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Gumus KZ, Virarkar M, Miyazaki M, Francois CJ, Kee-Sampson J, Gopireddy DR. Non-contrast MR angiography: physical principles and clinical applications in chest, abdomen and pelvis imaging. Abdom Radiol (NY) 2024:10.1007/s00261-024-04500-8. [PMID: 39031182 DOI: 10.1007/s00261-024-04500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 07/22/2024]
Abstract
This review article focuses on the advancements in non-contrast magnetic resonance angiography (NC-MRA) and its increasing importance in body imaging, especially for patients with renal complications, pregnant women, and children. It highlights the relevance of NC-MRA in chest, abdominal, and pelvis imaging and details various bright-blood NC-MRA techniques like cardiac-gated 3D Fast Spin Echo (FSE), balanced Steady-State Free Precession (bSSFP), Arterial Spin Labeling (ASL), and 4D flow methods. The article explains the operational principles of these techniques, their clinical applications, and their advantages over traditional contrast-enhanced methods. Special attention is given to the utility of these techniques in diverse imaging scenarios, including liver, renal, and pelvic imaging. The article underscores the growing importance of NC-MRA in medical diagnostics, offering insights into current practices and potential future developments. This comprehensive review is a valuable resource for radiologists and clinicians, emphasizing NC-MRA's role in enhancing patient care and diagnostic accuracy across various medical conditions.
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Affiliation(s)
- Kazim Z Gumus
- Department of Radiology, College of Medicine, University of Florida, Jacksonville, FL, USA.
| | - Mayur Virarkar
- Department of Radiology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Mitsue Miyazaki
- Department of Radiology, University of California, San Diego, School of Medicine, San Diego, CA, USA
| | | | - Joanna Kee-Sampson
- Department of Radiology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Dheeraj R Gopireddy
- Department of Radiology, College of Medicine, University of Florida, Jacksonville, FL, USA
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2
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Regi SS, Irodi A, Keshava SN, Agarwal S. Balanced Steady-State Free Precision and Time of Flight Noncontrast Magnetic Resonance Angiography in Peripheral Arterial Disease. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1730845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Purpose To determine the diagnostic efficacy of balanced steady-state free precession (bSSFP) and time-of-flight (TOF)-based noncontrast magnetic resonance angiography (NC-MRA) in lower limb peripheral arterial disease (PAD).
Material and Methods 10 patients with suspected PAD underwent both NC-MRA (bSSFP and 2D TOF) and contrast-enhanced MR angiography (CE-MRA)/CT angiography (CTA). A total of 170 arterial segments (17 segments in each patient) were analyzed on NC-MRA and compared with CE-MRA/CTA for quality of images and for estimating the degree of stenoses. Image quality was graded as 1—poor, 2—fair, 3—good, and 4—excellent. The degree of stenoses was graded as 0—normal, 1— ≤ 50% narrowing, 2— > 50% narrowing, 3—near complete/100% occlusion. Sensitivity, specificity, positive predictive value, and negative predictive value of NC-MRA in identifying significant stenosis, as compared with CE-MRA/CTA, were estimated.
Results a) Mean grade of the image quality of NC-MRA was 3.10 and the CE-MRA/CTA was 3.64. b) The agreement in the estimation of the degree of stenosis on NC-MRA as compared with CE-MRA/CTA was substantial in aortoiliac segments (weighted kappa 0.646 [95% CI] [0.361–0.931] [p < 0.001]), almost perfect in femoropopliteal segments (weighted kappa 0.911 [95% CI] [0.79–1.032] [p < 0.001]), and poor in infrapopliteal segments (weighted kappa 0.052 [95% CI] [0.189–0.293] [p < 0.33587]).
Conclusion TOF and bSSFP-based NC-MRA was found to be comparable to the CE-MRA/CTA in the evaluation of PAD in lower limbs in the aortoiliac and femoropopliteal regions. NC-MRA was especially helpful in assessing the aortoiliac vessels and femoropopliteal vessels, with the imaging of infrapopliteal arteries being suboptimal.
