Dural arteriovenous fistula involving the transverse sigmoid sinus after treatment: assessment with magnetic resonance digital subtraction angiography

Introduction The purpose of this study was to evaluate the utility of magnetic resonance digital subtraction angiography (MRDSA) in showing the presence or absence of retrograde venous drainage (RVD) in patients with intracranial dural arteriovenous fistula (DAVF) involving the transverse sigmoid sinus (TSS) after treatment. Methods Of 16 patients with DAVF involving the TSS, 13 underwent digital subtraction angiography (DSA) and MRDSA before and after treatment, and 3 underwent DSA before treatment and DSA and MRDSA after treatment. Five patients underwent these procedures twice after treatment. A total of 21 examinations after treatment were evaluated retrospectively. The presence or absence of DAVF and RVD was decided on the basis of the DSA findings. Two neuroradiologists reviewed the MRDSA findings concerning the presence or absence of DAVF and RVD. Results DSA showed residual DAVF in 9 and residual RVD in 5 of 21 examinations. MRDSA revealed residual DAVF in 8 of 21 examinations. MRDSA did not show residual DAVF in one examination because of a very small (low-flow) residual DAVF without RVD. MRDSA identified residual RVD in 5 of 21 examinations. MRDSA was completely consistent with DSA concerning the presence or absence of residual RVD. Conclusion MRDSA could evaluate the presence or absence of RVD in patients with DAVF involving TSS after treatment. MRDSA may give reliable information as to whether patients with DAVF involving the TSS should undergo additional DSA after treatment.     

Time‐resolved dual‐station calf–foot three‐dimensional bolus chase MR angiography with fluoroscopic tracking

Purpose:

To refine, adapt, and evaluate the technical aspects of fluoroscopic tracking for generating dual‐station high‐spatial‐resolution MR angiograms of the calves and feet using a single injection of contrast material.

Materials and Methods:

Nine subjects (seven healthy volunteers followed by two patients) were imaged using a two‐station calf–foot three‐dimensional time‐resolved bolus chase MR angiography protocol which provided <1.0 mm³ spatial resolution throughout and 2.5‐ and 6.6‐s frame times at the calf and foot stations, respectively. Real‐time reconstruction of calf station time frames allowed visually guided triggering of table advance to the foot station. The studies were independently read and scored by two radiologists in six image quality categories.

Results:

On average, overall diagnostic quality at the calf and foot stations was good‐to‐excellent, the calf arteries and all but the smallest foot arteries had good‐to‐excellent signal and sharpness, artifact and venous contamination were minor, and signal continuity across the inter‐station interface was good.

Conclusion:

The feasibility of fluoroscopic tracking has been demonstrated as an efficient approach for high spatiotemporal imaging of the arteries of the calves and feet with good‐to‐excellent diagnostic quality and low degrading venous contamination. J. Magn. Reson. Imaging 2012;36:1168–1178. © 2012 Wiley Periodicals, Inc.     

High‐resolution magnetic resonance angiography in the mouse using a nanoparticle blood‐pool contrast agent

High‐resolution magnetic resonance angiography is already a useful tool for studying mouse models of human disease. Magnetic resonance angiography in the mouse is typically performed using time‐of‐flight contrast. In this work, a new long‐circulating blood‐pool contrast agent—a liposomal nanoparticle with surface‐conjugated gadolinium (SC‐Gd liposomes)—was evaluated for use in mouse neurovascular magnetic resonance angiography. A total of 12 mice were imaged. Scan parameters were optimized for both time‐of‐flight and SC‐Gd contrast. Compared to time‐of‐flight contrast, SC‐Gd liposomes (0.08 mmol/kg) enabled improved small‐vessel contrast‐to‐noise ratio, larger field of view, shorter scan time, and imaging of venous structures. For a limited field of view, time‐of‐flight and SC‐Gd were not significantly different; however, SC‐Gd provided better contrast‐to‐noise ratio when the field of view encompassed the whole brain (P < 0.001) or the whole neurovascular axis (P < 0.001). SC‐Gd allowed acquisition of high‐resolution magnetic resonance angiography (52 × 52 × 100 micrometer³ or 0.27 nL), with 123% higher (P < 0.001) contrast‐to‐noise ratio in comparable scan time (～45 min). Alternatively, SC‐Gd liposomes could be used to acquire high‐resolution magnetic resonance angiography (0.27 nL) with 32% higher contrast‐to‐noise ratio (P < 0.001) in 75% shorter scan time (12 min). Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Non‐contrast‐enhanced vascular magnetic resonance imaging using flow‐dependent preparation with subtraction

