Non-contrast-enhanced MR angiography of the thoracic aorta using cardiac and navigator-gated magnetization-prepared three-dimensional steady-state free precession

PURPOSE: To assess the usefulness of non-contrast-enhanced MR angiography using cardiac and navigator-gated magnetization-prepared three-dimensional (3D) steady-state free precession (SSFP) imaging for the diagnosis of diseases of the thoracic aorta. MATERIALS AND METHODS: Twenty-two patients with diseases of the thoracic aorta were examined using a 1.5 Tesla unit. Non-contrast-enhanced MR angiography was done using parasagittal 3D SSFP combined with cardiac-gating and k-space weighted navigator-gating techniques, using T2-prepared and fat-suppression pulses. Imaging quality and the diagnostic capability of this technique were compared with the imaging quality of 2D SSFP or contrast-enhanced 3D MR angiography and with final diagnoses. RESULTS: Non-contrast-enhanced 3D MR angiography provided signal-to-noise and contrast-to-noise ratios of the thoracic aorta comparable to non-contrast-enhanced 2D or contrast-enhanced 3D MR angiography (P > 0.17). This imaging technique gave accurate diagnoses in 19 of the 22 patients. CONCLUSION: Non-contrast-enhanced MR angiography using cardiac and navigator-gated magnetization-prepared 3D SSFP technique was useful for the diagnosis of diseases of the thoracic aorta.     

Non‐contrast renal artery MRA using an inflow inversion recovery steady state free precession technique (Inhance): Comparison with 3D contrast‐enhanced MRA

Purpose:

To assess the performance of a three‐dimensional (3D) non‐contrast respiratory‐triggered steady state free precession (SSFP) pulse sequence for detection of renal artery stenosis.

Materials and Methods:

A total of 64 patients who had non‐contrast MR angiography (NC MRA) and 3D contrast‐enhanced MRA (CE MRA) performed during the same exam and three patients who had NC MRA followed by conventional catheter angiography within one month of the MRI exam were included in this retrospective study. Two blinded readers evaluated NC MRA images for the presence of significant renal artery stenosis and also rated their diagnostic confidence and evaluated the images for artifact. A similar analysis was performed for CE MRA images by two additional blinded readers, and discrepancies were resolved by consensus reading.

Results:

The 67 patients had 168 main and accessory renal arteries, with significant (>50%) stenosis in 34 arteries on CE MRA or conventional angiography. The two NC MRA readers had sensitivity and specificity for detection of significant stenosis of 94%/82% and 82%/87% respectively on a per renal artery basis.

Conclusion:

There was good agreement between CE MRA and NC MRA for detection of significant renal artery stenosis. This technique should prove useful in evaluating patients with suspected renovascular hypertension who are unable to undergo CE MRA. J. Magn. Reson. Imaging 2010;31:1411–1418. © 2010 Wiley‐Liss, Inc.     

Cardiac fat navigator-gated steady-state free precession 3D magnetic resonance angiography of coronary arteries.

Motion artifacts and the lack of accurate detection of cardiac motion present a major challenge for high-resolution cardiac MRI. Recently a multidimensional cardiac fat navigator was proposed to provide a fast and direct measurement of bulk cardiac motion. The objective of this study was to demonstrate the feasibility of employing the cardiac fat navigator in balanced steady-state free precession (SSFP) free-breathing 3D coronary MRA (CMRA). The cardiac fat navigator echo is optimized to provide both motion monitoring and epicardial fat suppression. Steady-state magnetization preparation, which is needed for SSFP CMRA, is optimized by comparing three preparation schemes: alpha/2, linear ramp with 20 RF pulses (20LR), and Kaiser ramp with six RF pulses (6KR). The present preliminary human study shows that the 6KR preparation provides better image quality than both the alpha/2 (P<0.0025) and the 20LR preparations (P<0.025) for free-breathing SSFP 3D CMRA (N=11).     

