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Yang H, Yang R. The renal artery-aorta angle associated with renal artery plaque: a retrospective analysis based on CT. BMC Med Imaging 2023; 23:42. [PMID: 36966287 PMCID: PMC10039526 DOI: 10.1186/s12880-023-00997-5] [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: 10/12/2022] [Accepted: 03/14/2023] [Indexed: 03/27/2023] Open
Abstract
PURPOSE To investigate the relationship between renal artery anatomical configuration and renal artery plaque (RAP) based on 320-row CT. METHODS The abdominal contrast-enhanced CT data from 210 patients was retrospectively analyzed. Among 210 patients, there were 118 patients with RAP and 92 patients with no RAP. The anatomical parameters between lesion group and control group were compared and analyzed by using t-test, χ2-test and logistic regression analysis. RESULTS (1) There were statistical differences on age, hypertension, diabetes, hypertriglyceridemia and hypercholesterolemia between lesion group and control group. (2) The differences on the distribution and type and of RAP between lesion group and control group were statistically significant. The most common position was the proximal, and the most common type was calcified plaque. (3)There were significant statistical differences on the proximal diameter of renal artery and renal artery-aorta angle A between lesion group and control group. The differences on the other anatomical factors between two groups were not statistically significant. (4) The result of logistic regression analysis showed that right RAP was related to age, hypertension and right renal artery angle A (the AUC of ROC = 0.82), and left RAP was related to high serum cholesterol, age and left renal artery angle A(the AUC of ROC = 0.83). (5) The RAP was associated with renal artery-aorta angle A, but the differences on distribution, type stability of RAP between R1 (L1) group and R2 (L2) group were not statistically significant. CONCLUSIONS The RAP was associated with age, hypertension, hypercholesterolemia and renal artery-aorta angle A. Adults which had the greater renal artery-aorta angle A and the other above risk factors may be at increased risk for RAP.
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Affiliation(s)
- Hongzhi Yang
- Department of Radiology, XD Group Hospital, Xi'an, 710077, Shaanxi, China.
| | - Ruwu Yang
- Department of Radiology, XD Group Hospital, Xi'an, 710077, Shaanxi, China
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Liang P, Li S, Xu C, Li J, Tan F, Hu D, Kamel I, Li Z. Assessment of renal function using magnetic resonance quantitative histogram analysis based on spatial labeling with multiple inversion pulses. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1614. [PMID: 34926658 PMCID: PMC8640904 DOI: 10.21037/atm-21-2299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/15/2021] [Indexed: 12/17/2022]
Abstract
Background The incidence of chronic kidney disease (CKD) is high, and is easy to develop into end-stage renal disease (ESRD), which requires kidney dialysis or kidney transplantation. Therefore, we want to explore the clinical value of magnetic resonance quantitative histogram analysis based on spatial labeling with multiple inversion pulses (SLEEK) in assessing renal function in the early stage. Methods One hundred and twenty-nine patients underwent abdominal MRI examination, including a coronal SLEEK sequence. The patients were divided into the control group [CG, 47 cases, estimated glomerular filtration rate (eGFR) >90], the mild renal function impairment (mRI) group (48 cases, eGFR =60–90), and the moderate to severe renal function impairment (m-sRI) group (34 cases, eGFR <60). Two experienced radiologists delineated cortex and medulla regions of interest (ROIs) on SLEEK images to obtain cortex and medulla quantitative histogram parameters [Mean, Median, Percentiles (5th, 10th, 25th, 75th, and 90th), Skewness, Kurtosis, and Entropy] using FireVoxel. These histogram parameters were compared by proper statistical methods such as one-way analysis of variance, the χ2 test, and receiver operating characteristic (ROC) curve analysis. Results Four histogram parameters (Inhomogeneitycortex, Skewnesscortex, Kurtosismedulla, and Entropymedulla) differed significantly between the CG and the mRI group. One medulla (Entropymedulla) and nine cortex (Meancortex, Mediancortex, Kurtosiscortex, Entropycortex, and 5th, 10th, 25th, 75th, and 90th Percentilecortex) histogram parameters were significantly different between the m-RI and m-sRI groups. The most relevant parameter to eGFR was Inhomogenitycortex (r=−0.450, P<0.001). Inhomogeneitycortex had the largest area under the curve (AUC) for differentiating the mRI group from the CG (AUC =0.718; 95% CI: 0.616–0.806), while 25th Percentilecortex generated the largest AUC (AUC =0.786; 95% CI: 0.681–0.869) for differentiating the mRI and m-sRI groups. Conclusions Quantitative histogram parameters based on a SLEEK sequence can be used to supplement renal dysfunction assessment. Cortex histogram parameters are more valuable for evaluating renal function than medulla histogram parameters.
