Venous Suppression Research Articles

DANTE-CAIPI Accelerated Contrast-Enhanced 3D T1: Deep Learning-Based Image Quality Improvement for Vessel Wall MRI.

Accelerated and blood-suppressed postcontrast 3D intracranial vessel wall MRI (IVW) enables high-resolution rapid scanning but is associated with low SNR. We hypothesized that a deep-learning (DL) denoising algorithm applied to accelerated, blood-suppressed postcontrast IVW can yield high-quality images with reduced artifacts and higher SNR in shorter scan times. Sixty-four consecutive patients underwent IVW, including conventional postcontrast 3D T1-sampling perfection with application-optimized contrasts by using different flip angle evolution (SPACE) and delay alternating with nutation for tailored excitation (DANTE) blood-suppressed and CAIPIRINHIA-accelerated (CAIPI) 3D T1-weighted TSE postcontrast sequences (DANTE-CAIPI-SPACE). DANTE-CAIPI-SPACE acquisitions were then denoised by using an unrolled deep convolutional network (DANTE-CAIPI-SPACE+DL). SPACE, DANTE-CAIPI-SPACE, and DANTE-CAIPI-SPACE+DL images were compared for overall image quality, SNR, severity of artifacts, arterial and venous suppression, and lesion assessment by using 4-point or 5-point Likert scales. Quantitative evaluation of SNR and contrast-to-noise ratio (CNR) was performed. DANTE-CAIPI-SPACE+DL showed significantly reduced arterial (1 [1-1.75] versus 3 [3-4], P < .001) and venous flow artifacts (1 [1-2] versus 3 [3-4], P < .001) compared with SPACE. There was no significant difference between DANTE-CAIPI-SPACE+DL and SPACE in terms of image quality, SNR, artifact ratings, and lesion assessment. For SNR ratings, DANTE-CAIPI-SPACE+DL was significantly better compared with DANTE-CAIPI-SPACE (2 [1-2], versus 3 [2-3], P < .001). No statistically significant differences were found between DANTE-CAIPI-SPACE and DANTE-CAIPI-SPACE+DL for image quality, artifact, arterial blood and venous blood flow artifacts, and lesion assessment. Quantitative vessel wall SNR and CNR median values were significantly higher for DANTE-CAIPI-SPACE+DL (SNR: 9.71, CNR: 4.24) compared with DANTE-CAIPI-SPACE (SNR: 5.50, CNR: 2.64) (P < .001 for each), but there was no significant difference between SPACE (SNR: 10.82, CNR: 5.21) and DANTE-CAIPI-SPACE+DL. DL denoised postcontrast T1-weighted DANTE-CAIPI-SPACE accelerated and blood-suppressed IVW showed improved flow suppression with a shorter scan time and equivalent qualitative and quantitative SNR measures relative to conventional postcontrast IVW. It also improved SNR metrics relative to postcontrast DANTE-CAIPI-SPACE IVW. Implementing DL denoised DANTE-CAIPI-SPACE IVW has the potential to shorten protocol time while maintaining or improving the image quality of IVW.

Image-Quality Assessment of 3D Intracranial Vessel Wall MRI Using DANTE or DANTE-CAIPI for Blood Suppression and Imaging Acceleration.

