First-Pass and Steady-State MR Angiography of Thoracic Vasculature in Children and Adolescents

Abstract

Magnetic resonance angiography (MRA) is an established noninvasive imaging modality for detection and evaluation of vascular pathologies in children with congenital heart disease. Standard first-pass (FP)-MRA uses a 3-dimensional MRA sequence with an extracellular contrast agent, in which spatial resolution is limited by breath-hold duration, and image quality (IQ) is limited by motion artifacts. The purpose of this study was to compare the diagnostic confidence, IQ, and image artifacts of standard FP-MRA to a high-resolution, motion compensated steady-state (SS)-MRA of the thoracic vasculature in children and adolescents with congenital heart disease using a blood-pool contrast agent (gadofosveset trisodium). SS-MRA of the thoracic vasculature (technically successful in 90% of patients) offers superior diagnostic confidence and IQ compared with FP-MRA and shows fewer motion-related image artifacts. In addition, SS-MRA revealed findings missed by FP-MRA. Therefore, SS-MRA may prove specifically beneficial for imaging of thoracic vessels that are small and/or subject to motion.

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

“…112 MRI may also be used as a tool to investigate aortic physiology. Quantification of stiffness, an important predictor of cardiovascular outcome, can be obtained with pulsewave measurements from high-temporal resolution cine imaging.…”

Congenital heart disease in adults: Quantitative and qualitative evaluation of IR FLASH and IR SSFP MRA techniques using a blood pool contrast agent in the steady state and comparison to first pass MRA

“…For FP-MRA, an ECG-gated, T1 weighted gradient-echo contrast-enhanced MRA (CE-MRA) [15,16] was carried out during intravenous injection of 0.03 mmol/kg of gadofosveset trisodium (Ablavar, Lantheus Medical Imaging, North Billerica, MA, USA). Images were acquired in the coronal orientation and contrast timing was achieved with the care bolus technique.…”

“…The overall objective therefore was to ascertain which MRA technique provided superior image quality during the steady state with a blood-pool agent in the setting of adult congenital heart diseases. Previous studies have shown gadofosveset trisodium to be effective in visualizing the thoracic vasculature in patients with congenital heart disease [15,16]. Naehle et al [16] compared conventional FP-MRA using gadofosveset trisodium with imaging in the SS phase using a T1-weighted 3D-IR sequence, similar to the IR-FLASH technique used in this study.…”

“…Previous studies have shown gadofosveset trisodium to be effective in visualizing the thoracic vasculature in patients with congenital heart disease [15,16]. Naehle et al [16] compared conventional FP-MRA using gadofosveset trisodium with imaging in the SS phase using a T1-weighted 3D-IR sequence, similar to the IR-FLASH technique used in this study. Makowski et al [15] compared several techniques: conventional FP-MRA after either gadofosveset trisodium or standard extracellular contrast agent, T2-prepared SSFP sequence after injection of one of the previous described contrast agents, and IRprepared SSFP sequence after injection of gadofosveset trisodium.…”

Noninvasive Evaluation of Cerebral Arteriovenous Malformations by 4D-MRA for Preoperative Planning and Postoperative Follow-Up in 56 Patients: Comparison with DSA and Intraoperative Findings

“…22 Measurements were performed in large, medium-sized, and small intracranial arteries and veins, respectively, including the internal cerebral artery (A1), the middle cerebral artery (A2), and the proximal A3-segment of the anterior cerebral artery (A3) as well as the superior sagittal sinus (V1), the straight sinus (V2), and the inferior sagittal sinus (V3). To guarantee analysis at corresponding enhancement levels, we standardized dynamic time frames for quantitative measurements (3 seconds after initial arterial bolus arrival for all arterial vessels and 3 seconds after the initial venous bolus arrival for all venous vessels).…”