Magnetic Resonance Angiography Techniques Research Articles

Update on state of the art magnetic resonance angiography techniques

Update on state of the art magnetic resonance angiography techniques

Technical assessment of whole body angiography and cardiac function within a single MRI examination

AimTo evaluate a combined protocol for simultaneous cardiac MRI (CMR) and contrast-enhanced (CE) whole-body MR angiography (WB-MRA) techniques within a single examination.Materials and methodsAsymptomatic volunteers (n = 48) with low-moderate risk of cardiovascular disease (CVD) were recruited. The protocol was divided into four sections: (1) CMR of left ventricle (LV) structure and function; (2) CE-MRA of the head, neck, and thorax followed by the distal lower limbs; (3) CMR LV “late gadolinium enhancement” assessment; and (4) CE-MRA of the abdomen and pelvis followed by the proximal lower limbs. Multiple observers undertook the image analysis.ResultsFor CMR, the mean ejection fraction (EF) was 67.3 ± 4.8% and mean left ventricular mass (LVM) was 100.3 ± 22.8 g. The intra-observer repeatability for EF ranged from 2.1–4.7% and from 9–12 g for LVM. Interobserver repeatability was 8.1% for EF and 19.1 g for LVM. No LV delayed myocardial enhancement was observed. For WB-MRA, some degree of luminal narrowing or stenosis was seen at 3.6% of the vessel segments (involving n = 29 of 48 volunteers) and interobserver radiological opinion was consistent in 96.7% of 1488 vessel segments assessed.ConclusionCombined assessment of WB-MRA and CMR can be undertaken within a single examination on a clinical MRI system. The associated analysis techniques are repeatable and may be suitable for larger-scale cardiovascular MRI studies.

Emerging techniques for evaluation of the hemodynamics of intracranial vascular pathology.

Advances in imaging modalities have improved the assessment of intracranial hemodynamics using non-invasive techniques. This review examines new imaging modalities and clinical applications of currently available techniques, describes pathophysiology and future directions in hemodynamic analysis of intracranial stenoses, aneurysms and arteriovenous malformations and explores how hemodynamic analysis may have prognostic value in predicting clinical outcomes and assist in risk stratification. The advent of new technologies such as pseudo-continuous arterial spin labeling, accelerated magnetic resonance angiography (MRA) techniques, 4D digital subtraction angiography, and improvements in clinically available techniques such as phase-contrast MRA may change the landscape of vascular imaging and modify current clinical practice guidelines.

Aneurisma sacular de la vena ácigos en un paciente con cisura accesoria de la ácigos

The saccular aneurysm of the azygos vein is an extremely rare condition, which when located in the path of an accesory pulmonary fissure, becomes a diagnostic challenge because it can be mistaken for tumors arising from the accesory pleura, like solitary fibrous tumor of the pleura or mesothelioma. The diagnosis should ideally be done by non-invasive methods such as CT or MR angiographic technique in multiple phases, thus avoiding unnecessary surgical intervention. This case is exceptional because, to our knowledge, it is the first to report both concomitant clinical situations, an aneurysm of the azygos vein in the pathway of its accessory fissure.

4D DSA a new technique for arteriovenous malformation evaluation: a feasibility study

BackgroundThe angioarchitectural features of an arteriovenous malformation (AVM) provide key information regarding natural history and treatment planning. Because of rapid filling and vascular overlap, two-dimensional (2D) and three-dimensional (3D) digital...

Free breathing contrast-enhanced time-resolved magnetic resonance angiography in pediatric and adult congenital heart disease.