3D intracranial vessel wall MRI techniques are time consuming and prone to artifacts, especially flow artifacts. Our aim was to compare the image quality of accelerated and flow-suppressed 3D intracranial vessel wall MR imaging techniques relative to conventional acquisitions. Consecutive patients undergoing MR imaging had conventional postcontrast 3D T1-sampling perfection with application-optimized contrasts by using different flip angle evolution (SPACE) and either postcontrast delay alternating with nutation for tailored excitation (DANTE) flow-suppressed or DANTE-controlled aliasing in parallel imaging results in higher acceleration (CAIPI) flow-suppressed and accelerated T1-SPACE sequences performed. The sequences were evaluated using 4- or 5-point Likert scales for overall image quality, SNR, extent/severity of artifacts, motion, blood suppression, sharpness, and lesion assessment. Quantitative assessment of lumen and wall-to-lumen contrast ratios was performed. Eighty-nine patients were included. T1-DANTE-SPACE had significantly better qualitative ratings relative to T1-SPACE for image quality, SNR, artifact impact, arterial and venous suppression, and lesion assessment (P < .001 for each, respectively), with the exception of motion (P = .16). T1-DANTE-CAIPI-SPACE had significantly better image quality, lesion assessment, arterial and venous blood suppression, less artifact impact, and less motion compared with T1-SPACE (P < .001 for each, respectively). The SNR was higher with T1-SPACE compared with T1-DANTE-CAIPI-SPACE (P < .001). T1-DANTE-CAIPI-SPACE showed significantly worse lumen (P = .005) and wall-to-lumen contrast ratios (P = .001) compared with T1-SPACE, without a significant difference between T1-SPACE and T1-DANTE-SPACE. T1-DANTE-CAIPI-SPACE scan time was 5:11 minutes compared with 8:08 and 8:41 minutes for conventional T1-SPACE and T1-DANTE-SPACE, respectively. Accelerated postcontrast T1-DANTE-CAIPI-SPACE had fewer image artifacts, less motion, improved blood suppression, and a shorter scan time, but lower qualitative and quantitative SNR ratings relative to conventional T1-SPACE intracranial vessel wall MR imaging. Postcontrast T1-DANTE-SPACE had superior SNR, blood suppression, higher image quality, and fewer image artifacts, but slightly longer scan times relative to T1-SPACE.

Chronic, Combined Cardiac and Renal Dysfunction Exacerbates Renal Venous Pressure-Induced Suppression of Renal Function in Rats.

Background and ObjectiveIncreased renal venous pressure (RVP) is common in combined heart and kidney failure. We previously showed that acute RVP elevation depresses renal blood flow (RBF), glomerular filtration rate (GFR), and induces renal vasoconstriction in the absence of changes in blood pressure in healthy rats. We used our established rodent model of chronic combined heart and kidney failure (H/KF) to test whether RVP elevation would impair cardiovascular stability, renal perfusion and exacerbate renal dysfunction.MethodsMale rats were subjected to 5/6 nephrectomy (SNx or Sham) and 6% high salt diet followed 7 weeks later by ligation of the left anterior descending coronary artery (CL or Sham). Experimental groups: CL + SNx (n = 12), Sham CL + SNx (n = 9), CL+ Sham SNx (n = 6), and Sham Control (n = 6). Six weeks later, anesthetized rats were subjected to an acute experiment whereupon mean arterial pressure (MAP), heart rate (HR), RVP, RBF, and GFR were measured at baseline and during elevation of RVP to 20–25 mmHg for 120 min.ResultsBaseline MAP, HR, RBF, and renal vascular conductance (RVC) were comparable among groups. Baseline GFR was significantly depressed in CL + SNx and Sham CL + SNx groups compared to Sham Control and CL + Sham SNx groups. Upon RVP increase, MAP and HR fell in all groups. Increased RVP exacerbated the reduction in RBF in CL + SNx (−6.4 ± 0.9 ml/min) compared to Sham Control (−3.7 ± 0.9 ml/min, p < 0.05) with intermediate responses in Sham CL + SNx (−6.8 ± 1.3 ml/min) and CL + Sham SNx (−5.1 ± 0.4 ml/min) groups. RVP increase virtually eliminated GFR in CL + SNx (−99 ± 1%), Sham CL + SNx (−95 ± 5%), and CL + Sham SNx (−100%) groups compared to Sham Control (−84 ± 15% from baseline; p < 0.05). Renal vascular conductance dropped significantly upon RVP increase in rats with HF (CL + SNx: −0.035 ± 0.011; CL + Sham SNx: −0.050 ± 0.005 ml/min·mmHg−1, p < 0.05) but not Sham CL + SNx (−0.001 ± 0.019 ml/min·mmHg−1) or Control (−0.033 ± mL/min·mmHg−1).ConclusionChronic combined heart and kidney failure primarily impairs renal hemodynamic stability in response to elevated RVP compared to healthy rats.

