Three-dimensional Gadolinium-enhanced Magnetic Resonance Angiography Research Articles

Magnetic resonance angiography vs. angiography in tetralogy of Fallot

: To determine whether gadolinium-enhanced three-dimensional magnetic resonance angiography can provide a noninvasive alternative to diagnostic catheterization for evaluation of pulmonary artery anatomy in tetralogy of Fallot. Thirty-five consecutive patients with tetralogy of Fallot, who attended the cardiology outpatient department between January 2008 and December 2009, were included in the study. There were 21 males and 14 females, with a mean age of 9 ± 4.15 years (range, 3-21 years). Thirty-two patients had tetralogy of Fallot with varying severities of valvular and infundibular stenosis. Three patients had tetralogy of Fallot with pulmonary atresia. All patients underwent both cardiac catheterization with X-ray angiography and 3-dimensional magnetic resonance angiography within one month. Measurements of right and left pulmonary arteries and aortopulmonary collaterals were equal by both methods. There was a good correlation between magnetic resonance angiography and catheterization measurements of branch pulmonary arteries. Gadolinium-enhanced three-dimensional magnetic resonance angiography can be used as a reliable noninvasive alternative to X-ray cineangiography for delineation of pulmonary arterial anatomy in sick infants and young children, obviating the need for catheterization.

Evaluation of the vascular anatomy in potential living kidney donors with gadolinium‐enhanced magnetic resonance angiography: comparison with digital subtraction angiography and intraoperative findings

X-ray contrast arteriography has traditionally been used for pre-operative evaluation in living kidney donors. However, magnetic resonance angiography (MRA) offers a non-invasive alternative, which has been considered to be less accurate. This study was performed to determine whether MRA in the pre-operative investigation of living kidney donors provides sufficient information. From December 2005 to December 2007, 173 potential live donors were evaluated in this study. Donors performed digital subtraction angiography (DSA) and those with one or more accessory arteries at least on one side recruited for further evaluation with three-dimensional gadolinium-enhanced MRA. A total of 30 donors constituted the study population. When compared with DSA as the reference method, MRA detected 20 of 36 renal accessory arteries which indicates a sensitivity of 55.6%. The difference between MRA and DSA in identifying accessory renal arteries was significant (p-value <0.001). Considering intraoperative findings as the standard of reference, MRA depicted correctly four of six (66.7%) accessory arteries on the transplanted kidneys. MRA has the advantage of avoiding exposure to ionizing radiation and is non-invasive. These are important considerations in pre-operative evaluation of a generally healthy donor population. However, MRA provides suboptimal accuracy in detecting small accessory arteries.

Gadolinium-Enhanced Three-Dimensional Magnetic Resonance Angiographic Assessment of the Pulmonary Artery Anatomy in Cyanotic Congenital Heart Disease With Pulmonary Stenosis or Atresia: Comparison With Cineangiography

Pulmonary stenosis (PS) or pulmonary atresia (PA) is an important component of complex cyanotic congenital heart disease, especially in tetralogy of Fallot or lesions with ventricular septal defect (VSD)-PS physiology. Management strategy in these patients depends on accurate assessment of PAs and identification of all sources of pulmonary blood flow. X-ray cineangiography is the "gold standard" for this purpose, but it has the inherent risks of an invasive procedure. Gadolinium-enhanced three-dimensional magnetic resonance angiography (Gd-MRA) has been shown to noninvasively and accurately evaluate various lesions of the vascular system. This study was undertaken to evaluate the accuracy of Gd-MRA compared with cineangiography in the evaluation of pulmonary anatomy. Nineteen patients having complex cyanotic heart disease with PS or PA were included in the study. All patients underwent Gd-MRA and cineangiography. Catheterisation and MRA findings regarding the anatomic variable of interest were analysed for agreement by Bland-Altman analysis. There was total agreement between the two modalities in the delineation of confluent PAs. McGoon's ratio and the Nakata index, which are standard measures of the adequacy of PA size, also showed excellent agreement between the two modalities. MRA was able to delineate all aorto-pulmonary collaterals in the setting of PA. MRA can delineate all sources of pulmonary blood supply in cyanotic congenital heart disease with PS and/or PA as well as provide accurate assessment of PA size for planning corrective surgery.

