RESUMEN
Moyamoya disease is characterized by progressive internal carotid artery (ICA) occlusion. Extracranial-intracranial bypass surgery is effective, particularly in pediatric patients; imaging plays a crucial role in evaluating intracranial perfusion pre- and post-surgery. Arterial spin labeling (ASL) is a magnetic resonance technique employed for noninvasive, whole-brain perfusion assessment by magnetically labeling inflowing blood. However, ASL cannot evaluate the territories and development of each vessel perfusion compared with digital subtraction angiography (DSA). Recently, super-selective ASL (SS-ASL) has been developed, performing pinpoint labeling on a specific artery at a time, and offering a tomographic view that distinctly displays blood supply areas for each vessel. Unlike DSA, SS-ASL is noninvasive and can be repeatedly performed in pediatric patients. In conclusion, SS-ASL is useful for evaluating bypass development over time and understanding the pathophysiology of pediatric moyamoya disease.
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Angiografía por Resonancia Magnética , Enfermedad de Moyamoya , Marcadores de Spin , Humanos , Enfermedad de Moyamoya/diagnóstico por imagen , Enfermedad de Moyamoya/cirugía , Niño , Angiografía por Resonancia Magnética/métodos , Masculino , Femenino , Angiografía Cerebral/métodos , Revascularización Cerebral/métodos , Preescolar , Angiografía de Substracción Digital/métodosRESUMEN
PURPOSE: This study aimed to compare assessments by radiologists, artificial intelligence (AI), and quantitative measurement using synthetic MRI (SyMRI) for differential diagnosis between astrocytoma, IDH-mutant and oligodendroglioma, and IDH-mutant and 1p/19q-codeleted and to identify the superior method. METHODS: Thirty-three cases (men, 14; women, 19) comprising 19 astrocytomas and 14 oligodendrogliomas were evaluated. Four radiologists independently evaluated the presence of the T2-FLAIR mismatch sign. A 3D convolutional neural network (CNN) model was trained using 50 patients outside the test group (28 astrocytomas and 22 oligodendrogliomas) and transferred to evaluate the T2-FLAIR mismatch lesions in the test group. If the CNN labeled more than 50% of the T2-prolonged lesion area, the result was considered positive. The T1/T2-relaxation times and proton density (PD) derived from SyMRI were measured in both gliomas. Each quantitative parameter (T1, T2, and PD) was compared between gliomas using the Mann-Whitney U-test. Receiver-operating characteristic analysis was used to evaluate the diagnostic performance. RESULTS: The mean sensitivity, specificity, and area under the curve (AUC) of radiologists vs. AI were 76.3% vs. 94.7%; 100% vs. 92.9%; and 0.880 vs. 0.938, respectively. The two types of diffuse gliomas could be differentiated using a cutoff value of 2290/128 ms for a combined 90th percentile of T1 and 10th percentile of T2 relaxation times with 94.4/100% sensitivity/specificity with an AUC of 0.981. CONCLUSION: Compared to the radiologists' assessment using the T2-FLAIR mismatch sign, the AI and the SyMRI assessments increased both sensitivity and objectivity, resulting in improved diagnostic performance in differentiating gliomas.