Study of the vasodilatory effect of extract from tissue culture biomass of Rauwolfia serpentina Benth.

Design of novel herbal drugs with a wide range of activity is an important object of pharmacology. Herbal remedies having antiarrhythmic, cardiotonic and vasodilatory effects are useful for treatment of heart arrhythmias. Vasodilating drugs are prescribed for medication of hypertension and migraine. Also they are a part of comprehensive treatment of various diseases such as disturbed peripheral blood circulation and atherosclerosis of arteries of extremities as well as problems with urination and potency. Search for novel herbal preparations with vasorelaxant activity in our view is a promising matter of current interest.&#x0D; This work is aiming in study of vasodilatory activity of methanol extract of strain K-27 tissue culture of Rauwolfia serpentina.&#x0D; Evaluation of vasodilatory activity extract of high-productive strain K-27 tissue culture of Rauwolfia serpentina has been carried out by the method of auxotonic mechanography of vascular smooth muscles. Strength and frequency of spontaneous contractions of portal vein as well as relaxation of aortic smooth muscles activated with phenylephrine were evaluation indicators of extract activity.&#x0D; In order to estimate working concentration of extract of strain K-27 tissue culture of Rauwolfia serpentina we have studied vascular activity at sequentially increasing concentrations of extract solution on the portal vein. Overlay of sequence of growing concentrations exhibited decrease in basal level of venous tone and dose-dependent suppression of phasic contractions with complete inhibition of spontaneous activity of portal vein at 1.44 mg/ml concentration and uprise of toxicity at higher concentrations. It has been shown dose-dependent relaxation of vascular preparations followed by development of α-adrenoceptor blocking effect and loss of sensibility to phenylephrine at the end of experiment. After discontinuing exposure with a substance the activating effect of phenylephrine remained not renewed during 30-50 minutes, at the same time contractile activity of aorta on the response to the other type activation (60 mM K+) took place.&#x0D; It was found that at the studied range of concentrations: 0.0288 μg/ml–28.8 μg/ml the extract of strain K-27 tissue culture of Rauwolfia serpentina has distinct vasodilatory effect. Also it was discovered α-adrenoceptor blocking effect of that extract, so it can find wide application in therapy as vasorelaxant and α-blocker, for instance in treatment of prostate diseases.

High resolution time-of-flight MR-angiography at 7 T exploiting VERSE saturation, compressed sensing and segmentation

Background3D Time-of-Flight (TOF) MR-angiography (MRA) substantially benefits from ultra-high magnetic field strengths (≥7 T) due to increased Signal-to-Noise ratio and improved contrast. However, high-resolution TOF-MRA usually requires long acquisition times. In addition, specific absorption rate constraints limit the choice of optimal pulse sequence parameters, especially if venous saturation is employed. PurposeTo implement and evaluate an arterial TOF-MRA for accelerated high-resolution angiography at ultra-high magnetic field strength. Field strengths/sequence7 T modified gradient-echo TOF sequence including venous saturation using Variable-Rate Selective Excitation (VERSE), Compressed Sensing (CS) and sparse application of saturation pulses, called segmentation, were included for acceleration. AssessmentTo analyze the acceleration techniques all volunteers were examined with the same protocols. CS with different sampling patterns and regularization factors as well as segmentation were applied for acceleration. For comparison, conventional acceleration techniques were applied (GRAPPA PAT 3 and Partial Fourier (6/8 in slice/phase encoding)). Images were co-registered and 40 mm thick transversal maximum intensity projections were created to calculate the relative number of vessels. To analyze the visibility of small vessels, the lenticulostriate arteries (LSA) were examined. This was done via multiscale vessel enhancement filtering in a VOI and quantification via Fiji ImageJ as well as qualitatively evaluation by two radiologists. Additionally, the venous/arterial vessel-to-background ratios (vVBR/aVBR) were calculated for chosen protocols. ResultsFor the acceleration of a high resolution TOF-MRA (0.31 mm isotropic), under-sampling of 9.6 showed aliasing artifacts, whereas 7.2 showed no aliasing. The regularization factor R had a strong impact on the image quality according to smoothing (R = 0.01 to R = 0.005) and noise (R = 0.0005 to R = 0.00005). With the alternating sampling patterns it was shown that the k-space center should not be under-sampled too much. Additionally segmentation could be verified to be feasible for stronger acceleration with sufficient venous suppression. ConclusionThe combination of several independent techniques (VERSE, CS with acceleration factor 7.2, R = 0.001, Poisson disc radius of 80%, 3 segments) enables the application of high-resolution (0.31 mm isotropic) TOF-MRA with venous saturation at 7 T in clinical time settings (TA ≈ 5 min) and within the SAR limits.

