Whole-heart coronary magnetic resonance angiography at 3 Tesla in 5 minutes with slow infusion of Gd-BOPTA, a high-relaxivity clinical contrast agent.

T(1)-shortening contrast agents have been used to improve the depiction of coronary arteries with breath-hold magnetic resonance angiography (MRA). The spatial resolution and coverage are limited by the duration of the arterial phase of the contrast media passage. In this study we investigated the feasibility of acquiring free-breathing, whole-heart coronary MRA during slow infusion of the contrast media (0.3 ml/s) for prolonged blood signal enhancement time. Ultrashort TR (3 ms) and parallel data acquisition were used to allow the whole-heart MRA in approximately 5 min. A newly approved gadolinium (Gd)-based high T(1) relaxivity contrast agent, gadobenate dimeglumine ([Gd-BOPTA](2-)), was used and coronary MRA was performed on a whole-body 3 Tesla (T) system to improve the signal-to-noise ratio (SNR). Results from eight volunteers demonstrate that this coronary MRA method is capable of imaging the whole heart in 4.5 +/- 0.6 min. Major coronary arteries are well depicted with high SNR (42.4 +/- 12.5) and contrast-to-noise ratio (CNR; 27.1 +/- 7.6).     

Three-dimensional contrast-enhanced steady-state free precession for improved catheter-directed coronary magnetic resonance angiography

PURPOSE: To demonstrate the feasibility of three-dimensional thick-partition, contrast-enhanced, catheter-directed coronary artery magnetic resonance angiography (MRA) and test the hypothesis that three-dimensional imaging improves coronary artery background contrast-to-noise ratio (CNR) compared to two-dimensional imaging. MATERIALS AND METHODS: Catheters were advanced into the coronary arteries of swine (N = 6) under MR guidance. Three-dimensional coronary MRA was performed after intracoronary injection of a small dose of contrast media using magnetization-prepared steady-state free precession (SSFP) with two thick partitions. For comparison, two magnetization-prepared two-dimensional SSFP scans were also performed, one with no signal averaging and one with two signal averages. All sequences had the same coverage and in-plane spatial resolution. RESULTS: The coronary artery was successfully catheterized in all (6/6) animals. CNR for three-dimensional imaging was 11.1 +/- 1.2 for proximal arterial segments and 4.3 +/- 0.4 for distal segments. Without averaging, two-dimensional imaging CNRs for proximal and distal segments were 5.0 +/- 0.7 and 1.2 +/- 0.2, respectively. With averaging, two-dimensional imaging CNRs for proximal and distal segments were 9.4 +/- 1.5 and 2.9 +/- 0.4, respectively. Three-dimensional imaging showed a statistically significant increase in CNR over all two-dimensional imaging for both proximal and distal segments (P < 0.05). CONCLUSION: Three-dimensional thick-partition, contrast-enhanced, catheter-directed coronary MRA is feasible and improves CNR over two-dimensional projection imaging.     

Coronary arteries at 3.0 T: Contrast-enhanced magnetization-prepared three-dimensional breathhold MR angiography

PURPOSE: To evaluate the efficacy of contrast-enhanced coronary magnetic resonance angiography (MRA) at 3.0 T. MATERIALS AND METHODS: Nine healthy human volunteers were studied on a 3.0-T whole-body MR system. A three-dimensional, breathhold, magnetization-prepared, segmented, gradient-echo sequence was used, with injection of 20 mL gadopentetate dimeglumine for each three-dimensional slab. Imaging parameters were optimized based on computer simulations. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), depicted coronary artery length, lumen diameter, and imaging sharpness with contrast agent were evaluated. SNR and CNR were compared to the results from a previous 1.5-T study. RESULTS: A 53% increment in SNR and a 305% enhancement in CNR were measured with contrast. Vessel length and sharpness depicted were higher and the lumen diameter was lower (all P values < 0.05) in postcontrast images. Compared to previous results from 1.5-T, the SNR, CNR, and vessel sharpness were enhanced at 3.0 T with higher spatial resolution. CONCLUSION: Contrast-enhanced, three-dimensional, coronary MRA at 3.0 T is a promising technique for diagnosing coronary artery diseases. Patient studies are necessary to evaluate its clinical utility.     