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Affiliation(s)
- Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuou Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fangqin Tan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ihab Kamel
- Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Chen X, Meng X, Zhu D, Zou X, Shen Y, Li Z, Peng J, Hu D. Hemodynamic study of unenhanced magnetic resonance angiography using spatial labeling with multiple inversion pulses sequence: a phantom study. Quant Imaging Med Surg 2021; 11:1828-1835. [PMID: 33936968 DOI: 10.21037/qims-20-633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study sought to explore the functional relationship between displayed vascular length and blood suppression inversion time (BSP TI) and flow velocity in a phantom, and to provide a theoretical basis for quantitatively assessing vascular hemodynamic responses using unenhanced magnetic resonance angiography (MRA) and spatial labeling with multiple inversion pulses sequence (SLEEK). Methods A polyethylene catheter was laid in a long rectangular container filled with pork fat. The entrance of the catheter into the container was connected to a high-pressure syringe filled with normal saline. The high-pressure injector flow rates were set at 0.0, 0.2, 0.4, 0.8, 1.2, 1.6, 2.0, and 2.4 mL/s. SLEEK was performed 19 times for each flow rate with parameter BSP TI values of 50, 75, 100, 150, 200, 300, 400, 500, 600, 700, 800, 900, 1,000, 1,100, 1,200, 1,300, 1,400, 1,600, and 1,800 ms. Maximum intensity projection was employed to reconstruct all SLEEK original images to determine the measurements of the displayed vascular lengths. A regression analysis was undertaken to assess the relationship between the displayed vascular lengths and BSP TI values for each flow rate, and to assess the relationship between the displayed vascular lengths and flow rates at each BSP TI. Results The displayed vascular length had a linear relationship with BSP TI for each flow rate (P<0.05) (R2=0.754, 0.941, 0.988, 0.988, 0.977, 0.966, and 0.982 for flow rates of 0.0, 0.2, 0.4, 0.8, 1.2, 1.6, and 2.0 mL/s, respectively). The displayed vascular length also had a linear relationship with flow rate for each BSP TI value (P<0.05) (R2 =0.914, 0.912, 0.834, 0.989, 0.980, 0.996, 0.992, 0.960, 0.975, 0.979, 0.982, 0.981, 0.976, and 0.993 for BSP TI 50, 75, 100, 150, 200, 300, 400, 500, 600, 700, 800, 900, 1,000, and 1,100 ms, respectively). No significant linear relationship was found between displayed vascular length and flow rate when the BSP TI value was 1,200 ms (P>0.05). Conclusions Vascular displayed length has a linear relationship to BSP TI for flow ranges from 0.0 to 2.0 mL/s. Vascular displayed length has a linear relationship to flow rate for BSP TI values of 50 to 1,100 ms. Flow rate can be assessed in relation to vascular displayed length.