Subtractive non-contrast-enhanced MRI of lower limb veins using multiple flow-dependent preparation strategies.

To evaluate the performance of acceleration-dependent vascular anatomy for non-contrast-enhanced MR venography (ADVANCE-MRV) in femoral veins and to investigate whether venous signal uniformity can be improved by applying multiple acquisitions with different flow suppressions or multiple flow suppressions in 1 acquisition. The ADVANCE-MRV method uses flow-sensitized modules to acquire a dark-artery image set and a dark-artery vein set, which are subsequently subtracted. Ten healthy volunteers were imaged using the ADVANCE-MRV sequence with improved venous suppression uniformity in the dark-artery vein images achieved by applying multiple flow suppressions in the same acquisition or by combining multiple images acquired with different flow suppressions. The performance of the improved technique was also evaluated in 13 patients with lower-limb deep venous thrombosis. Multiple-preparation and multiple-acquisition approaches all improved venous signal uniformity and reduced the signal void artifacts observed in the original ADVANCE-MRV images. The multiple-acquisition approaches achieved excellent blood signal uniformity and intensity, albeit at the cost of an increase in the total acquisition time. The double-preparation approach demonstrated good performance in all measurements, providing a good compromise between signal uniformity and acquisition time. The blood signal spatial variation and its variation using different gradient amplitudes were reduced by 20% and 29%. All patient images showed uniform and bright venous signal in nonoccluded sections of vein. The enhanced ADVANCE-MRV methods substantially improved signal uniformity in healthy volunteers and patients with known deep venous thrombosis. The double-preparation approach gave good-quality femoral vein images, providing improved venous signal uniformity without increasing acquisition time in comparison to the original sequence.

Improved visualization of superficial temporal artery using segmentedtime-of-flight MR angiography with venous suppression at 7T.

To evaluate the quality of time-of-flight MR angiography (TOF-MRA) with venous suppression at 7T on imaging superficial temporal artery (STA). A recently developed segmented TOF technique with reduced specific absorption rate (SAR) of venous suppression (VS) module was employed to achieve high-resolution arterial angiography without the contamination of venous signal. Images of segmented TOF with VS at 7T, TOF without VS at 7T, and TOF with VS at 3T were collected on 17 healthy volunteers. The number of STA branches and their local contrast achieved by the three methods were quantified and compared using paired t test. Segmented TOF with VS at 7T successfully suppressed venous signal without reducing the contrast of arterial angiography. The numbers of STA branches in 7T images were significantly higher than that in 3T images (5.79 vs. 4.50, p < 0.001). The contrast of 7T segmented TOF was significantly higher than 3T TOF (7.21 vs. 5.56, p = 0.006). Segmented TOF with VS at 7T displayed more branches of STA, while eliminating the signal of superficial temporal vein (STV). The improved visualization of STA will potentially facilitate the pre-operative assessment of STA in STA-MCA bypass surgery.