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Astrocitoma , Neoplasias Encefálicas , Glioma , Oligodendroglioma , Masculino , Humanos , Femenino , Oligodendroglioma/diagnóstico por imagen , Oligodendroglioma/genética , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patología , Inteligencia Artificial , Diagnóstico Diferencial , Estudios Retrospectivos , Mutación , Glioma/diagnóstico por imagen , Glioma/genética , Glioma/patología , Imagen por Resonancia Magnética/métodos , Astrocitoma/diagnóstico por imagen , Astrocitoma/genética , Isocitrato Deshidrogenasa/genéticaRESUMEN
Arterial spin labeling (ASL) is a noninvasive imaging technique that labels the proton spins in arterial blood and uses them as endogenous tracers. Brain perfusion imaging with ASL is becoming increasingly common in clinical practice, and clinical applications of ASL for intracranial magnetic resonance angiography (MRA) have also been demonstrated. Unlike computed tomography (CT) angiography and cerebral angiography, ASL-based MRA does not require contrast agents. ASL-based MRA overcomes most of the disadvantages of time-of-flight (TOF) MRA. Several schemes have been developed for ASL-based MRA; the most common method has been pulsed ASL, but more recently pseudo-continuous ASL, which provides a higher signal-to-noise ratio (SNR), has been used more frequently. New methods that have been developed include direct intracranial labeling methods such as velocity-selective ASL and acceleration-selective ASL. MRA using an extremely short echo time (eg, silent MRA) or ultrashort echo-time (TE) MRA can suppress metal susceptibility artifacts and is ideal for patients with a metallic device implanted in a cerebral vessel. Vessel-selective 4D ASL MRA can provide digital subtraction angiography (DSA)-like images. This review highlights the principles, clinical applications, and characteristics of various ASL-based MRA techniques. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
RESUMEN
This study aimed to investigate whether arterial spin labeling (ASL) features allow differentiation of oligodendroglioma, IDH-mutant and 1p/19q-codeleted (IDHm-codel) from diffuse glioma with IDH-wildtype (IDHw) or astrocytoma, IDH-mutant (IDHm-noncodel). Participants comprised 71 adult patients with pathologically confirmed diffuse glioma, classified as IDHw, IDHm-noncodel, or IDHm-codel. Subtraction images were generated from paired-control/label images on ASL and used to assess the presence of a cortical high-flow sign. The cortical high-flow sign was defined as increased ASL signal intensity within the tumor-affecting cerebral cortex compared with normal-appearing cortex. Regions without contrast enhancement on conventional MR imaging were targeted. The frequency of the cortical high-flow sign on ASL was compared among IDHw, IDHm-noncodel, and IDHm-codel. As a result, the frequency of the cortical high-flow sign was significantly higher for IDHm-codel than for IDHw or IDHm-noncodel. In conclusion, the cortical high-flow sign could represent a hallmark of oligodendroglioma, IDH-mutant, and 1p/19q-codeleted without intense contrast enhancement.
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Neoplasias Encefálicas , Glioma , Oligodendroglioma , Adulto , Humanos , Oligodendroglioma/diagnóstico por imagen , Oligodendroglioma/genética , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/genética , Mutación , Glioma/diagnóstico por imagen , Glioma/genética , Biomarcadores , Isocitrato Deshidrogenasa/genéticaRESUMEN
PURPOSE: Isocitrate dehydrogenase (IDH)-wildtype diffuse astrocytic glioma with telomerase reverse transcriptase (TERT) promoter mutation is defined as glioblastoma by the WHO 2021 criteria, revealing that TERT promotor mutation is highly associated with tumor aggressiveness. The aim of this study was to identify features from MR spectroscopy (MRS) and multi-exponential models of DWI distinguishing wild-type TERT (TERTw) from TERT promoter mutation (TERTm) in IDH-wildtype diffuse astrocytic glioma. METHODS: Participants comprised 25 adult patients with IDH-wildtype diffuse astrocytic glioma. Participants were classified into TERTw and TERTm groups. Point-resolved spectroscopy sequences were used for MRS data acquisition. DWI was performed with 13 different b-factors. Peak height ratios of NAA/Cr and Cho/Cr were calculated from MRS data. Mean apparent diffusion coefficient (ADC), perfusion fraction (f), diffusion coefficient (D), pseudo-diffusion coefficient (D*), distributed diffusion coefficient (DDC), and heterogeneity index (α) were obtained using multi-exponential models from DWI data. Each parameter was compared between TERTw and TERTm using the Mann-Whitney U test. Correlations between parameters derived from MRS and DWI were also evaluated. RESULTS: NAA/Cr and Cho/Cr were both higher for TERTw than for TERTm. The α of TERTw was smaller than that of TERTm, while the f of TERTw was higher than that of TERTm. NAA/Cr correlated negatively with α, but not with other DWI parameters. Cho/Cr did not show significant correlations with any DWI parameters. CONCLUSION: The combination of NAA/Cr and α may have merit in clinical situation to predict the TERT mutation status of IDH-wildtype diffuse astrocytic glioma without intense enhancement.
