Clinical evaluation of stenosis of the carotid bifurcation with magnetic resonance angiographic techniques.

We evaluated the images of 60 carotid artery bifurcations in 31 patients suspected to have carotid artery disease who underwent invasive carotid angiography and combined two-dimensional, phase-sensitive and a gradient-echo magnetic resonance angiography. The phase scans consisted of seven serial projections that were obtained at 20 degrees intervals (11.0 minutes) around the carotid bifurcation; the gradient-echo (GRASS) scans were composed of 11 axial images (2.4 minutes) acquired through the bifurcation. The two magnetic resonance angiographic techniques yielded complementary pieces of information and were used together to compare magnetic resonance angiography with invasive angiography. Comparison of magnetic resonance and invasive angiograms of the 60 carotid arteries shows that the sensitivity (86%) and specificity (92%) of the magnetic resonance angiographic techniques we used to diagnose clinically significant carotid stenosis approach but do not reach those of invasive angiography.

3DFT MR angiography of carotid and basilar arteries.

Three-dimensional Fourier transform (3DFT) time-of-flight and two-dimensional Fourier transform (2DFT) projection phase-contrast MR angiography was performed in eight healthy volunteers and in 14 patients with known carotid artery or basilar artery occlusion, stenosis, or dissection. Comparative angiography was available in 13 cases (although in some cases the studies were separated by a number of months) and duplex sonography in one case. After localization of the carotid artery bifurcations by using 2DFT projection phase-contrast angiography, multiple 1.25-mm contiguous images were obtained with the 3DFT technique. In all cases, the lesions were identified on MR angiography. Because flow is detected in a manner that is independent of flow-induced phase shifts in the 3DFT time-of-flight technique, signal loss arising from complex flow and turbulence is minimized, yet the flow image remains sensitive to all velocity components of flow. Applications of this technique are ideal for relatively straight vessels where flow is laminar, but it can also be used to evaluate the carotid artery bifurcations where flow becomes complex.

Three-dimensional phase-contrast MR angiography in the head and neck: preliminary report.

Morbidity and possible mortality associated with contrast angiography lead to its cautious use. A noninvasive method for screening and further delineating known abnormalities would be welcomed. This article reviews the initial results and application of MR imaging to vascular imaging in the head and neck. By using the three-dimensional phase-sensitive method of Dumoulin, Souza, and collaborators, we acquired MR angiograms in 37 min and portrayed blood flow in all the major arteries and veins. Feeding arteries and draining veins of arteriovenous malformations were well delineated; aneurysms as small as 3-4 mm were shown, and obstructed cerebral vessels and the patency of a highly stenotic internal carotid artery were demonstrated. MR angiography of the head or neck offers great promise as a noninvasive means of studying vascular abnormalities.

Human exposure to 4.0-Tesla magnetic fields in a whole-body scanner.

Details are given for the design, construction, properties, and performance of a large, highly homogeneous magnet designed to permit whole-body magnetic resonance imaging and spectroscopy at 4 T. The magnet has an inductance of 1289 H and a stored energy of 33.4 MJ at rated field. The health of a group of 11 volunteers who had varying degrees of exposure to this field was followed over a 12-month period and no change that could be associated with this exposure was detected. A mild level of sensory experiences, apparently associated with motion within the field of the magnet, was reported by some of the volunteers during some of their exposures. A questionnaire regarding sensory effects associated with magnetic resonance scanners and possibly caused by the static magnetic field of these instruments, was given to nine respondents who had experience within both 1.5-T scanners and this 4-T scanner and to another group of 24 respondents who had experience only within 1.5-T scanners. For the sensations of vertigo, nausea, and metallic taste there was statistically significant (p less than 0.05) evidence for a field-dependent effect that was greater at 4 T. In addition, there was evidence for motion-induced magnetophosphenes caused by motion of the eyes within the static field. These results indicate the practicality of experimental whole-body body scanners operating at 4 T and the possibility of mild sensory effects in humans associated with motion within a static magnetic field. The results also indicate the likelihood of a wide margin of safety for the exposure of noncompromised patients to the static fields of conventional magnetic resonance scanners operated at 1.5 to 2 T and below.

