Single breathhold noncontrast thoracic MRA using highly accelerated parallel imaging with a 32‐element coil array

Xu, Jian; McGorty, Kelly Anne; Lim, Ruth; Bruno, Mary; Babb, James S.; Srichai, Monvadi B.; Kim, Daniel; Sodickson, Daniel K.

doi:10.1002/jmri.23535

Cited by 13 publications

(6 citation statements)

References 32 publications

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“…However, ECG-gated CE-MRA does not provide the same high image quality of ECG-and navigator gated non-CE-MRA techniques such as 3D SSFP for the aortic root [11,30]. Additionally, ECG-gating proves to be challenging and leads to prolonged scan time potentially resulting in suboptimal contrast phase, especially in bradycardic patients; therefore, non-ECG-gated CE-MRA is still the most widely used technique in clinical routine [38].…”

Section: Limitationsmentioning

confidence: 99%

Comparison of a novel Compressed SENSE accelerated 3D modified relaxation-enhanced angiography without contrast and triggering with CE-MRA in imaging of the thoracic aorta

Pennig

Wagner

Weiss

et al. 2020

Int J Cardiovasc Imaging

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To compare a novel Compressed SENSE accelerated ECG- and respiratory-triggered flow-independent 3D isotropic Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT) with standard non-ECG-triggered 3D contrast-enhanced magnetic resonance angiography (CE-MRA) for imaging of the thoracic aorta in patients with connective tissue diseases (CTD) or other aortic diseases using manual and semiautomatic measurement approaches. This retrospective, single-center analysis of 30 patients (June–December 2018) was conducted by two radiologists, who independently measured aortic diameters on modified REACT and CE-MRA using manual (Multiplanar-Reconstruction) and semiautomatic (Advanced Vessel Analysis) measurement tools on seven levels (inner edge): Aortic annulus and sinus, sinotubular junction, mid- and high-ascending aorta, aortic isthmus, and descending aorta. Bland–Altman analysis was conducted to evaluate differences between the mean values of aortic width and ICCs were calculated to assess interobserver agreement. For each level, image quality was evaluated on a four-point scale in consensus with Wilcoxon matched-pair test used to evaluate for differences between both MRA techniques. Additionally, evaluation time for each measurement technique was noted, which was compared applying one-way ANOVA. When comparing both imaging and measurement methods, CE-MRA (mean difference 0.24 ± 0.27 mm) and the AVA-tool (− 0.21 ± 0.15 mm) yielded higher differences compared to modified REACT (− 0.11 ± 0.11 mm) and the MPR-tool (0.07 ± 0.21 mm) for all measurement levels combined without yielding clinical significance. There was an excellent interobserver agreement between modified REACT and CE-MRA using both tools of measurement (ICC > 0.9). Modified REACT (average acquisition time 06:34 ± 01:36 min) provided better image quality from aortic annulus to mid-ascending aorta (p < 0.05), whereas at distal measurement levels, no significant differences were noted. Regarding time requirement, no statistical significance was found between both measurement techniques (p = 0.08). As a novel non-CE-MRA technique, modified REACT allows for fast imaging of the thoracic aorta with higher image quality in the proximal aorta than CE-MRA enabling a reliable measurement of vessel dimensions without the need for contrast agent. Thus, it represents a clinically suitable alternative for patients requiring repetitive imaging. Manual and semiautomatic measurement approaches provided comparable results without significant difference in time need.

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Section: Limitationsmentioning

confidence: 99%

Comparison of a novel Compressed SENSE accelerated 3D modified relaxation-enhanced angiography without contrast and triggering with CE-MRA in imaging of the thoracic aorta

Pennig

Wagner

Weiss

et al. 2020

Int J Cardiovasc Imaging

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“…Most previous studies assessed the image quality of the thoracic aorta with ECG-triggered SSFP-MRA versus non-ECG-triggered CE-MRA using visual classification criteria [ 18 , 19 , 28 , 29 , 31 , 33 ], whereas one lacked these criteria [ 15 ] and another two studies used a semi-automatic approach [ 24 , 30 ]. Despite the variation of methods, all studies reported improved image quality with SSFP-MRA for the aortic root [ 15 , 19 , 28 – 31 , 33 , 34 ]. Some studies also reported increased image quality of the mid-ascending aorta [ 19 , 24 , 29 , 30 , 34 ] and mid-descending aorta [ 19 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Validation of thoracic aortic dimensions on ECG-triggered SSFP as alternative to contrast-enhanced MRA