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Affiliation(s)
- Soumya Susan Regi
- Division of Clinical Radiology, Department of Diagnostic Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aparna Irodi
- Division of Clinical Radiology, Department of Diagnostic Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shyamkumar N. Keshava
- Division of Clinical Radiology, Department of Interventional Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sunil Agarwal
- Department of Vascular Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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3
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Velloni FG, Cardia PP, Torres UDS, Pereira MAH, Penachim TJ, Favaro LR, Ramalho M, D'Ippolito G. Unenhanced magnetic resonance angiography as an accurate alternative in the preoperative assessment of potential living kidney donors with contraindications to computed tomography angiography and to contrast-enhanced magnetic resonance angiography. Radiol Bras 2020; 53:229-235. [PMID: 32904775 PMCID: PMC7458566 DOI: 10.1590/0100-3984.2019.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the accuracy of steady-state free precession (SSFP) unenhanced magnetic resonance angiography (MRA) at 1.5 T for the identification of multiple renal arteries, using computed tomography angiography (CTA) as the reference standard. Materials and Methods This was a prospective study involving 39 patients (26 males; mean age, 62.6 years) who underwent CTA and unenhanced MRA to evaluate the proximal and middle segments of the renal arteries. The analysis was performed in two phases: the quality of unenhanced MRA images was classified as diagnostic or nondiagnostic for the presence of multiple renal arteries by two independent readers; two other independent readers then evaluated the images previously classified as being of diagnostic quality. The sensitivity, specificity, and overall accuracy of unenhanced MRA were calculated, CTA being used as the reference standard. The kappa statistic was used in order to calculate interobserver agreement. Results The image quality of unenhanced MRA was considered diagnostic in 70-90% of the extrarenal arterial segments. The CTA examination revealed 19 multiple renal arteries (8 on the right and 11 on the left). The accuracy of unenhanced MRA for the identification of multiple renal arteries was greater than 90%, with a sensitivity of 72.7-100% and a specificity of 96.3-100%. Conclusion Unenhanced MRA provides high quality imaging of the extrarenal segments of renal arteries. This method may be used as an alternative for the evaluation of the renal arteries, given that it has an accuracy comparable to that of CTA.
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Affiliation(s)
- Fernanda Garozzo Velloni
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Diagnósticos da América SA (DASA), São Paulo, SP, Brazil
| | - Patrícia Prando Cardia
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Centro Radiológico Campinas, Campinas, SP, Brazil
| | | | - Marco Antonio Haddad Pereira
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Diagnósticos da América SA (DASA), São Paulo, SP, Brazil
| | | | - Larissa Rossini Favaro
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Giuseppe D'Ippolito
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Grupo Fleury, São Paulo, SP, Brazil
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4
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Hu Z, Christodoulou AG, Wang N, Shaw JL, Song SS, Maya MM, Ishimori ML, Forbess LJ, Xiao J, Bi X, Han F, Li D, Fan Z. Magnetic resonance multitasking for multidimensional assessment of cardiovascular system: Development and feasibility study on the thoracic aorta. Magn Reson Med 2020; 84:2376-2388. [PMID: 32301164 DOI: 10.1002/mrm.28275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To develop an MR multitasking-based multidimensional assessment of cardiovascular system (MT-MACS) with electrocardiography-free and navigator-free data acquisition for a comprehensive evaluation of thoracic aortic diseases. METHODS The MT-MACS technique adopts a low-rank tensor image model with a cardiac time dimension for phase-resolved cine imaging and a T2 -prepared inversion-recovery dimension for multicontrast assessment. Twelve healthy subjects and 2 patients with thoracic aortic diseases were recruited for the study at 3 T, and both qualitative (image quality score) and quantitative (contrast-to-noise ratio between lumen and wall, lumen and wall area, and aortic strain index) analyses were performed in all healthy subjects. The overall image quality was scored based on a 4-point scale: 3, excellent; 2, good; 1, fair; and 0, poor. Statistical analysis was used to test the measurement agreement between MT-MACS and its corresponding 2D references. RESULTS The MT-MACS images reconstructed from acquisitions as short as 6 minutes demonstrated good or excellent image quality for bright-blood (2.58 ± 0.46), dark-blood (2.58 ± 0.50), and gray-blood (2.17 ± 0.53) contrast weightings, respectively. The contrast-to-noise ratios for the three weightings were 49.2 ± 12.8, 20.0 ± 5.8 and 2.8 ± 1.8, respectively. There were good agreements in the lumen and wall area (intraclass correlation coefficient = 0.993, P < .001 for lumen; intraclass correlation coefficient = 0.969, P < .001 for wall area) and strain (intraclass correlation coefficient = 0.947, P < .001) between MT-MACS and conventional 2D sequences. CONCLUSION The MT-MACS technique provides high-quality, multidimensional images for a comprehensive assessment of the thoracic aorta. Technical feasibility was demonstrated in healthy subjects and patients with thoracic aortic diseases. Further clinical validation is warranted.