Vascular staging of renal and adrenal malignancies with a noncontrast enhanced steady state free precession technique

Purpose:

To compare a noncontrast enhanced balanced steady state free precession (bSSFP) MRI technique with a conventional dynamic contrast‐enhanced (DCE) three‐dimensional (3D) spoiled gradient recalled echo (SPGR) imaging in the vascular staging of renal and adrenal malignancies.

Materials and Methods:

Sixty‐three MRIs with both bSSFP and DCE acquisitions performed for initial staging of renal and adrenal malignancies were retrospectively evaluated for presence and extent of thrombus in the renal veins and inferior vena cava (IVC). Thrombus characterization was also evaluated. DCE imaging was used as the standard‐of‐reference. Histopathology was available in 46 of 63 cases as an additional external standard.

Results:

There is very good agreement between bSSFP and DCE imaging for determining the presence or absence of thrombus in the renal veins (r = 0.95; P < 0.0001) and IVC (r = 0.91; P < 0.0001). BSSFP is less successful at distinguishing bland from tumor thrombus.

Conclusion:

Noncontrast enhanced bSSFP is an acceptable alternative to DCE imaging for vascular staging of locally advanced renal/adrenal malignancies, with somewhat limited ability to distinguish bland from tumor thrombus. J. Magn. Reson. Imaging 2011;33:1406–1413. © 2011 Wiley‐Liss, Inc.     

Breath-hold 3D steady-state free precession coronary MRA compared with conventional X-ray coronary angiography

PURPOSE: To evaluate the use of breath-hold three-dimensional (3D) steady-state free precession (SSFP) coronary magnetic resonance angiography (MRA) in patients with coronary artery disease (CAD) in comparison with conventional coronary x-ray angiography (XRA). MATERIALS AND METHODS: Twenty-eight patients with suspected CAD were examined with the use of a breath-hold 3D-SSFP-MRA sequence and conventional XRA. To assess the accuracy of MRA, two clinicians who were blinded to patient information independently reviewed the MRA and XRA data, which were presented in a randomized order. To identify discrepancies between MRA and XRA, and assess features of coronary lesions on MRA, two additional clinicians examined MRA and XRA data that were presented side by side, divided into proximal, mid, and distal segments, and compared them segment by segment. RESULTS: The sensitivity and specificity for diagnosing significant coronary stenoses (> 50% diameter narrowing) were 64% and 94%, respectively. At sites of coronary lesions identified on XRA, bright signals and enlarged vessel profiles, in addition to the characteristic narrow lumen, were frequently observed on MRA. CONCLUSION: Breath-hold SSFP coronary MRA has good specificity but inconclusive sensitivity in diagnosing significant coronary stenoses, and provides important image features for depicting coronary lesions.     

Magnetic resonance portography using contrast-enhanced fat-saturated three-dimensional steady-state free precession imaging

PURPOSE: To assess the feasibility of contrast-enhanced fat-saturated three-dimensional steady-state free precession (FIESTA) imaging for contrast-enhanced magnetic resonance (MR) portography. MATERIALS AND METHODS: Contrast-enhanced fat-saturated three-dimensional fast spoiled gradient-echo (SPGR) and FIESTA were performed as MR portography. In 10 cases, fat-saturated three-dimensional FIESTA was first performed and followed by fast SPGR, and the order of post-contrast imaging was reversed in the other 10 cases. Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) were estimated for portal and visceral veins on the source images. The visualization of portal vein was scored on three-dimensional MR portography. Portal venous system disorders were assessed using three-dimensional MR portography. RESULTS: The SNRs, CNRs, and visual assessment of portal and visceral veins were significantly higher in contrast-enhanced fat-saturated three-dimensional FIESTA than contrast-enhanced fat-saturated three-dimensional fast SPGR (P < 0.05). The contrast-enhanced fat-saturated three-dimensional FIESTA provided high venous signals even at 8 minutes after gadolinium injection. The abnormalities of portal venous system were well visualized with MR portography using contrast-enhanced fat-saturated three-dimensional FIESTA. CONCLUSION: Contrast-enhanced fat-saturated three-dimensional FIESTA was valuable for MR portography, with flexible time window and high vascular signals. This imaging may allow for other post-contrast imaging options before portography and release patients from consecutive breath-holds.     