BackgroundContrast enhanced magnetic resonance angiography (MRA) is generally performed during a long breath-hold (BH), limiting its utility in infants and small children. This study proposes a free-breathing (FB) time resolved MRA (TRA) technique for use in pediatric and adult congenital heart disease (CHD).MethodsA TRA sequence was developed by combining spiral trajectories with sensitivity encoding (SENSE, x4 kx-ky and x2 kz) and partial Fourier (75% in kz). As no temporal data sharing is used, an independent 3D data set was acquired every ~1.3s, with acceptable spatial resolution (~2.3x2.3x2.3mm). The technique was tested during FB over 50 consecutive volumes. Conventional BH-MRA and FB-TRA data was acquired in 45 adults and children with CHD. We calculated quantitative image quality for both sequences. Diagnostic accuracy was assessed in all patients from both sequences. Additionally, vessel measurements were made at the sinotubular junction (N = 43), proximal descending aorta (N = 43), descending aorta at the level of the diaphragm (N = 43), main pulmonary artery (N = 35), left pulmonary artery (N = 35) and the right pulmonary artery (N = 35). Intra and inter observer variability was assessed in a subset of 10 patients.ResultsBH-MRA had significantly higher homogeneity in non-contrast enhancing tissue (coefficient of variance, P <0.0001), signal-to-noise ratio (P <0.0001), contrast-to-noise ratio (P <0.0001) and relative contrast (P = 0.02) compared to the FB-TRA images. However, homogeneity in the vessels was similar in both techniques (P = 0.52) and edge sharpness was significantly (P <0.0001) higher in FB-TRA compared to BH-MRA. BH-MRA provided overall diagnostic accuracy of 82%, and FB-TRA of 87%, with no statistical difference between the two sequences (P = 0.77). Vessel diameter measurements showed excellent agreement between the two techniques (r = 0.98, P <0.05), with no bias (0.0mm, P = 0.71), and clinically acceptable limits of agreement (-2.7 to +2.8mm). Inter and intra observer reproducibility showed good agreement of vessel diameters (r>0.988, P<0.0001), with negligible biases (between -0.2 and +0.1mm) and small limits of agreement (between -2.4 and +2.5mm).ConclusionsWe have described a FB-TRA technique that is shown to enable accurate diagnosis and vessel measures compared to conventional BH-MRA. This simplifies the MRA technique and will enable angiography to be performed in children and adults whom find breath-holding difficult.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-015-0138-9) contains supplementary material, which is available to authorized users.

Blood Pool Contrast-enhanced Magnetic Resonance Angiography with Correlation to Digital Subtraction Angiography: A Pictorial Review.

Magnetic resonance angiography (MRA) provides noninvasive visualization of the vascular supply of soft tissue masses and vascular pathology, without harmful radiation. This is important for planning an endovascular intervention, and helps to evaluate the efficiency and effectiveness of the treatment. MRA with conventional extracellular contrast agents relies on accurate contrast bolus timing, limiting the imaging window to first-pass arterial phase. The recently introduced blood pool contrast agent (BPCA), gadofosveset trisodium, reversibly binds to human serum albumin, resulting in increased T1 relaxivity and prolonged intravascular retention time, permitting both first-pass and steady-state phase high-resolution imaging. In our practice, high-quality MRA serves as a detailed “roadmap” for the needed endovascular intervention. Cases of aortoiliac occlusive disease, inferior vena cava thrombus, pelvic congestion syndrome, and lower extremity arteriovenous malformation are discussed in this article. MRA was acquired at 1.5 T with an 8-channel phased array coil after intravenous administration of gadofosveset (0.03 mmol/kg body weight), at the first-pass phase. In the steady-state, serial T1-weighted 3D spoiled gradient echo images were obtained with high resolution. All patients underwent digital subtraction angiography (DSA) and endovascular treatment. MRA and DSA findings of vascular anatomy and pathology are discussed and correlated. BPCA-enhanced MRA provides high-quality first-pass and steady-state vascular imaging. This could increase the diagnostic accuracy and create a detailed map for pre-intervention planning. Understanding the pharmacokinetics of BPCA and being familiar with the indications and technique of MRA are important for diagnosis and endovascular intervention.

Revisiting renovascular imaging for renal sympathetic denervation: current techniques and applications.

Renal sympathetic denervation (RDN) is an emerging technique in the treatment of resistant hypertension, most commonly performed using an endovascular approach. Clinical and anatomical criteria for RDN are well established and imaging plays an integral role in selecting patients with suitable anatomy, procedural planning and device selection. Nevertheless, the current body of literature surrounding imaging related to RDN remains limited. The purpose of this article is to illustrate the expectations and limitations of various imaging techniques, including Doppler ultrasound, CT angiography, MR angiography and newer techniques such as non-contrast MR angiography, in the context of RDN. • To understand the role of imaging in renal denervation • To understand strengths and weaknesses of current imaging techniques • To understand the relevant imaging findings in the context of renal denervation.

