High-resolution magnetic resonance angiography of the lower extremities with a dedicated 36-element matrix coil at 3 Tesla

INTRODUCTION: Recent developments in hard- and software help to significantly increase image quality of magnetic resonance angiography (MRA). Parallel acquisition techniques (PAT) help to increase spatial resolution and to decrease acquisition time but also suffer from a decrease in signal-to-noise ratio (SNR). The movement to higher field strength and the use of dedicated angiography coils can further increase spatial resolution while decreasing acquisition times at the same SNR as it is known from contemporary exams. The goal of our study was to compare the image quality of MRA datasets acquired with a standard matrix coil in comparison to MRA datasets acquired with a dedicated peripheral angio matrix coil and higher factors of parallel imaging. MATERIALS AND METHODS: Before the first volunteer examination, unaccelerated phantom measurements were performed with the different coils. After institutional review board approval, 15 healthy volunteers underwent MRA of the lower extremity on a 32 channel 3.0 Tesla MR System. In 5 of them MRA of the calves was performed with a PAT acceleration factor of 2 and a standard body-matrix surface coil placed at the legs. Ten volunteers underwent MRA of the calves with a dedicated 36-element angiography matrix coil: 5 with a PAT acceleration of 3 and 5 with a PAT acceleration factor of 4, respectively. The acquired volume and acquisition time was approximately the same in all examinations, only the spatial resolution was increased with the acceleration factor. The acquisition time per voxel was calculated. Image quality was rated independently by 2 readers in terms of vessel conspicuity, venous overlay, and occurrence of artifacts. The inter-reader agreement was calculated by the kappa-statistics. SNR and contrast-to-noise ratios from the different examinations were evaluated. RESULTS: All 15 volunteers completed the examination, no adverse events occurred. None of the examinations showed venous overlay; 70% of the examinations showed an excellent vessel conspicuity, whereas in 50% of the examinations artifacts occurred. All of these artifacts were judged as none disturbing. Inter-reader agreement was good with kappa values ranging between 0.65 and 0.74. SNR and contrast-to-noise ratios did not show significant differences. CONCLUSION: Implementation of a dedicated coil for peripheral MRA at 3.0 Tesla helps to increase spatial resolution and to decrease acquisition time while the image quality could be kept equal. Venous overlay can be effectively avoided despite the use of high-resolution scans.     

Dual-source computed tomography: advances of improved temporal resolution in coronary plaque imaging

OBJECTIVES: The aim of this study was to quantify image quality gains of a moving coronary plaque phantom using dual-source computed tomography (DSCT) providing 83 milliseconds temporal resolution in direct comparison to 64 slice single-source multidetector CT (MDCT) with a temporal resolution of 165 milliseconds. MATERIALS AND METHODS: Three cardiac vessel phantoms with fixed 50% stenosis and changing plaque configurations were mounted on a moving device simulating cardiac motion. Scans were performed at a simulated heart frequency of 60 to 120 bpm. Image quality assessment was performed in different anatomic orientations inside a thoracic phantom. RESULTS: A significant improvement of image quality using the DSCT could be found (P=0.0002). Relevant factors influencing image quality aside from frequency (P=0.0002) are plaque composition (P<0.0001), as well as orientation (P<0.0001). CONCLUSION: Scanning with 83 milliseconds temporal resolution improved image quality of coronary plaque at higher heart frequencies.     

Quantitative PET comparing gated with nongated acquisitions using a NEMA phantom with respiratory-simulated motion

This study evaluated the use of gated versus nongated PET acquisitions for absolute quantification of radioisotope concentration (RC) in a respiratory motion-simulated moving phantom filled with radioactive spheres and background for both 2-dimensional (2D) and 3-dimensional (3D) acquisitions. METHODS: An image-quality phantom with all 6 spheres filled with the same (18)F RC (range, 19-62 kBq/mL) was scanned with PET/CT at rest and in motion with and without gating. The background was filled with (18)F solution to yield sphere-to-background ratios of approximately 5, 10, 15, and 20 to 1. Both 2D and 3D acquisitions were used for all combinations. Respiratory motion was simulated by using a motor-driven plastic platform to move the phantom periodically with a displacement of 2 cm and a cycle time of 5.8 s. For gated acquisitions, the phantom was tracked using a real-time position management system. Images were reconstructed, and regions of interest with the same sizes as the actual spheres were manually placed on axial slices to determine maximum and mean pixel RC. A threshold method (70% and 94% for 2D and 3D modes) was also used to determine a mean voxel RC. All values were compared with the expected RC; percentage differences were calculated for each sphere. To reduce partial-volume effects, only data for the 4 largest spheres were analyzed. RESULTS: The mean pixel method was the only method with linear responses for all 3 scan types, enabling direct comparisons. The ranges of RC percentage differences were underestimated for all scan types (using the mean pixel method). The overall mean percentage differences were 37, 49, and 41 in 2D mode and 40, 51, and 41 in 3D mode for static, nongated, and gated acquisitions, respectively. Gated acquisitions improved quantification (by reducing underestimation) over nongated acquisitions by 8% and 10% for 2D and 3D modes. CONCLUSION: In the presence of motion, the use of gated PET acquisitions appears to improve quantification accuracy over nongated acquisitions, almost restoring the results to those observed when the phantom is static.     