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Affiliation(s)
- Zhehao Hu
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Anthony G Christodoulou
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Medicine, University of California, Los Angeles, California
| | - Nan Wang
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California
| | - Jaime L Shaw
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Shlee S Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marcel M Maya
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mariko L Ishimori
- Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Lindsy J Forbess
- Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jiayu Xiao
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Fei Han
- Siemens Healthcare, Los Angeles, California
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California.,Department of Medicine, University of California, Los Angeles, California
| | - Zhaoyang Fan
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Bioengineering, University of California, Los Angeles, California.,Department of Medicine, University of California, Los Angeles, California
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5
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Renal artery assessment with non-enhanced MR angiography versus digital subtraction angiography: comparison between 1.5 and 3.0 T. Eur Radiol 2019; 30:1747-1754. [DOI: 10.1007/s00330-019-06440-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/09/2019] [Accepted: 09/09/2019] [Indexed: 01/07/2023]
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6
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Beck L, Mohamed AA, Strugnell WE, Bartlett H, Rodriguez V, Hamilton-Craig C, Slaughter RE. MRI measurements of the thoracic aorta and pulmonary artery. J Med Imaging Radiat Oncol 2017; 62:64-71. [DOI: 10.1111/1754-9485.12637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 05/12/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Leyla Beck
- The Prince Charles Hospital; Brisbane Queensland Australia
- Sunshine Coast University Hospital; Birtinya Queensland Australia
| | | | | | - Harry Bartlett
- Science and Engineering Faculty; Queensland University of Technology; Brisbane Queensland Australia
| | - Viviana Rodriguez
- The Prince Charles Hospital; Brisbane Queensland Australia
- Department Of Evaluation & Research; General Practice Training Queensland (GPTQ); Brisbane Queensland Australia
| | - Christian Hamilton-Craig
- The Prince Charles Hospital; Brisbane Queensland Australia
- Centre for Advanced Imaging; University of Queensland; Brisbane Queensland Australia
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7
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Beiderwellen K, Kraff O, Laader A, Maderwald S, Orzada S, Ladd ME, Forsting M, Lauenstein TC, Umutlu L. Contrast enhanced renal MR angiography at 7 Tesla: How much gadolinium do we need? Eur J Radiol 2016; 86:76-82. [PMID: 28027770 DOI: 10.1016/j.ejrad.2016.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate whether a dose reduction of Gadobutrol for renal magnetic resonance angiography (MRA) at 7 Tesla (T) is feasible while preserving diagnostic image quality. METHODS Ten healthy volunteers were enrolled for a renal MRA on a 7T scanner. Fast low angle shot (FLASH) MRA data sets were obtained utilizing three different doses of Gadobutrol (0.1, 0.05 and 0.025mmol/kg body weight [BW]). Contrast ratios (CR) were measured in the aorta as well as in the intra- and extraparenchymal arteries compared to the psoas muscle. Qualitative analysis regarding the delineation of vessel structures was performed using a four-point-scale. RESULTS All doses of Gadobutrol allowed for a good delineation of the aorta and renal arteries. For the extra- and intraparenchymal segmental arteries higher values were observed for full and half dose in comparison to quarter dose. No significant difference was observed for full and half dose. A lower CR was observed for quarter compared to half dose (p<0.05) for the renal arteries. CONCLUSIONS While best results were observed for half and full dose, a dose reduction to 0.025mmol/kg BW is justifiable, maintaining a diagnostic image quality. This may be of high interest considering patients with renal impairment.
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Affiliation(s)
- Karsten Beiderwellen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.
| | - Anja Laader
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.
| | - Stephan Orzada
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.
| | - Mark E Ladd
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.
| | - Thomas C Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany.