Recent concerns over contrast agent safety have encouraged new developments in non‐contrast‐enhanced vascular imaging techniques. This work investigates the potential for imaging both arteries and veins with vascular anatomy by nonenhanced static subtraction angiography (VANESSA), a method using controllable flow suppression together with subtraction of bright‐ and dark‐blood images. The lower legs of eight healthy volunteers and three patients were imaged using a modified motion‐sensitized driven equilibrium preparation, with three‐dimensional balanced steady‐state free precession readout. The vascular signal decreased with increasing motion‐suppression gradient amplitude, and was suppressed when the velocity‐encoding parameter was (approximately) less than the measured flow velocity. Selected pairs of images were subtracted to depict vessels with either fast flow (e.g. arteries), slow flow (e.g. veins), or both. Several methodological modifications improved image quality and reduced the background signal from static tissues. Subjectively assessed image quality in volunteers was rated as excellent for 56/64 arterial segments, and good or excellent for 35/64 veins. In conclusion, VANESSA enables rapid non‐contrast‐enhanced imaging of arteries and veins, combining information on both morphology and flow. This study demonstrates good technical performance in volunteers and evaluation in patients with vascular disease is warranted. Magn Reson Med, 2012. © 2011 Wiley Periodicals, Inc.     

Time-resolved two-dimensional thick-slice magnetic resonance digital subtraction angiography in assessing brain tumors

The aim of this study was to evaluate clinical applicability of two-dimensional (2D) thick-slice, contrast-enhanced magnetic resonance digital subtraction angiography (MRDSA) with high temporal resolution in diagnosis of brain tumors. Forty-four patients with brain tumors including, 15 meningiomas, 8 gliomas, 6 metastatic tumors, 4 neuromas, and 2 hemangioblastomas, were studied with 2D MRDSA with frame rate approximately 1 s. Images were continuously obtained following the initiation of bolus injection of gadolinium chelates for 40 s and subtraction images were generated in a workstation. We evaluated visualization of normal cranial vessels on MRDSA and compared MRDSA and intra-arterial digital subtraction angiography (IADSA) with regard to hemodynamic information. Large cerebral arteries, all venous sinuses, and most tributaries were clearly visualized. A stain was present in hypervascular tumors including all 15 meningiomas and 2 hemangioblastomas on MRDSA. Presence of a stain demonstrated on MRDSA and that on IADSA coincided in 16 of 20 cases (Spearman rank correlation value was 0.85). The location, shape, and phase of the stain on MRDSA were similar to those on IADSA. Two-dimensional MRDSA with high temporal resolution has a unique ability to demonstrate cerebral hemodynamics, such as IADSA, and can play an important role in assessing brain tumors. Received: 8 October 1999; Revised: 30 November 1999; Accepted: 7 December 1999     

Comparison of digital subtraction angiography with gadolinium-enhanced magnetic resonance angiography in the diagnosis of renal artery stenosis

Renal artery stenosis (RAS) is a treatable cause of hypertension and renal failure for which no ideal screening technique is currently available. We evaluated the use of dynamic gadolinium-enhanced magnetic resonance angiography (MRA) for the diagnosis of RAS. Sixty-two patients with secondary hypertension were enrolled in the study. All patients had conventional renal angiography and gadolinium enhanced MRA. The sequence used was a 3D FMP SPGR sequence with the following parameters (TR: 26 ms, TE: 6.9 ms, flip angle 40 °, field of view 36 × 36 cm, matrix 246 × 256, 1 excitation). Gadolinium 0.3 mmol/kg was administered and 60 1.5-mm-thick partitions were obtained over a duration of 3.5 min. The MRA images were then compared with conventional digital subtraction angiography (DSA) images. Conventional DSA demonstrated 138 renal arteries, whereas gadolinium-enhanced MRA demonstrated 129 (93 %). Twenty-one renal artery stenoses and four occluded arteries were seen at conventional DSA. Gadolinium-enhanced MRA had a sensitivity of 88 %, specificity of 98 %, accuracy of 96 %, positive predictive value of 92 % and negative predictive value of 97 % when compared with conventional DSA. Gadolinium-enhanced MRA is an accurate technique for identifying patients with RAS. It is less sensitive in picking up accessory renal arteries. Received: 17 March 1998; Revision received: 30 June 1998; Accepted: 28 August 1998     

Evaluation of the carotid artery bifurcation: comparison of magnetic resonance angiography and digital subtraction arch aortography

Summary Thirty-four carotid artery bifurcations were examined using both magnetic resonance angiography (MRA) and digital subtraction arch aortography to determine their accuracy when compared to selective carotid angiography. The sensitivity of MRA was 73% and its specificity was 91% when compared with selective carotid angiography. The sensitivity of arch aortography was 27% and its specificity was 100%.     