et al. 2020

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Objectives Assessment of thoracic aortic dimensions with non-ECG-triggered contrast-enhanced magnetic resonance angiography (CE-MRA) is accompanied with motion artefacts and requires gadolinium. To avoid both motion artefacts and gadolinium administration, we evaluated the similarity and reproducibility of dimensions measured on ECG-triggered, balanced steady-state free precession (SSFP) MRA as alternative to CE-MRA. Methods All patients, with varying medical conditions, referred for thoracic aortic examination between September 2016 and March 2018, who underwent non-ECG-triggered CE-MRA and SSFP-MRA (1.5 T) were retrospectively included (n = 30). Aortic dimensions were measured after double-oblique multiplanar reconstruction by two observers at nine landmarks predefined by literature guidelines. Image quality was scored at the sinus of Valsalva, mid-ascending aorta and mid-descending aorta by semi-automatically assessing the vessel sharpness. Results Aortic dimensions showed high agreement between non-ECG-triggered CE-MRA and SSFP-MRA (r = 0.99, p < 0.05) without overestimation or underestimation of aortic dimensions in SSFP-MRA (mean difference, 0.1 mm; limits of agreement, − 1.9 mm and 1.9 mm). Intra- and inter-observer variabilities were significantly smaller with SSFP-MRA for the sinus of Valsalva and sinotubular junction. Image quality of the sinus of Valsalva was significantly better with SSFP-MRA, as fewer images were of impaired quality (3/30) than in CE-MRA (21/30). Reproducibility of dimensions was significantly better in images scored as good quality compared to impaired quality in both sequences. Conclusions Thoracic aortic dimensions measured on SSFP-MRA and non-ECG-triggered CE-MRA were similar. As expected, SSFP-MRA showed better reproducibility close to the aortic root because of lesser motion artefacts, making it a feasible non-contrast imaging alternative. Key Points • SSFP-MRA provides similar dimensions as non-ECG-triggered CE-MRA. • Intra- and inter-observer reproducibilities improve for the sinus of Valsalva and sinotubular junction with SSFP-MRA. • ECG-triggered SSFP-MRA shows better image quality for landmarks close to the aortic root in the absence of cardiac motion.

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“…These approaches used lower acceleration factor of 2. Although parallel imaging has been used with higher rate for breath-hold non-contrast thoracic MRA [ 47 , 48 ], its feasibility for free breathing CE-PV MRA has not been shown yet. Furthermore, due to noise penalty induced by the g-factor maps, parallel imaging has been shown to result in higher noise level than compressed sensing [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Accelerated free breathing ECG triggered contrast enhanced pulmonary vein magnetic resonance angiography using compressed sensing

Roujol

Foppa

Basha

et al. 2014

Journal of Cardiovascular Magnetic Resonance

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BackgroundTo investigate the feasibility of accelerated electrocardiogram (ECG)-triggered contrast enhanced pulmonary vein magnetic resonance angiography (CE-PV MRA) with isotropic spatial resolution using compressed sensing (CS).MethodsNineteen patients (59 ± 13 y, 11 M) referred for MR were scanned using the proposed accelerated free breathing ECG-triggered 3D CE-PV MRA sequence (FOV = 340 × 340 × 110 mm3, spatial resolution = 1.5 × 1.5 × 1.5 mm3, acquisition window = 140 ms at mid diastole and CS acceleration factor = 5) and a conventional first-pass breath-hold non ECG-triggered 3D CE-PV MRA sequence. CS data were reconstructed offline using low-dimensional-structure self-learning and thresholding reconstruction (LOST) CS reconstruction. Quantitative analysis of PV sharpness and subjective qualitative analysis of overall image quality were performed using a 4-point scale (1: poor; 4: excellent).ResultsQuantitative PV sharpness was increased using the proposed approach (0.73 ± 0.09 vs. 0.51 ± 0.07 for the conventional CE-PV MRA protocol, p < 0.001). There were no significant differences in the subjective image quality scores between the techniques (3.32 ± 0.94 vs. 3.53 ± 0.77 using the proposed technique).ConclusionsCS-accelerated free-breathing ECG-triggered CE-PV MRA allows evaluation of PV anatomy with improved sharpness compared to conventional non-ECG gated first-pass CE-PV MRA. This technique may be a valuable alternative for patients in which the first pass CE-PV MRA fails due to inaccurate first pass timing or inability of the patient to perform a 20–25 seconds breath-hold.

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Single breathhold noncontrast thoracic MRA using highly accelerated parallel imaging with a 32‐element coil array

Cited by 13 publications

References 32 publications

Comparison of a novel Compressed SENSE accelerated 3D modified relaxation-enhanced angiography without contrast and triggering with CE-MRA in imaging of the thoracic aorta

Comparison of a novel Compressed SENSE accelerated 3D modified relaxation-enhanced angiography without contrast and triggering with CE-MRA in imaging of the thoracic aorta

Validation of thoracic aortic dimensions on ECG-triggered SSFP as alternative to contrast-enhanced MRA

Accelerated free breathing ECG triggered contrast enhanced pulmonary vein magnetic resonance angiography using compressed sensing

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