Contrast‐enhanced magnetic resonance angiography of patent ductus arteriosus in a dog

Gadolinium-enhanced three-dimensional magnetic resonance angiography is a relatively new technique in the veterinary field. A mature dog with suspected patent ductus arteriosus underwent contrast-enhanced magnetic resonance angiography at 1.0 T with a three-dimensional fast low-angle shot (FLASH) gradient-echo technique. Qualitatively, three-dimensional images of the ductus were particularly clear with surface reconstructions, and ductus diameters were easy to assess in native images. Contrast-enhanced magnetic resonance angiography is a fast, relatively non-invasive procedure that could be particularly useful when non-surgical interventional procedures are anticipated for ductus occlusion.

MR angiography with parallel acquisition for assessment of the visceral arteries: comparison with conventional MR angiography and 64-detector-row computed tomography

The purpose of the study was to retrospectively compare three-dimensional gadolinium-enhanced magnetic resonance angiography (conventional MRA) with MRA accelerated by a parallel acquisition technique (fast MRA) for the assessment of visceral arteries, using 64-detector-row computed tomography angiography (MDCTA) as the reference standard. Eighteen patients underwent fast MRA (imaging time 17 s), conventional MRA (29 s) and MDCTA of the abdomen and pelvis. Two independent readers assessed subjective image quality and the presence of arterial stenosis. Data were analysed on per-patient and per-segment bases. Fast MRA yielded better subjective image quality in all segments compared with conventional MRA (P = 0.012 for reader 1, P = 0.055 for reader 2) because of fewer motion-induced artefacts. Sensitivity and specificity of fast MRA for the detection of arterial stenosis were 100% for both readers. Sensitivity of conventional MRA was 89% for both readers, and specificity was 100% (reader 1) and 99% (reader 2). Differences in sensitivity between the two types of MRA were not significant for either reader. Interobserver agreement for the detection of arterial stenosis was excellent for fast (kappa = 1.00) and good for conventional MRA (kappa = 0.76). Thus, subjective image quality of visceral arteries remains good on fast MRA compared with conventional MRA, and the two techniques do not differ substantially in the grading of arterial stenosis, despite the markedly reduced acquisition time of fast MRA.

Cardiac Magnetic Resonance Imaging Evaluation of Sinus Venosus Defects

Sinus venosus defect (SVD) is an uncommon type of interatrial communication in which cardiac magnetic resonance (CMR) is increasingly used as an alternative imaging modality. The goal of this study was to determine the accuracy of CMR in patients with SVD compared with surgical findings. The diagnostic studies and operative reports of all patients who had CMR followed by surgical repair of SVD (n = 16) from 1996 to 2005 were reviewed and discrepancies were recorded. CMR studies included assessment of anatomy (evaluated by a combination of gradient echo cine, spin echo, and gadolinium-enhanced three-dimensional magnetic resonance angiography), ventricular volumes and function, and flow measurements. The median age at CMR was 14 years (range, 0.4-42). Compared with operative findings, there were no major discrepancies with CMR. The SVD was clearly imaged in all patients and 36 anomalously draining pulmonary veins were identified. The median pulmonary-to-systemic flow ratio was 2.4 (range, l.3-4.6). Patients had an average of 1.7 previous diagnostic tests (range, 1-3; 19 transthoracic echo, 5 catheterizations, and 3 transesophageal echo). Before CMR, SVD was diagnosed in 1 patient, suspected in 7, and not suspected in 8. Additional unsuspected findings identified by CMR included malposition of septum primum (n = 2), left superior vena cava to coronary sinus (n = 2), and aortic arch anomalies (n = 2). CMR accurately depicts SVD anatomy and associated anomalous pulmonary venous drainage, provides quantitative information on the hemodynamic burden, and reveals additional cardiovascular abnormalities. This experience indicates that CMR provides the information necessary for surgical planning of SVD repair.