Autologous Breast Reconstruction: Preoperative Magnetic Resonance Angiography for Perforator Flap Vessel Mapping

Selection of a vascular pedicle for autologous breast reconstruction is time consuming and depends on visual evaluation during the surgery. Preoperative imaging of donor site for mapping the perforator artery anatomy greatly improves the efficiency of perforator selection and significantly reduces the operative time. In this article, we present our experience with magnetic resonance angiography (MRA) for perforator vessel mapping including MRA technique and interpretation. We have performed over 400 MRA examinations from August 2008 to August 2013 at our institution for preoperative imaging of donor site for mapping the perforator vessel anatomy. Using our optimized imaging protocol with blood pool magnetic resonance imaging contrast agents, multiple donor sites can be imaged in a single MRA examination. Following imaging using the postprocessing and reporting tool, we estimated incidence of commonly used perforators for autologous breast reconstruction. In our practice, anterior abdominal wall tissue is the most commonly used donor site for perforator flap breast reconstruction and deep inferior epigastric artery perforators are the most commonly used vascular pedicle. A thigh flap, based on the profunda femoral artery perforator has become the second most used flap at our institution. In addition, MRA imaging also showed evidence of metastatic disease in 4% of our patient subset. Our MRA technique allows the surgeons to confidently assess multiple donor sites for the best perforator and flap design. In conclusion, a well-performed MRA with specific postprocessing provides an accurate method for mapping perforator vessel, at the same time avoiding ionizing radiation.

Initial Evaluation of Non–Contrast-Enhanced Magnetic Resonance Angiography in Patients With Peripheral Arterial Occlusive Disease at 7 T

The aim of this study was to achieve initial experience with non-contrast-enhanced (ne) magnetic resonance angiography (MRA) of the lower leg arteries in patients with peripheral arterial occlusive disease (PAOD) at 7 T. Seven patients with PAOD were examined on a 7-T whole-body magnetic resonance system. A custom-built 16-channel transmit/receive coil and a manually positionable AngioSURF table were used for multistation imaging. For ne-MRA, an axial T1-weighted Turbo-fast low angle shot sequence (repetition time, 700 milliseconds; echo time, 3.84 milliseconds; bandwidth, 930 Hz/pixel; voxel volume, 1 × 1 × 2 mm; matrix, 384 × 288) with phonocardiogram gating was acquired at 7 T. Acquisition time of an entire angiogram covering the vasculature from pelvis to feet amounted to approximately 30 minutes, depending on the patient's heart frequency. All patients underwent a contrast-enhanced MRA (ce-MRA) at 1.5 T as standard of reference. The presence of stenosis and occlusions was evaluated segment based and compared for both MRA techniques. The degree of stenosis was defined as low grade (<50%), high grade (50%-99%), and occlusion (100%). High-grade stenosis and occlusion were considered to be hemodynamically significant stenosis. The 7-T ne-MRA enabled a homogenous, hyperintense artery signal and nearly total venous suppression with accurate delineation of arterial anatomy both proximal and distal to stenotic disease. A total of 154 artery segments were depicted with ce-MRA at 1.5 T. At 7 T, only 124 segments (80.5%) were displayed and involved for analysis, as the iliacal region was displayed incompletely in 4 patients because of the fact that the fixed coil diameter was too small to contain the lower abdomen and pelvis of these patients. In comparison with ce-MRA at 1.5 T as the reference standard, there was total agreement regarding the characterization of an artery segment as being normal or having any kind of stenosis. Of the 124 included segments, 28 segments (23%) had hemodynamically significant stenosis evaluated with 7-T ne-MRA and 26 segments (21%) assessed with 1.5-T ce-MRA. The sensitivity and specificity values of 7-T ne-MRA for detecting segments with hemodynamically significant stenosis were 93% and 98%, respectively. Non-contrast-enhanced MRA by means of T1-weighted Turbo-fast low angle shot imaging at 7 T in patients with PAOD is feasible and allowed for good visualization of stenosis and occlusions in all analyzed artery segments in this small patient group. However, this study also shows the challenges of ultrahigh-field body imaging, and more experience is required to determine the impact of 7-T ne-MRA in clinical practice.