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8
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Ohno T, Isoda H, Furuta A, Togashi K. Non-contrast-enhanced MR portography and hepatic venography with time-spatial labeling inversion pulses: comparison at 1.5 Tesla and 3 Tesla. Acta Radiol Open 2015; 4:2058460115584110. [PMID: 26019890 PMCID: PMC4437907 DOI: 10.1177/2058460115584110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/04/2015] [Indexed: 11/28/2022] Open
Abstract
Background A 3 Tesla (3 T) magnetic resonance (MR) scanner is a promising tool for upper abdominal MR angiography. However, there is no report focused on the image quality of non-contrast-enhanced MR portography and hepatic venography at 3 T. Purpose To compare and evaluate images of non-contrast-enhanced MR portography and hepatic venography with time-spatial labeling inversion pulses (Time-SLIP) at 1.5 Tesla (1.5 T) and 3 T. Material and Methods Twenty-five healthy volunteers were examined using respiratory-triggered three-dimensional balanced steady-state free-precession (bSSFP) with Time-SLIP. For portography, we used one tagging pulse (selective inversion recovery) and one non-selective inversion recovery pulse; for venography, two tagging pulses were used. The relative signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were quantified, and the quality of visualization was evaluated. Results The CNRs of the main portal vein, right portal vein, and left portal vein at 3 T were better than at 1.5 T. The image quality scores for the portal branches of segment 4, 5, and 8 were significantly higher at 3 T than at 1.5 T. The CNR of the right hepatic vein (RHV) at 3 T was significantly lower than at 1.5 T. The image quality scores of RHV and the middle hepatic vein were higher at 1.5 T than at 3 T. For RHV visualization, the difference was statistically significant. Conclusion Non-contrast-enhanced MR portography with Time-SLIP at 3 T significantly improved visualization of the peripheral branch in healthy volunteers compared with1.5 T. Non-contrast-enhanced MR hepatic venography at 1.5 T was better than at 3 T.
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Affiliation(s)
- Tsuyoshi Ohno
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Furuta
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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9
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Park SY, Kim CK, Kim E, Park BK. Noncontrast-enhanced magnetic resonance renal angiography using a repetitive artery and venous labelling technique at 3 T: comparison with contrast-enhanced magnetic resonance angiography in subjects with normal renal function. Eur Radiol 2014; 25:533-40. [DOI: 10.1007/s00330-014-3416-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/16/2014] [Accepted: 08/26/2014] [Indexed: 11/29/2022]
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Abstract
Magnetic resonance (MR) imaging is a robust imaging modality for evaluation of vascular diseases. Technological advances have made MR imaging widely available for accurate and time-efficient vascular assessment. In this article the clinical usefulness of MR imaging techniques and their application are reviewed, using examples of vascular abnormalities commonly encountered in clinical practice, including abdominal, pelvic, and thoracic vessels. Common pitfalls and problem solving in interpretation of vascular findings in body MR imaging are also discussed.
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Affiliation(s)
- Wirana Angthong
- Department of Radiology, University of North Carolina Hospitals, UNC at Chapel Hill, CB 7510, 2001 Old Clinic Building, Chapel Hill, NC 27599-7510, USA; Department of Radiology, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, 62 Moo 7, Khlong Sip, Ongkharak, Nakhon Nayok, Thailand
| | - Richard C Semelka
- Department of Radiology, University of North Carolina Hospitals, UNC at Chapel Hill, CB 7510, 2001 Old Clinic Building, Chapel Hill, NC 27599-7510, USA.
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Xie Y, Fan Z, Saouaf R, Natsuaki Y, Laub G, Li D. Adaptive online self-gating (ADIOS) for free-breathing noncontrast renal MR angiography. Magn Reson Med 2014; 73:312-7. [PMID: 24478221 DOI: 10.1002/mrm.25121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/15/2013] [Accepted: 12/16/2013] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop a respiratory self-gating method, adaptive online self-gating (ADIOS), for noncontrast MR angiography (NC MRA) of renal arteries to overcome some limitations of current free-breathing methods. METHODS A NC MRA pulse sequence for online respiratory self-gating was developed based on three-dimensional balanced steady-state free precession (bSSFP) and slab-selective inversion-recovery. Motion information was derived directly from the slab being imaged for online gating. Scan efficiency was maintained by an automatic adaptive online algorithm. Qualitative and quantitative assessments of image quality were performed and results were compared with conventional diaphragm navigator (NAV). RESULTS NC MRA imaging was successfully completed in all subjects (n = 15). Similarly good image quality was observed in the proximal-middle renal arteries with ADIOS compared with NAV. Superior image quality was observed in the middle-distal renal arteries in the right kidneys with no NAV-induced artifacts. Maximal visible artery length was significantly longer with ADIOS versus NAV in the right kidneys. NAV setup was completely eliminated and scan time was significantly shorter with ADIOS on average compared with NAV. CONCLUSION The proposed ADIOS technique for noncontrast MRA provides high-quality visualization of renal arteries with no diaphragm navigator-induced artifacts, simplified setup, and shorter scan time.