Coronary artery imaging using contrast-enhanced 3D segmented EPI

The purpose of the work was to evaluate the effectiveness of extracellular contrast media in improving MR coronary angiography using breath-hold segmented echo-planar imaging (SEPI). Two protocols were designed to optimize the inversion recovery-prepared contrast-enhanced SEPI method. In 15 healthy volunteers, significant improvements in signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel sharpness, and length of visualization were observed post-contrast. The method with two targeted scans to cover the left and right arteries, respectively, following separate 20-mL contrast injections, was found to yield thinner slices and longer right coronary artery (RCA) visualization than a single scan following a 40-mL contrast injection without compromising SNR and CNR. In conclusion, extracellular contrast media substantially improves the delineation of coronary arteries with SEPI. J. Magn. Reson. Imaging 2001;13:676-681.     

Dynamic contrast-enhanced myocardial perfusion imaging using saturation-prepared TrueFISP

PURPOSE: To develop and test a saturation-recovery TrueFISP (SR-TrueFISP) pulse sequence for first-pass myocardial perfusion imaging. MATERIALS AND METHODS: First-pass magnetic resonance imaging (MRI) of Gd-DTPA (2 mL) kinetics in the heart was performed using an SR-TrueFISP pulse sequence (TR/TE/alpha = 2.6 msec/1.4 msec/55 degrees ) with saturation preparation TD = 30 msec before the TrueFISP readout. Measurements were also performed with a conventional saturation-recovery TurboFLASH (SRTF) pulse sequence for comparison. RESULTS: SR-TrueFISP images were of excellent quality and demonstrated contrast agent wash-in more clearly than SRTF images. The signal increase in myocardium was higher in SR-TrueFISP than in SRTF data. Precontrast SNR and peak CNR were not significantly different between both sequences despite 57% improved spatial resolution for SR-TrueFISP. CONCLUSION: SR-TrueFISP first-pass MRI of myocardial perfusion leads to a substantial improvement of image quality and spatial resolution. It is well suited for first-pass myocardial perfusion studies at cardiovascular MR systems with improved gradient hardware.     

1.0-M gadobutrol versus 0.5-M gadoterate for peripheral magnetic resonance angiography: a prospective randomized controlled clinical trial

PURPOSE: To perform a quantitative and qualitative comparison of gadobutrol and gadoterate in three-station contrast enhanced magnetic resonance angiography (CE-MRA) of the lower limbs. MATERIALS AND METHODS: In this prospective randomized controlled trial, 52 patients with leg ischemia were randomly assigned to one of two groups receiving either gadobutrol (1.0 mmol Gd/mL, 15 mL) or gadoterate (0.5 mmol Gd/mL, 30 mL). Three-station 3D CE-MRAs from the pelvis to the ankles were performed with moving-table technique on a 1.5T MR scanner. Injection time was identical in both groups. Signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were calculated for 816 arteries. Contrast quality in 1196 vessel segments was evaluated separately by two blinded readers on a three-point scale. RESULTS: Mean SNR (61.8 +/- 7.8 for gadobutrol vs. 61.9 +/- 9.1 for gadoterate, P = 0.257), CNR (52.8 +/- 9.1 vs. 52.8 +/- 10.7, P = 0.154), and qualitative ranking (1.41 vs. 1.44, P = 0.21) for all vessels did not differ significantly between the two patient groups. The overall quality was good in 90.4% with gadoterate and 94.2% with gadobutrol (P = 0.462). CONCLUSION: High-concentration gadobutrol allows neither a higher CNR nor any qualitative advantage over the ordinary unspecific Gd agent gadoterate when the same Gd load and injection times are used in multistation CE-MRA of the peripheral arteries.     

3D magnetization-prepared true-FISP: a new technique for imaging coronary arteries.

The purpose of this work was to develop an ECG-triggered, segmented 3D true-FISP (fast imaging with steady-state precession) technique to improve the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of breath-hold coronary artery imaging. The major task was to optimize an appropriate magnetization preparation scheme to permit saturation of the epicardial fat signal. An alpha/2 preparation pulse was used to speed up the approach to steady-state following a frequency-selective fat-saturation pulse in each heartbeat. The application of dummy cycles was found to reduce the oscillation of the magnetization during data acquisition. The fat saturation and magnetization preparation scheme was validated with simulations and phantom studies. Volunteer studies demonstrated substantially increased SNR (55%) and CNR (178%) for coronary arteries compared to FLASH (fast low-angle shot) with the same imaging time. In conclusion, true-FISP is a promising technique for coronary artery imaging.     