Seven-Tesla Time-of-Flight Angiography Using a 16-Channel Parallel Transmit System With Power-Constrained 3-dimensional Spoke Radiofrequency Pulse Design

Ultrahigh magnetic fields of 7 T or higher have proven to significantly enhance the contrast in time-of-flight (TOF) imaging, one of the most commonly used non-contrast-enhanced magnetic resonance angiography techniques. Compared with lower field strength, however, the required radiofrequency (RF) power is increased at 7 T and the contrast obtained with a conventional head transmit RF coil is typically spatially heterogeneous.In this work, we addressed the contrast heterogeneity in multislab TOF acquisitions by optimizing the excitation flip angle homogeneity while constraining the RF power using 3-dimensional tailored RF pulses ("spokes") with a 16-channel parallel transmission system and a 16-channel transceiver head coil. We investigated in simulations and in vivo experiments flip angle homogeneity and angiogram quality with a same 3-slab TOF protocol for different excitations including 1-, 2-, and 3-spoke parallel transmit RF pulses and compared the results with a circularly polarized (CP) phase setting similar to a birdcage excitation. B1 and B0 calibration maps were obtained in multiple slices, and the RF pulse for each slab was designed on the basis of 3 calibration slices located at the bottom/middle/top of each slab, respectively. By design, all excitations were computed to generate the same total RF power for the same flip angle. In 8 subjects, we quantified the excitation homogeneity and the distribution of the RF power to individual channels. In addition, we investigated the consequences of local flip angle variations at the junction between adjacent slabs as well as the impact of ΔB0 on image quality. The flip angle heterogeneity, expressed as the coefficient of variation, averaged over all volunteers and all slabs could be reduced from 29.4% for CP mode excitation to 14.1% for a 1-spoke excitation and to 7.3% for 2-spoke excitations. A separate detailed analysis shows only a marginal improvement for 3-spoke compared with the 2-spoke excitation. The strong improvement in flip angle homogeneity particularly impacted the junction between adjacent TOF slabs, where significant residual artifacts observed with 1-spoke excitation could be efficiently mitigated using a 2-spoke excitation with same RF power and same average flip angle. Although the total RF power is maintained at the same level than that in CP mode excitation, the energy distribution is fairly heterogeneous through the 16 transmit channels for 1- and 2-spoke excitations, with the highest energy for 1 channel being a factor of 2.4 (1 spoke) and 2.2 (2 spokes) higher than that in CP mode. In vivo experiments demonstrated the necessity for including ΔB0 spatial variations during 2-spoke RF pulse design, particularly in areas with strong local susceptibility variations such as the lower frontal lobe. Significant improvement in excitation fidelity leading to improved TOF contrast, particularly in the brain periphery, as well as smooth slab transitions can be achieved with 2-spoke excitation while maintaining the same excitation energy as that in CP mode. These results suggest that expanding parallel transmit methods, including the use of multidimensional spatially selective excitation, will also be very beneficial for other techniques, such as perfusion imaging.

A Comparative Study of Magnetic Resonance Angiography &amp; Digital Subtraction Angiography in Diagnosis of Cerebral Arteriovenous Malformation

Background and purpose: Although phase-contrast MR angiography (MRA) provides some information regarding hemodynamics of cerebral arteriovenous malformations (AVMs), but mos t Conventional MR angiographic techniques have not been helpful in this respect. We attempted to determine the value of MR digital subtraction angiography (DSA) in assessing AVM hemodynamics. Soin this retrospective observational study was carried out to compare MRA and DSA in diagnosis of cerebral AVM. Methods and materials: It was a retrospective observational study conducted in the Department of Neurology Dhaka Medical College Hospital (DMCH), Dhaka during the period of January 2010 to December 2010. Thirty patients with haemorrhagic stroke age ranging from 13 to 65 years were selected on the basis of inclusion and exclusion criteria as the study sample. MRA and DSA were done in all the selected patients. Results: The mean age of the patients of haemorrhagic stroke was 30.3±14.3years and male female ratio was 2.7:1.The venous drainage of AVM 13 and 12 were superficial and deep respectively evaluated 100% by MRA. In the diagnosis of cerebral AVM nidussize S1&lt;3, S2:6 cm sensitivity 100% but accuracy 100% and 73.3% respectively. Sensitivity 33.3% found in diagnosis of cerebral AVM nidus size S3:&gt;6cm, 100% sensitive in the diagnosis of superficial and deep venous drainage AVM. Regarding the eloquence of brain area 15 was no eloquence by both MRA and DSA and identification of eloquence of brain area sensitivity 73.3% and accuracy 86.7%.The feeding vessels main vessels was found 22(73.3%) in both DSA and MRA findings. Distal vessels was seen 8(26.7%) in DSA but not seen in MRA findings. Intranidal aneurysm and Angiopathic AVM were seen 3(10.0%) and 4(13.3%) respectively in DSA, Conclusion: This study was carried out to diagnose the patients presented with cerebral AVM by MRA and DSA. MRA could not be evaluated flow status of AVM, distal feeding arteries, intranidal aneurysm and angiopathic AVM which could be detected by DSA. So, DSA is superior to MRA in diagnosis of cerebral AVM. DOI: http://dx.doi.org/10.3329/bjmed.v24i2.18699 Bangladesh J Medicine 2013; 24 : 51-58

