3D Steady-state Free Precession Research Articles

Cerebrospinal fluid otorhinorrhoea due to inner-ear malformations: clinical presentation and new perspectives in management

In children cerebrospinal fluid (CSF) otorhinorrhoea can be due to congenital inner-ear malformations. Cochlear dysplasia associated with a defect in the stapes footplate is usually the cause of the CSF leak. Repair of the CSF leak in these cases is usually done by packing the vestibule with muscle or fascia. This traditional method of repair has a 30 to 60 per cent failure rate. CSF otorhinorrhoea due to congenital inner-ear anomalies in four patients was repaired using multiple-layer packing of the vestibule with glue, muscle and fascia, reinforced by a pedicle temporalis muscle graft. Intra-operatively, continous lumbar drainage was performed. Repair of the CSF leak was successful in four cases and no recurrence was noticed. Inner-ear magnetic resonance imaging (MRI) using three-dimensional fast-spin echo (3D FSE) T2-weighted imaging (T2WI) and 3D steady-state free precession (FIESTA) sequences was found to be a very helpful, noninvasive investigation to localize the site and route of the CSF leak. Children presenting with recurrent meningitis and CSF rhinorrhoea should be investigated for congenital inner-ear anomalies. In these cases CSF fistulae should be repaired using fibrin or cyanoacrylate glue and intra-operative continuous lumbar drainage; 3D FSE T2WI and 3D FIESTA MRI sequences of the inner ear are helpful.

Comparison of 3D Segmented Gradient-Echo and Steady-State Free Precession Coronary MRI Sequences in Patients with Coronary Artery Disease

Our objective was to compare two state-of-the-art coronary MRI (CMRI) sequences with regard to image quality and diagnostic accuracy for the detection of coronary artery disease (CAD). Twenty patients with known CAD were examined with a navigator-gated and corrected free-breathing 3D segmented gradient-echo (turbo field-echo) CMRI sequence and a steady-state free precession sequence (balanced turbo field-echo). CMRI was performed in a transverse plane for the left coronary artery and a double-oblique plane for the right coronary artery system. Subjective image quality (1- to 4-point scale, with 1 indicating excellent quality) and objective image quality parameters were independently determined for both sequences. Sensitivity, specificity, and accuracy for the detection of significant (> or = 50% diameter) coronary artery stenoses were determined as defined in invasive catheter X-ray coronary angiography. Subjective image quality was superior for the balanced turbo field-echo approach (1.8 +/- 0.9 vs 2.3 +/- 1.0 for turbo field-echo; p < 0.001). Vessel sharpness, signal-to-noise ratio, and contrast-to-noise ratio were all superior for the balanced turbo field-echo approach (p < 0.01 for signal-to-noise ratio and contrast-to-noise ratio). Of the 103 segments, 18% of turbo field-echo segments and 9% of balanced turbo field-echo segments had to be excluded from disease evaluation because of insufficient image quality. Sensitivity, specificity, and accuracy for the detection of significant coronary artery stenoses in the evaluated segments were 92%, 67%, 85%, respectively, for turbo field-echo and 82%, 82%, 81%, respectively, for balanced turbo field-echo. Balanced turbo field-echo offers improved image quality with significantly fewer nondiagnostic segments when compared with turbo field-echo. For the detection of CAD, both sequences showed comparable accuracy for the visualized segments.

Free‐breathing renal magnetic resonance angiography with steady‐state free‐precession and slab‐selective spin inversion combined with radial k‐space sampling and water‐selective excitation

The impact of radial k-space sampling and water-selective excitation on a novel navigator-gated cardiac-triggered slab-selective inversion prepared 3D steady-state free-precession (SSFP) renal MR angiography (MRA) sequence was investigated. Renal MRA was performed on a 1.5-T MR system using three inversion prepared SSFP approaches: Cartesian (TR/TE: 5.7/2.8 ms, FA: 85 degrees), radial (TR/TE: 5.5/2.7 ms, FA: 85 degrees) SSFP, and radial SSFP combined with water-selective excitation (TR/TE: 9.9/4.9 ms, FA: 85 degrees). Radial data acquisition lead to significantly reduced motion artifacts (P < 0.05). SNR and CNR were best using Cartesian SSFP (P < 0.05). Vessel sharpness and vessel length were comparable in all sequences. The addition of a water-selective excitation could not improve image quality. In conclusion, radial k-space sampling reduces motion artifacts significantly in slab-selective inversion prepared renal MRA, while SNR and CNR are decreased. The addition of water-selective excitation could not improve the lower CNR in radial scanning.