Noninvasive determination of regional myocardial perfusion with first-pass magnetic resonance (MR) imaging

RATIONALE AND OBJECTIVES: To develop a method to provide absolute values of regional myocardial perfusion by means of color maps, and to determine myocardial perfusion reserve using magnetic resonance imaging during the first pass of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). MATERIALS AND METHODS: The study population consisted of five patients with hypertrophic cardiomyopathy, two with dilated cardiomyopathy, four with coronary artery disease, and one with normal coronary arteries who presented with mildly abnormal electrocardiogram findings. For each heartbeat, six continuous slices were acquired during the first pass of Gd-DTPA (0.05 mmol/kg body weight) before and during adenosine triphosphate (ATP) **stress using an electrocardiogram-triggered fast low-angle shot (FLASH) sequence on a 1.5-T magnetic resonance unit. Myocardial perfusion images were created and displayed by means of a color scale. The parameters were calculated pixel by pixel, using the upslope method. Myocardial perfusion reserve was then calculated, as the quotient of myocardial perfusion during ATP stress and perfusion before ATP stress. RESULTS: Myocardial perfusion during ATP stress in patients with normal coronary arteries (n = 1) or after successful percutaneous coronary intervention (n = 2) was increased compared with that before ATP stress. However, the patients with coronary artery disease (n = 2) failed to show increased myocardial perfusion. The patients with hypertrophic cardiomyopathy showed increased myocardial perfusion during ATP stress, although two with dilated cardiomyopathy did not. CONCLUSION: Our new technique can provide absolute values of regional myocardial perfusion by means of color maps, and has potential for widespread use for evaluation of ischemic and other types of heart disease.     

Catheter-directed contrast-enhanced coronary MR angiography in swine using magnetization-prepared True-FISP.

Contrast-enhanced (CE) coronary magnetic resonance angiography (MRA) following intraarterial (IA) injection of contrast agent was compared using two sequences in swine: magnetization-prepared fast imaging with steady-state precession (True-FISP), and magnetization-prepared fast low-angle shot (FLASH). Thick-slice projection images were acquired with submillimeter in-plane spatial resolution (0.9 x 0.8 mm(2)). The magnetization-preparation scheme provided a clear delineation of the major coronary arteries with excellent background suppression. The True-FISP acquisition resulted in an increase in signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) by approximately a factor of 2 over FLASH (P < 0.05). Magnetization-prepared True-FISP is a promising technique for catheter-directed CE thick-slice projection coronary MRA.     

Multislice breath-hold spiral magnetic resonance coronary angiography in patients with coronary artery disease: effect of intravascular contrast medium

PURPOSE: First, to apply a breath-hold multislice 2D spiral magnetic resonance (MR) approach in patients acquiring within 16 heartbeats (acquisition window, 116 msec) a 10-mm-thick stack of four slices (resolution, 1.3 x 1.3 mm(2)); and second, to evaluate the effect of an intravascular Fe-based contrast medium (CM) on a signal-to-noise ratio (SNR) and a contrast-to-noise ratio (CNR). MATERIALS AND METHODS: In each patient one or two coronary arteries were imaged prior to and following cumulative doses of 0.25, 0.5, and 0.75 mg of Fe/kg of body weight (bw) of an intravascular CM (CLARISCAN trade mark, Nycomed-Amersham, Princeton, NJ, USA) containing ultrasmall superparamagnetic iron oxide (USPIO) particles. RESULTS: On precontrast maximum intensity projection (MIP) images generated from the stack of slices, 10 and 11 stenoses of 12 stenoses confirmed by coronary angiography were detected by readers 1 and 2, respectively. SNR and CNR in the coronary arteries peaked at 0.50 mg of Fe/kg of bw, yielding a slight increase of 15.5% and 18.4%, respectively (P < 0.05 vs. precontrast), which did not improve detection of coronary artery stenoses. CONCLUSION: The presented multislice spiral approach allows display of coronary anatomy in MIP formats for convenient display of coronary stenoses. The pulse sequence did not benefit from an intravascular USPIO-based CM, since little improvement in SNR and CNR was achieved.     