Magnetic resonance angiography: today and tomorrow.

Magnetic resonance angiography (MRA) has enjoyed enthusiastic success at many research institutions where it is now routinely used in place of invasive x-ray angiography (XRA) for a variety of applications. While the physical principles of MRA are well understood, there is still plenty of opportunity for growth in the coming years. Recent improvements in instrumentation have permitted more rapid acquisition and manipulation of larger data sets. Instruments in the future are sure to continue this trend as computer hardware becomes more capable and less expensive. New clinical applications will also expand the utility of MRA beyond its current use. MRA is already being used in peripheral vessels and it appears to have great potential in the abdomen. Research into MRA methods for coronary vessel imaging is also beginning to show intriguing results. In addition, preliminary research results suggest that interventional MRA may one day become a reality.

3D reconstruction of the brain from magnetic resonance images using a connectivity algorithm.

We present high resolution three dimensional (3D) connectivity, surface construction and display algorithms that detect, extract, and display the surface of a brain from contiguous magnetic resonance (MR) images. The algorithms identify the external brain surface and create a 3D image, showing the fissures and surface convolutions of the cerebral hemispheres, cerebellum, and brain stem. Images produced by these algorithms also show the morphology of other soft tissue boundaries such as the cerebral ventricular system and the skin of the patient. For the purposes of 3D reconstruction, our experiments show that T1 weighted images give better contrast between the surface of the brain and the cerebral spinal fluid than T2 weighted images. 3D reconstruction of MR data provides a non-invasive procedure for examination of the brain surface and other anatomical features.

Magnetic resonance angiography of abdominal vessels: early experience using the three-dimensional phase-contrast technique.

Based on three-dimensional acquisition of three sequences sensitive to one flow-direction, abdominal magnetic resonance phase-contrast angiography (MRA) was performed in 13 volunteers and 20 patients. The subjects received no antiperistaltic medication and were allowed to breath normally during the three acquisition periods of 11 minutes. The frequency of demonstration of the normal aorta, superior mesenteric and right and left renal arteries was 100%/100%/91%/100%, and of the inferior vena cava, splenic, superior mesenteric and portal veins was 92%/67%/92%/100%, respectively, whereas other abdominal vessels were seen less constantly. In renal artery stenosis or occlusion, MRA detected eight out of nine pathological arteries, missed only a minimal stenosis and was never false positive. In all 10 cases of portal hypertension, MRA demonstrated the venous collaterals detected by conventional angiography and in six cases showed more collaterals, particularly paravertebral vessels. A Budd-Chiari syndrome was investigated as well. If the accuracy of MRA can be proved in larger studies, it may become an important diagnostic tool in evaluating abdominal vascular pathology, such as renal artery stenosis or portal hypertension.

Phase contrast MR angiography techniques.

Phase contrast MR methods encode information from macroscopic motion into the phase of the MR signal. Phase contrast methods can be applied with small and large fields-of-view, can give quantitative measures of velocity, and provide excellent suppression of signals from stationary tissue. Unlike time-of-flight methods, phase contrast methods directly measure flow and thus are not hindered by the artifactual appearance of tissue having short T1. Phase contrast angiograms can be two-dimensional (thin slice or projectile), three-dimensional, and/or time resolved and have applications throughout the body.

Active MR tracking on a 0.2 Tesla MR imager.

An active MR tracking system was implemented on a 0.2 Tesla open MRI system. Interventional devices with receive-only microcoils at their tips were developed and investigated on the scanner. Microcoils having a diameter of about 1 mm and 20 turns were found to provide sufficient signal-to-noise ratios for stable tracking. Positional accuracy and precision were found to be acceptable under practical conditions. Simulation of MR-guided biopsy using biplane images with tracking was performed in a gelatin phantom and dog livers. Successful tracking of catheters with integrated microcoils was also demonstrated in the aorta and IVC of live dogs.

A method for chemical-shift-selective imaging.

Selective suppression of a given resonance in an NMR image can be obtained with a pi/2 pulse whose excitation spectrum is zero at the appropriate chemical shift. The selective pi/2 pulse presented here is composed of two nonselective pi/2 pulses of opposite phase. The two pulses are separated by a short interval which determines the excitation spectrum.