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Astrocitoma , Neoplasias Encefálicas , Telomerasa , Adulto , Humanos , Isocitrato Deshidrogenasa/genética , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patología , Imagen de Difusión por Resonancia Magnética/métodos , Astrocitoma/diagnóstico por imagen , Astrocitoma/genética , Astrocitoma/patología , Espectroscopía de Resonancia Magnética/métodos , Mutación , Telomerasa/genéticaRESUMEN
PURPOSE: Accurate assessment of cerebral perfusion in moyamoya disease is necessary to determine the indication for treatment. We aimed to investigate the usefulness of dynamic PCASL using a variable TR scheme with optimized background suppression in the evaluation of cerebral perfusion in moyamoya disease. METHODS: We retrospectively analyzed the images of 24 patients (6 men and 18 women, mean age 31.4 ± 18.2 years) with moyamoya disease; each of whom was imaged with both dynamic PCASL using the variable-TR scheme and 123IMP SPECT with acetazolamide challenge. ASL dynamic data at 10 phases are acquired by changing the LD and PLD. The background suppression timing was optimized for each phase. CBF and ATT were measured with ASL, and CBF and CVR to an acetazolamide challenge were measured with SPECT. RESULTS: A significant moderate correlation was found between the CBF measured by dynamic PCASL and that by SPECT (r = 0.53, P < 0.001). The CBF measured by dynamic PCASL (52.5 ± 13.3 ml/100 mg/min) was significantly higher than that measured by SPECT (43.0 ± 12.6 ml/100 mg/min, P < 0.001). The ATT measured by dynamic PCASL showed a significant correlation with the CVR measured by SPECT (r = 0.44, P < 0.001). ATT was significantly longer in areas where the CVR was impaired (CVR < 18.4%, ATT = 1812 ± 353 ms) than in areas where it was preserved (CVR > 18.4%, ATT = 1301 ± 437 ms, P < 0.001). The ROC analysis showed a moderate accuracy (AUC = 0.807, sensitivity = 87.7%, specificity = 70.4%) when the cutoff value of ATT was set at 1518 ms. CONCLUSION: Dynamic PCASL using this scheme was found to be useful for assessing cerebral perfusion in moyamoya disease.
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Enfermedad de Moyamoya , Masculino , Humanos , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Imagen por Resonancia Magnética/métodos , Acetazolamida , Marcadores de Spin , Estudios Retrospectivos , Circulación CerebrovascularRESUMEN
OBJECTIVES: To develop an automated model to detect brain metastases using a convolutional neural network (CNN) and volume isotropic simultaneous interleaved bright-blood and black-blood examination (VISIBLE) and to compare its diagnostic performance with the observer test. METHODS: This retrospective study included patients with clinical suspicion of brain metastases imaged with VISIBLE from March 2016 to July 2019 to create a model. Images with and without blood vessel suppression were used for training an existing CNN (DeepMedic). Diagnostic performance was evaluated using sensitivity and false-positive results per case (FPs/case). We compared the diagnostic performance of the CNN model with that of the twelve radiologists. RESULTS: Fifty patients (30 males and 20 females; age range 29-86 years; mean 63.3 ± 12.8 years; a total of 165 metastases) who were clinically diagnosed with brain metastasis on follow-up were used for the training. The sensitivity of our model was 91.7%, which was higher than that of the observer test (mean ± standard deviation; 88.7 ± 3.7%). The number of FPs/case in our model was 1.5, which was greater than that by the observer test (0.17 ± 0.09). CONCLUSIONS: Compared to radiologists, our model created by VISIBLE and CNN to diagnose brain metastases showed higher sensitivity. The number of FPs/case by our model was greater than that by the observer test of radiologists; however, it was less than that in most of the previous studies with deep learning. KEY POINTS: ⢠Our convolutional neural network based on bright-blood and black-blood examination to diagnose brain metastases showed a higher sensitivity than that by the observer test. ⢠The number of false-positives/case by our model was greater than that by the previous observer test; however, it was less than those from most previous studies. ⢠In our model, false-positives were found in the vessels, choroid plexus, and image noise or unknown causes.