Three-dimensional, isotropic MRI: a unified approach to quantification and visualization in congenital heart disease

Current standards in magnetic resonance imaging of congenital heart disease are based mostly on anisotropic protocols to image both morphology and function. Operator-dependent acquisition planning is typically needed to obtain the desired images. We propose to instead use operator-independent, three-dimensional, isotropic imaging protocols to acquire both morphology and function (cine and flow) of the entire heart in a few standardized acquisitions. Subsequently, due to the isotropic property of the data, any desired imaging plane can be "imaged" offline by interactive planar reformatting and used for qualitative and quantitative diagnostic evaluation. Morphological data was acquired in patients using 3D steady state free precession (SSFP) protocols, and functional data in volunteers using multislice 2D or 3D cine SSFP as well as 3D, three-component phase-contrast velocity mapping with EPI readouts. Tools to integrate morphological and functional offline image evaluation based on interactive planar reformatting, volume rendering, and corresponding quantification tools were implemented and discussed. We successfully acquired and integrated morphology and flow and demonstrated potential clinical applications. User independent acquisitions of morphological and functional isotropic 3D datasets with real-time, interactive planar reformatting, volume rendering, and integration of morphology and function, have the potential to replace conventional, user dependent, anisotropic 2D imaging in patients with cardiac malformations.

Short breath‐hold, volumetric coronary MR angiography employing steady‐state free precession in conjunction with parallel imaging

An ECG-gated, 3D steady-state free precession (SSFP) technique in conjunction with sensitivity encoding (SENSE)-based parallel imaging was implemented for short breath-hold, volumetric coronary MR angiograpy (CMRA). Two parallel imaging acquisition strategies (employing 1 R-R and 2 R-R intervals, respectively) were developed to achieve 1) very short breath-hold times (12 s for a heart rate of 60 bpm), and 2) small acquisition windows to minimize sensitivity to physiologic motion. Both strategies were examined in CMRA applications over a range of heart rates. A four-point scale blinded reading (with 4 indicating the most desirable features) revealed substantial image quality improvements for the accelerated data as compared to the nonaccelerated approach. The 1 R-R interval scheme yielded an image score of 3.39 +/- 0.60, and was found to be particularly suitable for low heart rates (P = 0.0008). The 2 R-R interval strategy yielded an image score of 3.35 +/- 0.64, and was more appropriate for higher heart rates (P = 0.03). The results demonstrate that 3D SSFP combined with parallel imaging is a versatile method for short breath-hold CMRA while maintaining high spatial resolution. This strategy permits imaging of the major coronary artery distributions in two to three breath-holds using targeted slabs, and offers the potential for single breath-hold, large-volume CMRA.

MR imaging of articular cartilage at 1.5 T and 3.0 T: Comparison of SPGR and SSFP sequences