Technical Aspects of Contrast-enhanced MR Angiography: Current Status and New Applications.

This article is based on a presentation at the meeting of the Japanese Society of Magnetic Resonance in Medicine in September 2016. The purpose is to review the technical developments which have contributed to the current status of contrast-enhanced magnetic resonance angiography (CE-MRA) and to indicate related emerging areas of study. Technical developments include MRI physics-based innovations as well as improvements in MRI engineering. These have collectively addressed not only early issues of timing and venous suppression but more importantly have led to an improvement in spatiotemporal resolution of CE-MRA of more than two orders of magnitude compared to early results. This has allowed CE-MRA to be successfully performed in virtually all vascular territories of the body. Contemporary technical areas of study include improvements in implementation of high rate acceleration, extension of high performance first-pass CE-MRA across multiple imaging stations, expanded use of compressive sensing techniques, integration of Dixon-based fat suppression into CE-MRA sequences, and application of CE-MRA sequences to dynamic-contrast-enhanced perfusion imaging.

MR Neurography of Brachial Plexus at 3.0 T with Robust Fat and Blood Suppression.

Purpose To develop and evaluate magnetic resonance (MR) neurography of the brachial plexus with robust fat and blood suppression for increased conspicuity of nerves at 3.0 T in clinically feasible acquisition times. Materials and Methods This prospective study was HIPAA compliant, with institutional review board approval and written informed consent. A low-refocusing-flip-angle three-dimensional (3D) turbo spin-echo (TSE) sequence was modified to acquire both in-phase and out-of-phase echoes, required for chemical shift (Dixon) reconstruction, in the same repetition by using partial echoes combined with modified homodyne reconstruction with phase preservation. This multiecho TSE modified Dixon (mDixon) sequence was optimized by using simulations and phantom studies and in three healthy volunteers. The sequence was tested in five healthy volunteers and was evaluated in 10 patients who had been referred for brachial plexopathy at 3.0 T. The images were evaluated against the current standard of care, images acquired with a 3D TSE short inversion time inversion recovery (STIR) sequence, qualitatively by using the Wilcoxon signed-rank test and quantitatively by using the Friedman two-way analysis of variance, with P < .05 considered to indicate a statistically significant difference. Results Multiecho TSE-mDixon involving partial-echo and homodyne reconstruction with phase preservation achieved uniform fat suppression in half the imaging time compared with multiacquisition TSE-mDixon. Compared with 3D TSE STIR, fat suppression, venous suppression, and nerve visualization were significantly improved (P < .05), while arterial suppression was better but not significantly so (P = .06), with increased apparent signal-to-noise ratio in the dorsal nerve root ganglion and C6 nerve (P < .001) with the multiecho TSE-mDixon sequence. Conclusion The multiecho 3D TSE-mDixon sequence provides robust fat and blood suppression, resulting in increased conspicuity of the nerves, in clinically feasible imaging times and can be used for MR neurography of the brachial plexus at 3.0 T. © RSNA, 2016 Online supplemental material is available for this article.

Acceleration-selective arterial spin labeling for intracranial MR angiography with improved visualization of cortical arteries and suppression of cortical veins.

A new approach for intracranial MR angiography (MRA) is introduced, using acceleration-selective arterial spin labeling (AccASL). The aim of this study was to investigate the arterial visualization and venous suppression using AccASL. Intracranial MRA images obtained by AccASL and time-of-flight (TOF) were compared in seven healthy volunteers and one patient with occlusion of the terminal portion of the left internal carotid artery. The volunteer images were assessed by measuring the contrast-to-noise ratio (CNR) between the middle cerebral artery (MCA) and white matter (WM) and between the confluence of sinuses and WM. Additionally, visualized peripheral arteries were counted and qualitative scoring of the MCA visualization and vein signal contamination was conducted. The CNR at the M4 branch and the number of visualized arteries was significantly higher using AccASL compared with that in TOF (P < 0.05). In the qualitative comparison, the score for artery visualization was higher using AccASL (P < 0.05), while minimizing signal contamination by cortical veins. Additionally, in patient examination, the collateral flow visualization was better with AccASL. AccASL enables better efficiency for visualizing peripheral arteries compared with TOF, while suppressing cortical vein signal. Magn Reson Med 77:1996-2004, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Segmented TOF at 7 T MRI: Technique and clinical applications

