Three-dimensional Turbo Spin-echo Imaging Research Articles

3D Turbo Spin-echo MRI-based Mechanical Thrombectomy at Middle Cerebral Artery Bifurcations.

We describe three cases with acute middle cerebral artery (MCA) occlusion. From the pre-operative MRI, including three-dimensional turbo spin-echo sequences using T1WI and T2WI, we assessed both thrombus configuration and arterial anatomy at the MCA bifurcations. For efficient endovascular thrombectomy, we identified the applied MCA segment 2 (M2) branch, in which the main thrombus was buried. Sufficient recanalization after a single pass was achieved and the patients made a marked recovery. Although mechanical thrombectomy for M2 occlusion has not been of proven benefit, the endovascular procedure based on three-dimensional turbo spin-echo imaging is useful for more complete thrombus removal at MCA bifurcations.

High-resolution MRI of the vessel wall in patients with symptomatic atherosclerotic stenosis of the middle cerebral artery

Intracranial atherosclerosis is associated with recurrent ischemic stroke. High-resolution MRI (HR MRI) can provide information about atheroma in vivo. We aimed to analyze and compare vascular wall imaging characteristics between patients with symptomatic and asymptomatic atherosclerotic stenosis of the middle cerebral artery (MCA) using 3.0 Tesla HR MRI. The HR MRI protocol included four different scans: black blood T1-weighted, T2-weighted and proton density-weighted MRI, as well as three-dimensional turbo spin echo imaging techniques with multiplanar reconstruction. Plaque characteristics, including location, morphology, and signal intensity, were analyzed in 51 patients (29 symptomatic, 22 asymptomatic) with atherosclerotic stenosis of the middle cerebral artery. The vessel wall area, lumen area, and plaque area (PA) were also calculated and compared between the symptomatic and asymptomatic groups. We found that PA, remodeling index (RI), and positive remodeling (PR) prevalence were significantly greater in the symptomatic group than in the asymptomatic group (PA: p=0.033; RI: p=0.020; PR: p=0.032). Plaque location in the superior aspect of the vessel wall and irregular plaque surface were more frequently observed in the symptomatic group than in the asymptomatic group (superior location: p=0.031; irregular surface: p=0.036). Moreover, multivariate logistic regression identified plaque location on the superior wall as an independent predictor of symptomatic MCA stenosis (odds ratio: 4.471; p=0.039). Therefore, we can conclude that patients with symptomatic atherosclerotic stenosis of the MCA are more likely to have larger plaques, PR, superiorly located plaques, and irregular plaque surface. These characteristics are promising factors for stratifying stroke risk.

SNR‐optimized phase‐sensitive dual‐acquisition turbo spin echo imaging: A fast alternative to FLAIR

Phase-sensitive dual-acquisition single-slab three-dimensional turbo spin echo imaging was recently introduced, producing high-resolution isotropic cerebrospinal fluid attenuated brain images without long inversion recovery preparation. Despite the advantages, the weighted-averaging-based technique suffers from noise amplification resulting from different levels of cerebrospinal fluid signal modulations over the two acquisitions. The purpose of this work is to develop a signal-to-noise ratio-optimized version of the phase-sensitive dual-acquisition single-slab three-dimensional turbo spin echo. Variable refocusing flip angles in the first acquisition are calculated using a three-step prescribed signal evolution while those in the second acquisition are calculated using a two-step pseudo-steady state signal transition with a high flip-angle pseudo-steady state at a later portion of the echo train, balancing the levels of cerebrospinal fluid signals in both the acquisitions. Low spatial frequency signals are sampled during the high flip-angle pseudo-steady state to further suppress noise. Numerical simulations of the Bloch equations were performed to evaluate signal evolutions of brain tissues along the echo train and optimize imaging parameters. In vivo studies demonstrate that compared with conventional phase-sensitive dual-acquisition single-slab three-dimensional turbo spin echo, the proposed optimization yields 74% increase in apparent signal-to-noise ratio for gray matter and 32% decrease in imaging time. The proposed method can be a potential alternative to conventional fluid-attenuated imaging.