Comparison of contrast‐enhanced multi‐station MR angiography and digital subtraction angiography of the lower extremity arterial disease

Purpose:

To compare diagnostic accuracy of multi‐station, high‐spatial resolution contrast‐enhanced MR angiography (CE‐MRA) of the lower extremities with digital subtraction angiography (DSA) as the reference standard in patients with symptomatic peripheral arterial occlusive disease.

Materials and Methods:

Of 485 consecutive patients undergoing a run‐off CE‐MRA, 152 patients (86 male, 66 female; mean age, 71.6 years) with suspected peripheral arterial occlusive disease were included into our Institutional Review Board approved study. All patients underwent MRA and DSA of the lower extremities within 30 days. MRA was performed at 1.5 Tesla with a single bolus of 0.1 mmol/kg body weight of gadobutrol administered at a rate of 2.0 mL/s at three stations. Two readers evaluated the MRA images independently for stenosis grade and image quality. Sensitivity and specificity were derived.

Results:

Sensitivity and specificity ranged from 73% to 93% and 64% to 89% and were highest in the thigh area. Both readers showed comparable results. Evaluation of good and better quality MRAs resulted in a considerable improvement in diagnostic accuracy.

Conclusion:

Contrast‐enhanced MRA demonstrates good sensitivity and specificity in the investigation of the vasculature of the lower extremities. While a minor investigator experience dependence remains, it is standardizable and shows good inter‐observer agreement. Our results confirm that the administration of Gadobutrol at a standard dose of 0.1 mmol/kg for contrast‐enhanced runoff MRA is able to detect hemodynamically relevant stenoses. Use of contrast‐enhanced MRA as an alternative to intra‐arterial DSA in the evaluation and therapeutic planning of patients with suspected peripheral arterial occlusive disease is well justified. J. Magn. Reson. Imaging 2013;37:1427–1435. © 2012 Wiley Periodicals, Inc.     

Rapid time‐resolved magnetic resonance angiography via a multiecho radial trajectory and GraDeS reconstruction

Contrast‐enhanced magnetic resonance angiography is challenging due to the need for both high spatial and temporal resolution. A multishot trajectory composed of pseudo‐random rotations of a single multiecho radial readout was developed. The trajectory is designed to give incoherent aliasing artifacts and a relatively uniform distribution of projections over all time scales. A field map (computed from the same data set) is used to avoid signal dropout in regions of substantial field inhomogeneity. A compressed sensing reconstruction using the GraDeS algorithm was used. Whole brain angiograms were reconstructed at 1‐mm isotropic resolution and a 1.1‐s frame rate (corresponding to an acceleration factor > 100). The only parameter which must be chosen is the number of iterations of the GraDeS algorithm. A larger number of iterations improves the temporal behavior at cost of decreased image signal‐to‐noise ratio. The resulting images provide a good depiction of the cerebral vasculature and have excellent arterial/venous separation. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.     

Resolution improvement in thick-slab magnetic resonance digital subtraction angiography using SENSE at 3T

PURPOSE: To evaluate the use of parallel imaging (sensitivity encoding [SENSE]) to improve spatial resolution and achieve sub-second temporal resolution in fluoroscopic contrast-enhanced, magnetic resonance digital subtraction angiography (MR-DSA). MATERIALS AND METHODS: A MR-DSA sequence was optimized on a 3-T scanner with respect to sampling bandwidth and SENSE acceleration factor subject to the constraints of half-second acquisition time and 0.6 x 1.2 mm in-plane resolution. MR-DSA with and without SENSE acceleration was then evaluated in patients with arterio-venous malformations (AVMs). RESULTS: Consistent with previously reported results and theory, SENSE factors greater than two and increasing sampling bandwidth both led to increasing image noise. Compared to lower resolution MR-DSA images with similar temporal resolution, the SENSE accelerated sequence provided better spatial resolution without notable changes in the contrast enhancement of the vascular territories of the AVMs but was hampered somewhat in the late venous phases by a reconstruction artifact. CONCLUSION: SENSE acceleration of MR-DSA by a factor of two allows improved temporal or spatial resolution without significant loss of image quality. Signal-to-noise degradation associated with higher SENSE acceleration factors are likely to necessitate other approaches to further improving resolution in MR-DSA. Clinically, SENSE accelerated MR-DSA improves the non-invasive pre- and postoperative depiction of AVM flow dynamics.     

