Contrast‐enhanced whole‐heart coronary magnetic resonance angiography at 3 T with radial EPI

Whole‐heart coronary magnetic resonance angiography is a promising method for detecting coronary artery disease. However, the imaging time is relatively long (typically 10–15 min). The goal of this study was to implement a radial echo planar imaging sequence for contrast‐enhanced whole‐heart coronary magnetic resonance angiography, with the aim of combining the scan efficiency of echo planar imaging with the motion insensitivity of radial k‐space sampling. A self‐calibrating phase correction technique was used to correct for off‐resonance effects, trajectory measurement was used to correct for k‐space trajectory errors, and variable density sampling was used in the partition direction to reduce streaking artifacts. Seven healthy volunteers and two patients were scanned with the proposed radial echo planar imaging sequence, and the images were compared with a traditional gradient echo and X‐ray angiography techniques, respectively. Whole‐heart images with the radial EPI technique were acquired with a resolution of 1.0 × 1.0 × 2.0 mm³ in a scan time of 5 min. In healthy volunteers, the average image quality scores and visualized vessel lengths of the RCA and LAD were similar for the radial EPI and gradient echo techniques (P value > 0.05 for all). Anecdotal patient studies showed excellent agreement of the radial EPI technique with X‐ray angiography. Magn Reson Med, 2011. © 2011 Wiley‐Liss, Inc.     

Self‐tracking of contrast kinetics for automatic triggering of contrast‐enhanced whole‐heart coronary magnetic resonance angiography

Purpose

To develop a method for automatically triggering centric data acquisition during contrast‐enhanced whole‐heart coronary magnetic resonance angiography (MRA).

Materials and Methods

The hypothesis of this work is that the blood signal changes during contrast infusion can be estimated by obtaining a projection of the heart during inversion‐recovery prepared data acquisition. A validation study was performed on seven healthy volunteers to test this hypothesis. The peak blood signal enhancement detected from the projection was then used to automatically trigger the start of central k‐space data acquisition. Simulations were performed to compare the signal‐to‐noise ratio (SNR) of the proposed self‐triggering method with the fixed delay method. Six healthy volunteers were scanned on a 3T MR system using the proposed self‐triggered method to test its effectiveness on coronary artery visualization.

Results

Based on the validation study, the self‐triggering method provides an accurate representation of the contrast enhancement. Based on the simulations, self‐triggering with centric ordering is expected to give a 27% higher SNR than linear ordering with a fixed imaging delay. Self‐triggering was successfully used in all volunteers and showed excellent depiction of the major coronary arteries.

Conclusion

The self‐triggering method can be used to automatically determine the optimal delay time for central k‐space acquisition, for each individual subject, without the need of any extra setup or user interaction. J. Magn. Reson. Imaging 2009;29:809–816. © 2009 Wiley‐Liss, Inc.     

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).     

Correction for heart rate variability improves coronary magnetic resonance angiography

PURPOSE: To address degradation of coronary MR angiography (MRA) image quality due to heart rate variability (HRV)-associated variations in coronary artery position and motion. MATERIALS AND METHODS: Free-breathing navigator-gated and -corrected coronary MRA using subject-specific trigger delays and acquisition windows was combined with a real-time HRV correction algorithm, such as commonly used in left ventricular wall motion studies. Ten healthy adults underwent free-breathing navigator-gated and -corrected coronary MRA with and without HRV correction. Signal-to-noise (SNR), contrast-to-noise (CNR), vessel length, diameter, sharpness, and subjective image quality (on a five-point scale) were compared in a blinded fashion. RESULTS: Vessel sharpness improved significantly for both the left (LCA) and right (RCA) coronary artery systems (P = 0.016 and P = 0.015, respectively) with the use of HRV correction. Subjective image quality also improved significantly when HRV correction was used (P = 0.003). There were no significant differences with regard to SNR and CNR (P > 0.1). CONCLUSIONS: Preliminary results suggest that HRV correction improves objective and subjective image quality in coronary MRA. Continued studies in patients with known or suspected coronary artery disease are warranted to investigate the clinical impact of this technique.     

Volume‐targeted and whole‐heart coronary magnetic resonance angiography using an intravascular contrast agent

Purpose

To compare volume‐targeted and whole‐heart coronary magnetic resonance angiography (MRA) after the administration of an intravascular contrast agent.

Materials and Methods

Six healthy adult subjects underwent a navigator‐gated and ‐corrected (NAV) free breathing volume‐targeted cardiac‐triggered inversion recovery (IR) 3D steady‐state free precession (SSFP) coronary MRA sequence (t‐CMRA) (spatial resolution = 1 × 1 × 3 mm³) and high spatial resolution IR 3D SSFP whole‐heart coronary MRA (WH‐CMRA) (spatial resolution = 1 × 1 × 2 mm³) after the administration of an intravascular contrast agent B‐22956. Subjective and objective image quality parameters including maximal visible vessel length, vessel sharpness, and visibility of coronary side branches were evaluated for both t‐CMRA and WH‐CMRA.

