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Tan EJ, Zhang S, Tirukonda P, Chong LR. REACT - A novel flow-independent non-gated non-contrast MR angiography technique using magnetization-prepared 3D non-balanced dual-echo dixon method: Preliminary clinical experience. Eur J Radiol Open 2020; 7:100238. [PMID: 32548214 PMCID: PMC7286964 DOI: 10.1016/j.ejro.2020.100238] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/29/2022] Open
Abstract
Flow-independent relaxation-based non-contrast MR angiography techniques yield good signal-to-noise ratio and high blood-tissue contrast, complementing non-contrast flow-dependent and contrast-enhanced MR angiography techniques in the assessment of vascular disorders. However, these techniques often suffer from imaging artifacts at high magnetic field strengths or across large fields-of-view. Relaxation-Enhanced Angiography without Contrast and Triggering (REACT) is a recently introduced flow-independent non-gated non-contrast three-dimensional MR angiography technique that has been developed to mitigate some of these issues. We present our initial experience with the clinical applications of REACT in imaging disorders of the central and peripheral vascular systems.
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Affiliation(s)
- Eu Jin Tan
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Shuo Zhang
- Philips Healthcare Singapore, 622 Lorong 1 Toa Payoh, Philips APAC Center Level 1, 319763, Singapore.,Philips DACH GmbH, Röntgenstraße 24-26, 22335, Hamburg, Germany
| | - Prasanna Tirukonda
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Le Roy Chong
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
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Gale EM, Caravan P, Rao AG, McDonald RJ, Winfeld M, Fleck RJ, Gee MS. Gadolinium-based contrast agents in pediatric magnetic resonance imaging. Pediatr Radiol 2017; 47:507-521. [PMID: 28409250 DOI: 10.1007/s00247-017-3806-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/16/2016] [Accepted: 02/10/2017] [Indexed: 12/17/2022]
Abstract
Gadolinium-based contrast agents can increase the accuracy and expediency of an MRI examination. However the benefits of a contrast-enhanced scan must be carefully weighed against the well-documented risks associated with administration of exogenous contrast media. The purpose of this review is to discuss commercially available gadolinium-based contrast agents (GBCAs) in the context of pediatric radiology. We discuss the chemistry, regulatory status, safety and clinical applications, with particular emphasis on imaging of the blood vessels, heart, hepatobiliary tree and central nervous system. We also discuss non-GBCA MRI contrast agents that are less frequently used or not commercially available.
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Affiliation(s)
- Eric M Gale
- Department of Radiology, The Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Caravan
- Department of Radiology, The Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anil G Rao
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Robert J McDonald
- Department of Radiology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew Winfeld
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert J Fleck
- Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael S Gee
- Division of Pediatric Imaging, Department of Radiology, MassGeneral Hospital for Children, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA.
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Intra- and Extracranial MR Venography: Technical Notes, Clinical Application, and Imaging Development. Behav Neurol 2016; 2016:2694504. [PMID: 27340338 PMCID: PMC4906191 DOI: 10.1155/2016/2694504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/11/2016] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
Scientific debate over chronic cerebrospinal venous insufficiency (CCSVI) has drawn attention to venous system involvement in a series of pathologic brain conditions. In the last few decades, the MRI venography (MRV) field has developed a number of valuable sequences to better investigate structural anatomy, vessel patency, and flow characteristics of venous drainage in the intra- and extracranial systems. A brief two-tier protocol is proposed to encompass the study of intra- and extracranial venous drainage with and without contrast administration, respectively. Contrast-enhanced protocol is based on time-resolved contrast-enhanced MRV of the whole region plus extracranial flow quantification through 2D Cine phase contrast (PC); non-contrast-enhanced protocol includes intracranial 3D PC, extracranial 2D time of flight (TOF), and 2D Cine PC flow quantification. Total scanning time is reasonable for clinical applications: approximately seven minutes is allocated for the contrast protocol (most of which is due to 2D Cine PC), while the noncontrast protocol accounts for around twenty minutes. We believe that a short though exhaustive MRI scan of the whole intra- and extracranial venous drainage system can be valuable for a variety of pathologic conditions, given the possible venous implication in several neurological conditions.