Multislice first-pass myocardial perfusion imaging: Comparison of saturation recovery (SR)-TrueFISP-two-dimensional (2D) and SR-TurboFLASH-2D pulse sequences

PURPOSE: To compare signal-to-noise ratio (SNR), contrast-to-noise (CNR) ratio, and diagnostic accuracy of a newly developed saturation recovery (SR)-TrueFISP-two-dimensional (2D) sequence with an SR-TurboFLASH-2D sequence. MATERIALS AND METHODS: In seven healthy subjects and nine patients with coronary artery disease (CAD), contrast-enhanced perfusion imaging (with Gd-DTPA) was performed with SR-TrueFISP and SR-TurboFLASH sequences. Hypoperfused areas were assessed qualitatively (scale = 0-4). Furthermore, SNR and CNR were calculated and semiquantitative perfusion parameters were determined from signal intensity (SI) time curves. Standard of reference for patient studies was single-photon emission computer tomography (SPECT) and angiography. RESULTS: The perception of perfusion deficits was superior in TrueFISP images (2.6 +/- 1.0) than in TurboFLASH (1.4 +/- 0.6) (P < 0.001). Phantom measurements yielded increased SNR (143 +/- 34%) and CNR (158 +/- 64%) values for TrueFISP. In patient/volunteer studies SNR was 61% to 100% higher and signal enhancement was 110% to 115% higher with TrueFISP than with TurboFLASH. Qualitative and semiquantitative assessment of perfusion defects yielded higher sensitivities for detection of perfusion defects with TrueFISP (68% to 78%) than with TurboFLASH (44% to 59%). CONCLUSION: SR-TrueFISP-2D perfusion imaging provides superior SNR and CNR than TurboFLASH imaging. Moreover, the dynamic range of SIs was found to be higher with TrueFISP, resulting in an increased sensitivity for detection of perfusion defects.     

Validation of injection parameters for catheter-directed intraarterial gadolinium-enhanced MR angiography

RATIONALE AND OBJECTIVES: Catheter-directed intraarterial (IA) injections of gadolinium contrast agents may be used during endovascular interventions with magnetic resonance (MR) imaging guidance. Injection protocols require further validation. Using a flow phantom and swine, the authors aimed to (a) measure the optimal arterial gadolinium concentration ([Gd]) required for MR angiography and (b) validate a proposed IA injection protocol for gadolinium-enhanced MR angiography. MATERIALS AND METHODS: For in vitro experiments, the authors placed a catheter in the aorta of an aorto-renal-iliac flow phantom. Injected [Gd], injection rates, and aortic blood flow rates were varied independently for 36 separate IA gadolinium injections. The authors performed 2D and 3D MR angiography with a fast spoiled gradient-recalled echo sequence. For subsequent in vivo experiments, they selectively placed catheters within the aorta, renal artery, or common iliac artery of three pigs. Injection rate and injected [Gd] were varied. The authors performed 32 separate IA gadolinium injections for 2D MR angiography. Signal-to-noise ratios (SNRs) were compared for the various combinations of injection rate and injected [Gd]. RESULTS: In vitro, an arterial [Gd] of 2%-4% produced an optimal SNR for 2D MR angiography, and 3%-5% was best for 3D MR angiography. In swine, an arterial [Gd] of 1%-4% produced an optimal SNR. In the phantom and swine experiments, SNR was maintained at higher injection rates by inversely varying the injected [Gd]. CONCLUSION: Dilute arterial [Gd] is required for optimal IA gadolinium-enhanced MR angiography. To maintain an optimal SNR, injection rates and injected [Gd] should be varied inversely. The postulated injection protocol was validated.     