Results

No significant differences (P = NS) in image quality were observed between contrast‐enhanced t‐CMRA and WH‐CMRA. However, using an intravascular contrast agent, significantly longer vessel segments were measured on WH‐CMRA vs. t‐CMRA (right coronary artery [RCA] 13.5 ± 0.7 cm vs. 12.5 ± 0.2 cm; P < 0.05; and left circumflex coronary artery [LCX] 11.9 ± 2.2 cm vs. 6.9 ± 2.4 cm; P < 0.05). Significantly more side branches (13.3 ± 1.2 vs. 8.7 ± 1.2; P < 0.05) were visible for the left anterior descending coronary artery (LAD) on WH‐CMRA vs. t‐CMRA. Scanning time and navigator efficiency were similar for both techniques (t‐CMRA: 6.05 min; 49% vs. WH‐CMRA: 5.51 min; 54%, both P = NS).

Conclusion

Both WH‐CMRA and t‐CMRA using SSFP are useful techniques for coronary MRA after the injection of an intravascular blood‐pool agent. However, the vessel conspicuity for high spatial resolution WH‐CMRA is not inferior to t‐CMRA, while visible vessel length and the number of visible smaller‐diameter vessels and side‐branches are improved. J. Magn. Reson. Imaging 2009;30:1191–1196. © 2009 Wiley‐Liss, Inc.     

Coronary magnetic resonance angiography: experimental evaluation of the new rapid clearance blood pool contrast medium P792.

The signal-enhancing characteristics of a new monodisperse monogadolinated macromolecular MR contrast medium (P792) were evaluated for magnetic resonance angiography (MRA) of the coronary arteries. A total of 15 cardiac examinations were performed in pigs at 1.5 T using a 3D gradient-echo sequence. Images were acquired during breath-hold before and up to 35 min after IV injection of Gd-DTPA (0.3 mmol Gd/kg), Gd-BOPTA (0.2 mmol Gd/kg), and P792 (13 micromol Gd/kg). An increase in the signal-to-noise ratio (SNR) of 97% +/- 17%, 108% +/- 37%, and 109% +/- 31% in coronary arteries and of 82% +/- 19%, 82% +/- 24%, and 28% +/- 18% in myocardium, respectively, was measured during the first postcontrast acquisition. The blood-to-myocardium signal-difference-to-noise ratio (SDNR) was significantly higher for P792 than for the other Gd compounds (P <.05) for up to 15 min after injection. Qualitative assessment showed that visualization of the coronary arteries and their branches was significantly better for P792 compared to the low-molecular Gd compounds (P <.05). The blood pool contrast medium P792 is well suited for MRA of the coronary arteries.     

Profile order and time‐dependent artifacts in contrast‐enhanced coronary MR angiography at 3T: Origin and prevention

To enhance the clinical value of coronary magnetic resonance angiography (MRA), high‐relaxivity contrast agents have recently been used at 3T. Here we examine a uniform bilateral shadowing artifact observed along the coronary arteries in MRA images collected using such a contrast agent. Simulations were performed to characterize this artifact, including its origin, to determine how best to mitigate this effect, and to optimize a data acquisition/injection scheme. An intraluminal contrast agent concentration model was used to simulate various acquisition strategies with two profile orders for a slow‐infusion of a high‐relaxivity contrast agent. Filtering effects from temporally variable weighting in k‐space are prominent when a centric, radial (CR) profile order is applied during contrast infusion, resulting in decreased signal enhancement and underestimation of vessel width, while both pre‐ and postinfusion steady‐state acquisitions result in overestimation of the vessel width. Acquisition during the brief postinfusion steady‐state produces the greatest signal enhancement and minimizes k‐space filtering artifacts. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Non‐contrast‐enhanced flow‐independent peripheral MR angiography with balanced SSFP

Flow‐independent angiography is a non‐contrast‐enhanced technique that can generate vessel contrast even with reduced blood flow in the lower extremities. A method is presented for producing these angiograms with magnetization‐prepared balanced steady‐state free precession (bSSFP). Because bSSFP yields bright fat signal, robust fat suppression is essential for detailed depiction of the vasculature. Therefore, several strategies have been investigated to improve the reliability of fat suppression within short scan times. Phase‐sensitive SSFP can efficiently suppress fat; however, partial volume effects due to fat and water occupying the same voxel can lead to the loss of blood signal. In contrast, alternating repetition time (ATR) SSFP minimizes this loss; however, the level of suppression is compromised by field inhomogeneity. Finally, a new double‐acquisition ATR‐SSFP technique reduces this sensitivity to off‐resonance. In vivo results indicate that the two ATR‐based techniques provide more reliable contrast when partial volume effects are significant. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.     