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Neoplasias Encefálicas , Imagen por Resonancia Magnética , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/secundario , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Redes Neurales de la Computación , Estudios RetrospectivosRESUMEN
OBJECTIVES: To evaluate the usefulness of 4D-MR angiography based on super-selective pseudo-continuous ASL combined with keyhole and view-sharing (4D-S-PACK) for vessel-selective visualization and to examine the ability of this technique to visualize brain arteriovenous malformations (AVMs). METHODS: In this retrospective study, 15 patients (ten men and five women, mean age 44.0 ± 16.9 years) with brain AVMs were enrolled. All patients were imaged with 4D-PACK (non-selective), 4D-S-PACK, and digital subtraction angiography (DSA). Observers evaluated vessel selectivity, identification of feeding arteries and venous drainage patterns, visualization scores, and contrast-to-noise ratio (CNR) for each AVM component. Measurements were compared between the MR methods. RESULTS: Vessel selectivity was graded 4 in 43/45 (95.6%, observer 1) and 42/45 (93.3%, observer 2) territories and graded 3 in two (observer 1) and three (observer 2) territories. The sensitivity and specificity for identification of feeding arteries for both observers was 88.9% and 100% on 4D-PACK, and 100% and 100% on 4D-S-PACK, respectively. For venous drainage, the sensitivity and specificity was 100% on both methods for observer 1. The sensitivity and specificity for observer 2 was 94.4% and 83.3% on 4D-PACK, and 94.4% and 91.7% on 4D-S-PACK, respectively. The CNRs at the timepoint of 1600 ms were slightly lower in 4D-S-PACK than in 4D-PACK for all AVM components (Feeding artery, p = .02; nidus, p = .001; and draining artery, p = .02). The visualization scores for both observers were not significantly different between 4D-PACK and 4D-S-PACK for all components. CONCLUSIONS: 4D-S-PACK could be a useful non-invasive clinical tool for assessing hemodynamics in brain AVMs. KEY POINTS: ⢠The 4D-MR angiography based on super-selective pseudo-continuous arterial spin labeling combined with CENTRA-keyhole and view-sharing (4D-S-PACK) enabled excellent vessel selectivity. ⢠The 4D-S-PACK enabled the perfect identification of feeding arteries of brain arteriovenous malformation (AVM). ⢠4D-S-PACK could be a non-invasive clinical tool for assessing hemodynamics in brain AVMs.
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Hemodinámica/fisiología , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/fisiopatología , Angiografía por Resonancia Magnética/métodos , Adolescente , Adulto , Anciano , Angiografía de Substracción Digital/métodos , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Encéfalo/fisiopatología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Marcadores de Spin , Adulto JovenRESUMEN
PURPOSE: MRI-based risk stratification should be established to identify patients with internal carotid artery stenosis (ICS) who require further PET or SPECT evaluation. This study assessed whether multiparametric flow analysis using time-resolved 3D phase-contrast (4D flow) MRI can detect cerebral hemodynamic impairment in patients with ICS. METHODS: This retrospective study analyzed 26 consecutive patients with unilateral ICS (21 men; mean age, 71 years) who underwent 4D flow MRI and acetazolamide-stress brain perfusion SPECT. Collateral flow via the Willis ring was visually evaluated. Temporal mean flow volume rate (Net), pulsatile flow volume (ΔV), and pulsatility index (PI) at the middle cerebral artery were measured. Cerebral vascular reserve (CVR) was calculated from the SPECT dataset. Patients were assigned to the misery perfusion group if the CVR was < 10% and to the nonmisery perfusion group if the CVR was ≥ 10%. Parameters showing a significant difference in both groups were statistically evaluated. RESULTS: Affected side ΔV, ratio of affected to contralateral side Net (rNet), and ratio of affected to contralateral side ΔV were significantly correlated to CVR (p = 0.030, p = 0.010, p = 0.015, respectively). Absence of retrograde flow at the posterior communicating artery was observed in the misery perfusion group (p = 0.020). Combined cut-off values of the affected side ΔV (0.18 ml) and rNet (0.64) showed a sensitivity and specificity of 100% and 77.8%, respectively. CONCLUSION: Multiparametric flow analysis using 4D flow MRI can detect misery perfusion by comprehensively assessing blood flow data, including blood flow volume, pulsation, and collateral flow.
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Estenosis Carotídea/fisiopatología , Circulación Cerebrovascular , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/fisiopatología , Hemodinámica , Imagen por Resonancia Magnética/métodos , Anciano , Velocidad del Flujo Sanguíneo , Arteria Carótida Interna , Círculo Arterial Cerebral/diagnóstico por imagen , Femenino , Humanos , Imagenología Tridimensional , Masculino , Estudios Retrospectivos , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
PURPOSE: A new sequence for intracranial MRA is developed, named enhanced acceleration-selective arterial spin labeling (eAccASL), to improve main artery visualization at middle cerebral artery (MCA). The aim of this study is to assess the visualization improvement using eAccASL, compared with the previously developed AccASL. METHODS: eAccASL and AccASL were performed in 8 healthy volunteers and images were compared between the 2 sequences. One patient with Moyamoya disease was evaluated by eAccASL and time of flight. For the volunteer images, vessel visualization was assessed by measuring the contrast-to-noise ratio between MCA M1 to M4 and white matter and by counting the peripheral arteries. Venous artifact level was assessed by measuring the contrast-to-noise ratio between the confluence of the sinuses and white matter and by evaluating cortical vein visualization. For the patient images, qualitative assessment of peripheral and collateral vessel visualization was conducted. RESULTS: In the MCA main trunk, higher arterial signal intensity, with reduced flow void, was observed in eAccASL compared with AccASL. Contrast-to-noise ratios of M1 to M3 for eAccASL were significantly higher than those of AccASL. There was no significant difference between AccASL and eAccASL for venous artifact. CONCLUSION: eAccASL could produce better MCA main trunk visualization compared with AccASL, while maintaining good venous signal suppression.
