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Edelman R, Leloudas N, Pang J, Bailes J, Merrell R, Koktzoglou I. Twofold improved tumor-to-brain contrast using a novel T1 relaxation-enhanced steady-state (T 1RESS) MRI technique. Sci Adv 2020; 6:6/44/eabd1635. [PMID: 33115747 PMCID: PMC7608787 DOI: 10.1126/sciadv.abd1635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
A technique that provides more accurate cancer detection would be of great value. Toward this end, we developed T1 relaxation-enhanced steady-state (T1RESS), a novel magnetic resonance imaging (MRI) pulse sequence that enables the flexible modulation of T1 weighting and provides the unique feature that intravascular signals can be toggled on and off in contrast-enhanced scans. T1RESS makes it possible to effectively use an MRI technique with improved signal-to-noise ratio efficiency for cancer imaging. In a proof-of-concept study, "dark blood" unbalanced T1RESS provided a twofold improvement in tumor-to-brain contrast compared with standard techniques, whereas balanced T1RESS greatly enhanced vascular detail. In conclusion, T1RESS represents a new MRI technique with substantial potential value for cancer imaging, along with a broad range of other clinical applications.
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Affiliation(s)
- R Edelman
- Radiology, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201, USA.
- Northwestern Medicine, 251 E. Huron St., Chicago, IL 60611, USA
| | - N Leloudas
- Radiology, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201, USA
| | - J Pang
- Siemens Medical Solutions USA Inc., 737 N. Michigan Ave., Chicago, IL 60611, USA
| | - J Bailes
- University of Chicago Pritzker School of Medicine, 924 E. 57th St., Chicago, IL 60637, USA
- Neurosurgery, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201, USA
| | - R Merrell
- University of Chicago Pritzker School of Medicine, 924 E. 57th St., Chicago, IL 60637, USA
- Neurology, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201, USA
| | - I Koktzoglou
- Radiology, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201, USA
- University of Chicago Pritzker School of Medicine, 924 E. 57th St., Chicago, IL 60637, USA
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Peters S, Huhndorf M, Jensen-Kondering U, Larsen N, Koktzoglou I, Edelman RR, Graessner J, Both M, Jansen O, Salehi Ravesh M. Non-Contrast-Enhanced Carotid MRA: Clinical Evaluation of a Novel Ungated Radial Quiescent-Interval Slice-Selective MRA at 1.5T. AJNR Am J Neuroradiol 2019; 40:1529-1537. [PMID: 31395666 DOI: 10.3174/ajnr.a6171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/04/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Non-contrast-enhanced MRA techniques have experienced a renaissance due to the known correlation between the use of gadolinium-based contrast agents and the development of nephrogenic systemic fibrosis and the deposition of gadolinium in some brain regions. The purpose of this study was to assess the diagnostic performance of ungated non-contrast-enhanced radial quiescent-interval slice-selective MRA of the extracranial supra-aortic arteries in comparison with conventional contrast-enhanced MRA in patients with clinical suspicion of carotid stenosis. MATERIALS AND METHODS In this prospective study, both MRA pulse sequences were performed in 31 consecutive patients (median age, 68.8 years; 19 men). For the evaluation, the cervical arterial system was divided into 35 segments (right and left side). Three blinded reviewers separately evaluated these segments. An ordinal scoring system was used to assess the image quality of arterial segments and the stenosis grading of carotid arteries. RESULTS Overall venous contamination in quiescent-interval slice-selective MRA was rated as "none" by all readers in 84.9% of cases and in 8.1% of cases in contrast-enhanced MRA (P < .0001). The visualization quality of arterial segments was considered good to excellent in 40.2% for the quiescent-interval slice-selective MRA and in 52.2% for the contrast-enhanced MRA (P < .0001). The diagnostic accuracy of ungated quiescent-interval slice-selective MRA concerning the stenosis grading showed a total sensitivity and specificity of 85.7% and 90.0%, respectively. CONCLUSIONS Ungated quiescent-interval slice-selective MRA can be used clinically as an alternative to contrast-enhanced MRA without a significantly different image quality or diagnostic accuracy for the detection of carotid stenosis at 1.5T.
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Affiliation(s)
- S Peters
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - M Huhndorf
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - U Jensen-Kondering
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - N Larsen
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - I Koktzoglou
- Department of Radiology (I.K., R.R.E.), NorthShore University Health System, Evanston, Illinois.,University of Chicago Pritzker School of Medicine (I.K.), Chicago, Illinois
| | - R R Edelman
- Department of Radiology (I.K., R.R.E.), NorthShore University Health System, Evanston, Illinois.,Northwestern University Feinberg School of Medicine (R.R.E.), Chicago, Illinois
| | | | - M Both
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - O Jansen
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
| | - M Salehi Ravesh
- From the Department of Radiology and Neuroradiology (S.P., M.H., U.J.-K., N.L., M.B., O.J., M.S.R.), University Medical Center Schleswig-Holstein, Kiel University, Kiel, Germany
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Abstract
There is a pressing clinical need to develop accurate, efficient non-contrast magnetic resonance angiography (NC-MRA) techniques. Our efforts in the field have focused on a novel non-subtractive technique called quiescent-interval slice-selective (QISS) MRA. Compared with other NC-MRA techniques, QISS has the advantage of being more accurate while enabling a simpler and more efficient workflow. The original implementation, which uses electrocardiogram (ECG) gating and a Cartesian k-space trajectory, is a reliable technique for the evaluation of peripheral arterial disease (PAD). Recent advances in QISS technology include the use of a radial k-space trajectory, which facilitates rapid imaging of the coronary, renal, and pulmonary arteries as well as other vascular beds, and ungated ("UnQISS") acquisitions for PAD.