Three-dimensional breathhold SSFP coronary MRA: a comparison between 1.5T and 3.0T

PURPOSE: To assess the feasibility of three-dimensional breathhold coronary magnetic resonance angiography (MRA) at 3.0T using the steady-state free precession (SSFP) sequence, and quantify the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) gains of coronary MRA from 1.5T to 3.0T using whole-body and phased-array cardiac coils as the signal receiver. MATERIALS AND METHODS: Eight healthy volunteers were scanned on 1.5T and 3.0T whole-body systems using the SSFP sequence. Numerical simulations were performed for the SSFP sequence to optimize the flip angle and predict signal enhancement from 1.5T to 3.0T. Coronary artery images were acquired with the whole-body coil in transmit-receive mode or transmit-only with phased-array cardiac coil receivers. RESULTS: In vivo studies of the same volunteer group at both field strengths showed increases of 87% in SNR and 83% in CNR from 1.5T to 3.0T using a whole-body coil as the signal receiver. The corresponding increases using phased-array receivers were 53% in SNR and 92% in CNR. However, image quality at 3.0T was more variable than 1.5T, with increased susceptibility artifacts and local brightening as the result of increased B(0) and B(1) inhomogeneities. CONCLUSION: Coronary MRA at 3.0T using a three-dimensional breathhold SSFP sequence is feasible. Improved SNR at 3.0T warrants the use of coronary MRA with faster acquisition and/or improved spatial resolution. Further investigations are required to improve the consistency of image quality and signal uniformity at 3.0T.     

Effect of the rate of gadolinium injection on magnetic resonance pulmonary perfusion imaging.

PURPOSE: To determine whether the injection rate of contrast agent affects the dynamics of enhancement of the pulmonary parenchyma on magnetic resonance (MR) pulmonary perfusion imaging. MATERIALS AND METHODS: Fifteen healthy volunteers underwent enhanced MR pulmonary perfusion imaging to evaluate the effects of different injection rates. Injection rates were 1, 3, or 5 mL/second. Regions of interest (ROIs) were chosen in the lung and aorta to analyze the change in signal intensity over time. RESULTS: As the injection rate increased, the peak enhancement occurred significantly earlier (P = 0.0012), but the peak enhancement signal-to-noise ratio (SNR) value was not affected (P = 0.25). With the 3- and 5-mL/second injection rates, images of both the pulmonary circulation and systemic circulation were obtained separately. However, with 1 mL/second, higher enhancement of the aorta was overlapped with peak enhancement of the lung tissue. CONCLUSION: The injection rate affects the enhancement profiles of the pulmonary parenchyma.     

Free-breathing, three-dimensional coronary artery magnetic resonance angiography: comparison of sequences

PURPOSE: To compare six free-breathing, three-dimensional, magnetization-prepared coronary magnetic resonance angiography (MRA) sequences. MATERIALS AND METHODS: Six bright-blood sequences were evaluated: Cartesian segmented gradient echo (C-SGE), radial SGE (R-SGE), spiral SGE (S-SGE), spiral gradient echo (S-GE), Cartesian steady-state free precession (C-SSFP), and radial SSFP (R-SSFP). The right coronary artery (RCA) was imaged in 10 healthy volunteers using all six sequences in randomized order. Images were evaluated by two observers with respect to signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), visible vessel length, vessel edge sharpness, and vessel diameter. RESULTS: C-SSFP depicted RCA over the longest distance with high vessel sharpness, good SNR, and excellent background suppression. S-GE provided best SNR and CNR in proximal segments, but more vessel blurring and poorer background suppression, resulting in poor visualization of distal segments. R-SSFP images showed good background suppression and best vessel sharpness, but only moderate SNR. C-SGE provided good SNR and reasonable CNR, but lowest vessel sharpness. S-SGE and R-SGE visualized the RCA over the smallest distance, mostly due to vessel blurring and low SNR, respectively. CONCLUSION: Overall, Cartesian SSFP provided the best image quality with excellent vessel sharpness, visualization of long vessel segments, and good SNR and CNR.     