Unenhanced MR Angiography of the Foot: Initial Experience of Using Flow-Sensitive Dephasing–prepared Steady-State Free Precession in Patients with Diabetes

To assess image quality and diagnostic performance of unenhanced magnetic resonance (MR) angiography with use of flow-sensitive dephasing (FSD)-prepared steady-state free precession (SSFP) of the foot arteries in patients with diabetes. This prospective study was approved by institutional review board. Informed consent was obtained from all subjects. Thirty-two healthy volunteers and 38 diabetic patients who had been scheduled for lower-extremity contrast material-enhanced MR angiography were recruited to undergo unenhanced MR angiography with a 1.5-T MR unit. Image quality and diagnostic accuracy of unenhanced MR angiography in the detection of significant arterial stenosis (≥50%) were assessed by two independent reviewers. Contrast-enhanced MR angiography was used as the reference standard. The difference in the percentage of diagnostic arterial segments at unenhanced MR angiography between healthy volunteers and diabetic patients was evaluated with the McNemar test and generalized estimating equation for correlated data. Signal-to-noise ratio (SNR) and artery-to-muscle contrast-to-noise ratio (CNR) of pedal arteries were measured and compared between the two MR angiography techniques by using the paired t test. All subjects successfully underwent unenhanced MR angiography of the foot. Unenhanced MR angiography yielded a high percentage of diagnostic arterial segments in both healthy volunteers (303 of 320 segments, 95%) and patients (341 of 370 segments, 92%), and there was no difference in the percentage between the two populations (P = .195). In patients, the average SNR and CNR at unenhanced MR angiography were higher than those at contrast-enhanced MR angiography (SNR: 90.7 ± 38.1 vs 81.7 ± 34.7, respectively, P = .023; CNR: 85.2 ± 33.2 vs 76.6 ± 33.5, respectively, P = .013). The average sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of unenhanced MR angiography were 88% (35 of 40 segments), 93% (107 of 115 segments), 81% (35 of 43 segments), 96% (107 of 112 segments), and 92% (142 of 155 segments), respectively. Interobserver agreement between the two readers for diagnostic accuracy was good (κ = 0.83). Unenhanced MR angiography with use of FSD-prepared SSFP allows clear depiction of the foot arterial tree and accurate detection of significant arterial stenosis. The technique has the potential to be a safe and reliable screening tool for the assessment of foot arteries in diabetic patients without the use of gadolinium-based contrast material.

Diagnosing Intracranial Aneurysms With MR Angiography

The aim of this study was to evaluate the sensitivity and specificity of MR angiography (MRA) in the diagnosis of ruptured and unruptured intracranial aneurysms. A systematic search was performed on 4 electronic databases on relevant articles that were published from January 1998 to October 2013. Inclusion criteria were met by 12 studies that compared MRA with digital subtraction angiography as reference standard. Two independent reviewers evaluated the methodological quality of the studies. Data from eligible studies were extracted and used to construct 2×2 contingency tables on a per-aneurysm level. Pooled estimates of sensitivity and specificity were calculated for all studies and subgroups of studies. Heterogeneity was tested, and risk for publication bias was assessed. Included studies were of high methodological quality. Studies with larger sample size tended to have higher diagnostic performance. Most studies used time-of-flight MRA technique. Among the 960 patients assessed, 772 aneurysms were present. Heterogeneity with reference to sensitivity and specificity was moderate to high. Pooled sensitivity of MRA was 95% (95% confidence interval, 89%-98%), and pooled specificity was 89% (95% confidence interval, 80%-95%). False-negative and false-positive aneurysms detected on MRA were mainly located at the skull base and middle cerebral artery. Freehand 3-dimensional reconstructions performed by the radiologist significantly increased diagnostic performance. Studies performed on 3 Tesla showed a trend toward higher performance (P=0.054). Studies on diagnostic performance of MRA show high sensitivity with large variation in specificity in the detection of intracranial aneurysms.

