiol 2020; 17:S315-S322. [PMID: 32370975 DOI: 10.1016/j.jacr.2020.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 01/13/2023]
Abstract
This publication includes the appropriate imaging modalities to assess suspected deep vein thrombosis in the upper extremities. Ultrasound duplex Doppler is the most appropriate imaging modality to assess upper-extremity deep vein thrombosis. It is a noninvasive test, which can be performed at the bedside and used for serial evaluations. Ultrasound can also directly identify thrombus by visualizing echogenic material in the vein and by lack of compression of the vein walls from manual external pressure. It can indirectly identify thrombus from altered blood-flow patterns. It is most appropriate in the evaluation of veins peripheral to the brachiocephalic vein. CT venography and MR venography are not first-line imaging tests, but are appropriate to assess the central venous structures, or to assess the full range of venous structures from the hand to the right atrium. Catheter venography is appropriate if therapy is required. Radionuclide venography and chest radiography are usually not appropriate to assess upper-extremity deep vein thrombosis. 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)
| | - Michael Hanley
- Panel Chair, University of Virginia Health System, Charlottesville, Virginia
| | | | - Ayaz Aghayev
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Ankur Chandra
- Scripps Green Hospital, La Jolla, California; Society for Vascular Surgery
| | - Sandeep S Hedgire
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bruce M Lo
- Sentara Norfolk General/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - David M Mauro
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Thomas Ptak
- University of Maryland Medical Center, Baltimore, Maryland
| | | | - Pal S Suranyi
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Karin E Dill
- Specialty Chair, UMass Memorial Medical Center, Worcester, Massachusetts
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Obmann VC, Chalian M, Mansoori B, Sanchez E, Gulani V. Advantages of time-resolved contrast-enhanced 4D MR angiography in splenic arterial steal syndrome. Clin Imaging 2018; 49:169-173. [PMID: 29558712 DOI: 10.1016/j.clinimag.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/01/2018] [Accepted: 03/01/2018] [Indexed: 01/17/2023]
Abstract
Splenic artery steal syndrome (SASS) is a severe complication affecting up to 10% of orthotopic liver transplant (OLT) patients. In this case report, we present a 35-year-old male with OLT secondary to liver failure due to hemochromatosis, who developed SASS. We describe potential application of different imaging techniques for diagnosis of SASS with focus on the value of time-resolved contrast enhanced 4D magnetic resonance angiography (MRA).
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Affiliation(s)
- Verena C Obmann
- Department of Radiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Majid Chalian
- Department of Radiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Bahar Mansoori
- Department of Radiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
| | - Edmund Sanchez
- Division of Hepatobiliary and Transplant Surgery, University Hospitals Cleveland Medical Center Transplant Institute, Cleveland, OH, United States.
| | - Vikas Gulani
- Department of Radiology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
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Bak SH, Roh HG, Moon WJ, Choi JW, An HS. Appropriate Minimal Dose of Gadobutrol for 3D Time-Resolved MRA of the Supra-Aortic Arteries: Comparison with Conventional Single-Phase High-Resolution 3D Contrast-Enhanced MRA. AJNR Am J Neuroradiol 2017; 38:1383-1390. [PMID: 28473338 DOI: 10.3174/ajnr.a5176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/13/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE The development of nephrogenic systemic fibrosis and neural tissue deposition is gadolinium dose-dependent. The purpose of this study was to determine the appropriate minimal dose of gadobutrol with time-resolved MRA to assess supra-aortic arterial stenosis with contrast-enhanced MRA as a reference standard. MATERIALS AND METHODS Four hundred sixty-two consecutive patients underwent both standard-dose contrast-enhanced MRA and low-dose time-resolved MRA and were classified into 3 groups; group A (a constant dose of 1 mL for time-resolved MRA), group B (2 mL), or group C (3 mL). All studies were independently evaluated by 2 radiologists for image quality by using a 5-point scale (from 0 = failure to 4 = excellent), grading of arterial stenosis (0 = normal, 1 = mild [<30%], 2 = moderate [30%-69%], 3 = severe to occlusion [≥70%]), and signal-to-noise ratio. RESULTS The image quality of time-resolved MRA was similar to that of contrast-enhanced MRA in groups B and C, but it was inferior to contrast-enhanced MRA in group A. For the grading of arterial stenosis, there was an excellent correlation between contrast-enhanced MRA and time-resolved MRA (R = 0.957 for group A, R = 0.988 for group B, R = 0.991 for group C). The SNR of time-resolved MRA tended to be lower than that of contrast-enhanced MRA in groups A and B. However, SNR was higher for time-resolved MRA compared with contrast-enhanced MRA in group C. CONCLUSIONS Low-dose time-resolved MRA is feasible in the evaluation of supra-aortic stenosis and could be used as an alternative to contrast-enhanced MRA for a diagnostic technique in high-risk populations.