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.     

Navigator-gated three-dimensional MR angiography of the pulmonary arteries using steady-state free precession

PURPOSE: To assess the quality of a navigator-gated, free breathing, steady-state free precession (SSFP) technique in comparison to a single breathhold for pulmonary artery imaging in normal volunteers. MATERIALS AND METHODS: Sagittal sections of the left pulmonary arteries of 10 volunteers were obtained with a three-dimensional SSFP sequence using both a single breathhold of 30 seconds and a navigator-gated version of the same sequence. The images were compared and rated by a blinded cardiovascular radiologist for image quality, sharpness, and artifact. RESULTS: On a scale ranging from -2 to 2, in which positive numbers denote that the navigator method was favorable compared to the single breathhold method, image quality was rated 0.7+/-1.4, sharpness 0.6+/-1.5, and artifact 0.1+/-1.4. Thus, there was no statistical difference between the two methods. CONCLUSION: The navigator-gated SSFP sequence is able to acquire images equal in quality to the breathhold sequence. This may be of clinical importance for pulmonary imaging in patients who are unable to sustain a long breathhold.     

Performance of steady-state free precession for imaging carotid artery disease

PURPOSE: To evaluate steady-state free precession (SSFP) for diagnosing carotid artery disease. MATERIALS AND METHODS: Following bilateral x-ray angiography, seven patients with suspected carotid artery disease were imaged with SSFP, black blood fast spin echo (BB FSE), and time-of-flight MR angiography (TOF MRA). The techniques were compared for characterizing the vessel lumen. Flow phantom experiments were also performed, using speeds of 0 to 40 cm/second, to further evaluate the merits of each MR technique. RESULTS: In the patient studies, of the 14 arteries available, a correct grading of stenosis was possible with SSFP in 9 of 14, FSE in 12 of 14, and TOF in 13 of 14, assuming x-ray angiography as the gold standard. The SSFP technique was the least reliable and had severe artifacts in 5 of 14 arteries, making these images nondiagnostic. The flow phantom demonstrated that although the SSFP technique performs well under slow or no flow, it breaks down at higher flow levels. CONCLUSION: The continuous SSFP sequence used here was not reliable for imaging carotid artery disease owing to artifact in many cases. Nevertheless, the high speed of this SSFP technique does allow it to serve as a rapid scouting method prior to a more detailed evaluation with other MRI methods.     

3D non-contrast-enhanced MR angiography with balanced steady-state free precession Dixon method.

Balanced steady-state free precession (bSSFP) is capable of producing ample fat-water separation. In the case of the bSSFP Dixon method, the phase between fat and water can be manipulated by setting repetition time (TR) to an odd-half-multiple of the cycle time and adjusting the center frequency to acquire fat-water in in-phase and opposed-phase images. Adding an image collected when fat and water are in-phase to an image in which fat and water are opposed-phase produces a water-only image. Of the water signals, arterial blood has the highest T(2)/T(1) contrast, making the arterial signal appear brighter than both venous blood and muscle in the final image. In this study, the bSSFP Dixon method was used to collect coronal water-only three-dimensional (3D) volumes at multiple anatomical stations in the legs of five healthy volunteers. The image quality was quantified by region-of-interest (ROI) analysis of signal intensities between arterial blood, venous blood, muscle, and fat. The images were also assessed for diagnostic quality by a trained radiologist. The bSSFP Dixon method was successful in producing non-contrast-enhanced (NCE) images of the blood vessels in the lower limbs. The work presented here is a proof-of-concept for the use of the bSSFP Dixon method for 3D peripheral angiography.     