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Affiliation(s)
- Xiao Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyan Meng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianlun Zou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Peng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Paro EDL, Puchnick A, Szejnfeld J, Goldman SM. Use of diffusion-weighted imaging in the noninvasive diagnostic of obstructed biliary ducts. Abdom Radiol (NY) 2021; 46:268-279. [PMID: 32666232 DOI: 10.1007/s00261-020-02636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/22/2020] [Accepted: 07/04/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study sought to evaluate the role of diffusion-weighted imaging (DWI) in differentiation between obstructed and unobstructed bile ducts in patients undergoing magnetic resonance imaging (MRI). METHODS Eighty-four patients, 40 males and 44 females (mean age: 56.4 ± 15.1 years), undergoing MRI with DWI (0-50-500-700) were evaluated and divided into two groups: 58 with abnormal laboratory tests (obstructed group) and 26 with normal laboratory values (unobstructed group). Laboratory tests were total bilirubin, alkaline phosphatase, and gamma-glutamyltransferase. Median ADC values were calculated and correlated with laboratory tests and degree of bile-duct dilatation (absent, moderate, or severe). The persistence of signal on DWI (b500 and b700) in the biliary tract was evaluated. Bilirubin values were tested for correlation with bile-duct ADC values and persistence of b700 signal. For statistical analysis, Student t test, chi-square test and Wilcoxon-Mann-Whitney test were used. ADC maps were plotted for three levels of the biliary tree, and a receiver operating characteristic (ROC) curve was calculated. RESULTS In the obstructed group, 15 patients had severe dilatation, 24 had moderate dilatation, and 19 had no appreciable dilatation; 38 patients had persistent signal on b700 images. In the unobstructed group, 23 patients had no dilatation and 3 had moderate dilatation; 4 patients had persistent signal on b700 images. Correlation was found between degree of bile-duct dilatation, bilirubin levels, persistence of b700 signal, and ADC map values. The calculated ADC map cutoff value (353 10-6 mm2/s) was able to differentiate the obstructed and unobstructed groups with 92.3% sensitivity, 81% specificity, and 91.9% accuracy. CONCLUSIONS DWI is able to distinguish patients with obstructed versus unobstructed bile ducts, regardless of the degree of dilatation, correlating with clinical and laboratory findings.
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Affiliation(s)
- Eliane Donato Leite Paro
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil.
| | - Andrea Puchnick
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Jacob Szejnfeld
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Suzan Menasce Goldman
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil
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Zhu D, Li W, Liu D, Liu G, Pei Y, Shin T, Sedaghat F, Qin Q. Non-contrast-enhanced abdominal MRA at 3 T using velocity-selective pulse trains. Magn Reson Med 2020; 84:1173-1183. [PMID: 32017173 PMCID: PMC7263981 DOI: 10.1002/mrm.28187] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/16/2019] [Accepted: 01/07/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE Most existing non-contrast-enhanced methods for abdominal MR arteriography rely on a spatially selective inversion (SSI) pulse with a delay to null both static tissue and venous blood, and are limited to small spatial coverage due to the sensitivity to slow arterial inflow. Velocity-selective inversion (VSI) based approach has been shown to preserve the arterial blood inside the imaging volume at 1.5 T. Recently, velocity-selective saturation (VSS) pulse trains were applied to suppress the static tissue and have been combined with SSI pulses for cerebral MR arteriography at 3 T. The aim of this study is to construct an abdominal MRA protocol with large spatial coverage at 3 T using advanced velocity-selective pulse trains. METHODS Multiple velocity-selective MRA protocols with different sequence modules and 3D acquisition methods were evaluated. Sequences using VSS only as well as SSI+VSS and VSI+VSS preparations were then compared among a group of healthy young and middle-aged volunteers. Using MRA without any preparations as reference, relative signal ratios and relative contrast ratios of different vascular segments were quantitatively analyzed. RESULTS Both SSI+VSS and VSI+VSS arteriograms achieved high artery-to-tissue and artery-to-vein relative contrast ratios above aortic bifurcation. The SSI+VSS sequence yielded lower signal at the bilateral iliac arteries than VSI+VSS, reflecting the benefit of the VSI preparation for imaging the distal branches. CONCLUSION The feasibility of noncontrast 3D MR abdominal arteriography was demonstrated on healthy volunteers using a combination of VSS pulse trains and SSI or VSI pulse.
