Hemodynamic assessment of celiaco-mesenteric anastomosis in patients with pancreaticoduodenal artery aneurysm concomitant with celiac artery occlusion using flow-sensitive four-dimensional magnetic resonance imaging.

OBJECTIVES: Many pancreaticoduodenal artery (PDA) aneurysms are associated with celiac artery (CA) stenosis. The pathogenesis of PDA aneurysm may be associated with hemodynamic changes due to CA stenosis/occlusion. The aim of this study was to assess the hemodynamic changes of celiaco-mesenteric anastomosis in patients with PDA aneurysms concomitant with CA occlusion using four-dimensional flow-sensitive magnetic resonance imaging (4D-Flow). METHODS: 4D-Flow was performed preoperatively on five patients. Seven age- and sex-matched individuals were used as controls. Hemodynamic parameters such as flow volume and maximum flow velocity in PDAs, gastroduodenal arteries, common hepatic arteries, and superior mesenteric arteries were compared between both groups. Wall shear stress (WSS) and oscillatory shear index (OSI) were mapped in both groups. RESULTS: In the patient group, 4D-Flow identified retrograde flow of both gastroduodenal arteries and common hepatic arteries. Heterogeneous distribution patterns of both WSS and OSI were identified across the entire PDA in the patient group. OSI mapping showed multiple regions with extremely high OSI values (OSI > 0.3) in all patients. All PDA aneurysms, which were surgically resected, were atherosclerotic. CONCLUSIONS: 4D-Flow identified hemodynamic changes in celiaco-mesenteric arteries in patients with PDA aneurysms with concomitant CA occlusion. These hemodynamic changes may be associated with PDA aneurysm formation.

Visualization of hemodynamics in a silicon aneurysm model using time-resolved, 3D, phase-contrast MRI.

We performed time-resolved 3D phase-contrast MR imaging by using a 1.5T MR scanner to visualize hemodynamics in a silicon vascular model with a middle cerebral aneurysm. We ran an aqueous solution of glycerol as a flowing fluid with a pulsatile pump. Time-resolved images of 3D streamlines and 2D velocity vector fields clearly demonstrated that the aneurysm had 3D complex vortex flows within it during systolic phase. This technique provided us with time-resolved 3D hemodynamic information about the intracranial aneurysm.

MR imaging of flow with locally high spatial resolution.

Locally focused magnetic resonance imaging (LF MRI) allows imaging with variable spatial resolution within the field of view (FOV). Because LF MRI uses a priori information to provide locally high resolution in regions with rapid spatial variations in intensity (e.g., blood/tissue interface), it allows accurate reproduction of intense sharp edges in the specimen without blurring and truncation artifacts. This study employs LF MRI for 3D imaging of stationary and pulsatile flow. In the implemented version of LF MRI analytically defined basis functions are used to determine image intensity in regions depicted with low or high resolution. It is demonstrated that LF MRI of flow allows a significant (i.e. 3-4 times) reduction in scan time as compared to conventional FT MRI. It is also shown that LF images of pulsatile flow have a decreased appearance of ghosting artifacts as compared to the images reconstructed by using the conventional method.

Complete intracranial arterial and venous blood flow evaluation with 4D flow MR imaging.

SUMMARY: Time-resolved, 3D velocity-encoded MR imaging (4D Flow) allows for the acquisition of dynamic, multidirectional data on blood flow and has recently been used for the evaluation of intracranial arterial flow. Using a 3T system with optimization of both temporal resolution and k-space subsampling with a combination of parallel imaging and cut-corner acquisition, we present the clinical assessment of a patient with an arteriovenous malformation by providing complete intracranial arterial and venous coverage in a reasonable scan time.

Differentiation between the effects of T1 and T2* shortening in contrast-enhanced MRI of the breast.

The purpose of this study is to describe a technique for magnetic resonance imaging (MRI) that can potentially improve identification of malignant tissue in the human breast. The suggested MRI technique is based on the differentiation between two competing effects leading to opposite changes in image intensity, namely, T1 and T2* shortening caused by administration of gadolinium chelate. The proposed approach also allows calculation of changes in the R2* relaxation rate in breast tissue. The feasibility of the technique for in vivo MRI and increased lesion contrast is demonstrated. The results indicate that this technique may improve detection of malignant breast tissue.

Balanced phase-contrast steady-state free precession (PC-SSFP): a novel technique for velocity encoding by gradient inversion.