PurposeTime-of-flight (TOF) MR angiography has an advantage of contrast and resolution in ultra-high field (7T) MRI systems. However, increased specific absorption rate (SAR) prohibits the application of spatial saturation band, leading to venous contamination in maximum intensity projection (MIP) images. MethodsA segmented k-space filling scheme with sparse venous saturation pulses was developed for 7T TOF-MRA. The effectiveness of the segmented TOF sequence was verified by Bloch equation simulation and experiments on 3T. The protocol on 7T was optimized and applied for healthy volunteers and patients with vascular diseases. ResultsSegmented TOF achieved equivalent contrast and venous suppression effect as conventional methods, while SAR values had a remarkable reduction and obeyed the limit of a 7T MRI system. The decreased number of saturation pulses allowed shorter acquisition time than existing solutions. The comparison of segmented TOF and conventional TOF revealed flow direction in vascular diseases. ConclusionSegmented TOF is proved to be a time-efficient way to achieve high-resolution angiograms without venous contamination at ultra-high field. The sequence holds strong promise for non-contrast clinical diagnosis on cerebrovascular diseases.

Phase based venous suppression in resting-state BOLD GE-fMRI

Resting-state functional MRI (RS-fMRI) is a widely used method for inferring connectivity between brain regions or nodes. As with task-based fMRI, the spatial specificity of the connectivity maps can be distorted by the strong biasing effect of the BOLD signal in macroscopic veins. In RS-fMRI this effect is exacerbated by the temporal coherences of physiological origin between large veins that are widely distributed in the brain. In gradient echo based EPI, used for the vast majority of RS-fMRI, macroscopic veins that carry BOLD-related changes exhibit a strong phase response. This allows for post-processing identification and removal of venous signals using a phase regressor technique. Here, we employ this approach to suppress macrovascular venous contributions in high-field whole-brain RS-fMRI data sets, resulting in significant changes to both the spatial localization of the networks and the correlations between the network nodes. These effects were observed at both the individual and group analysis level, suggesting that venous contamination is a confounding factor for RS-fMRI studies even at relatively low image resolutions. Suppression of the macrovascular signal using the phase regression approach may therefore help to better identify, delineate, and interpret the true structure of large-scale brain networks.

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.

Non-contrast peripheral angiography at 3T using QISS: improving venous suppression

Background Quiescent Interval Single Shot (QISS) has emerged as a robust technique for non-enhanced angiography of peripheral arteries (1). It has been clinically validated with contrast enhanced magnetic resonance angiography (CE-MRA) and digital subtraction angiography (DSA) (2,3). Both of these validation studies were performed at 1.5T field strength. Although the initial experience with QISS at 3T using similar imaging parameters as those at 1.5T were promising, venous suppression was inadequate in the thigh and pelvic regions of some patients (4,5). In this work, we present a strategy to improve venous signal suppression with the QISS sequence at 3T. Methods The imaging parameters were similar to those reported earlier for QISS at 1.5T (2) with the following exception: the tracking saturation pulse for venous signal attenuation was replaced with an adiabatic inversion pulse (hyperbolic secant). This enables a more homogenous venous suppression at 3T than is possible with regular sinc pulse due to B1 inhomogeneity. The prototype sequence was tested in three volunteers in a 3T system (MAGNETOM Skyra, Siemens Healthcare). Results

Cerebral TOF angiography at 7T: Impact of B1+ shimming with a 16‐channel transceiver array

