3D Phase-contrast Magnetic Resonance Angiography Research Articles

Venous 3D Phase Contrast Magnetic Resonance Angiography Increases Diagnostic Certainty in Children with Ventriculoperitoneal Shunt and Suspected Shunt Failure

BackgroundClinical symptoms in children with suspected malfunction of ventriculoperitoneal shunt may not be specific and difficult to interpret. The presence or absence of ventricular enlargement on magnetic resonance imaging (MRI) does not reliably predict raised intracranial pressure (ICP) in these patients. Therefore, the aim was to investigate the diagnostic utility of 3D venous phase-contrast MR angiography (vPCA) in these patients.MaterialsThe MR studies of two groups of patients at two different examination dates were retrospectively analyzed; one group without clinical symptoms on both examinations and one with symptoms of shunt dysfunction on one examination receiving surgery. Both MRI examinations had to have been performed including axial T2 weighted (T2-w) images and 3D vPCA. Two (neuro)radiologists evaluated T2-w images alone and in combination with 3D vPCA in terms of suspected elevated ICP. Interrater reliability, sensitivity and specificity were assessed.ResultsCompression of venous sinuses was seen significantly more often in patients with shunt failure (p = 0.00003). Consequently, evaluation of 3D vPCA and T2-w images increases sensitivity to 0.92/1.0 compared to T2-w images alone with 0.69/0.77, the interrater agreement for the diagnosis of shunt failure rises from κ = 0.71 to κ = 0.837. Concerning imaging markers, three groups could be identified in children with shunt failure.ConclusionIn accordance with the literature, the results show that ventricular morphology alone is an unreliable marker for elevated ICP in children with shunt malfunction. The findings confirmed 3D vPCA as a valuable supplemental diagnostic tool improving diagnostic certainty for children with unchanged ventricular size in cases of shunt failure.

The superior ophthalmic vein: delineation with high-resolution magnetic resonance imaging.

To delineate the superior ophthalmic vein (SOV) with high-resolution magnetic resonance (MR) imaging. This retrospective study enrolled 302 consecutive outpatients, 101 patients, 51 males and 50 females, who underwent coronal T2-weighted imaging and 201 patients, 99 males and 102 females, who underwent three-dimensional (3D) phase-contrast (PC) MR angiography. Coronal T2-weighted imaging clearly delineated the intraorbital course of SOV on serial images in all 101 subjects. The SOV could be topographically divided into three segments in relation to the superior rectus muscle. The SOV crossed over the optic nerve at the level of the anterior ethmoidal foramina in 87% of right orbits and 71% of left orbits. The mean outer diameter of the SOV at the crossing point was 1.7 mm on both sides, but the SOVs were asymmetric in the same individual in 75% of the subjects. 3D PC MR angiography showed that the bilateral SOVs were symmetrical in 16% of subjects, larger in the right orbit in 18%, and larger in the left orbit in 13%, and were unidentified in 52%. The SOV showed a consistent lateral course to the ophthalmic artery. The SOV consistently courses lateral to the ophthalmic artery, but tends to show bilateral asymmetry in the outer diameter. The superior rectus muscle, anterior ethmoidal foramen, and anterior ethmoidal artery are valuable landmarks to identify the SOV during transcranial orbital surgery. Combination of high-resolution MR imaging and 3D PC MR angiography is useful for delineating the SOV.

Accelerating phase contrast MR angiography by simplified skipped phase encoding and edge deghosting with array coil enhancement

The aim of this work is to investigate the feasibility of accelerating phase contrast magnetic resonance angiography (PC-MRA) by the fast imaging method of simplified skipped phase encoding and edge deghosting with array coil enhancement (S-SPEED-ACE). The parallel imaging method of skipped phase encoding and edge deghosting with array coil enhancement (SPEED-ACE) is simplified for imaging sparse objects like phase contrast MRA. This approach is termed S-SPEED-ACE in which k-space is sparsely sampled with skipped phase encoding at every Nth step using multiple receiver coils simultaneously. The sampled data are then Fourier transformed into a set of ghosted images, each with N-fold aliasing ghosts. Given signal sparseness of MRA, the ghosted images are modeled with a single-layer structure, in which the most dominant ghost within the potentially overlapped ghosts at each pixel is selected to represent the signal of that pixel. The single-layer model is analogous to that used in maximum-intensity-projection (MIP) that selects only the brightest signal even when there are overlapped vessels. With an algorithm based on a least-square-error solution, a deghosted image is obtained, along with a residual map for quality control. In this way, S-SPEED-ACE partially samples k-space using multiple receiver coils in parallel, and yields a deghosted image with an acceleration factor of N. Without full central k-space sampling and differential filtering, S-SPEED-ACE achieves further scan time reduction with a more straightforward reconstruction. In this work, S-SPEED-ACE is demonstrated to accelerate a computer simulated PC-MRA and a real human 3D PC-MRA, which was acquired using a clinical 1.5 T scanner on a healthy volunteer. Images are reconstructed by S-SPEED-ACE to achieve an undersampling factor of up to 8.3 with four receiver coils. The reconstructed images generally have comparable quality as that of the reference images reconstructed from full k-space data. Maximum-intensity-projection images generated from the reconstructed images also demonstrated to be consistent as those from the reference images. By taking advantage of signal sparsity naturally existing in the data, SPEED-ACE was simplified and its efficiency was improved. The feasibility of the proposed S-SPEED-ACE is demonstrated in this work with simulated sampling of an actual 3D head PC-MRA scan.