To compare articular cartilage signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and thickness measurements on a 1.5 T and a 3.0 T magnetic resonance (MR) scanner using three-dimensional spoiled gradient recalled echo (3D-SPGR) and two 3D steady-state free precession (SSFP) sequences. Both knees of five volunteers were scanned at 1.5 T and at 3.0 T using a transmit-receive quadrature extremity coil. Each examination consisted of a sagittal 3D-SPGR sequence, a sagittal fat suppressed 3D-SSFP (FS-SSFP) sequence, and a sagittal Dixon 3D-SSFP sequence. For quantitative analysis, we compared cartilage SNR and CNR efficiencies, as well as average cartilage thickness measurements. For 3D-SPGR, cartilage SNR efficiencies at 3.0 T increased compared to those at 1.5 T by a factor of 1.83 (range: 1.40-2.09). In comparison to 3D-SPGR, the SNR efficiency of FS-SSFP increased by a factor of 2.13 (range: 1.81-2.39) and for Dixon SSFP by a factor of 2.39 (range: 1.95-2.99). For 3D-SPGR, CNR efficiencies between cartilage and its surrounding tissue increased compared to those at 1.5 T by a factor of 2.12 (range: 1.75-2.47), for FS-SSFP by a factor 2.11 (range: 1.58-2.80) and for Dixon SSFP by a factor 2.39 (range 2.09-2.83). Average cartilage thicknesses of load bearing regions were not different at both field strengths or between sequences (P>0.05). Mean average cartilage thickness measured in all knees was 2.28 mm. Articular cartilage imaging of the knee on a 3.0 T MR scanner shows increased SNR and CNR efficiencies compared to a 1.5 T scanner, where SSFP-based techniques show the highest increase in SNR and CNR efficiency. There was no difference between average cartilage thickness measurements performed at the 1.5 T and 3.0 T scanners or between the three different sequences.

Catheter-directed MR Angiography and Cross-sectional Imaging for the Assessment of Renal Artery Stenosis

Catheter-directed intraarterial (IA) gadolinium (Gd)-enhanced gradient-echo (GRE) imaging has been used in the setting of magnetic resonance (MR) imaging-guided endovascular procedures for two-dimensional (2D) or three-dimensional (3D) depiction of blood vessels. In a swine model, the hypothesis was tested that the combination of 2D IA GRE and 2D cross-sectional steady-state free precession (SSFP) imaging improves assessment of renal artery stenosis (RAS) compared with 3D IA GRE imaging alone. Bilateral RAS was surgically induced in seven pigs. Detection of stenoses was then compared between the combination of 2D projection IA GRE and cross-sectional 2D SSFP imaging without contrast agent and 3D IA GRE alone. Radiographic digital subtraction angiography (DSA) was employed as the reference standard. Linear regression was used to compare stenosis measurements, with an alpha of 0.05. Radiographic DSA and MR imaging were successful in the seven animals (14 stenoses). With use of linear regression analysis, the combination of 2D IA GRE and 2D SSFP imaging had a higher r(2) (0.87 vs 0.72) and a slope closer to unity (1.02 vs 0.77) compared with 3D IA GRE imaging alone. When comparing intercepts, the regression line for SSFP significantly differed from that of 3D IA GRE imaging (P < .05). The combination of 2D IA GRE and cross-sectional 2D SSFP imaging improves the accuracy of RAS detection compared with IA 3D IA-GRE alone.

Inversion Prepared Coronary MR Angiography: Direct Visualization of Coronary Blood Flow

Visualization of coronary blood flow by means of a slice-selective inversion pre-pulse in concert with bright-blood coronary MRA. Coronary magnetic resonance angiography (MRA) of the right coronary artery (RCA) was performed in eight healthy adult subjects on a 1.5 Tesla MR system (Gyroscan ACS-NT, Philips Medical Systems, Best, NL) using a free-breathing navigator-gated and cardiac-triggered 3D steady-state free-precession (SSFP) sequence with radial k-space sampling. Imaging was performed with and without a slice-selective inversion pre-pulse, which was positioned along the main axis of the coronary artery but perpendicular to the imaging volume. Objective image quality parameters such as SNR, CNR, maximal visible vessel length, and vessel border definition were analyzed. In contrast to conventional bright-blood 3D coronary MRA, the selective inversion pre-pulse provided a direct measure of coronary blood flow. In addition, CNR between the RCA and right ventricular blood pool was increased and the vessels had a tendency towards better delineation. Blood SNR and CNR between right coronary blood and epicardial fat were comparable in both sequences. The combination of a free-breathing navigator-gated and cardiac-triggered 3D SSFP sequence with a slice-selective inversion pre-pulse allows for direct and directional visualization of coronary blood flow with the additional benefit of improved contrast between coronary and right ventricular blood pool.