Magnetic resonance imaging is the diagnostic tool of choice in the preoperative evaluation of patients with partial anomalous pulmonary venous return

Diagnosis of partial anomalous pulmonary venous return is usually suspected by echocardiography and often confirmed by cardiac catheterization. Magnetic resonance imaging is a powerful non-invasive diagnostic tool that can give accurate insight on systemic and pulmonary veins, cardiac anatomy and physiopathology. To test the diagnostic accuracy of magnetic resonance in patient with suspected partial anomalous pulmonary venous return. Twenty consecutive patients (10 male, mean age: 27+/-20 years) with suspected partial anomalous pulmonary venous return underwent a magnetic resonance study comprehensive of Gadolinium-enhanced three-dimensional magnetic resonance angiography and phase-velocity-contrast in order to evaluate pulmonary and systemic venous anatomy and QP/QS. In 14 of them a cardiac catheterization was also performed. Anatomy findings and QP/QS result of both exams were compared. Sixteen patients underwent surgical correction. In the other four patients with QP/QS<1.5, surgical correction was not indicated according to the literature (1). Among patients who had both magnetic resonance and cardiac catheterization (14 patients) anatomical findings were concordant in 12 of them. In all operated patients, surgical findings were concordant with MRI report. There was a good correlation between magnetic resonance and cardiac catheterization QP/QS evaluation (mean value 2.23 and 2.4, respectively). In patients with suspected anomalous pulmonary venous return, magnetic resonance provides a comprehensive evaluation of pulmonary venous return and the amount of shunt, overcoming most of the limitations of echocardiography. Therefore magnetic resonance is a powerful diagnostic tool for indicating therapeutic management and surgical strategies for this group of patients, and can be considered a non-invasive alternative to cardiac catheterization.

Giant Angioleiomyoma in Extremity: Report of Two Cases

Angioleiomyomas are smooth muscle tumors that occur most often in the extremities and are usually less than 2 cm in diameter. We present 2 case reports of giant angioleiomyoma. Case 1 was a 51-year-old woman with a 5-year history of a slowly growing mass 12x10 cm in diameter in the right posterior thigh. The tumor was larger than any previously reported. Case 2 was a 72-year-old man with an 8-year history of a slowly growing mass 6x6 cm in diameter in the left palm. The tumor was unique in that it grew to a giant size in the hand of the elderly patient. Magnetic resonance imaging of both cases confirmed the tumors' presence in the subcutis. T1-weighted images showed homogenous signal isointense to muscle. On T2-weighted images, areas of hyperintensity and hypointensity intermingled. Three-dimensional gadolinium-enhanced magnetic resonance angiography showed rapid initial enhancement followed by a gradual increase in enhancement, suggesting that the tumors were rich in vessels. Microscopic examination revealed numerous vascular channels embedded within a huge smooth muscle component.

Functional Renal Volume: Quantitative Analysis at Gadolinium-enhanced MR Angiography—Feasibility Study in Healthy Potential Kidney Donors

To assess the feasibility of quantifying functional renal volume with gadolinium-enhanced magnetic resonance (MR) angiography. Institutional review board approval was obtained, and all subjects gave informed consent. A contour-detection three-dimensional algorithm for determining renal volumes was developed. The method was validated in 18 cadaveric pig kidneys by measuring the water displacement caused by the kidneys. The kidney lengths and volumes in 19 consecutive potential kidney donors who underwent gadolinium-enhanced MR angiography of the renal arteries also were determined. Differences in volume measurements between men and women and between left and right kidneys were analyzed by using the Student t test. The volume of perfused renal cortex was calculated by extracting voxels on the basis of the cortex signal intensity threshold. The relevance of renal function parameters--namely, creatinine clearance rates--in the donor candidates was assessed by using a linear regression model. Intra- and interobserver variabilities of the measurements were determined by using the Bland-Altman method. Volume measurements of the cadaveric pig kidneys obtained by using MR angiography and the water displacement method were strongly correlated (r = 0.99). The mean total renal volume in the donor candidates was 196 mL (range, 136-295 mL). No significant differences in total renal volume between the men and women or between the left and right kidneys were found. The correlation between calculated renal cortex volumes (mean, 67 mL; range, 40-105 mL) and creatinine clearance rates was good (r = 0.69). Inter- and intraobserver variabilities were lower than 7%. Quantification of functional renal volume with three-dimensional gadolinium-enhanced MR angiography seems feasible with use of the described semiautomatic method.

