Electrocardiograph-triggered two-dimensional time-of-flight versus optimized contrast-enhanced three-dimensional MR angiography of the peripheral arteries |
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| Institution: | 1. Department of Radiology, Georg-August-Universitaet Goettingen, Siemens, and Germany;2. Medical Engineering Group, Erlangen, Germany;1. Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;2. Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;3. Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada;4. Department of Radiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado;5. Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;6. Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois;1. Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato s.s. 554 Monserrato, Cagliari, 09045, Italy;2. Vascular Center, Nuova Villa Claudia, Rome, Italy;3. Department of Radiology Weill Cornell Medical College, New York, NY, USA;4. Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece;5. Department of Vascular Disease, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia;6. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 367 East Park Building, 600 N Wolfe St, Baltimore, MD, 21287, USA;7. Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York, USA;8. Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa, USA;9. Department of Radiology, Antwerp University Hospital (UZA), Edegem, Belgium;10. University Clinic of Nuclear Medicine, Inselspital, University Hospital Bern, Bern, Switzerland;11. Angiology Care Unit, Private Villalba Hospital (GVM), Bologna, Italy;12. Neurosurgery, Mayo Clinic, Rochester, MN, USA;13. Department of Neurology and Neurosurgery, University College London Hospitals, London, UK;14. Department of Surgery, University of Washington, Seattle, WA, USA;15. Vascular surgery Department, Ain Shams University, Cairo, Egypt;p. Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA;q. Faculty of Medicine of University of Porto, Porto, Portugal;r. Department of Radiology, Neuroradiology Section, Stanford University School of Medicine, Stanford, CA, USA;s. Department of Angiology, University Hospital Basel and University of Basel, Basel, Switzerland;t. National Institute of Angiology and Vascular Surgery, Havana, Cuba;u. Laboratory for Atherosclerosis Research, Center for Clinical and Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic;v. Department of Radiology and Nuclear Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands;w. Department of Vascular Surgery, University of Maryland, Baltimore, USA;x. Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Road, London, N6G 2V4, ON, Canada;y. Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK;z. Institute of Biostructures and Bioimaging, National Research Council of Italy, Naples, 80145, Italy;11. Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore, MD, USA;12. Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia;13. Clinic of Vascular and Endovascular Surgery, Athens Medical Group, Greece;14. Knowledge Engineering Center, Global Biomedical Technologies, Inc, Roseville, CA, USA;15. Department of Electrical and Computer Engineering, Idaho State University, ID, USA;16. Vascular Service, Veterans Affairs Medical Center, Baltimore, USA |
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| Abstract: | We determined whether the accuracy of magnetic resonance angiography (MRA) in the peripheral run-off vessels can be improved by using contrast-enhanced (CE) three-dimensional (3D) technique in comparison to electrocardiograph (ECG)-triggered two-dimensional (2D) time-of-flight (TOF) technique. In a prospective study 20 patients with occlusions of the pelvic and/or femoral arteries underwent a CE 3D MRA (repetition time (TR): 5 ms, (TE) echo time: 2 ms, flip angle (FA): 30°) and an ECG-triggered 2D time-of-flight (TOF) technique (TR: 408 resp. 608 ms, TE: 7 ms, FA: 70°) of the run-off vessels on a 1.5 T MR system. Each patient received a contrast material volume of 0.15 mmol/kg of body weight of gadolinium (Gd)/DTPA using an automatic injector. The tube system to the patient was flushed by 50 mL of a saline solution applied with the same injection rate as the contrast material administration. The start of the 3D MR sequence was tailored individually to the applied contrast material after determination of circulation times by a prior bolus. All patients underwent each conventional or digital arteriography for comparison, as well. The visualization of the run-off vessels was ranked on a scale of 0–3 (0 = poor, 1 = fair, 2 = good, 3 = excellent) by three blinded reviewers. They also graded the vascular segments as either occluded or significantly altered (>50% reduction in diameter) or free of significant stenosis. CE 3D MRA was significantly faster in imaging the run-off vessels in comparison to the ECG-triggered 2D TOF technique. All 160 vascular segments were visualized with the 3D method, whereas only 142/160 segments were seen with 2D technique. The resulting image quality ranking of all vascular segments was significantly higher (p < 0.05) using CE 3D MRA (2.8) than with the 2D TOF technique (2.4). The detection of the stenoses was possible with both techniques. The grading of seven of seven stenoses was correct with 3D method and in five of seven cases with the 2D TOF technique. All vessel occlusions were detected by using both techniques. Small collaterals were visualized in more detail with the CE 3D MR angiography. These data demonstrate an improvement in image quality and accuracy of MRA of the peripheral arteries using a CE 3D technique in comparison to an ECG-triggered 2D TOF sequence. |
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