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Affiliation(s)
- Yibin Xie
- University of California, Los Angeles, Department of Bioengineering, Los Angeles, California, USA.,Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Department of Biomedical Sciences, Los Angeles, California, USA
| | - Zhaoyang Fan
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Department of Biomedical Sciences, Los Angeles, California, USA
| | - Rola Saouaf
- Cedars-Sinai Medical Center, Department of Imaging, Los Angeles, California, USA
| | | | - Gerhard Laub
- Siemens Medical Solutions, Los Angeles, California, USA
| | - Debiao Li
- University of California, Los Angeles, Department of Bioengineering, Los Angeles, California, USA.,Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Department of Biomedical Sciences, Los Angeles, California, USA
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12
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Unenhanced magnetic resonance portography using repetitive arterial or vein labeling method at 3.0-T. J Comput Assist Tomogr 2013; 37:856-61. [PMID: 24270106 DOI: 10.1097/rct.0b013e31829002ca] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether unenhanced magnetic resonance (MR) angiography using repetitive arterial or vein labeling (RAVEL) is feasible to visualize effectively the intrahepatic portal vein (PV) at 3.0 T. METHODS Forty patients underwent liver MR imaging (MRI) with unenhanced MR portography using RAVEL. Two radiologists performed a consensus review of unenhanced MR portography and portal-phase MRI with regard to anatomic type of PV, vessel conspicuity, and image quality. RESULTS For determination of the anatomic type of PV, the 2 techniques were equivalent. There were tendencies toward increased conspicuity for right segmental PV and its branches with unenhanced MR portography and for left PV with conventional MRI, although significant differences were not found between MRIs (P > 0.05). Image quality for unenhanced MR portography was poor in 1, moderate in 8, and good in 31 patients. CONCLUSIONS Unenhanced MR portography using RAVEL at 3.0 T is feasible and provides effective visualization of intrahepatic PV.
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13
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Angeretti MG, Lumia D, Canì A, Barresi M, Cardim LN, Piacentino F, Maresca AM, Novario R, Genovese EA, Fugazzola C. Non-enhanced MR angiography of renal arteries: comparison with contrast-enhanced MR angiography. Acta Radiol 2013; 54:749-56. [PMID: 23550187 DOI: 10.1177/0284185113482690] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The main causes of renal artery stenosis (RAS) are atherosclerosis and fibromuscular dysplasia. Despite contrast-enhanced magnetic resonance angiography (CE-MRA) being a safe and reliable method for diagnosis of RAS especially in young individuals, recently it has been possible to adopt innovative technologies that do not require paramagnetic contrast agents. PURPOSE To assess the accuracy of steady-state free-precession (SSFP) non-contrast-enhanced magnetic resonance angiography (NC-MRA) by using a 1.5 T MR scanner for the detection of renal artery stenosis, in comparison with breath-hold CE-MRA as the reference standard. MATERIAL AND METHODS Sixty-three patients (33 men, 30 women) with suspected renovascular hypertension (RVHT) were examined by a 1.5T MR scanner; NC-MRA with an electrocardiography (ECG)-gated SSFP sequence was performed in 58.7% (37/63) of patients; in 41.3% (26/63) of patients a respiratory trigger was used in addition to cardiac gating. CE-MRA, with a three-dimensional gradient echo (3D-GRE) T1-weighted sequence, was performed in all patients within the same session. Maximum intensity projection (MIP) image quality, number of renal arteries, and the presence of stenosis were assessed by two observers (independently for NC-MRA and together for CE-MRA). The agreement between NC-MRA and CE-MRA as well as the inter-observer reproducibility were calculated with Bland-Altman plots. RESULTS MIP image quality was considered better for NC-MRA. NC-MRA identified 143 of 144 (99.3%) arteries detected by CE-MRA (an accessory artery was not identified). Fourteen stenoses were detected by CE-MRA (11 atherosclerotic, 3 dysplastic) with four of 14 (28.5%) significant stenosis. Bland-Altman plot demonstrated an excellent concordance between NC-MRA and CE-MRA; particularly, the reader A evaluated correctly all investigated arteries, while over-estimation of two stenoses occurred for reader B. Regarding NC-MRA, inter-observer agreement was excellent. CONCLUSION NC-MRA is a valid alternative to CE-MRA for the assessment of renal arteries.