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Cina A, Di Stasi C, Semeraro V, Marano R, Savino G, Iezzi R, Bonomo L. Comparison of CT and MR angiography in evaluation of peripheral arterial disease before endovascular intervention. Acta Radiol 2016; 57:547-56. [PMID: 26185265 DOI: 10.1177/0284185115595657] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/20/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multidetector computed tomography angiography (MDCTA) and magnetic resonance angiography (MRA) are accurate techniques for selecting patients with peripheral arterial disease for surgical and endovascular treatment. No studies in the literature have directly compared MDCTA and MRA to establish which one should be employed, in patients suitable for both techniques, before endovascular treatment. PURPOSE To compare diagnostic performance of MDCTA vs MRA before endovascular intervention. MATERIAL AND METHODS We prospectively compared MDCTA (64 slices scanner) and MRA (1.5 T scanner; 3D gadolinium-enhanced bolus-chase acquisition plus time resolved acquisition on calves) to stratify 35 patients according to the TASC II score and a runoff severity score. We also evaluated the accuracy of both techniques in each arterial segment. Selective angiography performed during the treatment was the standard of reference. RESULTS MDCTA and MRA accurately classify disease in the aorto-iliac (accuracy 0.92 for MDCTA and MRA) and femoro-popliteal (MDCTA 0.94, MRA 0.90) segments. MDCTA was more accurate in stratifying disease in the infrapopliteal segments (0.96 vs. 0.9) and in assessing the impairment of runoff arteries (0.92 vs. 0.85) at per-segment analysis. MDCTA showed a higher confidence and a shorter examination time. CONCLUSION Our results suggest that MDCTA can be considered as a first-line investigation in patients being candidates for endovascular procedures when clinical history or duplex sonographic evaluation are indicative of severe impairment of the infrapopliteal segment.
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Affiliation(s)
- Alessandro Cina
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Carmine Di Stasi
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Vittorio Semeraro
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Riccardo Marano
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Roberto Iezzi
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
| | - Lorenzo Bonomo
- Department of Radiological Sciences, “Agostino Gemelli” Hospital, Catholic University, Rome, Italy
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Pediatric Body MR Angiography: Principles, Techniques, and Current Status in Body Imaging. AJR Am J Roentgenol 2015; 205:173-84. [DOI: 10.2214/ajr.14.13795] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Burbelko M, Augsten M, Kalinowski MO, Heverhagen JT. Comparison of contrast-enhanced multi-station MR angiography and digital subtraction angiography of the lower extremity arterial disease. J Magn Reson Imaging 2012. [DOI: 10.1002/jmri.23944] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Maximizing time-resolved MRA for differentiation of hemangiomas, vascular malformations and vascularized tumors. Pediatr Radiol 2012; 42:775-84. [PMID: 22398688 DOI: 10.1007/s00247-012-2359-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 01/26/2012] [Accepted: 01/27/2012] [Indexed: 10/28/2022]
Abstract
Contrast-enhanced magnetic resonance angiography (MRA) using time-resolved imaging is a relatively new and increasingly popular technique. We will describe the technique utilized at our institution, Time-Resolved Imaging of Contrast Kinetics (TRICKS; GE Healthcare, Milwaukee, WI), and the parameters that can be adjusted to optimize the exam. We will review key imaging features of hemangiomas and vascular malformations in various modalities, with a special emphasis on the TRICKS appearance.
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Schaper NC, Andros G, Apelqvist J, Bakker K, Lammer J, Lepantalo M, Mills JL, Reekers J, Shearman CP, Zierler RE, Hinchliffe RJ. Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot. Diabetes Metab Res Rev 2012; 28 Suppl 1:218-24. [PMID: 22271741 DOI: 10.1002/dmrr.2255] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The International Working Group on the Diabetic Foot (IWDGF) has produced in 2011 a guideline on the diagnosis and treatment of peripheral arterial disease in patients with diabetes and a foot ulcer. This document, together with a systematic review that provided the background information on management, was produced by a multidisciplinary working group of experts in the field and was endorsed by the IWDGF. This progress report is based on these two documents and earlier consensus texts of the IWDGF on the diagnosis and management of diabetic foot ulcers. Its aim is to give the clinician clear guidance on when and how to diagnose peripheral arterial disease in patients with diabetes and a foot ulcer and when and which treatment modalities should be considered, taking both risks and benefits into account.
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Affiliation(s)
- N C Schaper
- Division of Endocrinology, MUMC+, CARIM and CAPHRI Institute, Maastricht, The Netherlands.