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Affiliation(s)
- S H Bak
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.,Department of Radiology (S.H.B.), Kangwon National University Hospital, Chuncheon, Korea
| | - H G Roh
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - W-J Moon
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - J W Choi
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - H S An
- Department of Radiology (H.S.A.), Armed Forces Yangju Hospital, Yangju, Korea
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Armstrong L, Rodrigues J, Lawton C, Tyrell-Price J, Hamilton M, Manghat N. Application of TWIST MR angiography to aid successful central venous access in challenging patients: initial single-centre experience. Clin Radiol 2016; 71:1104-12. [DOI: 10.1016/j.crad.2016.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 12/31/2015] [Accepted: 04/05/2016] [Indexed: 12/21/2022]
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Wetzl J, Forman C, Wintersperger BJ, D'Errico L, Schmidt M, Mailhe B, Maier A, Stalder AF. High-resolution dynamic CE-MRA of the thorax enabled by iterative TWIST reconstruction. Magn Reson Med 2016; 77:833-840. [PMID: 26888549 DOI: 10.1002/mrm.26146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the clinical benefit of using a new iterative reconstruction technique fully integrated on a standard clinical scanner and reconstruction system using a TWIST acquisition for high-resolution dynamic three-dimensional contrast-enhanced MR angiography (CE-MRA). METHODS Low-dose, high-resolution TWIST datasets of 11 patients were reconstructed using both standard GRAPPA-based reconstruction for reference and iterative reconstruction, which reduces the temporal footprint of reconstructed images. Image quality of both techniques was assessed by two experienced readers, as well as quantitatively evaluated using a time-signal curve analysis. RESULTS Image quality scores consistently and significantly improved by using iterative reconstruction compared with the standard approach. Most notably, the delineation of small to mid-size vasculature improved from a mean Likert score between "nondiagnostic" and "poor" for standard to between "good" and "excellent" for iterative reconstruction. The full width at half maximum of the contrast agent bolus computed from the time-signal curve was also reduced by iterative reconstruction, allowing for more precise bolus timing. CONCLUSION Iterative reconstruction can substantially improve high-resolution dynamic CE-MRA image quality, most notably in small to mid-size vasculature. Dynamic CE-MRA with iterative reconstruction could become an alternative to conventional static 3D CE-MRA, thus simplifying the clinical workflow. Magn Reson Med 77:833-840, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Jens Wetzl
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Bernd J Wintersperger
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Luigia D'Errico
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | | | - Boris Mailhe
- Siemens Medical Solutions USA Inc., Princeton, New Jersey, USA
| | - Andreas Maier
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Dynamic contrast-enhanced magnetic resonance imaging assessment of kidney function and renal masses: single slice versus whole organ/tumor. Invest Radiol 2015; 49:720-7. [PMID: 24901546 DOI: 10.1097/rli.0000000000000075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The aim of this study was to compare single-slice and 3-dimensional (3D) analysis for magnetic resonance renography (plasma flow [FP], plasma volume [VP], and glomerular filtration rate [GFR]) and for dynamic contrast-enhanced magnetic resonance imaging (MRI) of renal tumors (FP, VP, permeability-surface area product), respectively. MATERIAL AND METHODS We prospectively included 22 patients (43 kidneys with 22 suspicious renal lesions) and performed preoperative and postoperative imaging before and after partial nephrectomy, respectively. Of the 22 renal lesions, 15 turned out to be renal cell carcinoma and