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Affiliation(s)
- R R Edelman
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL, USA; Department of Radiology, Northshore University Health System, Evanston, IL, USA.
| | - M Carr
- Department of Radiology, Northshore University Health System, Evanston, IL, USA
| | - I Koktzoglou
- Department of Radiology, Northshore University Health System, Evanston, IL, USA; Department of Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Edelman RR, Giri S, Pursnani A, Botelho MPF, Li W, Koktzoglou I. Breath-hold imaging of the coronary arteries using Quiescent-Interval Slice-Selective (QISS) magnetic resonance angiography: pilot study at 1.5 Tesla and 3 Tesla. J Cardiovasc Magn Reson 2015; 17:101. [PMID: 26597281 PMCID: PMC4655490 DOI: 10.1186/s12968-015-0205-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/15/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Coronary magnetic resonance angiography (MRA) is usually obtained with a free-breathing navigator-gated 3D acquisition. Our aim was to develop an alternative breath-hold approach that would allow the coronary arteries to be evaluated in a much shorter time and without risk of degradation by respiratory motion artifacts. For this purpose, we implemented a breath-hold, non-contrast-enhanced, quiescent-interval slice-selective (QISS) 2D technique. Sequence performance was compared at 1.5 and 3 Tesla using both radial and Cartesian k-space trajectories. METHODS The left coronary circulation was imaged in six healthy subjects and two patients with coronary artery disease. Breath-hold QISS was compared with T2-prepared 2D balanced steady-state free-precession (bSSFP) and free-breathing, navigator-gated 3D bSSFP. RESULTS Approximately 10 2.1-mm thick slices were acquired in a single ~20-s breath-hold using two-shot QISS. QISS contrast-to-noise ratio (CNR) was 1.5-fold higher at 3 Tesla than at 1.5 Tesla. Cartesian QISS provided the best coronary-to-myocardium CNR, whereas radial QISS provided the sharpest coronary images. QISS image quality exceeded that of free-breathing 3D coronary MRA with few artifacts at either field strength. Compared with T2-prepared 2D bSSFP, multi-slice capability was not restricted by the specific absorption rate at 3 Tesla and pericardial fluid signal was better suppressed. In addition to depicting the coronary arteries, QISS could image intra-cardiac structures, pericardium, and the aortic root in arbitrary slice orientations. CONCLUSIONS Breath-hold QISS is a simple, versatile, and time-efficient method for coronary MRA that provides excellent image quality at both 1.5 and 3 Tesla. Image quality exceeded that of free-breathing, navigator-gated 3D MRA in a much shorter scan time. QISS also allowed rapid multi-slice bright-blood, diastolic phase imaging of the heart, which may have complementary value to multi-phase cine imaging. We conclude that, with further clinical validation, QISS might provide an efficient alternative to commonly used free-breathing coronary MRA techniques.
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Affiliation(s)
- Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, USA.
| | - S Giri
- Siemens Medical Solutions USA, Inc., Chicago, USA.
| | - A Pursnani
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
- The University of Chicago Pritzker School of Medicine, Chicago, USA.
| | - M P F Botelho
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
| | - W Li
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
- The University of Chicago Pritzker School of Medicine, Chicago, USA.
| | - I Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
- The University of Chicago Pritzker School of Medicine, Chicago, USA.
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Edelman RR, Giri S, Dunkle E, Galizia M, Amin P, Koktzoglou I. Quiescent-inflow single-shot magnetic resonance angiography using a highly undersampled radial k-space trajectory. Magn Reson Med 2013; 70:1662-8. [PMID: 23348595 DOI: 10.1002/mrm.24596] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 11/01/2012] [Accepted: 11/26/2012] [Indexed: 11/09/2022]
Abstract
PURPOSE We hypothesized that high undersampling factors could be used in conjunction with radial quiescent-inflow single-shot magnetic resonance angiography (MRA) to accelerate the data acquisition and enable multislice acquisitions. METHODS Seven subjects were imaged on a 1.5 T MRI system. For multislice quiescent-inflow single-shot MRA, the venous saturation radiofrequency pulse, in-plane saturation radiofrequency pulse, and quiescent interval were applied only once before the first slice. RESULTS The mean (standard deviation) measurements for the intra-arterial signal-to-noise ratio were as follows: Cartesian 1 slice-29.3 (5.5); radial 1 slice, 92 views-22.3 (3.6); radial 1 slice, 46 views-18.5 (2.0); radial 2 slices, 46 views-18.3 (3.2); and radial 3 slices, 32 views-21.7 (3.9), normalized for pixel size to 15.8. Horizontal striping was present with multislice radial quiescent-inflow single-shot MRA (especially with the three-slice acquisition) due to variable T1 relaxation between the concurrently acquired slices, but the image quality remained diagnostic. Vascular pathology in patients with peripheral arterial disease was well shown by all techniques. CONCLUSION Very high undersampling factors in excess of 18 have been demonstrated for nonenhanced MRA using a radial quiescent-inflow single-shot technique, enabling the acquisition of two to three slices per cardiac cycle. Scan time for a complete peripheral MRA could be shortened to 2 min or less.
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Affiliation(s)
- R R Edelman
- NorthShore University HealthSystem, Evanston, Illinois, USA; Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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