Activity level and subjective knee function 15 years after anterior cruciate ligament injury: a prospective, longitudinal study of nonreconstructed patients

BACKGROUND: The activity level and subjective knee function after an anterior cruciate ligament (ACL) injury treated without reconstruction have not been well elucidated. HYPOTHESIS: Patients with ACL injury can achieve good knee function and satisfactory long-term activity level when treated by early activity modification combined with rehabilitation. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. Materials and METHODS: One hundred patients with an acute total ACL injury were observed for 15 years. All patients initially underwent arthroscopic surgery and a rehabilitation program. They were advised to modify their activity level, especially by avoiding contact sports. Patients with recurrent giving-way episodes and/or secondary meniscal injuries that required fixation (n = 6) were subsequently excluded and underwent reconstruction (n = 22). Sixty-seven patients with unilateral nonreconstructed ACL injury remained at the 15-year follow-up. The Lysholm knee score, Tegner activity level, and a visual analog score for global knee function were recorded at regular intervals. At the final follow-up, patients were further evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective knee evaluation form. RESULTS: Forty patients resumed their preinjury activity level or higher within 3 years. The median activity level 15 years after injury had decreased from 7 to 4 according to Tegner activity scale (P < .001). The mean Lysholm knee score was 96 and 95, 1 and 3 years after injury, respectively, but declined to 86 after 15 years (P < .001). Forty-nine patients had good/excellent results, and 14 had fair (n = 6) or poor function (n = 8) at 15 years. Patients injured in contact sports scored lower in the quality of life sub-scale of KOOS than those injured in noncontact sports (P < .05). Thirteen of the 67 patients (19%) were reoperated with an arthroscopic procedure because of knee symptoms. CONCLUSION: Early activity modification and neuromuscular rehabilitation resulted in a good knee function and an acceptable activity level in the majority of the nonreconstructed patients. The decline in activity level of patients engaged in contact sports at the time of injury affected their subjective quality of life more than patients involved in noncontact sports.     

Assessment of myocardial viability in a reperfused porcine model: evaluation of different MSCT contrast protocols in acute and subacute infarct stages in comparison with MRI

OBJECTIVE: To assess myocardial viability in acute and subacute infarcts using different multislice spiral computed tomography contrast protocols with magnetic resonance imaging (MRI) correlation. METHODS: Seven pigs were studied with 64-multislice spiral computed tomography and MRI (1.5 T) at a median of 1 and 21 days after temporary occlusion of the second diagonal branch. Computed tomography was performed at 3, 5, 10, and 15 minutes after injection of contrast medium. Contrast agent was applied either as a bolus (protocol 1; n = 7 for the first; n = 5 for the second scan) or as a bolus plus 30 mL of subsequent 0.1 mL/s low-flow (protocol 2; n = 7 for the first; n = 6 for the second scan). Finally, histological sections were obtained. Volumes of infarcted myocardium were assessed as the percentage of the left ventricle. Computed tomography attenuation values were obtained, and image quality was assessed. RESULTS: When compared with protocol 1, protocol 2 provided greater Hounsfield unit attenuation difference between viable and nonviable myocardium at 5, 10, and 15 minutes (P = 0.19; 0.003; 0.0006) and an additional significant contrast between nonviable myocardium and ventricular blood at 3 and 5 minutes (P < 0.001). Image quality was rated significantly higher with the use of protocol 2 at 5, 10, and 15 minutes (P < or = 0.027) and for all time points use of protocol 2 resulted in improved correlation of acute and subacute infarct size with MRI. CONCLUSIONS: Good correlation of infarct zones with MRI was achieved for both acute and subacute infarcts. With the use of a bolus/low-flow protocol, image quality was substantially improved by means of a higher tissue contrast.     

Efficacy and safety of gadodiamide (Gd-DTPA-BMA) in renal 3D-magnetic resonance angiography (MRA): a phase II study