A technique for measuring velocity is presented that combines cine phase contrast (PC) MRI and balanced steady-state free precession (SSFP) imaging, and is thus termed PC-SSFP. Flow encoding was performed without the introduction of additional velocity encoding gradients in order to keep the repetition time (TR) as short as in typical SSFP imaging sequences. Sensitivity to through-plane velocities was instead established by inverting (i.e., negating) all gradients along the slice-select direction. Velocity sensitivity (VENC) could be adjusted by altering the first moments of the slice-select gradients. Disturbances of the SSFP steady state were avoided by acquiring different flow echoes in consecutively (i.e., sequentially) executed scans, each over several cardiac cycles, using separate steady-state preparation periods. A comparison of phantom measurements with those from established 2D-cine-PC MRI demonstrated excellent correlation between both modalities. In examinations of volunteers, PC-SSFP exhibited a higher intrinsic signal-to-noise ratio (SNR) and consequently low phase noise in measured velocities compared to conventional PC scans. An additional benefit of PC-SSFP is that it relies less on in-flow-dependent signal enhancement, and thus yields more uniform SNRs and better depictions of vessel geometry throughout the whole cardiac cycle in structures with slow and/or pulsatile flow.

Gradient characterization using a Fourier-transform technique.

This paper describes a technique for characterizing the gradient subsystem of a magnetic resonance (MR) system. The technique uses a Fourier-transform analysis to directly measure the k-space trajectory produced by an arbitrary gradient waveform. In addition, the method can be easily extended to multiple dimensions and can be adapted to measuring residual gradient effects such as eddy currents. Several examples of gradient waveform and eddy-current measurements are presented. Also, it is demonstrated how the eddy-current measurements can be parameterized with an impulse-response formalism for later use in system tuning. When compared to a peak-fitting analysis, this technique provides a more direct extraction of the k-space measurements, which reduces the possibility of analysis error. This approach also has several advantages as compared to the conventional eddy-current measurement technique, including the ability to measure very short time constant effects.

Development of a phased-array coil for the lower extremities.

A phased-array coil was developed to facilitate imaging the vasculature of the lower extremities. The array consists of four surface coils placed in a Plexiglas "I-beam" frame that are configured to allow bilateral studies with up to a 40-cm field of view (FOV). Data from phantoms indicate an increase in signal-to-noise ratio (SNR) in the regions of interest by an average factor of 2.8 +/- 0.9 over that of the body coil. Preliminary in vivo data have also been obtained from n = 8 subjects and demonstrate significant improvements in image quality. The coil design described here should lead to reduced scan times through the ability to image both legs simultaneously with less need for patient repositioning.

Angiographic imaging with 2D RF pulses.

Magnetic resonance angiography (MRA) was performed by using RF pulses designed to excite a limited spatial extent in two orthogonal directions. The restriction in the second spatial dimension can be used to increase inflow enhancement and to improve small field-of-view imaging. A rectangular excitation was produced with an "echo-planar" k-space trajectory and a sinc-modulated RF waveform. In vivo images have demonstrated that vessels are more clearly delineated with the two-dimensional excitation. Aliasing artifacts in small field-of-view imaging are significantly reduced, although in some cases complete elimination is not possible due to the nature of the gradient trajectory.

Three-dimensional cardiac cine magnetic resonance imaging with an ultrasmall superparamagnetic iron oxide blood pool agent (NC100150).

The purpose of this study was to assess image quality of three-dimensional (3D) cardiac cine magnetic resonance (MR) imaging before and after administration of a T1-shortening ultrasmall superparamagnetic iron oxide blood pool agent (NC100150). 3D cardiac cine MR imaging was performed in 13 volunteers using a radiofrequency-spoiled cardiac-gated 3D cine gradient-echo sequence with short repetition and echo times. Compared with precontrast images, postcontrast images showed no enhancement in fat and skeletal muscle, moderate enhancement in myocardium, and significant enhancement in ventricular cavity. After contrast injection, the signal ratio of the ventricular chamber to the myocardium significantly increased, and dramatic improvements were seen in the quality of the cineangiographic images and the depiction of cardiac valves. This quantitative study has shown that 3D cardiac cine MR imaging using a blood pool agent provided MR ventriculography and cineangiography with excellent image quality.

A reduced field-of-view method to increase temporal resolution or reduce scan time in cine MRI.