Detection of infragenual arterial disease using non–contrast‐enhanced MR angiography in patients with diabetes

To evaluate the diagnostic performance of a newly developed non-contrast-enhanced MR angiography (NCE-MRA) technique using flow-sensitive dephasing (FSD) prepared steady-state free precession (SSFP) for detecting calf arterial disease in patients with diabetes. Forty-five patients with diabetes who underwent routine contrast-enhanced MR angiography (CE-MRA) of lower extremities were recruited for NCE-MRA at the calf on a 1.5 Tesla MR system. Image quality evaluated on a 4-point scale and diagnostic performance for detecting more than 50% arterial stenosis were statistically analyzed, using CE-MRA as the standard of reference. A total of 264 calf arterial segments were obtained in the 45 patients with 88 legs. The percentage of diagnostic arterial segments was all 98% for NCE- and CE-MRA. The image quality, SNR, CNR was 3.3, 177, 138, and 3.5, 103, 99, for NCE-MRA and CE-MRA, respectively. The average sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of NCE-MRA were 97%, 96%, 90%, 99%, and 96%, respectively on a per-segment basis and 90%, 84%, 82%, 91%, and 87%, respectively, on a per-patients basis. The NCE-MRA technique demonstrates adequate image quality in the delineation of calf arteries and consistent diagnostic performance for detecting significant stenosis with CE-MRA in patients with diabetes.

Noncontrast dynamic 3D intracranial MR angiography using pseudo-continuous arterial spin labeling (PCASL) and accelerated 3D radial acquisition

To develop a novel dynamic 3D noncontrast magnetic resonance angiography (MRA) technique that combines dynamic pseudo-continuous arterial spin labeling (dynamic PCASL), accelerated 3D radial sampling (VIPR), and time-of-arrival (TOA) mapping to provide quantitative assessment of arterial flow. Digital simulations were performed to investigate the effects of acquisition scheme and sequence parameters on image quality and TOA mapping fidelity. Five patients with vascular malformations (arteriovenous malformation [AVM] = 3, dural arteriovenous fistula [DAVF] = 2) were scanned and the images were compared to digital subtraction angiography (DSA) for the ability to identify the arterial supply, AVM location, nidus size, and venous drainage. Digital simulations demonstrated reduced image artifacts and improved TOA accuracy using radial acquisition over Cartesian. TOA mapping accuracy is more sensitive to sampling window length than time spacing. Dynamic PCASL MRA depicted seven of eight arterial pedicles, and accurately measured the AVM nidus size when the nidus was compact. The venous drainage in the AVM patients was not consistently visualized. Dynamic 3D PCASL-VIPR with TOA mapping is able to acquire both high temporal and spatial resolution inflow dynamics that could improve diagnosis of high-flow intracranial vascular diseases.

Noninvasive Evaluation of Collateral Blood Flow through Circle of Willis in Cervical Carotid Stenosis Using Selective Magnetic Resonance Angiography

Preoperative assessment of intracranial collateral circulation is helpful in predicting cerebral ischemia during surgical procedures for cervical internal carotid artery (ICA) stenosis. However, magnetic resonance angiography (MRA) and other less-invasive techniques cannot evaluate collateral blood flow because these techniques are nonselective. Hence, by using a newly developed selective MRA technique, we attempted to visualize collaterals via the circle of Willis in patients with ICA stenosis. Twelve patients who underwent carotid endarterectomy were prospectively examined with a 1.5-T MR scanner. Both selective and nonselective MRA were obtained using a 3-dimensional time-of-flight technique, with or without a cylindrical saturation pulse that suppresses the flow signal from the region of the target ICA. Maximum intensity projection MRA images were generated and compared with digital subtraction angiography (DSA) images. In all patients, the distal flow signal of the ipsilateral ICA was completely suppressed on selective MRA compared with nonselective MRA. In addition, collateral blood flow through the anterior and posterior communicating arteries was visualized in 5 and 2 patients, respectively. These findings corresponded well with the DSA imaging. Selective MRA techniques can readily suppress signals from the distal blood flow of the target artery and visualize the presence of collateral flows through the circle of Willis in patients with cervical ICA stenosis.