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Affiliation(s)
- Dan Zhu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wenbo Li
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Dapeng Liu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Guanshu Liu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Yigang Pei
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Taehoon Shin
- Division of Mechanical and Biomedical Engineering, Ewha Woman’s University, Seoul, South Korea
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Farzad Sedaghat
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
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Liang P, Xu C, Tripathi P, Li J, Li A, Hu D, Kamel I, Li Z. One-stop assessment of renal function and renal artery in hypertensive patients with suspected renal dysfunction: non-enhanced MRI using spatial labeling with multiple inversion pulses. Eur Radiol 2020; 31:94-103. [PMID: 32749582 DOI: 10.1007/s00330-020-07088-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/01/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess whether spatial labeling with multiple inversion pulses (SLEEK) sequence can be employed as a one-stop assessment method for evaluating renal function and displaying renal artery in hypertensive patients with suspected renal dysfunction. METHODS A total of 78 patients with suspected hypertensive renal damage were enrolled in this retrospective study. All patients underwent MRI examinations, and both SLEEK and DWI sequences were performed simultaneously. According to estimated glomerular filtration rate (eGFR), patients were divided into three groups (Group 1, eGFR> 90; Group 2, eGFR = 60-90; Group 3, eGFR< 60). Twenty-two of these patients also underwent CT angiography (CTA) examination. Comparison between CTA, DWI, and eGFR was performed to assess the value of SLEEK in evaluating renal function and displaying renal artery. RESULTS The performance of SLEEK to display renal artery was highly consistent with the results of CTA (kappa = 0.713). The corticomedullary contrast ratio positively correlated with eGFR (p = 0.004, r = 0.322) and was significantly higher in SLEEK images than in DWI images in all three groups (p < 0.001). There was no significant difference in corticomedullary contrast ratio in SLEEK images between Group 1 and Group 2 (p = 0.285). However, the minimal renal cortical thickness, which significantly correlated with eGFR (p < 0.001, r = 0.866), was significantly different between Group 1 and Group 2 (p < 0.001). ROC analysis showed good diagnostic performance when differentiating patients with eGFR> 60 from those with eGFR< 60. CONCLUSIONS The SLEEK sequence could evaluate simultaneously renal function through corticomedullary differentiation and renal arteries, enabling one-stop assessment in hypertensive patients with suspected renal dysfunction. KEY POINTS • Spatial labeling with multiple inversion pulses (SLEEK) improves renal corticomedullary differentiation in hypertensive patients with renal dysfunction compared with DWI. • SLEEK clearly displays renal artery in hypertensive patients with renal dysfunction. • SLEEK could be utilized as a one-stop assessment method for evaluating renal function and renal artery in hypertensive patients.
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Affiliation(s)
- Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chuou Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Pratik Tripathi
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Anqin Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ihab Kamel
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Accuracy of unenhanced magnetic resonance angiography for the assessment of renal artery stenosis. Eur J Radiol Open 2016; 3:200-6. [PMID: 27536710 PMCID: PMC4975703 DOI: 10.1016/j.ejro.2016.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the accuracy of unenhanced magnetic resonance angiography (U-MRA) using balanced steady-state free precession (SSFP) sequences with inversion recovery (IR) pulses for the evaluation of renal artery stenosis. Materials and methods U-MRA was performed in 24 patients with suspected main renal artery stenosis. Two radiologists evaluated the quality of the imaging studies and the ability of U-MRA to identify hemodynamically significant main renal artery stenosis (RAS) defined as a stenosis ≥50% when compared to gold standard tests: contrast-enhanced magnetic resonance angiography (CE-MRA) (18 patients) or digital subtraction arteriography (DSA) (6 patients). Results A total of 44 main renal arteries were evaluated. Of them, 32 renal arteries could be assessed with U-MRA. When CE-MRA or DSA was used as the reference standard, nine renal arteries had hemodynamically significant RAS. U-MRA correctly identified eight out of nine arteries as having ≥50% RAS, and correctly identified 22 out of 23 arteries as not having significant RAS, with a sensitivity of 88.8%, a specificity of 95.65%, positive and negative predictive value of 88.8% and 95.65%, respectively, and an accuracy of 93.75%. Renal artery fibromuscular dysplasia (FMD) was observed in the two misclassified arteries. Conclusion U-MRA is a reliable diagnostic method to depict normal and stenotic main renal arteries. U-MRA can be used as an alternative to contrast-enhanced magnetic resonance angiography or computer tomography angiography in patients with renal insufficiency unless FMD is suspected.