Free-breathing renal MR angiography with steady-state free-precession (SSFP) and slab-selective spin inversion: Initial results

The aim of our study was the investigation of a novel navigator-gated three-dimensional (3D) steady-state free-precession (SSFP) sequence for free-breathing renal magnetic resonance angiography (MRA) without contrast medium, and to examine the advantage of an additional inversion prepulse for improved contrast. Eight healthy volunteers (mean age 29 years) and eight patients (mean age 53 years) were investigated on a 1.5 Tesla MR system (ACS-NT, Philips, Best, The Netherlands). Renal MRA was performed using three navigator-gated free-breathing cardiac-triggered 3D SSFP sequences [repetition time (TR) = 4.4 ms, echo time (TE) = 2.2 ms, flip angle 85 degrees, spatial resolution 1.25 x 1.25 x 4.0 mm(3), scanning time approximately 1 minute 30 seconds]. The same sequence was performed without magnetization preparation, with a non-slab selective and a slab-selective inversion prepulse. Signal-to-noise ratio (SNR), contrast-to-noise (CNR) vessel length, and subjective image quality were compared. Three-dimensional SSFP imaging combined with a slab-selective inversion prepulse enabled selective and high contrast visualization of the renal arteries, including the more distal branches. Standard SSFP imaging without magnetization preparation demonstrated overlay by veins and renal parenchyma. A non-slab-selective prepulse abolished vessel visualization. CNR in SSFP with slab-selective inversion was 43.6 versus 10.6 (SSFP without magnetization preparation) and 0.4 (SSFP with non-slab-selective inversion), P < 0.008. Navigator-gated free-breathing cardiac-triggered 3D SSFP imaging combined with a slab-selective inversion prepulse is a novel, fast renal MRA technique without the need for contrast media.

View ordering for magnetization prepared steady state free precession acquisition: application in contrast-enhanced MR angiography.

Magnetization prepared segmented acquisition requires a view order that maximizes signal contrast during the acquisition of the central portion of k-space. Steady state free precession (SSFP) acquisition further requires a view order that minimizes changes in phase-encoding gradients from one repetition to the next in order to minimize eddy current artifacts. In this article, optimal view ordering schemes satisfying these two requirements are formulated and applied to inversion prepared 3D SSFP contrast-enhanced MR angiography (MRA). Experiments on phantoms and pigs demonstrated improved background suppression and reduced image artifacts.

Operator-independent isotropic three-dimensional magnetic resonance imaging for morphology in congenital heart disease: a validation study.

Operator-independent isotropic 3D MRI may greatly simplify the assessment of complex morphology in congenital heart disease. We sought to evaluate the reliability of this new approach. In 31 adolescent and adult patients (age, 6 to 42 years; median, 16 years) with congenital heart disease, cardiac morphology was determined with free-breathing (navigator-gated), isotropic, 3D steady-state free-precession (3D SSFP) MRI and independently evaluated by 2 observers. Cardiac diagnoses and multiple distance measurements were compared with conventional MR reference sequences (ie, spin-echo, cine gradient-echo, contrast-enhanced MR angiography) and with echocardiography/cine cardioangiography or surgery. Of the 31 patients, 24 had native congenital heart defects or residual defects after repair that warranted immediate treatment. None of these defects was missed by 3D SSFP. Novel diagnostic issues were discovered in 4 of 31 patients (coronary anomalies, n=3; left juxtaposition of the right atrial appendage in double-outlet right ventricle and transposition of the great arteries, 1). For sizes of valves and vessels, we found minor mean differences of -1.1 to 1.6 mm, with SD ranging from 1.2 to 2.9 mm, demonstrating overall good agreement with standard MRI (Bland-Altman analysis). Interobserver variability of 3D SSFP distance measures was low; mean differences ranged from -1.5 to 1.0 mm, and SD ranged from 0.8 to 2.5 mm. Scatter was lower for extracardiac than intracardiac measures. In adolescents and adults, isotropic 3D SSFP MRI allows reliable assessment of complex cardiac morphology. Distance measurements are accurate and reproducible. Thus, a single operator-independent acquisition may substitute for conventional 2D MRI sequences to accelerate and simplify MR scanning in congenital heart disease.