Three-Dimensional Gadolinium-Enhanced Magnetic Resonance Angiography Used as a “One-stop Shop” Imaging Procedure for Venous Thromboembolism: A Pilot Study

Pulmonary embolism and deep venous thrombosis are individual manifestations of a single entity, venous thromboembolic disease. This study aimed to assess the feasibility of 3-dimensional gadolinium-enhanced magnetic resonance angiography used as an "one-stop shop'' imaging procedure visualizing both the pulmonary arteries and the deep lower venous system within a single investigation. The inclusion criterion was a proven or excluded venous thromboembolism. Diagnosis was based on an imaging work-up for pulmonary embolism including either perfusion lung scan or contrast-enhanced spiral computed tomography, or both, and an imaging work-up for deep venous thrombosis including either venous color-coded duplex sonography or ascending phlebography, or both. A gadolinium-enhanced "one-stop shop'' magnetic resonance angiography was performed within 24 hours of completed diagnostic imaging work-up for pulmonary embolism and deep venous thrombosis in 20 patients. Results of pulmonary magnetic resonance angiography were concordant with perfusion lung scan and/or computed tomography in 90% of patients. Magnetic resonance angiography results of the deep lower venous system were concordant with venous duplex sonography and/or phlebography in 75% of patients and seemed to be more precise in 25% of patients. The "one-stop shop'' imaging procedure using gadolinium-enhanced magnetic resonance angiography was feasible and proved to offer a reliable and rapid diagnostic approach in thromboembolic disease, sparing patients' exposure to ionizing radiation and iodinated contrast media.

Critical Limb Ischemia: Hybrid MR Angiography Compared with DSA

To compare a hybrid magnetic resonance (MR) angiography protocol with selective digital subtraction angiography (DSA) in patients with critical limb ischemia. The study was approved by the institutional review board, and written consent was obtained from all patients. Pretreatment DSA and hybrid MR angiography were performed in 19 consecutive patients (15 men, four women; mean age, 69.8 years; range, 44-86 years). Hybrid MR angiography included submillimeter dual-phase three-dimensional gadolinium-enhanced MR angiography in lower calf and foot, and four-station bolus-chase MR angiography in pelvis, thigh, and upper calf. Three readers identified the target lesion and inflow and outflow segments and determined treatment (bypass graft placement, percutaneous transluminal angioplasty, conservative management, amputation). Results of interobserver and intermethod comparisons were expressed as percentage of agreement and 95% confidence interval (CI). On hybrid MR angiograms, no substantial venous overlay was present and image quality was excellent or adequate in 18 (95%) of 19 limbs. Readers 1, 2, and 3 selected the identical target lesion on the DSA image and the MR angiogram in 18, 17, and 18 of 18 comparable limbs, respectively. Mean percentage of agreement for readers 1 and 3 was 100% (95% CI: 81%, 100%) and for reader 2 was 94% (95% CI: 73%, 100%). Agreement of all three readers was superior with use of MR angiography for determination of inflow segments (13 [72%] of 18 limbs) and outflow segments (17 [94%] of 18 limbs), compared with agreement with use of DSA (13 [68%] of 19 inflow segments, 10 [53%] of 19 outflow segments). Agreement in therapy decisions was higher with DSA (15 [79%] of 19) than with MR angiography (11 [61%] of 18). Preliminary data strongly support the combination of submillimeter dual-phase MR angiography in lower calf and foot with four-station bolus-chase MR angiography to extend the utility of MR angiography to patients with critical limb ischemia.

Gadolinium-enhanced three-dimensional magnetic resonance angiography versus conventional digital subtraction angiography: which modality is superior in evaluating living kidney donors?

This study evaluates the correlation of magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) with the operative vessel findings in living kidney donors. The intraoperative vessel findings of 52 living renal donors were compared with the preoperative diagnoses of each imaging technique. Sixty-seven arteries were found during explantation. Forty kidneys showed a single arterial blood supply, and 12 kidneys showed a multiple arterial blood supply. No advantage of either imaging method was found for arterial imaging. There were 55 veins identified during organ harvesting. MRA could not determine the venous system in one donor (1.9%) and failed to detect one small pole vein in another. DSA did not yield a venous diagnosis in seven patients (13.5%) and yielded misdiagnoses in four patients. The correct diagnosis of renal donor veins differed significantly in favor of MRA (kappa 0.79 vs. 0.45; P=0.008). MRA is superior to DSA in assessing the renal vasculature in living kidney donors.

Gadolinium-enhanced three-dimensional magnetic resonance angiography of pulmonary and systemic venous anomalies

Gadolinium-enhanced three-dimensional magnetic resonance angiography of pulmonary and systemic venous anomalies

Mesenteric venous thrombosis: diagnosis and noninvasive imaging.