were included in the tumor analysis, altogether leading to 86 renal and 15 tumor MRI scans, respectively. Dynamic contrast-enhanced MRI was performed with a time-resolved angiography with stochastic trajectories sequence (spatial resolution, 2.6 × 2.6 × 2.6 mm3; temporal resolution, 2.5 seconds) at 3 T (Magnetom Verio; Siemens Healthcare Sector) after injection of 0.05 mmol/kg body weight Gadobutrol (Bayer Healthcare Pharmaceuticals). Analysis was performed using regions of interest encompassing a single central slice and the whole kidney/tumor, respectively. A 2-compartment model yielding FP, VP, GFR, or tumor permeability-surface area product was used for kinetic modelling. Modelling was performed based on relative contrast enhancement to account for coil-related inhomogeneity. Significance in difference, agreement, and goodness of fit of the data to the curve was assessed with paired t tests, Bland-Altman plots, and χ2 test, respectively. RESULTS Bland-Altman analysis revealed a good agreement between both types of measurement for kidneys and tumors, respectively. Results between single-slice and whole-kidney regions of interest showed significant differences for Fp (single slice, 256.1 ± 104.1 mL/100 mL/min; whole kidney, 217.2 ± 92.5 mL/100 mL/min; P < 0.01). Regarding VP and GFR, no significant differences were observed. The χ2 test showed a significantly better goodness of fit of the data to the curve for whole kidneys (0.30% ± 0.18%) than for single slices (0.43% ± 0.26%) (P < 0.01). In contrast to renal assessment, tumor analysis showed no significant differences regarding functional parameters and χ test, respectively. CONCLUSION In dynamic contrast-enhanced MRI of the kidney, both 3D whole-organ/tumor and single-slice analyses provide roughly comparable values in functional analysis. However, 3D assessment is considerably more precise and should be preferred if available.
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Epelman M, Johnson C, Hellinger JC, Darge K, Newman B. Vascular Lesions—Congenital, Acquired, and Iatrogenic: Imaging in the Neonate. Semin Ultrasound CT MR 2015; 36:193-215. [DOI: 10.1053/j.sult.2015.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rapacchi S, Natsuaki Y, Plotnik A, Gabriel S, Laub G, Finn JP, Hu P. Reducing view-sharing using compressed sensing in time-resolved contrast-enhanced magnetic resonance angiography. Magn Reson Med 2014; 74:474-81. [PMID: 25157749 DOI: 10.1002/mrm.25414] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/23/2014] [Accepted: 07/25/2014] [Indexed: 11/11/2022]
Abstract
PURPOSE To study temporal and spatial blurring artifacts from k-space view-sharing in time-resolved MR angiography (MRA) and to propose a technique for reducing these artifacts. METHODS We acquired k-space data sets using a three-dimensional time-resolved MRA view-sharing sequence and retrospectively reformatted them into two reconstruction frameworks: full view-sharing via time-resolved imaging with stochastic trajectories (TWIST) and minimal k-space view-sharing and compressed sensing (CS-TWIST). The two imaging series differed in temporal footprint but not in temporal frame rate. The artifacts from view-sharing were compared qualitatively and quantitatively in nine patients in addition to a phantom experiment. RESULTS CS-TWIST was able to reduce the imaging temporal footprint by two- to three-fold compared with TWIST, and the overall subjective image quality of CS-TWIST was higher than that for TWIST (P < 0.05). View sharing caused a delay in the visualization of small blood vessels, and the mean transit time of the carotid artery calculated based on TWIST reconstruction was 0.6 s longer than that for CS-TWIST (P < 0.01). In thoracic MRA, the shorter temporal footprint decreased the sensitivity to physiological motion blurring, and vessel sharpness was improved by 8.8% ± 6.0% using CS-TWIST (P < 0.05). CONCLUSION In time-resolved MRA, the longer temporal footprint due to view-sharing causes spatial and temporal artifacts. CS-TWIST is a promising method for reducing these artifacts.