Coronary MR imaging using free-breathing 3D steady-state free precession with radial k-space sampling.

To investigate the potential of free-breathing 3D steady-state free precession (SSFP) imaging with radial k-space sampling for coronary MR-angiography (MRA), coronary projection MR-angiography and coronary vessel wall imaging. A navigator-gated free-breathing T2-prepared 3D SSFP sequence (TR = 6.1 ms, TE = 3.0 ms, flip angle = 120 degrees, field-of-view = 360 mm(2)) with radial k-space sampling (384 radials) was implemented for coronary MRA. For projection coronary MRA, this sequence was combined with a 2D selective aortic spin tagging pulse. Coronary vessel wall imaging was performed using a high-resolution inversion-recovery black-blood 3D radial SSFP sequence (384 radials, TR = 5.3 ms, TE = 2.7 ms, flip angle = 55 degrees, reconstructed resolution 0.35 x 0.35 x 1.2 mm(3)) and a local re-inversion pulse. Six healthy volunteers (two for each sequence) were investigated. Motion artifact level was assessed by two radiologists. In coronary MRA, the coronary lumen was displayed with a high signal and high contrast to the surrounding lumen. Projection coronary MRA demonstrated selective visualization of the coronary lumen while surrounding tissue was almost completely suppressed. In coronary vessel wall imaging, the vessel wall was displayed with a high signal when compared to the blood pool and the surrounding tissue. No visible motion artifacts were seen. 3D radial SSFP imaging enables coronary MRA, coronary projection MRA and coronary vessel wall imaging with a low motion artifact level.

High-resolution diffusion-weighted 3D MRI, using diffusion-weighted driven-equilibrium (DW-DE) and multishot segmented 3D-SSFP without navigator echoes.

In this work we report on the development of a novel technique for high-resolution diffusion-weighted (DW) MRI based upon 3D steady-state free precession (3D-SSFP). First the 3D-SSFP acquisition was segmented (each segment consisting of a series of RF pulses and gradient-recalled echoes), and then DW-driven equilibrium (DE) was inserted between each segment. The in-plane imaging matrix was typically 256 x 192 or 256 x 160, which resulted in high-resolution DW images. The DW-DE segmented SSFP signal was contaminated by the non-DW magnetization, which recovered and contributed signal during the readout train (T(1) contamination). Center-out slice encoding was used to place the greatest diffusion weighting at the center of k-space. A numerical simulation and supporting experiments were performed to evaluate the relationship of the transverse magnetization to imaging parameters, such as the b-value, echo-train length (ETL), echo-train (group) repetition time (TR(g)), and RF excitation TR (Delta t). Both the numerical simulation and the experiments suggested that the effect of T(1) contamination would be reduced with a longer TR(g), smaller b-value, shorter ETL, and center-out slice phase encoding. Phase errors caused by microscopic motions during the diffusion gradients were converted into amplitude errors by the tip-up pulse at the end of the diffusion-weighting segment. As a result, small bulk motions, such as CSF pulsation, did not cause motion-related ghosting artifacts, which would be typical in images from other multishot DWI techniques. This technique can be used for high-resolution DWI of nonbrain anatomies.

Effects of view ordering and dummy pulse rate on two-dimensional and three-dimensional steady-state free precession imaging 1

Rationale and Objective. To assess the effects of view ordering and dummy pulse rate on the image quality of steady-state free precession (SSFP) imaging. Material and Methods. Two- and three-dimensional (2D and 3D) SSFP imaging with various view orderings (eg, centric, sequential, reverse centric) and dummy pulse rates were performed in the phantom including several concentrations of gadolinium and patients. Results. Centric view orderings increased the noise in 3D SSFP images in the phantom. In the patients studied, the centric view ordering increased the signals obtained from abdominal organs in 2D and 3D SSFP and the background signal in 3D images, without changing the vascular signals. An increased dummy pulse rate reduced the background signal in 2D SSFP, but not in 3D SSFP. Conclusion. Sequential ordering is recommended for both 2D and 3D SSFP, and centric view ordering combined with an increase in dummy pulse rate can be used for 2D imaging.