MR angiography using steady-state free precession.

Contrast-enhanced MR angiography (CE-MRA) using steady-state free precession (SSFP) pulse sequences is described. Using SSFP, vascular structures can be visualized with high signal-to-noise ratio (SNR) at a substantial (delay) time after the initial arterial pass of contrast media. The peak blood SSFP signal was diminished by <20% 30 min after the initial administration of 0.2 mmol/kg of Gd-chelate. The proposed method allows a second opportunity to study arterial or venous structures with high image SNR and high spatial resolution. A mask subtraction scheme using spin echo SSFP-S(-) acquisition is also described to reduce stationary background signal from the delayed SSFP angiography images.     

Improved magnetization preparation for navigator steady-state free precession 3D coronary MR angiography.

The purpose of this work was to investigate a new magnetization preparation scheme for navigator steady-state free precession (SSFP) 3D coronary MR angiography (MRA) that executes the navigator and fat saturation pulses in steady state after the dummy RFs in order to minimize the delay between the magnetization preparation and the image echoes. Compared to the previous preparation scheme that executes the navigator and fat saturation pulses before the dummy RFs, the new scheme was found to provide more effective motion suppression, significantly improved blood-to-myocardium contrast-to-noise ratio (46%, P < 0.001) at slightly but insignificantly decreased blood signal-to-noise ratio (SNR) (2%, P = 0.73), significantly reduced fat SNR (32%, P < 0.001), and better overall image quality (P = 0.05; Wilcoxon paired sample signed rank test).     

Sensitivity of diffusion weighted steady state free precession to anisotropic diffusion

Diffusion‐weighted steady‐state free precession (DW‐SSFP) accumulates signal from multiple echoes over several TRs yielding a strong sensitivity to diffusion with short gradient durations and imaging times. Although the DW‐SSFP signal is well characterized for isotropic, Gaussian diffusion, it is unclear how the DW‐SSFP signal propagates in inhomogeneous media such as brain tissue. This article presents a more general analytical expression for the DW‐SSFP signal which accommodates Gaussian and non‐Gaussian spin displacement probability density functions. This new framework for calculating the DW‐SSFP signal is used to investigate signal behavior for a single fiber, crossing fibers, and reflective barriers. DW‐SSFP measurements in the corpus callosum of a fixed brain are shown to be in good agreement with theoretical predictions. Further measurements in fixed brain tissue also demonstrate that 3D DW‐SSFP out‐performs 3D diffusion weighted spin echo in both SNR and CNR efficiency providing a compelling example of its potential to be used for high resolution diffusion tensor imaging. Magn Reson Med 60:405–413, 2008. © 2008 Wiley‐Liss, Inc.     

Whole-heart steady-state free precession coronary artery magnetic resonance angiography.

Current implementations of coronary artery magnetic resonance angiography (MRA) suffer from limited coverage of the coronary arterial system. Whole-heart coronary MRA was implemented based on a free-breathing steady-state free-precession (SSFP) technique with magnetization preparation. The technique was compared to a similar implementation of conventional, thin-slab coronary MRA in 12 normal volunteers. Three thin-slab volumes were prescribed: 1) a transverse slab, covering the left main (LM) artery and proximal segments of the left anterior ascending (LAD) and left circumflex (LCX) coronary arteries; 2) a double-oblique slab covering the right coronary artery (RCA); and 3) a double-oblique slab covering the proximal and distal segments of the LCX. The whole-heart data set was reformatted in identical orientations. Visible vessel length, vessel sharpness, and vessel diameter were determined and compared separately for each vessel. Whole-heart coronary MRA visualized LM/LAD (11.7 +/- 3.4 cm) and LCX (6.9 +/- 3.6 cm) over a significantly longer distance than the transverse volume (LM/LAD, 6.1 +/- 1.1 cm, P < 0.001; LCX, 4.2 +/- 1.2 cm, P < 0.05). Improvements in visible vessel length for RCA and LCX in the whole-heart approach vs. their respective targeted volumes were not significant. It is concluded that the whole-heart coronary MRA technique improves visible vessel length and facilitates high-quality coronary MRA of the complete coronary artery tree in a single measurement.     