Mesenteric venous thrombosis is an uncommon but potentially lethal cause of bowel ischemia. Several imaging methods are available for diagnosis, each of which has advantages and disadvantages. Doppler ultrasonography allows direct evaluation of the mesenteric and portal veins, provides semiquantitative flow information, and allows Doppler waveform analysis of the visceral vessels; however, it is operator dependent and is often limited by overlying bowel gas. Conventional contrast material-enhanced computed tomography (CT) allows sensitive detection of venous thrombosis within the central large vessels of the portomesenteric circulation and any associated secondary findings; however, it is limited by respiratory misregistration, motion artifact, and substantially decreased longitudinal spatial resolution. Helical CT and CT angiography, especially when performed with multi-detector row scanners, and magnetic resonance (MR) imaging, particularly gadolinium-enhanced MR angiography, enable volumetric acquisitions in a single breath hold, eliminating motion artifact and suppressing respiratory misregistration. Helical CT angiography and three-dimensional gadolinium-enhanced MR angiography should be considered the primary diagnostic modalities for patients with a high clinical suspicion of mesenteric ischemia. Conventional angiography is reserved for equivocal cases at noninvasive imaging and is also used in conjunction with transcatheter therapeutic techniques in management of symptomatic portal and mesenteric venous thrombosis.

Analysis of Recent Papers in Hypertension

Analysis of Recent Papers in Hypertension

Gadolinium-enhanced three-dimensional magnetic resonance angiography of pulmonary and systemic venous anomalies

ObjectivesThe goal of this study was to evaluate the diagnostic value of gadolinium (Gd)-enhanced three-dimensional (3D) magnetic resonance angiography (MRA) in patients with congenital and acquired anomalies of the pulmonary and systemic veins. BackgroundGadolinium-enhanced 3D MRA is a fast magnetic resonance imaging technique that has shown great promise in the evaluation of large and medium-sized arteries. However, its application to venous anomalies has not been studied in detail. MethodsThe study retrospectively analyzed all patients who underwent Gd-enhanced 3D MRA examination from January 1998 through January 2001, were diagnosed with anomalies of the pulmonary or systemic veins and had additional diagnostic data available for comparison with the MRA findings. ResultsSixty-one patients (age 1 day to 60 years) were included. Image acquisition was completed in 29 ± 6.9 s. Pulmonary venous anomalies were found in 37 patients, systemic venous anomalies in 17 patients and both pulmonary and systemic venous anomalies in 7 patients. Compared with available diagnostic information by other modalities, all known or suspected venous anomalies were imaged by 3D MRA. In three patients, catheterization did not detect anomalies of the pulmonary veins that were subsequently diagnosed by MRA. The 3D MRA diagnoses were followed by 10 interventional catheterization procedures and 15 operations. In 74% of patients, 3D MRA either diagnosed previously unsuspected venous anomalies (28%) or added new clinically important information (46%). The mechanism of pulmonary vein compression in eight patients was determined by MRA but not by other imaging modalities. Using a five-level grading system for MRA image quality (1 = nondiagnostic; 5 = excellent), the average grade was 4.6 ± 0.6, with a 0.28 ± 0.6 mean grade difference between two independent observers. ConclusionsGadolinium-enhanced 3D MRA is capable of rapidly and accurately diagnosing a wide spectrum of pulmonary and systemic venous anomalies and is a useful noninvasive alternative to diagnostic catheterization.

Moving-table reduced-dose gadolinium-enhanced three-dimensional magnetic resonance angiography: velocity-dependent method with three-phase gadolinium infusion.

The purpose of this study was to develop a method for reducing gadolinium dose and suppressing venous overlap in moving-table three-dimensional (3D) magnetic resonance (MR) angiography from the abdomen to the feet. Thirty-one patients underwent three-phase infusion of 16-18 mL of gadolinium: infusion rates and imaging times were determined after taking into account mean blood flow velocity, so that image acquisition was synchronized with peak arterial enhancement at both the first and third stations (velocity-dependent method). Twenty-three other patients underwent slow infusion of 38 mL of gadolinium with fixed acquisition time (high-dose method). The image quality for the two methods was compared. The velocity-dependent method produced good image quality with significantly less venous overlap than the high-dose method, especially in the below-the-knee region (P <.001). The velocity-dependent method provides satisfactory MR angiograms using 16-18 mL of gadolinium in patients having various blood flow velocities.