Non‐contrast‐enhanced four‐dimensional (4D) intracranial MR angiography: A feasibility study

T₁‐shortening contrast agents have been widely used in time‐resolved magnetic resonance angiography. To match imaging data acquisition with the short time period of the first pass of contrast agent, temporal resolution and/or spatial resolution have to be compromised in many cases. In this study, a novel non‐contrast‐enhanced technique was developed for time‐resolved magnetic resonance angiography. Alternating magnetization preparation was applied in two consecutive acquisitions of each measurement to eliminate the need for contrast media. Without the constraint of contrast media kinetics, temporal resolution is drastically improved from the order of a second as in conventional contrast‐enhanced approach to tens of milliseconds (50.9 msec) in this study, without compromising spatial resolution. Initial results from volunteer studies demonstrate the feasibility of this method to depict anatomic structure and dynamic filling of main vessels in the head. Magn Reson Med 63:835–841, 2010. © 2010 Wiley‐Liss, Inc.     

Vessel‐encoded dynamic magnetic resonance angiography using arterial spin labeling

A new noninvasive MRI method for vessel‐selective angiography is presented. The technique combines vessel‐encoded pseudocontinuous arterial spin labeling with a two‐dimensional dynamic angiographic readout and was used to image the cerebral arteries in healthy volunteers. Time‐of‐flight angiograms were also acquired prior to vessel‐selective dynamic angiography acquisitions in axial, coronal, and/or sagittal planes, using a 3‐T MRI scanner. The latter consisted of a vessel‐encoded pseudocontinuous arterial spin labeling pulse train of 300 or 1000 ms followed by a two‐dimensional thick‐slab flow‐compensated fast low‐angle shot readout combined with a segmented Look‐Locker sampling strategy (temporal resolution = 55 ms). Selective labeling was performed at the level of the neck to generate individual angiograms for both right and left internal carotid and vertebral arteries. Individual vessel angiograms were reconstructed using a bayesian inference method. The vessel‐selective dynamic angiograms obtained were consistent with the time‐of‐flight images, and the longer of the two vessel‐encoded pseudocontinuous arterial spin labeling pulse train durations tested (1000 ms) was found to give better distal vessel visibility. This technique provides highly selective angiograms quickly and noninvasively that could potentially be used in place of intra‐arterial x‐ray angiography for larger vessels. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

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.     

Comparison of contrast‐enhanced MR angiography to intraarterial digital subtraction angiography for evaluation of peripheral arterial occlusive disease: Results of a phase III multicenter trial

Purpose

To evaluate the efficacy and safety of 0.1 mmol/kg gadodiamide administration for contrast‐enhanced magnetic resonance angiography (CE‐MRA) in detecting hemodynamically relevant main stenosis (ie, ≥50% or occlusion) of aortoiliac arteries.

Materials and Methods

In a multicenter, phase 3, controlled study, patients with suspected or proven peripheral arterial occlusive disease (PAOD) underwent CE‐MRA with administration of gadodiamide. Intraarterial digital subtraction angiography (IA‐DSA) was used as the reference. The study was approved by all Institutional Review Boards or Institutional Ethic Committees prior to commencement of patient recruitment and written informed consent was obtained from all patients.

Results

Independent readers rated 25%–45% of CE‐MRA images as excellent compared with 0.3%–6% of noncontrast MRA images. Mean imaging acquisition time for CE‐MRA was <1 minute (0.7 ± 1.9 minutes) versus 10 minutes (10.8 ± 3.0) for noncontrast MRA. Sensitivity, specificity, and accuracy of CE‐MRA were superior compared with those of noncontrast MRA in detecting significant arterial stenoses. Compared with IA‐DSA, the sensitivity of CE‐MRA ranged from 80%–88% and the specificity from 73% to 92% for the three blinded readers, at the patient level.

Conclusion

Diagnostic results with CE‐MRA were superior and more consistent compared with noncontrast MRA for detecting hemodynamically relevant main stenoses in patients with suspected or proven PAOD and compared favorably with IA‐DSA as a reference standard. J. Magn. Reson. Imaging 2010;31:1402–1410. © 2010 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.     

Vessel‐encoded dynamic magnetic resonance angiography using arterial spin labeling

A new noninvasive MRI method for vessel selective angiography is presented. The technique combines vessel‐encoded pseudocontinuous arterial spin labeling with a two‐dimensional dynamic angiographic readout and was used to image the cerebral arteries in healthy volunteers. Time‐of‐flight angiograms were also acquired prior to vessel‐selective dynamic angiography acquisitions in axial, coronal, and/or sagittal planes, using a 3‐T MRI scanner. The latter consisted of a vessel‐encoded pseudocontinuous arterial spin labeling pulse train of 300 or 1000 ms followed by a two‐dimensional thick‐slab flow‐compensated fast low angle shot readout combined with a segmented Look‐Locker sampling strategy (temporal resolution = 55 ms). Selective labeling was performed at the level of the neck to generate individual angiograms for both right and left internal carotid and vertebral arteries. Individual vessel angiograms were reconstructed using a bayesian inference method. The vessel‐selective dynamic angiograms obtained were consistent with the time‐of‐flight images, and the longer of the two vessel‐encoded pseudocontinuous arterial spin labeling pulse train durations tested (1000 ms) was found to give better distal vessel visibility. This technique provides highly selective angiograms quickly and noninvasively that could potentially be used in place of intra‐arterial x‐ray angiography for larger vessels. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.