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Encéfalo/diagnóstico por imagen , Angiografía por Resonancia Magnética , Arteria Cerebral Media/diagnóstico por imagen , Enfermedad de Moyamoya/diagnóstico por imagen , Marcadores de Spin , Aceleración , Adulto , Artefactos , Medios de Contraste , Voluntarios Sanos , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Relación Señal-Ruido , Venas/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Adulto JovenRESUMEN
PURPOSE: To evaluate the performance of acceleration-selective arterial spin labeling (AccASL) MR angiography in the visualization of brain arteriovenous malformations (AVMs) in comparison with digital subtraction angiography (DSA) and time-of-flight (TOF) MR angiography. METHODS: Twenty-one patients with brain AVM (mean age 31.1 ± 18.6 years; 11 males, 10 females) underwent TOF and AccASL MR angiography and DSA. Two neuroradiologists conducted an observer study for detection, nidus size, eloquence, venous drainage pattern, and Spetzler-Martin (SM) grade. The evaluations included the visualization of each AVM component with reference to DSA and assessments of contrast-to-noise ratio (CNR). The kappa statistic, repeated measures analysis of variance, Wilcoxon matched pairs test, and paired t test were used. RESULTS: Both observers detected more AVMs with AccASL (95.2%, 90.5% for Observers 1 and 2) than with TOF (76.2% and 71.4%, respectively). The inter-modality agreement between AccASL and DSA was almost perfect for the eloquence, venous drainage pattern, and SM grade for Observer 1 and moderate for the venous drainage pattern and substantial for the eloquence and SM grade for Observer 2. The visualization scores were higher with AccASL than with TOF for the feeding artery (AccASL, 4.5 ± 1.0 vs. TOF, 3.9 ± 1.5, p = 0.0214), nidus (4.6 ± 1.1 vs. 3.2 ± 1.5, p = 0.0006), and draining vein (4.6 ± 1.0 vs. 2.2 ± 1.1, p < 0.0001), respectively. The CNRs in the nidus were higher in AccASL than in TOF (29.9 ± 16.7 vs. 20.8 ± 16.5, p = 0.0002), as in the draining vein (23.2 ± 13.0 vs. 12.6 ± 12.0, p = 0.0010), respectively. CONCLUSIONS: AccASL better visualized brain AVMs compared with TOF and was useful for grading without the use of contrast agents.
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Angiografía Cerebral , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Angiografía por Resonancia Magnética , Adolescente , Adulto , Angiografía de Substracción Digital , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Estudios Retrospectivos , Marcadores de Spin , Adulto JovenRESUMEN
Purpose To evaluate and compare the performance of acceleration-selective arterial spin labeling (AccASL) magnetic resonance (MR) angiography in the visualization of cerebral arteries and collateral vessels in patients with Moyamoya disease with that of time-of-flight (TOF) MR angiography, with digital subtraction angiography (DSA) as the reference standard. Materials and Methods Thirty-six cerebral hemispheres from 22 patients with Moyamoya disease underwent TOF and AccASL MR angiography and DSA. Qualitative evaluations included imaging of the terminal internal carotid artery (ICA), distal middle cerebral arteries (MCAs), Moyamoya vessels, and leptomeningeal anastomosis (LMA) collaterals with reference to DSA. Quantitative evaluations included assessment of contrast-to-noise ratio (CNR) and number of vessels in MCA branches. The linear mixed-effect model was used to compare the two methods. Results Mean scores for qualitative evaluation were significantly higher with AccASL angiography than with TOF angiography for imaging distal MCAs (3.9 ± 0.3 [standard deviation] vs 2.9 ± 1.1; P < .001), Moyamoya vessels (3.6 ± 0.6 vs 2.7 ± 0.9, P < .001), and LMA collaterals (3.8 ± 0.6 vs 1.8 ± 0.7, P < .001). Scores for steno-occlusive degree around the terminal ICAs were better with TOF angiography than with AccASL angiography (2.6 ± 0.5 vs 2.4 ± 0.6, P = .023). CNRs in the M4 segment were significantly higher with AccASL angiography (11.9 ± 12.9, P < .001) than with TOF angiography (4.1 ± 7.9). The number of vessels was significantly higher with AccASL angiography (18.3 ± 5.0, P < .001) than with TOF angiography (8.9 ± 4.9). The increase in the number of vessels from TOF angiography to AccASL angiography was greater in patients with severe ICA steno-occlusion (late ICA stage group, 11.4 ± 4.5; early ICA stage group, 6.8 ± 4.0; P = .007) and well-developed leptomeningeal anastomosis (mildly developed LMA group, 7.1 ± 4.3; well-developed LMA group, 11.3 ± 4.5; P = .011). Conclusion AccASL MR angiography enables better visualization of distal cerebral arteries and collateral vessels in patients with Moyamoya disease than does TOF MR angiography, while TOF MR angiography enables better visualization of stenosis of proximal arteries. Both methods work in a mutually beneficial manner in the assessment of cerebral arteries. © RSNA, 2017 Online supplemental material is available for this article.