Superbalanced steady state free precession

Steady state free precession (SSFP) signal theory is commonly derived in the limit of quasi-instantaneous radiofrequency (RF) excitation. SSFP imaging protocols, however, are frequently set up with minimal pulse repetition times and RF pulses can thus constitute a considerable amount to the actual pulse repetition time. As a result, finite RF pulse effects can lead to 10-20% signal deviation from common SSFP theory in the transient and in the steady state which may impair the accuracy of SSFP-based quantitative imaging techniques. In this article, a new and generic approach for intrinsic compensation of finite RF pulse effects is introduced. Compensation is based on balancing relaxation effects during finite RF excitation, similar to flow or motion compensation of gradient moments. RF pulse balancing, in addition to the refocusing of gradient moments with balanced SSFP, results in a superbalanced SSFP sequence free of finite RF pulse effects in the transient and in the steady state; irrespective of the RF pulse duration, flip angles, relaxation times, or off-resonances. Superbalancing of SSFP sequences can be used with all quantitative SSFP techniques where finite RF pulse effects are expected or where elongated RF pulses are used.     

Frequency-modulated steady-state free precession imaging.

Exploration of the possibilities of steady-state free precession (SSFP) excitation has led to the discovery that it is tolerant of slow variations in spectral offset frequency. The effect has been used to eliminate banding artifacts from images obtained with the fully balanced SSFP imaging sequence.     

Quantitative diffusion imaging with steady-state free precession.

The addition of a single, unbalanced diffusion gradient to the steady-state free precession (SSFP) imaging sequence sensitizes the resulting signal to free diffusion. Unfortunately, the confounding influence of both longitudinal (T1) and transverse (T2) relaxation on the diffusion-weighted SSFP (dwSSFP) signal has made it difficult to quantitatively determine the apparent diffusion coefficient (ADC). Here, a multistep method in which the T1, T2, and spin density (Mo) constants are first determined using a rapid mapping technique described previously is presented. Quantitative ADC can then be determined through a novel inversion of the appropriate signal model. The accuracy and precision of our proposed method (which we term DESPOD) was determined by comparing resulting ADC values from phantoms to those calculated from traditional diffusion-weighted echo planar imaging (dwEPI) images. Error within the DESPOD-derived ADC maps was found to be less than 3%, with good precision over a biologically relevant range of ADC values.     

Fast proton spectroscopic imaging using steady-state free precession methods.

Various pulse sequences for fast proton spectroscopic imaging (SI) using the steady-state free precession (SSFP) condition are proposed. The sequences use either only the FID-like signal S(1), only the echo-like signal S(2), or both signals in separate but adjacent acquisition windows. As in SSFP imaging, S(1) and S(2) are separated by spoiler gradients. RF excitation is performed by slice-selective or chemical shift-selective pulses. The signals are detected in absence of a B(0) gradient. Spatial localization is achieved by phase-encoding gradients which are applied prior to and rewound after each signal acquisition. Measurements with 2D or 3D spatial resolution were performed at 4.7 T on phantoms and healthy rat brain in vivo allowing the detection of uncoupled and J-coupled spins. The main advantages of SSFP based SI are the short minimum total measurement time (T(min)) and the high signal-to-noise ratio per unit measurement time (SNR(t)). The methods are of particular interest at higher magnetic field strength B(0), as TR can be reduced with increasing B(0) leading to a reduced T(min) and an increased SNR(t). Drawbacks consist of the limited spectral resolution, particularly at lower B(0), and the dependence of the signal intensities on T(1) and T(2). Further improvements are discussed including optimized data processing and signal detection under oscillating B(0) gradients leading to a further reduction in T(min).