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Affiliation(s)
| | | | | | | | | | | | | | - R Novario
- Department of Medical Physics, Insubria University, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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Evaluation of Renal Artery in Hypertensive Patients by Unenhanced MR Angiography Using Spatial Labeling With Multiple Inversion Pulses Sequence and by CT Angiography. AJR Am J Roentgenol 2012; 199:1142-8. [PMID: 23096191 DOI: 10.2214/ajr.11.7263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Klee D, Lanzman RS, Blondin D, Schmitt P, Oh J, Salgin B, Mayatepek E, Antoch G, Schaper J. Non-enhanced ECG-gated respiratory-triggered 3-D steady-state free-precession MR angiography with slab-selective inversion: initial experience in visualisation of renal arteries in free-breathing children without renal artery abnormality. Pediatr Radiol 2012; 42:785-90. [PMID: 22466749 DOI: 10.1007/s00247-011-2343-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/29/2011] [Accepted: 12/13/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND ECG-gated non-enhanced balanced steady-state free precession (bSSFP) MR angiography requires neither breath-holding nor administration of contrast material. OBJECTIVE To investigate the image quality of free-breathing ECG-gated non-enhanced bSSFP MR angiography of renal arteries in children. MATERIALS AND METHODS Fourteen boys and seven girls (mean age, 9.7 years; range, 7 weeks-17 years) with no history of renovascular disease were included. MRI was performed at 1.5 T. Subjective image quality of axial and coronal maximum-intensity-projection reconstructions of four segments (I, aorta and renal artery ostium; II, main renal artery; III, segmental branches; IV, intrarenal vessels) was evaluated using a 4-point scale (4 = excellent, 3 = good, 2 = acceptable, 1 = non-diagnostic). RESULTS Image quality was excellent for segments I (mean ± SD, 3.9 ± 0.3) and II (4.0 ± 0.1), good for segment III (3.4 ± 0.9) and acceptable for segment IV (2.3 ± 1.1 ). Mean image quality did not differ between sedated and non-sedated children. CONCLUSION bSSFP MR angiography enables visualisation of renal arteries in children.
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Affiliation(s)
- Dirk Klee
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany
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Umutlu L, Maderwald S, Kraff O, Kinner S, Schaefer L, Wrede K, Antoch G, Forsting M, Ladd M, Lauenstein T, Quick H. New look at renal vasculature: 7 tesla nonenhanced T1-weighted FLASH imaging. J Magn Reson Imaging 2012; 36:714-21. [DOI: 10.1002/jmri.23702] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 04/12/2012] [Indexed: 11/11/2022] Open
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Tan H, Koktzoglou I, Glielmi C, Galizia M, Edelman RR. Optimization of single shot 3D breath-hold non-enhanced MR angiography of the renal arteries. J Cardiovasc Magn Reson 2012; 14:30. [PMID: 22607351 PMCID: PMC3419127 DOI: 10.1186/1532-429x-14-30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 05/04/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cardiac and navigator-gated, inversion-prepared non-enhanced magnetic resonance angiography techniques can accurately depict the renal arteries without the need for contrast administration. However, the scan time and effectiveness of navigator-gated techniques depend on the subject respiratory pattern, which at times results in excessively prolonged scan times or suboptimal image quality. A single-shot 3D magnetization-prepared steady-state free precession technique was implemented to allow the full extent of the renal arteries to be depicted within a single breath-hold. METHODS Technical optimization of the breath-hold technique was performed with fourteen healthy volunteers. An alternative magnetization preparation scheme was tested to maximize inflow signal. Quantitative and qualitative comparisons were made between the breath-hold technique and the clinically accepted navigator-gated technique in both volunteers and patients on a 1.5 T scanner. RESULTS The breath-hold technique provided an average of seven fold reduction in imaging time, without significant loss of image quality. Comparable single-to-noise and contrast-to-noise ratios of intra- and extra-renal arteries were found between the breath-hold and the navigator-gated techniques in volunteers. Furthermore, the breath-hold technique demonstrated good image quality for diagnostic purposes in a small number of patients in a pilot study. CONCLUSIONS The single-shot, breath-hold technique offers an alternative to navigator-gated methods for non-enhanced renal magnetic resonance angiography. The initial results suggest a potential supplementary clinical role for the breath-hold technique in the evaluation of suspected renal artery diseases.