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Arterias Cerebrales/patología , Circulación Colateral/fisiología , Enfermedad de Moyamoya/patología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Adulto JovenRESUMEN
PURPOSE: 4D dynamic MR angiography (4D-MRA) using pseudo-continuous arterial spin labeling (pCASL), combined with Keyhole and View-sharing (4D-PACK) for scan acceleration, is introduced. Its validity for arterial inflow dynamics visualization was investigated through comparison with 4D-pCASL and contrast inherent inflow enhanced multiphase angiography (CINEMA). METHODS: Six healthy volunteers were included in the study. The arterial transit time (ATT) in 4D-PACK was measured at multiple regions in middle cerebral artery (MCA), and Pearson's correlation coefficient with ATT in 4D-pCASL was calculated. The contrast-to-noise ratio (CNR) in 4D-PACK was measured in four MCA segments and compared with that in 4D-pCASL and CINEMA. Arterial visualization in 4D-PACK was assessed qualitatively in patients with moyamoya disease and arteriovenous malformation by comparing with CINEMA. RESULTS: 4D-PACK achieved a 36% scan time reduction compared with 4D-pCASL. The correlation coefficient for ATT measured by 4D-pCASL and 4D-PACK was greater than 0.96. The CNR was significantly higher using 4D-PACK compared with CINEMA in the M4 segment (P < 0.01). In patient examinations, the flow in the collateral artery or draining vein was better visualized in 4D-PACK compared with CINEMA. CONCLUSION: 4D-PACK accelerates 4D-pCASL, shows similar inflow dynamics as 4D-pCASL and shows better peripheral visualization compared with CINEMA. Magn Reson Med 80:719-725, 2018. © 2018 International Society for Magnetic Resonance in Medicine.
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Arterias Cerebrales/diagnóstico por imagen , Imagenología Tridimensional/métodos , Angiografía por Resonancia Magnética/métodos , Adulto , Malformaciones Arteriovenosas/diagnóstico por imagen , Femenino , Humanos , Masculino , Enfermedad de Moyamoya/diagnóstico por imagen , Análisis de la Onda del PulsoRESUMEN
OBJECTIVES: To evaluate the performance of four-dimensional pseudo-continuous arterial spin labeling (4D-pCASL)-based angiography using CENTRA-keyhole and view sharing (4D-PACK) in the visualization of flow dynamics in distal cerebral arteries and leptomeningeal anastomosis (LMA) collaterals in moyamoya disease in comparison with contrast inherent inflow-enhanced multiphase angiography (CINEMA), with reference to digital subtraction angiography (DSA). METHODS: Thirty-two cerebral hemispheres from 19 patients with moyamoya disease (mean age, 29.7 ± 19.6 years; five males, 14 females) underwent both 4D-MR angiography and DSA. Qualitative evaluations included the visualization of anterograde middle cerebral artery (MCA) flow and retrograde flow via LMA collaterals with reference to DSA. Quantitative evaluations included assessments of the contrast-to-noise ratio (CNR) on these vessels. The linear mixed-effect model was used to compare the 4D-PACK and CINEMA methods. RESULTS: The vessel visualization scores were significantly higher with 4D-PACK than with CINEMA in the visualization of anterograde flow for both Observer 1 (CINEMA, 3.53 ± 1.39; 4D-PACK, 4.53 ± 0.80; p < 0.0001) and Observer 2 (CINEMA, 3.50±1.39; 4D-PACK, 4.31 ± 0.86; p = 0.0009). The scores were higher with 4D-PACK than with CINEMA in the visualization of retrograde flow for both Observer 1 (CINEMA, 3.44 ± 1.05; 4D-PACK, 4.47 ± 0.88; p < 0.0001) and Observer 2 (CINEMA, 3.19 ± 1.20; 4D-PACK, 4.38 ± 0.91; p < 0.0001). The maximum CNR in the anterograde flow was higher in 4D-PACK (40.1 ± 16.1, p = 0.0001) than in CINEMA (27.0 ± 16.6). The maximum CNR in the retrograde flow was higher in 4D-PACK (36.1 ± 10.0, p < 0.0001) than in CINEMA (15.4 ± 8.0). CONCLUSIONS: The 4D-PACK provided better visualization and higher CNRs in distal cerebral arteries and LMA collaterals compared with CINEMA in patients with this disease. KEY POINTS: ⢠The 4D-PACK enables good visualization of distal cerebral arteries in moyamoya disease. ⢠The 4D-PACK enables direct visualization of leptomeningeal collateral vessels in moyamoya disease. ⢠Vessel visualization by 4D-PACK can be useful in assessing cerebral hemodynamics.