PurposeTime‐of‐flight (TOF) MR imaging is clinically among the most common cerebral noncontrast enhanced MR angiography techniques allowing for high spatial resolution. As shown by several groups TOF contrast significantly improves at ultrahigh field of B0 = 7T, however, spatially varying transmit B1 (B1+) fields at 7T reduce TOF contrast uniformity, typically resulting in suboptimal contrast and reduced vessel conspicuity in the brain periphery.MethodsUsing a 16‐channel B1+ shimming system, we compare different dynamically applied B1+ phase shimming approaches on the radiofrequency excitation to improve contrast homogeneity for a (0.5 mm)3 resolution multislab TOF acquisition. In addition, B1+ shimming applied on the venous saturation pulse was investigated to improve venous suppression, subcutaneous fat signal reduction and enhanced background suppression originating from MT effect.ResultsB1+ excitation homogeneity was improved by a factor 2.2–2.6 on average depending on the shimming approach, compared to a standard CP‐like phase setting, leading to improved vessel conspicuity particularly in the periphery. Stronger saturation, higher fat suppression and improved background suppression were observed when dynamically applying B1+ shimming on the venous saturation pulse.ConclusionB1+ shimming can significantly improve high resolution TOF vascular investigations at ultrahigh field, holding strong promise for non contrast‐enhanced clinical applications. Magn Reson Med 71:966–977, 2014. © 2013 Wiley Periodicals, Inc.

Simultaneous static and time-resolved nonenhanced peripheral MR angiography

Background Due to the association of gadolinium with nephrogenic systemic fibrosis in patients with renal insufficiency, nonenhanced methods for peripheral angiography such as quiescent interval single shot (QISS) and subtractive fast spin-echo are of increasing clinical interest. Despite the ability of these methods to depict peripheral vascular pathology, they have limited ability to display the arterial pulse wave which may aid in characterization of peripheral vascular disease. We describe a rapid nonenhanced MRA method that provides for static and time-resolved display of blood flow within the peripheral vasculature. Methods This study was IRB approved. Imaging of 6 healthy subjects and 2 patients was performed on a 1.5T MRI system (MAGNETOM Avanto, Siemens Healthcare) with a cardiac-gated saturation-recovery 2D radial trueFISP sequence that acquired views over the entire cardiac cycle. A golden azimuthal angle increment (111.25°) was used to permit sliding window reconstruction at arbitrary temporal resolutions. The sequence was used to image the arteries of the lower and upper limbs. Typical imaging parameters were: TR/TE/flip of 4.1-4.5 ms/2.0-2.2 ms/90°, slice thickness 2.3-3.0 mm, in-plane spatial resolution 1.0-1.2 mm, 160 (upper limbs) to 432 (lower limbs) slices, 1 heartbeat/slice, 20 temporal frames/heartbeat, phase-based fat suppression, tracking saturation for venous suppression. A static angiogram was obtained by reconstructing all acquired views. A multi-shot implementation (2-4 heartbeats/slice) was tested for the purpose of improving temporal resolution. Results The described time-resolved nonenhanced MRA method depicted the onset and propagation of arterial flow in the

Magnetization‐prepared IDEAL bSSFP: A flow‐independent technique for noncontrast‐enhanced peripheral angiography

To propose a new noncontrast-enhanced flow-independent angiography sequence based on balanced steady-state free precession (bSSFP) that produces reliable vessel contrast despite the reduced blood flow in the extremities. The proposed technique addresses a variety of factors that can compromise the exam success including insufficient background suppression, field inhomogeneity, and large volumetric coverage requirements. A bSSFP sequence yields reduced signal from venous blood when long repetition times are used. Complex-sum bSSFP acquisitions decrease the sensitivity to field inhomogeneity but retain phase information, so that data can be processed with the Iterative Decomposition of Water and Fat with Echo Asymmetry and Least-Squares Estimation (IDEAL) method for robust fat suppression. Meanwhile, frequent magnetization preparation coupled with parallel imaging reduces the muscle and long-T(1) fluid signals without compromising scan efficiency. In vivo flow-independent peripheral angiograms with reliable background suppression and high spatial resolution are produced. Comparisons with phase-sensitive bSSFP angiograms (that yield out-of-phase fat and water signals, and exploit this phase difference to suppress fat) demonstrate enhanced vessel depiction with the proposed technique due to reduced partial-volume effects and improved venous suppression. Magnetization-prepared complex-sum bSSFP with IDEAL fat/water separation can create reliable flow-independent angiographic contrast in the lower extremities.