Improved three-dimensional free-breathing coronary magnetic resonance angiography using gadocoletic acid (B-22956) for intravascular contrast enhancement

PURPOSE: To evaluate gadocoletic acid (B-22956), a gadolinium-based paramagnetic blood pool agent, for contrast-enhanced coronary magnetic resonance angiography (MRA) in a Phase I clinical trial, and to compare the findings with those obtained using a standard noncontrast T2 preparation sequence. MATERIALS AND METHODS: The left coronary system was imaged in 12 healthy volunteers before B-22956 application and 5 (N = 11) and 45 (N = 7) minutes after application of 0.075 mmol/kg of body weight (BW) of B-22956. Additionally, imaging of the right coronary system was performed 23 minutes after B-22956 application (N = 6). A three-dimensional gradient echo sequence with T2 preparation (precontrast) or inversion recovery (IR) pulse (postcontrast) with real-time navigator correction was used. Assessment of the left and right coronary systems was performed qualitatively (a 4-point visual score for image quality) and quantitatively in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel sharpness, visible vessel length, maximal luminal diameter, and the number of visible side branches. RESULTS: Significant (P < 0.01) increases in SNR (+42%) and CNR (+86%) were noted five minutes after B-22956 application, compared to precontrast T2 preparation values. A significant increase in CNR (+40%, P < 0.05) was also noted 45 minutes postcontrast. Vessels (left anterior descending artery (LAD), left coronary circumflex (LCx), and right coronary artery (RCA)) were also significantly (P < 0.05) sharper on postcontrast images. Significant increases in vessel length were noted for the LAD (P < 0.05) and LCx and RCA (both P < 0.01), while significantly more side branches were noted for the LAD and RCA (both P < 0.05) when compared to precontrast T2 preparation values. CONCLUSION: The use of the intravascular contrast agent B-22956 substantially improves both objective and subjective parameters of image quality on high-resolution three-dimensional coronary MRA. The increase in SNR, CNR, and vessel sharpness minimizes current limitations of coronary artery visualization with high-resolution coronary MRA.     

Determination of optimal gadolinium concentration using SSFP for catheter-directed contrast-enhanced coronary MR angiography

RATIONALE AND OBJECTIVES: To determine the optimal gadolinium concentration for catheter-directed coronary magnetic resonance angiography (MRA) using magnetization-prepared steady-state free-precession (SSFP) in swine. MATERIALS AND METHODS: In six pigs, we performed real-time MR imaging-guided coronary artery catheterization using a 1.5 T MR scanner. For catheter-directed coronary MRA, we injected 3-4 mL of dilute Gd at 1 mL/second for each tested concentration (4%, 8%, 10%, and 12% Gd). Eleven images per concentration were acquired using electrocardiographic-triggered, magnetization-prepared two-dimensional (2D) projection SSFP. We compared mean relative signal-to-noise ratio (SNR) values for each concentration using two-way analysis of variance. RESULTS: The targeted coronary artery was catheterized under real-time MR guidance in all pigs. Magnetization-prepared 2D projection SSFP successfully depicted the coronary arteries in all 44 injections. Mean relative SNR (+/- standard error) was 7.2 +/- 0.49 for 4%, 8.8 +/- 0.47 for 8%, 9.5 +/- 0.38 for 10%, and 8.8 +/- 0.41 for 12%. Injections of 4% dilute gadolinium yielded significantly less relative SNR than the other tested concentrations (P < .05). There were no statistically significant differences between the remaining concentrations. CONCLUSION: For catheter-directed contrast-enhanced coronary MRA, the ideal gadolinium concentration should maximize relative SNR and limit the total gadolinium dose. Using these criteria, of those concentrations we tested in the swine model, 8% injected gadolinium was superior for catheter-directed SSFP coronary MRA.     

Improvement of image quality of non-invasive coronary artery imaging with magnetic resonance by the use of the intravascular contrast agent Clariscan (NC100150 injection) in patients with coronary artery disease

PURPOSE: To assess the feasibility of Clariscan, an intravascular contrast agent, for free breathing, navigator assisted, high resolution, three-dimensional-magnetic resonance coronary angiography (MRCA) in patients, as extracellular contrast agents are unfavorable for the improvement of image quality. MATERIALS AND METHODS: MRCA was performed in 10 patients with known coronary artery disease (CAD) with (1-5 mg Fe/kg body weight) and without contrast agent. RESULTS: Compared to unenhanced images, Clariscan did not improve signal-to-noise (SNR) or contrast-to-noise ratios (CNR) compared to fat or myocardium in the proximal parts of the coronary arteries. However, when analyzing the peripheral parts (>4 cm from origin), CNR(fat) and CNR(myo) improved up to a factor of 1.81 and 5.85, respectively, at a dose of 3 mg Fe/kg body weight, while SNR did not reach statistical significance. The visible length of the coronary arteries was improved from 49 +/- 18 mm to 73 +/- 33 mm. The proximal diameter was reduced from 3.6 +/- 0.8mm to 3.2 +/- 0.8 mm, representing more closely the diameter of 3.1 +/- 0.7 mm measured by quantitative coronary angiography. Of 11 significant stenoses (>50%), eight were identified in the enhanced compared to six in the unenhanced images. CONCLUSION: The use of Clariscan at a dose of 2-3 mg Fe/kg body weight improves image quality of three-dimensional-MRCA, especially in the peripheral segments, and, thus, the diagnostic accuracy for the detection of CAD.     