Rapid MR imaging of articular cartilage with steady-state free precession and multipoint fat-water separation.

To obtain high-quality high-resolution images of articular cartilage with reduced imaging time, we combined a novel technique of generalized multipoint fat-water separation with three-dimensional (3D) steady-state free precession (SSFP) imaging. The cartilage of 10 knees in five healthy volunteers was imaged with 3D SSFP imaging and a multipoint fat-water separation method capable of separating fat and water with short TE increments. Fat-saturated 3D spoiled gradient-echo (SPGR) images were obtained for comparison. High-quality images of the knee with excellent fat-water separation were obtained with 3D SSFP imaging. Total imaging time required was 58% less than that required for 3D SPGR imaging with a comparable cartilage signal-to-noise ratio and spatial resolution. Unlike 3D SPGR images, 3D SSFP images exhibited bright synovial fluid, providing a potential arthrographic effect. High-quality high-resolution images of articular cartilage with improved fat-water separation, bright synovial fluid, and markedly reduced acquisition times can be obtained with 3D SSFP imaging combined with a fat-water separation technique.

CSF flow imaging in the management of third ventriculostomy with a reversed fast imaging with steady-state precession sequence.

The aim of this study was evaluation of a fast and slow-flow sensitive 2D steady-state free-precession sequence for its capability to prove the patency of endoscopic third ventriculostomy (TVS) in obstructive hydrocephalus, and to exclude communicating third ventricle prior to TVS. We compared gated and ungated variants of this sequence for this purpose. Twenty-three patients with obstructive hydrocephalus underwent 36 MR examinations with a 2D reversed fast imaging with steady-state precession (PSIF) sequence in a retrospectively cardiac gated (cine) and a faster but ungated version beside T1- and T2-weighted sequences in three planes. Thirteen patients were examined both before and after TVS, 4 patients solely before, and 6 patients solely after TVS. Imaging diagnoses were compared with intraoperative findings and clinical findings after TVS. Preoperative diagnosis of non-communicating third ventricle and cisterns was intraoperatively confirmed in 16 of 17 cases. Preoperative MRI was inconclusive in 1 case. Postoperative MRI revealed sufficient TVS in 16 of 19 cases and obstructed TVS in 3 of 19 cases due to several reasons. Findings at MRI were consistent in 19 of 19 cases with the clinical course and intraoperative results. The faster but ungated PSIF sequence was found to be diagnostically equivalent to the cardiac gated cine sequence. The CSF flow imaging with a 2D reversed fast imaging with steady-state precession sequence in conjunction with conventional T1- and T2-weighted images is a fast and reliable tool for pre- and postoperative functional evaluation in third ventriculostomy.

Three-dimensional steady-state MR angiography of the lower extremities.

Volume steady-state black-blood magnetic resonance imaging was evaluated as a method for depicting lower extremity vasculature. In steady-state imaging, flow has low signal intensity because motion destroys the coherence of transverse magnetization. To optimize image contrast, computations and measurements were obtained for the three-dimensional (3D) GRASS (gradient-recalled acquisition in the steady state) and 3D SSFP (steady-state free precession) sequences and a range of TRs and flip angles to determine optimal vessel-muscle contrast. The best results were achieved with a 3D GRASS sequence with a TR msec/TE msec of 25/5 and a flip angle of 30 degrees. Coronal images of the femoral and popliteal vessels were obtained in healthy volunteers with various fields of view and voxel sizes. Inflow of unsaturated spins from outside the image region, yielding high signal intensity, could be a potential drawback in steady-state black-blood imaging; however, problems can be avoided by using coronal acquisitions and large fields of view. Steady-state black-blood imaging depicts vessels with high accuracy and is faster and free of flow artifacts.