Gadolinium dimeglumine: an alternative contrast agent for digital subtraction angiography

The aim of this study was to evaluate gadolinium diethylenetriaminepenta-acetic acid (Gd-DTPA) as an alternative contrast agent for digital subtraction angiography (DSA) in patients with renal insufficiency or previous anaphylactic reaction to iodinated contrast agents. We performed 34 DSAs in 31 patients by use of the commercially available 0.5-M Gd-DTPA solution (Magnevist, Schering, Berlin, Germany). The contrast material was power- or hand-injected at the same rate as iodinated contrast material, without exceeding a total amount of 0.4 mmol/kg body weight. In 18 studies Gd-DTPA was the sole contrast agent. In 9 cases gadolinium injections were combined with carbon dioxide. Restricted non-ionic contrast medium injections were administered to complete the examinations in 7 cases and for comparative purposes in 1 case. Cerebral and carotid arteries, one superior limb, abdominal aorta, renal arteries, renal transplants, iliac arteries and inferior limbs were imaged, and ten endovascular interventional procedures, including three transjugular intrahepatic percutaneous stent shunts, were performed. No side effects were observed. Diagnostic angiographic images were obtained in all cases except in 5 of the 8 distal run-off studies. Gadolinium-based contrast can produce clinically useful angiograms in patients with a contra-indication to iodine who must undergo angiography. Received: 15 April 1998; Revision received: 2 July 1998; Accepted: 25 July 1998     

Contrast‐enhanced MR angiography using time resolved interleaved projection sampling with three‐dimensional cartesian phase and slice encoding (TRIPPS)

Undersampled projection reconstruction (PR) techniques provide contrast enhanced MR angiography (CE‐MRA) with high temporal resolution, but sensitivity to eddy current, gradient error and off‐resonance effects. It is desirable to combine the time efficiency of undersampled PR acquisition with the robustness of Cartesian imaging. In this work we present a technique designed to do this termed time resolved projection sampling with three‐dimensional (3D) Cartesian phase and slice encoding (TRIPPS), where 3D Cartesian k‐space is partitioned into multiple half projections in the ky‐kz plane. The phase and slice encoding are performed along predefined center‐out radial trajectories. The whole set of half projections is interleaved into multiple groups of half projections, with each group sparsely but uniformly covering the ky‐kz space. A view sharing sliding window reconstruction algorithm is adapted to reconstruct the dynamic images. The feasibility of the TRIPPS technique for CE‐MRA was demonstrated on the renal, pulmonary, and intracranial vasculatures of healthy volunteers with a high temporal resolution of 2 s/frame. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

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.     

Time‐resolved three‐dimensional (3D) phase‐contrast (PC) balanced steady‐state free precession (bSSFP)

In this study the feasibility of a time‐resolved, three‐dimensional (3D), three‐directional flow‐sensitive balanced steady‐state free precession (bSSFP) sequence is demonstrated. Due to its high signal‐to‐noise ratio (SNR) in blood and cerebrospinal fluid (CSF) this type of sequence is particularly effective for acquisition of blood and CSF flow velocities. Flow sensitivity was achieved with the phase‐contrast (PC) technique, implementing a custom algorithm for calculation of optimal gradient parameters. Techniques to avoid the most important sources of bSSFP‐related artifacts (including distortion due to eddy currents and signal voids due to flow‐related steady‐state disruption) are also presented. The technique was validated by means of a custom flow phantom, and in vivo experiments on blood and CSF were performed to demonstrate the suitability of this sequence for human studies. Accurate depiction of blood flow in the cerebral veins and of CSF flow in the cervical portion of the neck was obtained. Possible applications of this technique might include the study of CSF flow patterns, direct in vivo study of pathologies such as hydrocephalus and Chiari malformation, and validation for the existing CSF circulation model. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Quantification and visualization of flow in the Circle of Willis: Time‐resolved three‐dimensional phase contrast MRI at 7 T compared with 3 T

The assessment of both geometry and hemodynamics of the intracranial arteries has important diagnostic value in internal carotid occlusion, sickle cell disease, and aneurysm development. Provided that signal to noise ratio (SNR) and resolution are high, these factors can be measured with time‐resolved three‐dimensional phase contrast MRI. However, within a given scan time duration, an increase in resolution causes a decrease in SNR and vice versa, hampering flow quantification and visualization. To study the benefits of higher SNR at 7 T, three‐dimensional phase contrast MRI in the Circle of Willis was performed at 3 T and 7 T in five volunteers. Results showed that the SNR at 7 T was roughly 2.6 times higher than at 3 T. Therefore, segmentation of small vessels such as the anterior and posterior communicating arteries succeeded more frequently at 7 T. Direction of flow and smoothness of streamlines in the anterior and posterior communicating arteries were more pronounced at 7 T. Mean velocity magnitude values in the vessels of the Circle of Willis were higher at 3 T due to noise compared to 7 T. Likewise, areas of the vessels were lower at 3 T. In conclusion, the gain in SNR at 7 T compared to 3 T allows for improved flow visualization and quantification in intracranial arteries. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.     