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Angiografía de Substracción Digital/métodos , Arterias Cerebrales/diagnóstico por imagen , Tomografía Computarizada Cuatridimensional/métodos , Angiografía por Resonancia Magnética/métodos , Enfermedad de Moyamoya/diagnóstico , Adolescente , Adulto , Arterias Cerebrales/fisiopatología , Niño , Preescolar , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Moyamoya/fisiopatología , Adulto JovenRESUMEN
Synthetic MRI can provide proton density (PD), T1 value, T2 value for each pixel by only one data acquisition and can create various contrast-weighted images. The aim of this study is to evaluate the effect on the calculation of the T1·T2 value when changing the scan parameters for synthetic MRI. In the phantom study, when changing 1st TE/2nd TE/TR/TSE factor, the effect on the T1·T2 value calculated by synthetic MRI was examined. In the volunteer study, the brain was imaged and compared with known T1·T2 value. In phantom study, the effect on the T2 value by the 1st TE/2nd TE/TSE factor was shown. In volunteer study, there was no problem in the calculated value of brain parenchyma. However, the T2 value of cerebrospinal fluid had the error of known value. The results show that it is necessary to set appropriate scan parameters on synthetic MRI.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Adulto , Encéfalo/diagnóstico por imagen , Femenino , Humanos , Masculino , Fantasmas de Imagen , Adulto JovenRESUMEN
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Asunto(s)
Encéfalo/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador/métodos , Angiografía por Resonancia Magnética/métodos , Arteria Cerebral Media/diagnóstico por imagen , Marcadores de Spin , Venas/diagnóstico por imagen , Aceleración , Angiografía de Substracción Digital/métodos , Encéfalo/patología , Arteria Carótida Interna/diagnóstico por imagen , Humanos , Perfusión , Relación Señal-Ruido , Venas/patología , Sustancia Blanca/diagnóstico por imagenRESUMEN
PURPOSE: To demonstrate the usefulness of hyperecho and PROPELLER (HEP) for carotid arterial vessel wall imaging by using a quantitative comparison with conventional methods. PROPELLER is a motion-insensitive turbo spin-echo (TSE) sequence and has recently been utilized in magnetic resonance (MR) plaque imaging instead of double inversion recovery TSE (DIR-TSE). Wider blade-width, higher k-space density, and an improved blood suppression effect result in better image quality. In this study we introduce a new combination of HEP. MATERIALS AND METHODS: A total of 17 subjects were examined on a 3.0T system. We conducted quantitative comparisons for signal-to-noise ratio (SNR), contrast-to-noise-ratio, and image sharpness among HEP, DIR-TSE, and conventional PROPELLER (c-PROPELLER). Subsequently, images obtained with DIR-TSE, c-PROPELLER, and HEP were visually evaluated using a three-point scale by two board-certified radiologists. RESULTS: HEP showed high SNR similar to c-PROPELLER, good T2 contrast approximating DIR-TSE, and better blood suppression compared with the other two methods (P < 0.05). The image sharpness of HEP (2.55 ± 0.53) was higher than that of DIR-TSE (1.89 ± 0.33) and the absence of ghost or streak artifacts in HEP (2.89 ± 0.33) was better than that in both other methods (2.22 ± 0.83 for DIR-TSE and 2.00 ± 0.50 for c-PROPELLER) (P < 0.05). Furthermore, the degree of blood suppression, particularly in cases of slow or turbulent flow close to the atherosclerotic plaque, was identical for HEP (2.80 ± 0.45) and DIR-TSE (2.80 ± 0.45) but was significantly better than for c-PROPELLER (1.60 ± 0.55) (P < 0.05). CONCLUSION: This study demonstrates the usefulness of HEP in the carotid arteries. HEP can provide higher-resolution T2 -weighted black-blood imaging without flow- and/or motion-related artifacts, compared to conventional techniques. LEVEL OF EVIDENCE: 3 J. Magn. Reson. Imaging 2017;45:515-524.