Pulmonary arteriovenous malformations: three-dimensional gadolinium-enhanced MR angiography-initial experience.

To determine whether three-dimensional gadolinium-enhanced magnetic resonance (MR) angiography could be used to identify pulmonary arteriovenous malformations (PAVMs) and to accurately identify the size and number of feeding arteries. Eight patients suspected of having PAVM were examined with three-dimensional MR angiography at 1.5 T. Images were reviewed by a single radiologist blinded to conventional angiographic findings who evaluated each image for the size, number, and location of PAVMs, as well as for the size and number of feeding arteries. Five patients underwent conventional angiography with embolization therapy, and one patient underwent lobectomy. Two patients did not undergo either surgery or angiography. Three-dimensional MR angiography revealed nine (90%) of 10 PAVMs that were confirmed at conventional angiography (n = 9) or examination of a surgical specimen (n = 1). The single PAVM that was not identified prospectively at MR angiography was small (3-4 mm) and peripheral. Two additional PAVMs were identified in the two patients who did not undergo surgery or angiography. Three-dimensional MR angiography is a promising technique for use in the diagnosis of PAVM, although small (<5-mm) PAVMs may be more difficult to identify with the technique. The technique is a particularly useful means of noninvasively demonstrating the size and number of feeding arteries prior to treatment.

Three-dimensional gadolinium-enhanced MR angiography: applications for abdominal imaging.

Three-dimensional (3D) gadolinium-enhanced magnetic resonance (MR) angiography is a versatile technique that combines speed, superb contrast, and relative simplicity. It has a wide range of applications, particularly in the abdomen and pelvis, where superb images of the abdominal aorta and renal arteries are routinely obtained. Aneurysms, atherosclerotic lesions, and occlusions of the major mesenteric arteries are also well depicted. In addition, 3D gadolinium-enhanced MR angiography is ideal for noninvasive evaluation of the systemic and mesenteric veins and can be used to demonstrate parenchymal lesions in the liver, pancreas, kidneys, and other organs. It is also useful in staging genitourinary neoplasms: Parenchymal lesions, venous extension, and adenopathy are all clearly depicted. Three-dimensional gadolinium-enhanced MR angiography can be useful in the preoperative evaluation of potential transplant donors and recipients and in the evaluation of vascular complications following transplantation. Delayed 3D acquisitions of the kidneys, ureters, and bladder can be performed routinely to generate gadolinium-enhanced urograms and demonstrate obstruction, delayed function, filling defects, and masses. A variety of methods for increasing the speed and improving the resolution of 3D acquisition are currently under investigation. These include novel imaging and reformatting techniques and the use of intravascular contrast agents with much longer vascular half-lives.

Peripheral arterial disease: meta-analysis of the diagnostic performance of MR angiography.

To summarize the overall diagnostic performance of magnetic resonance (MR) angiography in the evaluation of peripheral arteriosclerotic occlusive disease and to identify the most important sources of variation in diagnostic accuracy between studies. A search strategy in MEDLINE and citation tracking were used to identify relevant English-language articles published since 1991. Each article was critically appraised for examination, patient, and study design characteristics. The accuracy data from different studies were analyzed by constructing summary receiver operating characteristic curves; multiple linear regression was used to examine the variation between study results. Twenty-three studies were included. There was much heterogeneity in the study results, which could not be explained as differences in the threshold for a positive result. About half of the variation was due to the type of MR angiographic examination and the extent of image evaluation. The relative diagnostic odds ratio (DOR) for three-dimensional (3D) gadolinium-enhanced MR angiography compared with two-dimensional (2D) time-of-flight MR angiography was 7.46 (95% CI: 2.48, 22.20). The relative DOR for review of transverse source images or multiplanar reformations in addition to maximum intensity projections (MIPs) compared with the use of only MIPs for image evaluation was 4.53 (95% CI: 1.46, 13.87). The diagnostic accuracy of 3D gadolinium-enhanced MR angiography is superior to that of 2D time-of-flight MR angiography. Also, the review of transverse source images or use of additional postprocessing techniques, such as multiplanar reformation, results in significantly better diagnostic performance.