On the dual contrast enhancement mechanism in frequency‐selective inversion‐recovery magnetic resonance angiography (IRON‐MRA)

The susceptibility of blood changes after administration of a paramagnetic contrast agent that shortens T₁. Concomitantly, the resonance frequency of the blood vessels shifts in a geometry‐dependent way. This frequency change may be exploited for incremental contrast generation by applying a frequency‐selective saturation prepulse prior to the imaging sequence. The dual origin of vascular enhancement depending first on off‐resonance and second on T₁ lowering was investigated in vitro, together with the geometry dependence of the signal at 3T. First results obtained in an in vivo rabbit model are presented. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Value of blood pool contrast agents in magnetic resonance angiography of the pelvis and lower extremities

Our objective was: (1) to determine the appropriate dose of new ultrasmall superparamagnetic iron oxide particles for magnetic resonance angiography (MRA). This agent comprised of a single iron oxide crystal stabilized with a carbohydrate-polyethylene glycol coat (PEG-Ferron/NC 100150 injection); (2) to determine the proper flip angle for PEG-Ferron-enhanced 3 D time-of-flight (TOF) MRA sequence; and (3) to compare the enhancement of peripheral vessels following PEG-Ferron and GdDTPA-BMA. MRA parameters were: TR/TE = 50/2.1 ms, NEX = 1, FOV = 30 × 30 × 1.8 cm, and matrix = 256 × 128 × 64. In anesthetized beagle dogs (n = 10), the effects of PEG-Ferron and GdDTPA-BMA on regional signal were monitored for 45 min and compared. The lowest dose of PEG-Ferron (0.05 mmol/kg) produced the best enhancement of primary, secondary and tertiary vessels. The flip angle 60 ° provided better enhancement than 20 ° on contrast enhanced images. Unlike GdDTPA-BMA, PEG-Ferron allowed prolonged delineation (> 45 min) of the pelvis and lower extremities circulation. PEG-Ferron provided greater Contrast-to-noise ratio CNR (80.2 ± 6.2, P < 0.05) than GdDTPA-BMA (63.5 ± 2.5). It may be possible for blood pool contrast-enhanced 3 D TOF MRA to provide valuable information for visualization of vascular tree including guiding interventions. Received 6 August 1997; Revision received 25 November 1997; Accepted 3 February 1998     

Coronary MR angiography using citrate‐coated very small superparamagnetic iron oxide particles as blood‐pool contrast agent: Initial experience in humans

Purpose:

To evaluate very small superparamagnetic iron oxide particles (VSOP‐C184) as blood‐pool contrast agent for coronary MR angiography (CMRA) in humans.

Materials and Methods:

Six healthy volunteers and 14 patients with suspected coronary artery disease underwent CMRA after administration of VSOP‐C184 at the following doses: 20 μmol Fe/kg (4 patients), 40 μmol Fe/kg (5 patients), 45 μmol Fe/kg (6 healthy volunteers), and 60 μmol Fe/kg (5 patients). In healthy volunteers, contrast‐to‐noise ratio (CNR), signal‐to‐noise ratio (SNR), and vessel edge definition (VED) of contrast‐enhanced CMRA were compared with non–contrast‐enhanced CMRA. In patients, a per‐segment intention‐to‐diagnose evaluation of contrast‐enhanced CMRA for detection of significant coronary stenosis (≥50%) was performed.

Results:

Three healthy volunteers (45 μmol Fe/kg VSOP‐C184) and two patients (60 μmol Fe/kg VSOP‐C184) had adverse events of mild or moderate intensity. VSOP‐C184 significantly increased CNR (15.1 ± 4.6 versus 6.9 ± 1.9; P = 0.010), SNR (21.7 ± 5.3 versus 15.4 ± 1.6; P = 0.048), and VED (2.3 ± 0.6 versus 1.2 ± 0.2; P < 0.001) compared with non–contrast‐enhanced CMRA. In patients, contrast‐enhanced CMRA yielded sensitivity, specificity, and diagnostic accuracy for detection of significant coronary stenosis of 86.7%, 71.0%, 73.1%, respectively.

Conclusion:

CMRA using VSOP‐C184 was feasible and yielded moderate diagnostic accuracy for detection of significant coronary stenosis within this proof‐of‐concept setting. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.