Asunto(s)
Arterias Carótidas/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Angiografía por Resonancia Magnética/métodos , Procesamiento de Señales Asistido por Computador , Arterias Carótidas/patología , Estenosis Carotídea/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Movimiento (Física) , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To assess arterial visibility on 4D time-of-flight (4D-TOF) by temporal magnetization transfer contrast pulse (t-MTC) and temporal tilted optimized nonsaturating excitation (t-TONE). 3D-TOF magnetic resonance angiography (MRA) is used for the noninvasive assessment of the intracranial arteries. However, it does not provide temporal information for diagnosing hemodynamics. To noninvasively obtain more detailed hemodynamics-related information, we developed a novel time-resolved MRA without the arterial spin labeling technique, termed 4D-TOF MRA using saturation pulse. MATERIALS AND METHODS: On a 3.0T MRI, three techniques were compared to optimize the visibility of the arteries above the circle of Willis; 1) simple 4D-TOF, 2) 4D-TOF with t-MTC, and 3) 4D-TOF with t-MTC and t-TONE. Eight healthy volunteers were scanned with these three sequences. The contrast changes between the background tissue and the arteries in temporal phases were assessed and compared quantitatively and qualitatively. RESULTS: The contrast between the background and the arteries for 4D-TOF with t-MTC and t-TONE was significantly higher than those for the other methods in delayed phases (P < 0.001).The qualitative assessment showed that 4D-TOF with t-MTC and with t-MTC and t-TONE provided better visualization of the intracranial artery than simple 4D-TOF (P < 0.001). CONCLUSION: 4D-TOF with t-TONE and t-MTC enabled observation of the intracranial hemodynamics. Optimized 4D-TOF provides high-quality images without image subtraction, and good visibility of the intracranial arteries even in the prolonged observation time. J. Magn. Reson. Imaging 2016;43:1320-1326.
Asunto(s)
Angiografía Cerebral/métodos , Arterias Cerebrales/fisiología , Circulación Cerebrovascular/fisiología , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Angiografía por Resonancia Magnética/métodos , Procesamiento de Señales Asistido por Computador , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Arterias Cerebrales/diagnóstico por imagen , Humanos , Aumento de la Imagen/métodos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
PURPOSE: To assess the clinical utility of tissue-specific variable refocusing flip-angle (VRFA) turbo-spin echo imaging for three-dimensional T2-weighted imaging (3D-T2WI) of the liver. MATERIALS AND METHODS: Fifty-nine patients were scanned with three types of fat-suppressed T2WI for the comparison: two-dimensional single-shot turbo spin echo T2WI (ssT2WI), 3D-T2WI with tissue-specific VRFA (VISTA-TSV), and 3D-T2WI with low-constant VRFA (VISTA). Qualitatively, artifacts in the left and right lobes of the liver and black-blood effects in the liver were compared using the Wilcoxon signed-rank test with the Bonferroni correction. The detection and correct characterization rates of liver lesions were compared using McNemar's test. RESULTS: VISTA-TSV showed reduced artifacts in the left and right lobes of the liver compared with VISTA (P < 0.017). The artifacts shown by VISTA-TSV were equivalent to those shown by ssT2WI. The black-blood effects of VISTA-TSV and VISTA were better than that of ssT2WI (P < 0.017). VISTA-TSV showed the best detection and correct characterization rate of liver lesions among the three imaging techniques (P < 0.05). CONCLUSION: 3D-T2WI with tissue-specific VRFA can reduce artifacts of the liver, sufficiently suppress the signal in blood vessels, and has a potential to improve the detection and correct characterization rates of liver lesions.