In some dynamic applications of MRI, only a part of the field-of-view (FOV) actually undergoes dynamic changes. A class of methods, called reduced-FOV (rFOV) methods, convert the knowledge that some part of the FOV is static or not very dynamic into an increase in temporal resolution for the dynamic part, or into a reduction in the scan time. Although cardiac imaging is an important example of an imaging situation where changes are concentrated in a fraction of the FOV, the rFOV methods developed up to now are not compatible with one of the most common cardiac sequences, the so-called retrospective cine method. The present work is a rFOV method designed to be compatible with cine imaging. An increase by a factor n in temporal resolution or a decrease by n in scan time is obtained in the case where only one nth of the FOV is dynamic (the rest being considered static). Results are presented for both Cartesian and spiral imaging.

Ultrafast contrast-enhanced three-dimensional MR angiography: state of the art.

Ultrafast breath-hold contrast material-enhanced magnetic resonance (MR) angiography can be performed with a flexible imaging sequence. With the current generation of high-speed imaging gradients, it is possible to achieve sequence repetition times of 4 msec or less. These repetition times make it possible to obtain high-resolution (512 x 512 x 64) images in under 30 seconds. Applications of this versatile technique include imaging of aortic dissection, thoracic and abdominal aortic aneurysm, pulmonary embolus, carotid stenosis, and peripheral vascular disease. The administration of contrast material must be tailored to the vascular anatomy under examination to avoid venous enhancement. The rapid data acquisition times can be used to image multiple temporal phases or multiple locations. With this technique and administration of a T1-shortening contrast agent, high-quality MR angiography can be routinely performed in a variety of vascular regions (eg, thoracic and abdominal aorta, pulmonary arteries, carotid arteries, lower extremities).

Flow effects in balanced steady state free precession imaging.

An analysis of the effect of flow on 2D fully balanced steady state free precession (SSFP) imaging is presented. Transient and steady-state SSFP signal intensities in the presence of steady and pulsatile flow were simulated using a matrix formalism based on the Bloch equations. Various through-plane flow waveforms and rates were modeled numerically considering factors such as the excitation slice profile and both in- and out-flow effects. Phantom measurements in an experimental setup that allowed the assessment of SSFP signal properties as a function of frequency offset and flow rate demonstrated that the computer simulations provided a suitable description of the effects of flow in SSFP imaging. A volunteer scan was performed to provide in vivo validations. For accurate modeling of SSFP signal intensities it is crucial to include effects such as imperfect slice profiles and, more importantly, "out-of-slice" contributions to the signal. Both simulations and experiments show that there can be considerably large-frequency offset dependent-signal contributions from flowing spins that have already left the imaging slice but still add to the SSFP signal. Although spins leaving the slice do not experience additional RF-excitation, gradient activity is not confined to the region of excitations and the balanced nature of the SSFP imaging gradients allows "out-of-slice" transverse magnetization to contribute to the total SSFP signal, effectively by broadening the slice thickness for flowing spins. This results in a frequency dependence of in-flow related signal enhancement and flow artifacts.

Partial fat-saturated contrast-enhanced three-dimensional MR angiography compared with non-fat-saturated and conventional fat-saturated MR angiography.

Abdominal three-dimensional magnetic resonance angiography was performed in 35 patients in the equilibrium phase without fat saturation, with conventional fat saturation, and with fast partial fat saturation. Qualitative and quantitative evaluation demonstrated significantly better vessel visualization with both fat-saturated techniques. The partial fat-saturated technique provided water-specific images within a breath hold, reducing motion artifacts significantly.

A complex-difference phase-contrast technique for measurement of volume flow rates.

Magnetic resonance (MR) phase-difference methods work well for measuring volumetric flow rates when the vessel diameter is large compared with the in-plane voxel dimensions. For small vessels (eg, coronary arteries), partial-volume effects introduce substantial errors in the measured volume flow rate. To correctly measure flow rates through a voxel, both the fraction of the voxel containing moving spins and the phase shift imparted to those spins must be known. The authors propose a flow measurement method that combines information obtained with both the complex-difference and phase-difference processing techniques and thereby provides the fractional volume occupied by the moving spins and the phase of those spins. The complex-difference flow map method proposed results in improved accuracy of MR phase-contrast flow measurements in the presence of partial-volume effects.

Locally focused contrast-enhanced carotid MRA.

