Abstract
ObjectiveWe evaluated image quality differences between axial and coronal non-contrast-enhanced renal three-dimensional (3D) magnetic resonance angiography (MRA) acquisitions, using time-spatial labeling inversion pulse (Time-SLIP) with flow-in balanced steady-state free precession (bSSFP).Materials and methodsAxial and coronal images were acquired in 128 subjects using non-contrast-enhanced 3D-MRA with Time-SLIP flow-in bSSFP on a clinical 1.5-T MRI system. Visualization of source and maximum intensity projection (MIP) images of renal arteries were compared between the axial and coronal acquisitions using a four-point scale. For quantitative analysis, vessel-to-background contrast ratios of aorta and renal arteries were calculated.ResultsBoth acquisitions yielded similarly excellent quality. In source image evaluation, coronal acquisitions showed significantly more motion degradation (p < 0.01) than did axial acquisitions. In MIP image evaluation, coronal acquisitions yielded superior image quality, less motion degradation, and better visualization of the number of renal branches than did axial acquisition. The renal artery to background signal contrast was greater in coronal than in axial acquisitions (p < 0.01).ConclusionCoronal acquisition provides superior contrast between the renal arteries and background and allows more persistent visualization than axial acquisitions in non-contrast-enhanced MRA using flow-in bSSFP with Time-SLIP. First-line screening of renal non-contrast-enhanced MRA should involve coronal acquisition.
Highlights
Based on the consensus of the American College of Cardiology Foundation/American Heart Association (ACCF/ AHA) guidelines and European Society of Cardiology (ESC) guidelines, renal magnetic resonance angiography (MRA) has been established as a class IB diagnostic tool for the screening of renal artery stenosis (RAS), despite its tendency for overestimating the degree of luminal narrowing [1, 2]
Motion degradation can be seen in the distal segment of the right renal artery branches. Both axial and coronal flow-in balanced steady-state free precession (bSSFP) images with welldepicted renal arteries were successfully obtained in all 128 subjects
We believe that 2D scout images with 2D bSSFP without fat suppression helped providing advance knowledge of renal and surrounding tissue positions, which makes easy and simple for setting 3D scan with the Time-SLIP pulse and pre-saturation pulse
Summary
Based on the consensus of the American College of Cardiology Foundation/American Heart Association (ACCF/ AHA) guidelines and European Society of Cardiology (ESC) guidelines, renal magnetic resonance angiography (MRA) has been established as a class IB diagnostic tool for the screening of renal artery stenosis (RAS), despite its tendency for overestimating the degree of luminal narrowing [1, 2]. Non-contrast-enhanced MRA techniques have been gaining interest because gadolinium-based contrast agents (GBCA) may cause nephrogenic systemic fibrosis (NSF) in patients with renal insufficiency [3]. A technique for renal artery assessment using 3D bSSFP has been reported as a safe and effective approach for the evaluation of RAS [11,12,13,14,15]. Utsunomiya et al [16] have reported that non-contrast-enhanced MRA using time-spatial labeling inversion pulse (Time-SLIP) with 3D flow-in bSSFP provides a non-invasive and effective method for evaluating the degree of stenosis in renal arteries against contrast-enhanced computer tomography angiography (CTA) or digital subtraction angiography (DSA). Albert et al [17] have compared Time-SLIP with CTA and found that non-contrast approach has provided equivalence in determining the presence or absence of RAS in an international multi-center study
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