PURPOSE: To determine the most efficacious dose of gadodiamide for three-dimensional (3D) contrast-enhanced (CE) magnetic resonance angiography (MRA) of the renal arteries on a patient level based on the sensitivity in detecting the main hemodynamically relevant (> or =50% or occlusion) renal artery stenosis (RAS) using intra-arterial digital subtraction angiography (IA DSA) as the gold standard. MATERIALS AND METHODS: This prospective, randomized, double-blind, parallel-group, multicenter study included 273 patients referred to IA DSA for suspected RAS. Patients underwent 3D CE MRA after injection of 0.01, 0.05, 0.1, or 0.2mmol/kg of body weight gadodiamide (0.5mmol/ml). The images were assessed for location and degree of RAS by independent blinded readers (MRA: three readers, IA DSA: one reader). Hypothesis testing for a significant trend in sensitivity across dose groups was based on the one-sided Cochran-Armitage style trend test for each independent MRA reader. RESULTS: The lowest dose group (0.01mmol/kg) proved non-efficacious in detecting hemodynamically relevant (i.e., > or =50% or occlusion) RAS. A statistically significant dose trend (p<0.001) was shown for each of the three independent readers. Depending on reader, the sensitivity obtained with 0.05, 0.1, and 0.2mmol/kg was 63.9-86.1%, 75.8-91.4% and 80.6-90.6%, the specificity was 66.7-73.9%, 59.3-75.0%, and 59.3-75.0% and accuracy was 67.8-78.9%, 75.4-77.4%, and 76.3-81.0%, for the three dose groups, respectively. There were eight non-severe adverse events (AEs). Three serious AEs occurring in one patient were judged not related to gadodiamide by the on-site investigator. CONCLUSION: A significant dose trend between the four doses examined was observed. The lowest dose (0.01mmol/kg) differed significantly from those of the other three doses. Based on the analysis of the primary and secondary endpoints, 0.1mmol/kg gadodiamide appears to be the most suitable dose in diagnosing hemodynamically relevant RAS. The present study also demonstrated gadodiamide to be safe and well tolerated.     

Degenerate mode band-pass birdcage coil for accelerated parallel excitation.

An eight-rung, 3T degenerate birdcage coil (DBC) was constructed and evaluated for accelerated parallel excitation of the head with eight independent excitation channels. Two mode configurations were tested. In the first, each of the eight loops formed by the birdcage was individually excited, producing an excitation pattern similar to a loop coil array. In the second configuration a Butler matrix transformed this "loop coil" basis set into a basis set representing the orthogonal modes of the birdcage coil. In this case the rung currents vary sinusoidally around the coil and only four of the eight modes have significant excitation capability (the other four produce anticircularly polarized (ACP) fields). The lowest useful mode produces the familiar uniform B(1) field pattern, and the higher-order modes produce center magnitude nulls and azimuthal phase variations. The measured magnitude and phase excitation profiles of the individual modes were used to generate one-, four-, six-, and eightfold-accelerated spatially tailored RF excitations with 2D and 3D k-space excitation trajectories. Transmit accelerations of up to six-fold were possible with acceptable levels of spatial artifact. The orthogonal basis set provided by the Butler matrix was found to be advantageous when an orthogonal subset of these modes was used to mitigate B(1) transmit inhomogeneities using parallel excitation.     

Stent grafting of acute hepatic artery bleeding following pancreatic head resection

The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed. Because of bleeding from the hepatic artery, a stent graft (with the over-the-wire or monorail technique) was implanted to control the hemmorhage by preserving patency of the artery. The outcome was evaluated. In all cases, the hepatic artery stent grafting was successfully performed, and the bleeding was immediately stopped. Clinically, immediately after the procedure, there was an obvious improvement in the general patient condition. There were no immediate procedure-related complications. Completion angiography (n=5) demonstrated control of the hemorrhage and patency of the hepatic artery and the stent graft. Although all patients recovered hemodynamically, three individuals died 2 to 10 days after the procedure. The remaining two patients survived, without the need for re-operation. Transluminal stent graft placement in the hepatic artery is a safe and technically feasible solution to control life-threatening bleeding of the gastroduodenal artery stump.     

Whole-body magnetic resonance angiography with blood-pool agents

Although often asymptomatic, peripheral arterial disease (PAD) is associated with significant morbidity in a large proportion of patients. Atherosclerosis is the underlying pathology in many instances, involving the whole arterial tree. Whole-body magnetic resonance angiography (MRA) permits rapid, non-invasive and accurate evaluation of the entire vascular system and can be used for both diagnostic purposes and monitoring of vascular involvement in diseases such as diabetes, Marfan's syndrome and Takayasu arteritis. MRA has been used successfully in the identification of high-grade stenosis in PAD, abnormalities of the ileocaval veins and carotid plaque imaging. Carotid disease is significantly correlated with severe coronary artery disease and renal artery atherosclerosis. Symptomatic lesions in one vascular bed are often related to additional asymptomatic atherosclerotic lesions in other vascular regions. MRA may be advantageous over computed tomographic angiography because it can be performed with contrast media virtually devoid of serious toxicity and without utilization of ionizing radiation. Display of the entire arterial vasculature can be achieved in <90 s, with excellent sensitivity and specificity. Recent technological advances, such as parallel imaging and the implementation of dedicated matrix coils, have further increased image quality, and in combination with the blood-pool contrast agents, such as gadofosveset trisodium (Vasovist, Bayer Schering Pharma AG, Berlin, Germany), extended imaging time, higher spatial resolution and larger anatomical coverage can be achieved.