With conventional Fourier transform (FT) magnetic resonance imaging (MRI), it is difficult to perform contrast-enhanced three-dimensional (3D) MR angiography (MRA) with the temporal and spatial resolution necessary to depict the carotid arteries. However, locally focused (LF) MRI is a more efficient method that utilizes prior knowledge of the image content to reconstruct images from sparse k-space samples. In this paper, we show how LF MRI can be used to perform high-resolution gadolinium (Gd)-enhanced 3D carotid MRA in less than 10 seconds. First, the accuracy of the technique was demonstrated by comparing LF and conventional (FT) images of a vascular phantom. Then the method was used to perform Gd-enhanced 3D MRA of a patient's carotid arteries. Instead of using bolus timing, the arterial phase was retrospectively identified in a consecutive series of images, just as in X-ray angiography.

Coronary MRI with a respiratory feedback monitor: the 2D imaging case.

The inability to return the heart to the same position for all breath-holds during 2D coronary MR imaging can result in imaging different locations than desired. This can lead to problems such as (i) missing a whole vessel, or a part of it, (ii) misaligning segments of vessels imaged in different breath-holds, and (iii) degrading image quality when a single slice is acquired in multiple breath-holds. To reduce inconsistencies in the breath-hold level, we designed a respiratory feedback monitor (RFM) that uses a bellows to monitor the circumference of the subject's chest. When the circumference of the subject's chest is within preset limits, an audio signal alerts subjects to hold their breath at that position. Use of the RFM significantly reduces the problems caused by inconsistent breath-holds and the number of breath-holds for an examination in 2D coronary MR imaging.

Respiratory blur in 3D coronary MR imaging.

3D MR imaging of coronary arteries has the potential to provide both high resolution and high signal-to-noise ratio, but it is very susceptible to respiratory artifacts, especially respiratory blurring. Resolution loss caused by respiratory blurring in 3D coronary imaging is analyzed theoretically and verified experimentally. Under normal respiration, the width for any Gaussian point spread function is increased to a new value that is at least several millimeters (about 3-4 mm). In vivo studies were performed to compare respiratory pseudo-gated 3D acquisition with breath-hold 2D acquisition. On average, the overall quality of a pseudo-gated 3D image is worse than that of the corresponding breath-hold 2D image (P = 0.005). In most cases, respiratory blur caused coronary arteries in pseudo-gated 3D data to have lower resolution than in breath-hold 2D data.

Analysis and generalized correction of the effect of spatial gradient field distortions in diffusion-weighted imaging.

Nonuniformities of magnetic field gradients can cause serious artifacts in diffusion imaging. While it is well known that nonlinearities of the imaging gradients lead to image warping, those imperfections can also cause spatially dependent errors in the direction and magnitude of the diffusion encoding. This study shows that the potential errors in diffusion imaging are considerable. Further, we show that retrospective corrections can be applied to reduce these errors. A general mathematical framework was formulated to characterize the contribution of gradient nonuniformities to diffusion experiments. The gradient field was approximated using spherical harmonic expansion, and this approximation was employed (after geometric distortions were eliminated) to predict and correct the errors in diffusion encoding. Before the corrections were made, the experiments clearly revealed marked deviations of the calculated diffusivity for fields of view (FOVs) generally used in diffusion experiments. These deviations were most significant farther away from the magnet's isocenter. For an FOV of 25 cm, the resultant errors in absolute diffusivity ranged from approximately -10% to +20%. Within the same FOV, the diffusion-encoding direction and the orientation of the calculated eigenvectors can be significantly altered if the perturbations by the gradient nonuniformities are not considered. With the proposed correction scheme, most of the errors introduced by gradient nonuniformities can be removed.

Generalized reconstruction of phase contrast MRI: analysis and correction of the effect of gradient field distortions.

To characterize gradient field nonuniformity and its effect on velocity encoding in phase contrast (PC) MRI, a generalized model that describes this phenomenon and enables the accurate reconstruction of velocities is presented. In addition to considerable geometric distortions, inhomogeneous gradient fields can introduce deviations from the nominal gradient strength and orientation, and therefore spatially-dependent first gradient moments. Resulting errors in the measured phase shifts used for velocity encoding can therefore cause significant deviations in velocity quantification. The true magnitude and direction of the underlying velocities can be recovered from the phase difference images by a generalized PC velocity reconstruction, which requires the acquisition of full three-directional velocity information. The generalized reconstruction of velocities is applied using a matrix formalism that includes relative gradient field deviations derived from a theoretical model of local gradient field nonuniformity. In addition, an approximate solution for the correction of one-directional velocity encoding is given. Depending on the spatial location of the velocity measurements, errors in velocity magnitude can be as high as 60%, while errors in the velocity encoding direction can be up to 45 degrees. Results of phantom measurements demonstrate that effects of gradient field nonuniformity on PC-MRI can be corrected with the proposed method.