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Affiliation(s)
- Stanislas Rapacchi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Adam Plotnik
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Simon Gabriel
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Gerhard Laub
- Siemens Healthcare, Los Angeles, California, USA
| | - J Paul Finn
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Rapacchi S, Han F, Natsuaki Y, Kroeker R, Plotnik A, Lehrman E, Sayre J, Laub G, Finn JP, Hu P. High spatial and temporal resolution dynamic contrast-enhanced magnetic resonance angiography using compressed sensing with magnitude image subtraction. Magn Reson Med 2013; 71:1771-83. [PMID: 23801456 DOI: 10.1002/mrm.24842] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 04/29/2013] [Accepted: 05/21/2013] [Indexed: 11/06/2022]
Abstract
PURPOSE We propose a compressed-sensing (CS) technique based on magnitude image subtraction for high spatial and temporal resolution dynamic contrast-enhanced MR angiography (CE-MRA). METHODS Our technique integrates the magnitude difference image into the CS reconstruction to promote subtraction sparsity. Fully sampled Cartesian 3D CE-MRA datasets from 6 volunteers were retrospectively under-sampled and three reconstruction strategies were evaluated: k-space subtraction CS, independent CS, and magnitude subtraction CS. The techniques were compared in image quality (vessel delineation, image artifacts, and noise) and image reconstruction error. Our CS technique was further tested on seven volunteers using a prospectively under-sampled CE-MRA sequence. RESULTS Compared with k-space subtraction and independent CS, our magnitude subtraction CS provides significantly better vessel delineation and less noise at 4× acceleration, and significantly less reconstruction error at 4× and 8× (P < 0.05 for all). On a 1-4 point image quality scale in vessel delineation, our technique scored 3.8 ± 0.4 at 4×, 2.8 ± 0.4 at 8×, and 2.3 ± 0.6 at 12× acceleration. Using our CS sequence at 12× acceleration, we were able to acquire dynamic CE-MRA with higher spatial and temporal resolution than current clinical TWIST protocol while maintaining comparable image quality (2.8 ± 0.5 vs. 3.0 ± 0.4, P = NS). CONCLUSION Our technique is promising for dynamic CE-MRA.
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Affiliation(s)
- Stanislas Rapacchi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Contrast Dose, Temporal Footprint, and Spatial Resolution Tradeoffs in Dynamic Contrast-Enhanced MRA Performed in a Porcine Model of a Carotid Aneurysm. J Comput Assist Tomogr 2013; 37:105-10. [DOI: 10.1097/rct.0b013e318276fc92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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ACR Appropriateness Criteria® Suspected Upper Extremity Deep Vein Thrombosis. J Am Coll Radiol 2012; 9:613-9. [DOI: 10.1016/j.jacr.2012.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 12/18/2022]
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Karmonik C, Duran C, Davies MG, Shah DJ, Lumsden AB, Bismuth J. Correlation between hemodynamic parameters and intra-arterial septum motion in DeBakey Type III aortic dissections using 2D pcMRI and 4D MRA. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:2809-12. [PMID: 22254925 DOI: 10.1109/iembs.2011.6090777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Outcome prediction in DeBakey Type III aortic dissections (AD) remains challenging. Large variations in AD morphology, physiology and treatment exist. A patient-specific approach towards a detailed understanding of the distinct features of each single case might be needed to account for this variation. In particular, an improved characterization of hemodynamic parameters in addition to geometrical quantities may yield deeper insight into this complex disease. Advances in cardiovascular magnetic resonance imaging (CMR) have resulted in pulse sequences that provide time-resolved information of blood velocities, aortic wall motion