Time spatial labeling inversion pulse magnetic resonance angiography in pregnancy with adenomyosis

Time spatial labeling inversion pulse (Time-SLIP) is a non-contrast magnetic resonance angiography (MRA) technique. No cases in which this technique was used during pregnancy have been reported. We report herein two cases with adenomyosis of the same size and location that underwent Time-SLIP MRA during pregnancy. In case 1, the blood flow within the adenomyosis was poor, and the uterine blood flow toward the placenta was normal, resulting in no fetal growth restriction (FGR). In case 2, the blood flow within the adenomyosis was quite rich, and placental blood flow seemed decreased, resulting in severe FGR. As well as the Doppler ultrasonography, Time-SLIP MRA was useful for evaluating uterine blood flow during pregnancy. This is the first report of the use of Time-SLIP MRA during pregnancy.

A comparative study of magnetic resonance venography techniques for the evaluation of the internal jugular veins in multiple sclerosis patients

Background and PurposeThe use of magnetic resonance imaging (MRI) to assess the vascular nature of diseases such as multiple sclerosis (MS) is a growing field of research. This work reports on the application of MR angiographic (MRA) and venographic (MRV) techniques in assessing the extracranial vasculature in MS patients. Materials and MethodsA standardized MRI protocol containing 2D TOF-MRV and dynamic 3D contrast-enhanced (CE) MRAV was run for 170 MS patients and 40 healthy controls (HC). The cross-sectional area (CSA) of the internal jugular veins (IJVs) was measured at three neck levels in all subjects for both MRV techniques to determine the presence of venous stenoses. All data were analyzed retrospectively. ResultsFor the values where both methods showed signal, the 3D method showed larger CSA measurement values compared to 2D methods in both IJVs, in both MS and HC subjects which was confirmed with student paired t-tests. Of the 170 MS patients, 93 (55%) in CE-MRAV and 103 (61%) in TOF-MRV showed stenosis in at least one IJV. The corresponding numbers for the 40 HC subjects were 2 (5%) and 4 (10%), respectively. Carotid ectasias with IJV stenosis were seen in 26 cases (15%) with 3D CE-MRAV and were not observable with 2D TOF-MRV. Carotid ectasias were not seen in the HC group. In the 2D TOF-MRV data, banding of the IJVs related to slow flow was seen in 58 (34%) MS cases and in no HC cases. MS patients showed lower average CSAs than the HC subjects. ConclusionThe 3D CE MRAV depicted the vascular anatomy more completely than the 2D TOF-MRV. However, the 3D CE MRAV does not provide any information about the flow characteristics which are indirectly available in the 2D TOF-MRV in those cases where there is slow flow.

Pulmonary arteriovenous fistulas in patients with hereditary hemorrhagic telangiectasia: role of MR angiography

The aim of this work is to establish the accuracy of pulmonary magnetic resonance angiography (MRA) compared to multidetector computed tomography (MDCT) and pulmonary angiography in the diagnostic evaluation of pulmonary arteriovenous malformations (PAVMs) in patients with hereditary hemorrhagic telangiectasia. Eight consecutive patients underwent MRA, MDCT and pulmonary angiography. All patients were carriers of PAVMs amenable to endovascular treatment. The parameters we have evaluated were the presence, the number of fistulas and the diameter of the feeding artery of the malformation. In all cases, the findings of the three tests were comparable. In only one case, MR images were considered qualitatively poorer than MDCT, although sufficient for the recognition of the lesion located in the hilum. The diameters of the arteries showed no statistically differences between MRA and CT. In conclusion, the MRA technique was found to be valid and reliable in the diagnosis of PAVMs in patients with HHT.