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Affiliation(s)
- Huan Tan
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA
| | - Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA
- The University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | | | - Mauricio Galizia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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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.
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Affiliation(s)
- Mitsue Miyazaki
- Toshiba Medical Research Institute USA, Vernon Hills, Illinois 60061, USA.
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Shimada T, Amanuma M, Takahashi A, Tsushima Y. Non-Contrast Renal MR Angiography: Value of Subtraction of Tagging and Non-Tagging Technique. Ann Vasc Dis 2012; 5:161-5. [PMID: 23555505 DOI: 10.3400/avd.oa.11.00065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 01/29/2012] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The aim of this study was to examine the usefulness of the subtraction technique of non-contrast renal magnetic resonance angiography (MRA) between tagged and non-tagged data collection. MATERIAL AND METHODS We performed renal MRA on eleven healthy volunteers using a 3T MRI unit. For renal MRA, a three dimensional balanced type steady-state free precession (SSFP) sequence (True FISP, Siemens) was used with diaphragmatic navigator gating. We tried to acquire selective arterial images by subtracting black-blood images (tagged images, on which arterial longitudinal magnetization was nearly zero by selective inversion of upper-stream aortic flow) from bright-blood images (non-tagged images, on which arterial flow is bright due to inflow effect). For analysis, two radiologists independently evaluated the visual quality of the axial and coronal targeted maximum intensity projection images (MIP) of original bright-blood MRA and subtraction MRA. RESULTS Visualization of the main stem of the renal arteries and their 1st branches were satisfactory on both techniques, and there was no statistically significant difference. The score of 2nd branch appeared superior with the subtraction method, but only the right side showed a statistically significant difference (P <0.01). Visualization of small intraparenchymal arteries was significantly superior with subtraction method on both sides. CONCLUSION We tried to improve selective demonstration of renal arterial branches using subtraction technique. Although full sequence optimization was not performed, this pilot study showed this technique to be slightly time-consuming but superior in visualization of peripheral branches and possibly more sensitive in detecting small vessel abnormalities.
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Affiliation(s)
- Takehiro Shimada
- Department of Diagnostic, Interventional Radiology and Nuclear Medicine, Gunma University School of Medicine, Maebashi, Gunma, Japan
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20
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Miyazaki M, Isoda H. Non-contrast-enhanced MR angiography of the abdomen. Eur J Radiol 2011; 80:9-23. [DOI: 10.1016/j.ejrad.2011.01.093] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
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MD CT Angiography and MR Angiography of Nonatherosclerotic Renal Artery Disease. Cardiovasc Intervent Radiol 2011; 34:1151-64. [DOI: 10.1007/s00270-011-0202-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 05/22/2011] [Indexed: 11/25/2022]
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Hartung MP, Grist TM, François CJ. Magnetic resonance angiography: current status and future directions. J Cardiovasc Magn Reson 2011; 13:19. [PMID: 21388544 PMCID: PMC3060856 DOI: 10.1186/1532-429x-13-19] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 03/09/2011] [Indexed: 01/06/2023] Open
Abstract
With recent improvement in hardware and software techniques, magnetic resonance angiography (MRA) has undergone significant changes in technique and approach. The advent of 3.0 T magnets has allowed reduction in exogenous contrast dose without compromising overall image quality. The use of novel intravascular contrast agents substantially increases the image windows and decreases contrast dose. Additionally, the lower risk and cost in non-contrast enhanced (NCE) MRA has sparked renewed interest in these methods. This article discusses the current state of both contrast-enhanced (CE) and NCE-MRA. New CE-MRA methods take advantage of dose reduction at 3.0 T, novel contrast agents, and parallel imaging methods. The risks of gadolinium-based contrast media, and the NCE-MRA methods of time-of-flight, steady-state free precession, and phase contrast are discussed.