and, with the administration of exogenous intravenous contrast bolus, contrast passage timings. Here we provide a combined approach in a group of 10 AD patients using 2D phase contrast magnetic resonance imaging (2D pcMRI) and Time-resolved Angiography With Interleaved Stochastic Trajectories (TWIST) to quantify blood velocities, flow rates, maximum signal enhancement from exogenous contrast and time to maximum signal enhancement in the true lumen (TL) and false lumen (FL). The FL-TL dynamic pressure gradient was derived from 2D pcMRI velocity measurements. These hemodynamic parameters were correlated with dynamic parameters for the intra-arterial septum (IS) wall motion derived from 2D pcMRI. A strong positive correlation was found between the TL-FL dynamic pressure gradient and maximum IS extension (R=0.76) as well as with maximum IS contraction (R=-0.51) Taking the ratio of maximum extension to maximum contraction, the correlation increased to R= 0.81. The ratio of TL to FL volumetric flow rate showed a high correlation with the difference in FL-TL times to maximum enhancement (R=0.87) illustrating that higher flow in the TL will result in delayed contrast arrival in the FL and vice versa. Analogous, the TL to FL ratio of maximum enhancement correlated with the TL to FL ratio of the maximum volumetric flow rate (R=0.85). 2D pcMRI and 4D MRA in combination with exogenous intravenous contrast bolus allows characterization of hemodynamics in DeBakey type III AD. High correlations between IS wall motion, TL and FL pressure differences, flows and times to maximum enhancement were found. An extension of our analysis to follow-up imaging examinations are warranted to establish the potential for hemodynamic parameters determined with CMR as a marker for clinical outcome in longitudinal studies.
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Affiliation(s)
- Christof Karmonik
- The Methodist DeBakey Heart & Vascular Center, Houston, TX 77030, USA.ckarmonik@ tmhs.org
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Morelli JN, Ai F, Runge VM, Zhang W, Li X, Schmitt P, McNeal G, Michaely HJ, Schoenberg SO, Miller M, Gerdes CM, Sincleair ST, Spratt H, Attenberger UI. Time-resolved MR angiography of renal artery stenosis in a swine model at 3 Tesla using gadobutrol with digital subtraction angiography correlation. J Magn Reson Imaging 2012; 36:704-13. [PMID: 22645046 DOI: 10.1002/jmri.23696] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 04/09/2012] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To establish the minimum dose required for detection of renal artery stenosis using high temporal resolution, contrast enhanced MR angiography (MRA) in a porcine model. MATERIALS AND METHODS Surgically created renal artery stenoses were imaged with 3 Tesla MR and digital subtraction angiography (DSA) in 12 swine in this IACUC approved protocol. Gadobutrol was injected intravenously at doses of 0.5, 1, 2, and 4 mL for time-resolved MRA (1.5 × 1.5 mm(2) spatial resolution). Region of interest analysis was performed together with stenosis assessment and qualitative evaluation by two blinded readers. RESULTS Mean signal to noise ratio (SNR) and contrast to noise ratio (CNR) values were statistically significantly less with the 0.5-mL protocol (P < 0.001). There were no statistically significant differences among the other evaluated doses. Both readers found 10/12 cases with the 0.5-mL protocol to be of inadequate diagnostic quality (κ = 1.0). All other scans were found to be adequate for diagnosis. Accuracies in distinguishing between mild/insignificant (<50%) and higher grade stenoses (>50%) were comparable among the higher-dose protocols (sensitivities 73-93%, specificities 62-100%). CONCLUSION Renal artery stenosis can be assessed with very low doses (~0.025 mmol/kg bodyweight) of a high concentration, high relaxivity gadolinium chelate formulation in a swine model, results which are promising with respect to limiting exposure to gadolinium based contrast agents.