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Pei Y, Li F, Shen H, Long X, Liu H, Wang X, Liu J, Li W. Optimal Blood Suppression Inversion Time Based on Breathing Rates and Heart Rates to Improve Renal Artery Visibility in Spatial Labeling with Multiple Inversion Pulses: A Preliminary Study. Korean J Radiol 2016; 17:69-78. [PMID: 26798218 PMCID: PMC4720814 DOI: 10.3348/kjr.2016.17.1.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 10/20/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether an optimal blood suppression inversion time (BSP TI) can boost arterial visibility and whether the optimal BSP TI is related to breathing rate (BR) and heart rate (HR) for hypertension subjects in spatial labeling with multiple inversion pulses (SLEEK). MATERIALS AND METHODS This prospective study included 10 volunteers and 93 consecutive hypertension patients who had undergone SLEEK at 1.5T MRI system. Firstly, suitable BSP TIs for displaying clearly renal artery were determined in 10 volunteers. Secondly, non-contrast enhanced magnetic resonance angiography with the suitable BSP TIs were performed on those hypertension patients. Then, renal artery was evaluated and an optimal BSP TI to increase arterial visibility was determined for each patient. Patients' BRs and HRs were recorded and their relationships with the optimal BSP TI were analyzed. RESULTS The optimal BSP TI was negatively correlated with BR (r1 = -0.536, P1 < 0.001; and r2 = -0.535, P2 < 0.001) and HR (r1 = -0.432, P1 = 0.001; and r2 = -0.419, P2 = 0.001) for 2 readers (κ = 0.93). For improving renal arterial visibility, BSP TI = 800 ms could be applied as the optimal BSP TI when the 95% confidence interval were 17-19/min (BR1) and 74-82 bpm (HR1) for reader#1 and 17-19/min (BR2) and 74-83 bpm (HR2) for reader#2; BSP TI = 1100 ms while 14-15/min (BR1, 2) and 71-76 bpm (HR1, 2) for both readers; and BSP TI = 1400 ms when 13-16/min (BR1) and 63-68 bpm (HR1) for reader#1 and 14-15/min (BR2) and 64-70 bpm (HR2) for reader#2. CONCLUSION In SLEEK, BSP TI is affected by patients' BRs and HRs. Adopting the optimal BSP TI based on BR and HR can improve the renal arterial visibility and consequently the working efficiency.
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Affiliation(s)
- Yigang Pei
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Fang Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hao Shen
- GE Healthcare, Waukesha, WI 53188, USA
| | - Xueying Long
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hui Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiaoyi Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jinkang Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wenzheng Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, China
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An international multicenter comparison of time-SLIP unenhanced MR angiography and contrast-enhanced CT angiography for assessing renal artery stenosis: the renal artery contrast-free trial. AJR Am J Roentgenol 2015; 204:182-8. [PMID: 25539255 DOI: 10.2214/ajr.13.12022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The unenhanced MR angiography (MRA) technique time-spatial labeling inversion pulse (time-SLIP) may provide a safe alternative for evaluating the renal arteries for stenosis. This international multicenter trial tested the hypothesis that time-SLIP unenhanced MRA is accurate and robust for assessing the renal arteries for stenosis in comparison with contrast-enhanced CT angiography (CTA). SUBJECTS AND METHODS Four centers (United States, Europe, Asia) enrolled 75 patients (average age ± SD, 58 ± 13 years; 41 [55%] men and 34 [45%] women). Each patient underwent abdominal contrast-enhanced CTA and abdominal unenhanced MRA using time-SLIP with balanced steady-state free precession. All images were visually assessed for quality (arterial signal intensity) and for the absence or presence of renal artery stenosis (≤ 50% or > 50% stenosis, respectively). In addition, for arteries with any visible disease, the severity of the stenosis was quantified. Two blinded readers evaluated each study. No arteries were excluded from analysis. RESULTS Unenhanced MRA image quality was excellent for 56 of 75 patients (75%) and good for 16 of 75 patients (21%). CTA was used as the reference standard and showed that 23 of 161 renal arteries (14.3%) had stenosis > 50%. Unenhanced MRA correctly classified 17 of the 23 renal arteries with > 50% stenosis and correctly classified 128 of the 138 renal arteries as not having disease (≤ 50% stenosis) to yield a sensitivity of 74%, specificity of 93%, and accuracy of 90% (χ(2) = 0.56; p = 0.45, no statistically significant difference). Of the 16 misclassified arteries, only three had a clinically relevant misclassification (CTA ≥ 70% stenosis and unenhanced MRA ≤ 50% stenosis or unenhanced MRA ≥ 70% stenosis and CTA ≤ 50% stenosis). On average, measured stenotic severity (n = 28 arteries) was similar for unenhanced MRA (64% ± 17%) and CTA (62% ± 16%) (p = 0.51). CONCLUSION Compared with contrast-enhanced CTA, the unenhanced MRA technique time-SLIP shows promise for assessing the renal arteries for stenosis. The unenhanced MRA technique time-SLIP may provide a safe alternative for evaluating the renal arteries for stenosis.
