Abstract
OBJECTIVE—To evaluate the feasibility of performing single breath-hold 3D thoracic noncontrast magnetic resonance angiography (NC-MRA) using highly-accelerated parallel imaging. MATERIALS AND METHODS—We developed a single breath-hold NC MRA pulse sequence using balanced steady state free precession (SSFP) readout and highly-accelerated parallel imaging. In 17 subjects, highly-accelerated non-contrast MRA was compared against electrocardiogram (ECG)-triggered contrast-enhanced MRA. Anonymized images were randomized for blinded review by two independent readers for image quality, artifact severity in 8 defined vessel segments and aortic dimensions in 6 standard sites. NC-MRA and CE-MRA were compared in terms of these measures using paired sample t and Wilcoxon tests. RESULTS—The overall image quality (3.21±0.68 for NC-MRA vs. 3.12±0.71 for CE-MRA) and artifact (2.87±1.01 for NC-MRA vs. 2.92±0.87 for CE-MRA) scores were not significantly different, but there were significant differences for the great vessel and coronary artery origins. NC-MRA demonstrated significantly lower aortic diameter measurements compared to CE-MRA; however, this difference was not considered clinically relevant (>3 mm difference) for less than 12% of segments, most commonly at the sinotubular junction. Mean total scan time was significantly lower for NC-MRA compared to CE-MRA (18.2 ± 6.0s vs. 28.1 ± 5.4s, respectively; p < 0.05). CONCLUSION—Single breath-hold NC-MRA is feasible and can be a useful alternative for evaluation and follow-up of thoracic aortic diseases.
Highlights
Contrast-enhanced 3D magnetic resonance angiography (CE-MRA) provides accurate diagnosis of aortic disease [1-4]
Following informed consent, 10 subjects (7 controls, 3 patients; 6 male, mean age=35.1 ±17.0 years) were imaged on a 1.5T scanner (Siemens, Avanto) with BH Non-contrast ECG-gated MRA (NC-MRA) followed by CE-MRA
For the 10 subjects studied, there was no significant difference in image quality and artifact scores (p>0.05), with diagnostic quality image scores for all evaluated segments (Table1)
Summary
Contrast-enhanced 3D magnetic resonance angiography (CE-MRA) provides accurate diagnosis of aortic disease [1-4]. ECG-gated CE-MRA of the thoracic aorta is challenging, due to competing demands of high spatial resolution while imaging in a narrow window of the cardiac cycle within a breath-hold. Nephrogenic systemic fibrosis in patients with impaired renal function is a concern with gadolinium-based contrast agents [5]. Non-contrast ECG-gated MRA (NC-MRA) is a potential alternative [6], especially for patients with poor intravenous access or contraindications to gadolinium use. Navigator-gated NC-MRA can take approximately 10 minutes [6]. We propose to perform breath-hold, ECGgated NC-MRA (BH NC-MRA) using highly-accelerated parallel imaging with a 32-element coil array
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