Fast inversion recovery magnetic resonance angiography of the intracranial arteries

Inversion-prepared pulse sequences can be used for noncontrast MR angiography (MRA) but suffer from long scan times when acquired using conventional nonaccelerated techniques. This work proposes a subtraction-based spin-labeling, three-dimensional fast inversion recovery MRA (FIR-MRA) method for imaging the intracranial arteries. FIR-MRA uses alternating cycles of nonselective and slab-selective inversions, leading to dark-blood and bright-blood images, respectively. The signal difference between these images eliminates static background tissue and generates the angiogram. To reduce scan time, segmented fast gradient recalled echo readout and parallel imaging are applied. The inversion recovery with embedded self-calibration method used allows for parallel acceleration at factors of 2 and above. An off-resonance selective inversion provides effective venous suppression, with no detriment to the depiction of arteries. FIR-MRA was compared against conventional three-dimensional time-of-flight angiography at 3 T in eight normal subjects. Results showed that FIR-MRA had superior vessel conspicuity in the distal vessels (P < 0.05), and equal or better vessel continuity and venous suppression. However, FIR-MRA had inferior vessel sharpness (P < 0.05) in four of nine vessel groups. The clinical utility of FIR-MRA was demonstrated in three MRA patients.

Contrast-enhanced intracranial magnetic resonance angiography with a spherical shells trajectory and online gridding reconstruction

To evaluate the feasibility of applying the shells trajectory to single-phase contrast-enhanced magnetic resonance angiography. Several methods were developed to overcome the challenges of the clinical implementation of shells including off-resonance blurring (eg, from lipid signal), aliasing artifacts, and long reconstruction times. These methods included: 1) variable TR with variable readout length to reduce fat signal and off-resonance blurring; 2) variable sampling density to suppress aliasing artifacts while minimizing acquisition time penalty; and 3) an online 3D gridding algorithm that reconstructed an 8-channel, 240(3) image volume set. Both phantom and human studies were performed to establish the initial feasibility of the methods. Phantom and human study results demonstrated the effectiveness of the proposed methods. Shells with variable TR and readout length further suppressed the fat signal compared to the fixed-TR shells acquisition. Reduced image aliasing was achieved with minimal scan time penalty when a variable sampling density technique was used. The fast online reconstruction algorithm completed in 2 minutes at the scanner console, providing a timely image display in a clinical setting. It was demonstrated that the use of the shells trajectory is feasible in a clinical setting to acquire intracranial angiograms with high spatial resolution. Preliminary results demonstrate effective venous suppression in the cavernous sinuses and jugular vein region.

Echo-Sclerosis Hemodynamic Conservative: A New Technique for Varicose Vein Treatment

Treatment of venous insufficiency has been revolutionized by introduction of various less invasive procedures. The echo-sclerosis hemodynamic conservative (ESEC) technique is a completely new treatment of varicose veins that combines ultrasound-monitored sclerosis, innovative sclerotherapy findings, and hemodynamic principles. The objective of venous stasis suppression is achieved by the ESEC technique through a conservative and functional approach that preserves venous drainage and saphenous vessel integrity. The technique is efficient, simple, safe, in-office manageable, and easily repeatable, although it obviously requires training and skill. It may be considered as the primary treatment for most varicose patients. Evaluation of long-term results, with regard to comparison with other techniques, should assess cost efficacy from a lifelong point of view.