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Abstract
Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory angiopathy of unknown cause affecting medium-sized (most commonly renal) arteries and causing renovascular hypertension. The most common medial multifocal type of FMD (with the “string of beads” appearance) is more than four times more prevalent in females than in males. FMD accounts for up to 10% of cases of renovascular hypertension. Compared with patients with atherosclerotic renal artery stenosis, patients with FMD are younger, have fewer risk factors for atherosclerosis, and a lower occurrence of atherosclerosis in other vessels. The etiology is multifactorial, including vessel wall ischemia and smoking, as well as hormonal and genetic factors. Intra-arterial digital subtraction angiography is still the gold standard for exclusion or confirmation of renal artery stenosis caused by FMD, at least in young patients, who more often have lesions in branches of the renal artery. For FMD patients with atherosclerosis and those who are older (>50–55 years), significant renal artery stenosis may be confirmed or excluded with ultrasonography. The FMD lesion is typically truncal or distal, whereas atherosclerotic lesions are more often proximal or ostial. Treatment options are medical, endovascular (percutaneous transluminal renal angioplasty [PTRA]), and surgical. Invasive treatment should be considered when hypertension cannot be controlled with antihypertensive drugs and in patients with impaired renal function or ischemic nephropathy. PTRA has become the treatment of choice and normally yields good results, especially in unifocal disease and young patients. Pressure gradients are normally completely abolished, and there is no indication for stent placement. Surgical revascularization is indicated after PTRA complications; thrombosis, perforation, progressive dissection, repeated PTRA failure or restenosis. Centralization of handling is recommended.
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Affiliation(s)
- Anders Gottsäter
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden
| | - Bengt Lindblad
- Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden
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Tang H, Wang Z, Wang L, Hu X, Wang Q, Li Z, Li J, Meng X, Wang Y, Hu D. Depiction of transplant renal vascular anatomy and complications: unenhanced MR angiography by using spatial labeling with multiple inversion pulses. Radiology 2014; 271:879-87. [PMID: 24592960 DOI: 10.1148/radiol.14131800] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the ability to depict anatomy and complications of renal vascular transplant with unenhanced magnetic resonance (MR) angiography with spatial labeling with multiple inversion pulses (SLEEK) and to compare the results with color Doppler (CD) ultrasonography (US), digital subtraction angiography (DSA), and intraoperative findings. MATERIALS AND METHODS This study was approved by the institutional review board, and written informed consent was received before examination. Seventy-five patients who underwent renal transplantation were examined with unenhanced MR angiography with SLEEK and CD US. DSA was performed in 15 patients. Surgery was performed in eight patients. The ability of SLEEK to show transplant renal vascular anatomy and complications was evaluated by two experienced radiologists who compared the results with CD US, DSA, and intraoperative findings. RESULTS Patients successfully underwent SLEEK MR angiography. Transplant renal vascular anatomy was assessed in 87 arteries and 78 veins. Renal vascular complications from transplantation were diagnosed in 23 patients, which included 14 with arterial stenosis, three with arterial kinking, two with arteriovenous fistulas, two with venous stenosis, one with pseudoaneurysms, and one with fibromuscular dysplasia. Three patients had two renal transplants and nine patients had nine accessory renal arteries. More accessory renal arteries were detected with SLEEK than with CD US. Correlation was excellent between the stenosis degree with SLEEK and DSA (r = 0.96; P < .05). For those with significant artery stenosis (>50% narrowing) proved with DSA (n = 7) or surgery (n = 3), positive predictive value was 91% (10 of 11). CONCLUSION Unenhanced MR angiography with SLEEK preliminarily proved to be a reliable diagnostic method for depiction of anatomy and complications of renal vascular transplant. It may be used for evaluation of patients with renal transplant, and in particular for those with renal insufficiency.
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Affiliation(s)
- Hao Tang
- From the Departments of Radiology (H.T., Z.W., L.W., Q.W., Z.L., J.L., X.M., Y.W., D.H.) and Infection (X.H.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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