Laser Doppler velocimetry (LDV) and 3D phase‐contrast magnetic resonance angiography (PC‐MRA) velocity measurements: Validation in an anatomically accurate cerebral artery aneurysm model with steady flow

To verify the accuracy of velocity mapping with three-dimensional (3D) phase-contrast magnetic resonance angiography (PC-MRA) for steady flow in a realistic model of a cerebral artery aneurysm at a 3T scanner. Steady flow through an original geometry model of a cerebral aneurysm was mapped at characteristic positions by state-of-the-art laser Doppler velocimetry (LDV) as well as 3D PC-MRA at 3T. The spatial distributions and local values of two velocity components obtained with these two measurement methods were compared. The 3D PC-MRA velocity field distribution and mean velocity values exhibited only minor differences to compare to the LDV measurements in straight artery regions for both main and secondary velocities. The differences increased in regions with disturbed flow and in cases where the measurement plane was not perpendicular to the main flow direction. 3D PC-MRA can provide reliable measurements of velocity components of steady flow in small arteries. The accuracy of such measurements depends on the artery size and the measurement plane positioning.

Variations in the cerebral venous anatomy and pitfalls in the diagnosis of cerebral venous sinus thrombosis: Low field MR experience

Knowledge of variations in the cerebral venous anatomy and apparent signal abnormalities seen on Magnetic resonance (MR) angiography are essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST), while interpreting the MR angiograms. To evaluate the variations of cerebral venous anatomy and signal abnormalities by using 3D phase contrast MR angiography performed in a 0.5 Tesla MRI scanner. One hundred patients who underwent MR imaging and MR angiography examinations at our institution from March 2004 to February 2005, with normal MR imaging of brain were studied retrospectively. Patients with clinical suspicion of CVST and patients who underwent color doppler evaluation for suspected deep vein thrombosis were excluded. The superior sagittal, straight sinus and the internal cerebral veins were visualized in all patients. There was hypoplasia of the right transverse sinus in 13 patients, left transverse sinus in 35 patients, right sigmoid sinus in 6 patients and left sigmoid sinus in 19 patients. Absence of transverse sinus on left side was observed in one patient and absence of sigmoid sinus in 2 patients on left side. Flow gaps were observed in non-dominant transverse sinus, sigmoid sinus as well as transverse sigmoid sinus junctions. The occipital sinus was visualized in 17 patients. MR angiography done at low field strengths is also a reliable method, for assessing cerebral venous sinuses. Awareness of the normal anatomical variations of venous sinuses and apparent MR angiographic flow gaps prevent misdiagnosis of cerebral venous sinus thrombosis.

Three-Dimensional Phase-Contrast Magnetic Resonance Angiography: A Useful Clinical Adjunct to Gadolinium-Enhanced Three-Dimensional Renal Magnetic Resonance Angiography?

To assess the value of three-dimensional (3D) phase-contrast (PC) magnetic resonance angiography (MRA) after gadolinium (Gd)-enhanced 3D MRA for renal artery imaging. Twenty-one patients with suspected renal artery hypertension were reviewed. All studies included Gd-enhanced 3D MRA and 3D PC MRA. Blinded interpretation of the images was performed for each technique independently and in combination. Conventional X-ray angiography was used for diagnostic correlation when available. Renal artery stenosis was present in 7 (16.3%) of 43 renal arteries, confirmed by X-ray angiography. MRA images demonstrated 100% sensitivity and 74% specificity for Gd-enhanced 3D MRA and 100% sensitivity and 94% specificity for 3D PC MRA. All vessels were diagnosed correctly when both image sets were viewed. 3D PC MRA can improve the specificity of renal MRA by decreasing the number of false-positive Gd-enhanced 3D MRA interpretations.

MR angiography after renal revascularization: spectrum of expected anatomic results and postintervention complications.

The use of magnetic resonance (MR) angiography in screening for renal artery stenosis has been extensively evaluated. However, the MR angiographic findings after renal artery revascularization are not as well characterized. The renal artery and parenchyma can be evaluated after revascularization with a comprehensive MR imaging protocol that includes T1- and T2-weighted spin-echo sequences, three-dimensional (3D) gadolinium-enhanced MR angiography, and 3D phase-contrast MR angiography. Because surgical techniques for revascularization vary, knowledge of the surgical procedure is necessary to ensure inclusion of the pertinent anatomy at 3D gadolinium-enhanced MR angiography and to define appropriate 3D phase-contrast MR angiography volumes. The 3D gadolinium-enhanced MR angiography volume can be manipulated to view relevant vascular anatomy at the optimal obliquity and section thickness. This protocol allows robust, noninvasive evaluation of the expected arterial anatomy after revascularization, including renal artery endarterectomy, aortorenal bypass grafts, and extraanatomic reconstructions. In cases of suspected postrevascularization complications, gadolinium-enhanced MR angiography is useful because of its lack of nephrotoxicity and radiation exposure. Immediate complications of renal revascularization include renal artery thrombosis, renal infarction, and perinephric hemorrhage. Long-term complications include aneurysms of bypass grafts and recurrent stenosis of the renal artery.