Gd(ABE-DTTA)-enhanced cardiac MRI for the diagnosis of ischemic events in the heart

PURPOSE: To demonstrate that contrast-enhanced MRI (ceMRI) with the aid of Gd(ABE-DTTA) is able to detect ischemic events in the heart in a canine ischemia/reperfusion (30/40 minutes) model. MATERIALS AND METHODS: ECG-gated, T1-weighted MR image sets (four to five slices each) with three-minute time resolution were collected in transiently LAD-occluded dogs. Following the acquisition of control image sets, ischemia was started by occluding the LAD. Either Gd(ABE-DTTA) (N = 6) or Gd(DTPA) (N = 6) was injected, and imaging was continued for 30 minutes of ischemia and 40 minutes of reperfusion. The contrast agent (CA)-induced MRI signal intensity enhancement (SIE) and contrast were monitored. Microspheres measured myocardial perfusion (MP) to verify areas of ischemia and reperfusion. RESULTS: SIEs of 86% +/- 3% and 97% +/- 3% in nonischemic, and 25% +/- 5% and 29% +/- 8% in ischemic regions were found within three minutes of onset of ischemia with Gd(ABE-DTTA) and Gd(DTPA), respectively. For the rest of the 30 minutes of ischemia, with Gd(ABE-DTTA) SIE of 60% +/- 3% and 25% +/- 5% persisted in the nonischemic and ischemic regions, respectively. With Gd(DTPA), however, SIE in the nonischemic areas decreased rapidly after the first three minutes of ischemia, while SIE in the ischemic areas increased, abolishing contrast. Thus, there was a persistent contrast with Gd(ABE-DTTA) and a short-lived contrast with Gd(DTPA) during ischemia. Furthermore, with Gd(ABE-DTTA) some contrast was still visible in the early reperfusion period. CONCLUSION: Gd(ABE-DTTA) in an ischemia/reperfusion model induces a persistent MRI contrast between regions of normal and ischemic myocardium, and verifies reperfusion. Therefore, it can be used to detect myocardial ischemic events.     

Comparison of 0.5-M Gd-DTPA with 1.0-M gadobutrol for magnetic resonance angiography of the supplying arteries of the spinal cord in thoracoabdominal aortic aneurysm patients

PURPOSE: To prospectively compare 0.5-M gadopentetate dimeglumine (Gd-DTPA) with 1.0-M gadobutrol for contrast-enhanced magnetic resonance angiography (CE-MRA) of the blood supplying arteries of the spinal cord in patients referred for open surgical repair of a thoracoabdominal aortic aneurysm (TAAA). MATERIALS AND METHODS: A total of 11 patients with a TAAA underwent two three-dimensional CE-MRA exams of the aorta, segmental arteries (SAs), artery of Adamkiewicz (AKA), and anterior spinal artery (ASA). Imaging was performed on two separate occasions using Gd-DTPA and gadobutrol as contrast agents at 0.3 mmol/kg. Images were evaluated by measuring signal-to-noise (SNR) and contrast-to-noise (CNR) ratios and were judged for different image quality criteria by two blinded observers. RESULTS: In all patients both CE-MRA exams were of sufficient image quality to detect the AKA and ASA. No significant differences in SNR and CNR were observed between the two contrast agents. According to the observers, no significant differences in subjective image quality were found. CONCLUSIONS: Using both contrast agents it was possible to visualize the ultrasmall spinal cord arteries in all cases. The use of the 1.0-M contrast agent did not improve image quality of CE-MRA images of the blood supplying arteries of the spinal cord compared to the 0.5-M contrast agent.