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Affiliation(s)
- John N Morelli
- Scott and White Clinic and Hospital and Department of Radiology, Texas A&M University Health Science Center, Temple, TX, USA
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Notohamiprodjo M, Glaser C, Horng A, Helck A, Bauner KU, Reiser MF, Hatz HJ, Weckbach S. Dynamic 3D-MR-angiography for assessing rheumatoid disease of the hand—A feasibility study. Eur J Radiol 2012; 81:951-6. [DOI: 10.1016/j.ejrad.2011.01.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
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Le Y, Kroeker R, Kipfer HD, Lin C. Development and evaluation of TWIST Dixon for dynamic contrast-enhanced (DCE) MRI with improved acquisition efficiency and fat suppression. J Magn Reson Imaging 2012; 36:483-91. [PMID: 22544731 DOI: 10.1002/jmri.23663] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 03/07/2012] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To develop a new pulse sequence called time-resolved angiography with stochastic trajectories (TWIST) Dixon for dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). MATERIALS AND METHODS The method combines dual-echo Dixon to generate separated water and fat images with a k-space view-sharing scheme developed for 3D TWIST. The performance of TWIST Dixon was compared with a volume interpolated breathhold examination (VIBE) sequence paired with spectrally selective adiabatic inversion Recovery (SPAIR) and quick fat-sat (QFS) fat-suppression techniques at 3.0T using quantitative measurements of fat-suppression accuracy and signal-to-noise ratio (SNR) efficiency, as well as qualitative breast image evaluations. RESULTS The water fraction of a uniform phantom was calculated from the following images: 0.66 ± 0.03 for TWIST Dixon; 0.56 ± 0.23 for VIBE-SPAIR, and 0.53 ± 0.14 for VIBE-QFS, while the reference value is 0.70 measured by spectroscopy. For phantoms with contrast (Gd-BOPTA) concentration ranging from 0-6 mM, TWIST Dixon also provides consistently higher SNR efficiency (3.2-18.9) compared with VIBE-SPAIR (2.8-16.8) and VIBE-QFS (2.4-12.5). Breast images acquired with TWIST Dixon at 3.0T show more robust and uniform fat suppression and superior overall image quality compared with VIBE-SPAIR. CONCLUSION The results from phantom and volunteer evaluation suggest that TWIST Dixon outperforms conventional methods in almost every aspect and it is a promising method for DCE-MRI and contrast-enhanced perfusion MRI, especially at higher field strength where fat suppression is challenging.
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Affiliation(s)
- Yuan Le
- Department of Radiology and Imaging Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Hansch A, Kohlmann P, Hinneburg U, Boettcher J, Malich A, Wolf G, Laue H, Pfeil A. Quantitative evaluation of MR perfusion imaging using blood pool contrast agent in subjects without pulmonary diseases and in patients with pulmonary embolism. Eur Radiol 2012; 22:1748-56. [DOI: 10.1007/s00330-012-2428-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 01/20/2012] [Accepted: 01/27/2012] [Indexed: 11/30/2022]
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Theisen D, Dalla Pozza RD, Malec E, Reiser MF. [MRI for therapy control in patients with tetralogy of Fallot]. Radiologe 2011; 51:44-51. [PMID: 21243462 DOI: 10.1007/s00117-010-1995-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
With prevalences ranging from 0.26 to 0.8‰ of all live births tetralogy of Fallot (TOF) is the most common congenital heart disease with primary cyanosis. Due to improvements in surgical techniques, nearly all patients can nowadays expect to reach adulthood. After surgical repair, pulmonary regurgitation (PR) occurs in almost every child and is an important contributing factor in long-term morbidity and mortality. Cardiac magnetic resonance imaging is well established for functional assessment and flow measurements and is an ideal tool for serial post-surgical follow-up examinations, as it is non-invasive and does not expose patients to ionizing radiation. The timing of pulmonary valve replacement is crucial as right ventricular (RV) volumes have only proven to normalize when preoperative end-diastolic volumes are <170 ml/m(2) and end-systolic volumes are <85 ml/m(2). After surgical repair up to 15% of patients have residual or recurrent pulmonary artery stenosis. Distal pulmonary branch stenosis can aggravate PR and lead to right heart failure due to combined pressure and volume overload. Therefore, it has to be diagnosed in time and treated by angioplasty with or without stenting.