GD-enhanced 3D phase-contrast MR angiography and dynamic perfusion imaging in the diagnosis of renal artery stenosis

The objective of this study was to investigate the role of contrast enhancement using a three-dimensional (3D) phase-contrast (PC) magnetic resonance (MR) sequence (3D PC-MRA) and to assess the value of a dynamic MR perfusion study of the kidneys to determine the hemodynamic relevance of unilateral renal artery stenosis (RAS). Seventeen patients with unilateral RAS were examined on a standard 1.0 T imaging system using a phase shift and magnitude sensitive 3D PC sequence (TR = 160 ms, TE = 9 ms, venc. 30 cm/s). Following the initial pre-contrast 3D PC-MRA a dynamic first pass perfusion study was performed using a Turbo-FLASH 2D sequence (TR = 4.5 ms, TE = 2.2 ms, TI = 400 ms) after bolus injection of 0.15 mmol gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)/kg body weight. The 3D PC-MRA was then repeated during infusion of 0.15 mmol Gd-DTPA/kg body weight. Evaluation by three independent readers was based on maximum intensity projection images. Source images were rendered on request. Signal intensity (SI) over time curves of the renal cortex were obtained from the dynamic perfusion study and analyzed for maximum signal enhancement as well as temporal relationship to the aortic SI curve. Results from 3D PC-MRA revealed a sensitivity (pre-/post-contrast) of 100%/89%, specificity of 76%/63%, positive predictive value of 80%/69%, negative predictive value of 90%/78%, and accuracy of 85%/75% ( p = 0.07). Interobserver agreement was κ = 0.61/κ = 0.47 (pre/post Gd-DTPA), respectively. Increased signal-to-noise was present in all segments of the renal arteries post contrast ( p = 0.0003). This came along with image degradation due to aliasing and elevated SI of venous flow that partially obscured the renal arteries. Dynamic SI curves showed a significantly decreased maximum SI in RAS ( p = 0.01–0.001). A temporal delay of cortical signal intensity enhancement could not be confirmed in this setting. Gd-enhanced 3D PC-MRA did not yield a superior diagnostic value in the diagnosis of RAS compared to pre-contrast measurements. Dynamic perfusion imaging of the kidneys, in combination with 3D PC-MRA, can contribute additional information in suspected unilateral RAS.

Renal artery stenosis: value of screening with three-dimensional phase-contrast MR angiography with a phased-array multicoil.

To evaluate screening with three-dimensional (3D) phase-contrast magnetic resonance (MR) angiography with a phased-array multicoil to detect renal artery stenosis. Fifty consecutive patients suspected of having renovascular disease were prospectively examined with 3D phase-contrast MR imaging with a phased-array multicoil. Findings were correlated with those at intra-arterial digital subtraction angiography (DSA) as the standard of reference for grade of stenosis. MR angiography depicted 101 of 103 renal arteries depicted at intraarterial DSA; the two missed arteries were an accessory artery outside the imaging volume and an artery with a stent. At intraarterial DSA, a stenosis was found in 31 of 101 arteries. On the basis of findings at 3D phase-contrast MR angiography, the presence of any degree of stenosis was correctly depicted in 29 of 31 cases and the absence of stenosis was correctly depicted in 66 of 70 cases (accuracy, 94%; sensitivity, 94%; negative predictive value, 97%). Overall accuracy was 97% for correct depiction of severe renal artery stenosis (> 50%). 3D phase-contrast MR angiography with a phased-array multicoil was an accurate noninvasive screening technique in patients with suspected renal artery stenosis.

Role of 3D Display MR Angiography in the Study of Intracranial Aneurysms

This paper determines the usefulness of threedimensional (3D) phase-contrast (PC) magnetic resonance (MR) angiography with 3D display in characterizing large intracranial saccular aneurysms. Eight patients referred for non invasive confirmation of unruptured aneurysm (n=9) detected by conventional CT and/or MR imaging were studied by 3D PC (VENC of 20 cm/s, 3 axes) in axial acquisition localised on the circle of Willis using a 0.5 T unit (Vectra, GE). We used 3D display images to assess the feasibility of selective treatment. Results were correlated with catheter angiograms in 3 patients. In two thirds of the cases, location and size of the orifice, size of the sac, and clarification of parent artery were clearly provided allowing prediction of therapeutic management. In the remaining cases results remained doubful because of lack of spatial resolution. The benefit of the method was coupled with the clinical status of the patients to influence the final decision. 3D PC MR angiography with 3D display has emerged as an improvement in predicting therapeutic management, and is especially useful in large unruptured aneurysms in elderly or ill patients.