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Affiliation(s)
- Michael P Hartung
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Thomas M Grist
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Christopher J François
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
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Chennur VSS, Sharma R, Gamanagatti S, Bhatnagar V, Gupta AK, Vishnubhatla S. Multidetector CT venography and contrast-enhanced MR venography of the inferior mesenteric vein in paediatric extrahepatic portal vein obstruction. Pediatr Radiol 2011; 41:322-6. [PMID: 20949265 DOI: 10.1007/s00247-010-1833-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 07/31/2010] [Accepted: 08/18/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Extrahepatic portal vein obstruction (EHPVO) is a common cause of paediatric portal hypertension and the only permanent treatment is shunt surgery. The inferior mesenteric vein (IMV) is a portal venous channel that can be used for the shunt when the splenic vein/superior mesenteric vein is thrombosed or when a lienorenal shunt is not possible. OBJECTIVE To compare MDCT venography (MDCTV) and contrast-enhanced MR venography (CEMRV) for visualisation of the IMV in children with EHPVO. MATERIALS AND METHODS This was a prospective study of 26 children (4-12 years, median 10 years) who underwent MDCTV and CEMRV. The IMV visualisation was graded using 4- and 2-point scales and the difference in visualisation was assessed by calculating the exact significance probability (P). RESULTS The IMV was visualised in all children on MDCTV and 25/26 children on CEMRV (96%). The images were diagnostic in 23/26 children (88%) on MDCTV and in 18/26 (69%) children on CEMRV (P=0.063). CONCLUSION MDCTV and CEMRV are comparable for IMV visualisation with a tendency toward MDCTV being superior.
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Parienty I, Rostoker G, Jouniaux F, Piotin M, Admiraal-Behloul F, Miyazaki M. Renal artery stenosis evaluation in chronic kidney disease patients: nonenhanced time-spatial labeling inversion-pulse three-dimensional MR angiography with regulated breathing versus DSA. Radiology 2011; 259:592-601. [PMID: 21330564 DOI: 10.1148/radiol.11101422] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of nonenhanced magnetic resonance (MR) angiographic flow-in technique with three-dimensional balanced steady-state free precession (SSFP) (flow-in balanced SSFP), compared with digital subtraction angiography (DSA) as reference standard, for assessment of renal artery stenosis (RAS) in chronic kidney disease (CKD) patients. MATERIALS AND METHODS Institutional review board approval and written informed consent were obtained for this prospective HIPAA-compliant study. Twenty-three patients, 13 men (mean age, 67.6 years ± 8.1 [standard deviation]; age range, 58-86 years) and 10 women (mean age 73.1 years ± 12.4; age range, 49-89 years), were evaluated with flow-in balanced SSFP and DSA. Coronal and axial flow-in balanced SSFP images were obtained with 1.5-T system, with regulated breathing (recorded voice instruction). The quality of flow-in balanced SSFP images was visually evaluated; the degree of stenosis was compared between flow-in balanced SSFP source images and DSA images by using the Wilcoxon signed-rank test. Correlation between images from both modalities was calculated as the Spearman rank-order correlation coefficient; bias was examined with Bland-Altman plots. RESULTS Diagnostic images were obtained in all patients. Flow-in balanced SSFP image quality was good in 87% (20 of 23) and moderate in 13% (three of 23) of patients. Forty-five renal arteries were included in the statistical analysis. Of 36 stenoses detected with flow-in balanced SSFP, 28 were relevant (degree of stenosis, ≥ 50%). The stenosis measurements of flow-in balanced SSFP were highly correlated (ρ = 0.91, P < .001) with those of DSA. The Bland-Altman plot showed a slight overestimation of the degree of stenosis (mean bias, 2.33% ± 11.95). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of flow-in balanced SSFP relative to DSA for the diagnosis of a stenosis of 50% or greater were 93% (26 of 28), 88% (15 of 17), 93% (26 of 28), 88% (15 of 17), and 91% (41 of 45), respectively. CONCLUSION Flow-in balanced SSFP with regulated breathing is an appropriate nonenhanced MR angiographic technique for RAS assessment in CKD patients. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101422/-/DC1.
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