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Time-resolved MR angiography of the intracranial venous system: an alternative MR venography technique. Eur Radiol 2011; 22:980-9. [DOI: 10.1007/s00330-011-2330-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 09/06/2011] [Accepted: 09/19/2011] [Indexed: 10/15/2022]
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Anzidei M, Cavallo Marincola B, Napoli A, Saba L, Zaccagna F, Lucatelli P, Fanelli F, Bassetti E, Salvatori FM, Catalano C, Passariello R. Low-dose contrast-enhanced time-resolved MR angiography at 3T: diagnostic accuracy for treatment planning and follow-up of vascular malformations. Clin Radiol 2011; 66:1181-92. [PMID: 21899830 DOI: 10.1016/j.crad.2011.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 07/24/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
Abstract
AIM To assess the accuracy of low-dose contrast-enhanced time-resolved 3T magnetic resonance angiography (MRA) for the morphological and functional assessment of vascular malformations (VM), and to evaluate its diagnostic potential for the depiction of treatment-induced changes. MATERIALS AND METHODS Twenty-five patients with known VM underwent MRA to evaluate the location and extent of lesions and their haemodynamic characteristics. Three-dimensional (3D) T1-weighted time-resolved sequences were acquired following the administration of 0.05mmol/kg of gadobenate dimeglumine. VM were classified according to their morphology and haemodynamic characteristics. All patients thereafter underwent conventional angiography to confirm the diagnosis and to treat the lesions (embolization or sclerotherapy). Follow-up MRA was performed 30 days after treatment to assess morphological and functional changes. A visual analogue scale (VAS) was used to clinically assess the severity of symptoms before and after therapy. RESULTS Based on haemodynamic characteristics, VM were classified as predominantly arterial [4 (16%)], artero-venous [19 (76%)] or venous [2 (8%)]. Twenty-three (92%) lesions were classified as high-flow VM and two (8%) as low-flow VM. Intralesional thrombosis was present in 17 (68%) lesions before therapy and in 10 lesions (40%) after therapy. The median VAS scores were 5±1 before treatment and 4±2 after treatment. Very good correlation (Spearman's correlation coefficient: rho=0.87; p=0.000) was noted between the reduction of lesion size on follow-up MRA and pain relief as assessed by VAS. CONCLUSION Low-dose contrast-enhanced time-resolved 3T MRA can be used to define morphological and functional aspects of VM accurately during treatment planning and follow-up, and can identify post-therapy changes that positively correlate with treatment outcome.
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Affiliation(s)
- M Anzidei
- Department of Radiological Sciences, University of Rome "La Sapienza", Rome, Italy.
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Diagnostic value of high spatial and temporal resolution time-resolved MR angiography in the workup of peripheral high-flow vascular malformations at 1.5 Tesla. Int J Cardiovasc Imaging 2011; 28:823-34. [DOI: 10.1007/s10554-011-9887-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
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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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Achenbach M, Figiel JH, Burbelko M, Heverhagen JT. Prospective comparison of image quality and diagnostic accuracy of 0.5 molar gadobenate dimeglumine and 1.0 molar gadobutrol in contrast-enhanced run-off magnetic resonance angiography of the lower extremities. J Magn Reson Imaging 2011; 32:1166-71. [PMID: 21031523 DOI: 10.1002/jmri.22355] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To compare image quality and diagnostic accuracy of 0.5 molar gadobenate dimeglumine and 1.0 molar gadobutrol in contrast-enhanced (CE) magnetic resonance angiography (MRA) of the lower extremities interindividually. MATERIALS AND METHODS The study was approved by our Institutional Review Board. Written informed consent was obtained from all patients before enrollment in the study. We prospectively included 74 patients (21 women, 53 men; mean age ± SD: 67.9 ± 11.0 years) with suspected peripheral occlusive vascular disease. All patients underwent a contrast-enhanced MRA of both lower extremities with either 0.1 mL/kg body weight gadobutrol or gadobenate dimeglumine. Image quality, stenosis grade, and artifacts were assessed by two blinded, independent investigators. Signal intensity (SI), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured by a third investigator. Contrast agent groups were compared to each other using a two-sided Student's t-test. RESULTS The results did not show significant differences for SI, SNR, or CNR. Both investigators were in significant accordance (P < 0.05) with regard to stenosis detection. CONCLUSION We conclude that application of standard clinical doses (0.1 mL/kg body weight) of both contrast agents provides similar diagnostic results and gadolinium dose could be reduced by the application of a single dose of gadobenate dimeglumine for CE run-off MRA.
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Affiliation(s)
- Marina Achenbach
- Department of Diagnostic Radiology, Philipps University Marburg, University Hospital Giessen and Marburg GmbH, Marburg, Germany
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