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Affiliation(s)
- D Theisen
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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Abstract
Over the last decade, three-dimensional contrast-enhanced magnetic resonance angiography (CE-MRA) has emerged as a widely accepted and powerful technique for diagnostic assessment of almost all vascular territories. Its non-invasive nature and lack of ionizing radiation, its potential to cover a large field of view and the safety of gadolinium-based contrast agents make CE-MRA an appealing alternative to digital subtraction angiography (DSA) or computed tomography angiography (CTA). However, recent reports linking high dose gadolinium-based contrast agents to the development of nephrogenic systemic fibrosis [1-3] have raised concerns over the safety of CE-MRA. As a result, many investigators have focused attention on gadolinium dose reduction strategies [4,5]. This article reviews existing state-of-the-art 3D CE-MRA strategies to reduce contrast dose and summarizes current applications and clinical experience to date. It also highlights evolving techniques, which the authors feel are likely to enhance the future impact of CE-MRA.
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Affiliation(s)
- Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, 10945 Le Conte Avenue, Suite # 3371. Los Angeles, CA 90095-7206, United States.
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Pretreatment Evaluation of Peripheral Vascular Malformations Using Low-Dose Contrast-Enhanced Time-Resolved 3D MR Angiography: Initial Results in 22 Patients. AJR Am J Roentgenol 2011; 196:702-11. [DOI: 10.2214/ajr.10.5092] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Winterer JT, Blanke P, Schaefer A, Pache G, Langer M, Markl M. Bilateral contrast-enhanced MR angiography of the hand: diagnostic image quality of accelerated MRI using echo sharing with interleaved stochastic trajectories (TWIST). Eur Radiol 2010; 21:1026-33. [PMID: 21085967 DOI: 10.1007/s00330-010-2002-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 09/10/2010] [Accepted: 09/15/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the image quality of time-resolved contrast-enhanced MRA (tr-MRA) employing echo-sharing with stochastic trajectories for the bilateral examination of the hands. METHODS In this institutional review-board approved study, Tr-MRA was compared with multiphasic contrast-enhanced MRA (mp-MRA) featuring sub-systolic venous compression in 20 healthy volunteers at 3.0 T using the following settings: TR/TE: 2.8/1.2 ms, flip angle: 25°, acceleration factor: 4, effective voxel size: 0.9 × 0.8 × 0.9 cm, acquisition time 4.9 s per 3D volume. RESULTS With tr-MRA the arterial first-pass contrast agent transit is clearly seen. On average the contrast agent arrived 34 s post-injection and reached the proper digital arteries after 44 s. The mean arterio-venous window was 13 s. Bilateral contrast enhancement was asynchronous in 56-62%. On a semiquantitative scale (0 = non-sufficient to 4 = excellent) tr-MRA (mp-MRA) yielded an average ranking of 2.8-3.6 (3.1-3.8) in the greater and intermediate sized segments and 1.3-2.0 (1.6-2.3) in the proper digital arteries. CONCLUSION Compared with established multiphasic ce-MRA, time-resolved MRA allows a four times faster acquisition. It reflects the natural haemodynamics of the hand arteries with no need for sub-systolic venous compression and may be beneficial in the detection of hand circulation disorders. Image quality is comparable to mp-MRA. In both techniques depiction of the proper digital arteries is limited.
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Affiliation(s)
- Jan Thorsten Winterer
- Department of Radiology, University Hospital of Freiburg, Hugstetter Str 55, D-79106 Freiburg, Germany.
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