Suppression of water and other noncoupled spins by homonuclear polarization transfer in magnetic resonance imaging.

The water component of an NMR image is suppressed by selectively detecting only those protons which are coupled to other protons. Selectivity is obtained by polarization transfer between the coupled spins. Since spin-spin coupling is independent of magnetic field strength, the suppression obtainable by polarization transfer is independent of chemical shift. Consequently, this technique does not require extremely homogeneous magnetic fields for the separation of water and lipid signals. In addition, water suppression by this technique is independent of T1 and T2. Suppression of the water signal intensity has been observed experimentally to be as high as a factor of 100. Suppression is limited only by instrumental imperfections.

Magnetic resonance angiography in the head and neck.

Magnetic resonance angiography (MRA) provides a means to visualize vessel structure without the use of contrast agents and consequently without the risks and discomfort associated with contrast media. We have developed a flow encoding procedure which exploits the spatial dependence in the phase of spin magnetization generated by a gradient pulse. This technique yields image information for only those spins having macroscopic motion (i.e. flowing blood). Excellent suppression of non-moving spins can be obtained despite the overwhelming abundance of stationary spins. Data are presented in a projection format similar to that of traditional subtraction angiography.

Lipid and water suppression by selective 1H homonuclear polarization transfer.

A pulse sequence is presented which uses Polarization Transfer by a Selective Homonuclear Technique (POTSHOT) to retain all resonances, in phase, from a selected coupled spin system while suppressing all other peaks, from both coupled and noncoupled spins. This technique, which is a selective form of Homonuclear Polarization Transfer (HPT), has been used in a 1.5-T whole-body system to generate edited 1H lactate spectra from lactate/oil phantoms and from excised dog hearts.

Magnetic resonance angiography.

Pulse sequences that permit selective detection of moving spins in a magnetic resonance image have been developed. Experiments were performed by the authors to produce projected angiographic data without the use of contrast agents, with the intensity of each image pixel determined by the macroscopic velocity of the detected spins. With this method, suppression of nonmoving spins is essentially complete, yielding a high dynamic range in signal intensity for detected vessels. Selective detection of moving spins is not dependent on pulsatile flow. Consequently, not only arterial structures, but also venous structures can easily be visualized. High-resolution angiographic images can be obtained by combining the flow experiment with surface coil techniques.

Water suppression in 1H magnetic resonance images by the generation of multiple-quantum coherence.

Pulse sequences which generate multiple- and zero-quantum coherence and suppress the detection of single-quantum coherence have ben used to greatly reduce the intensity of the water signal in NMR images. In the experiment, image signals having multiple-quantum behavior add constructively while single-quantum signals, such as the signal arising from water, are canceled. Since the generation of multiple-quantum coherence is only a function of spin-spin coupling, water suppression by this technique is independent of chemical shift. Consequently, suppression of the water resonance in a 1H NMR image can be accomplished in an inhomogeneous magnetic field provided that the excitation profile of the rf pulses is equal for all spins. Furthermore, variations in the T1 and T2 of coupled and uncoupled spins do not affect the efficiency of the multiple-quantum filter.

Quantitative flow measurement in phase contrast MR angiography.

The quantitative nature of phase contrast magnetic resonance angiography is explored, and a technique of blood flow measurement that is independent of system and patient parameters is presented. Phantom and patient studies demonstrate that quantitative flow measurements by phase contrast angiography can be routinely obtained with good accuracy despite nonuniform sensitivity profiles, blood flow pulsatility, and patient-to-patient changes in system gain. The calibration method requires the acquisition of only two flow images and thus can be performed as part of an angiographic session. Flow calibration of any flow profile can be accomplished with this technique. The solutions for plug flow and parabolic flow are presented.

Multiecho magnetic resonance angiography.

Several pulse sequences which generate projected MR angiograms are presented. These pulse sequences exploit multiple-gradient refocused echoes to obtain several independent angiograms, which can be combined or separately analyzed to provide more information than an individual angiogram. For example, a series of angiograms, each with a different projection axis, can be obtained in the time required to obtain a single angiogram using a single-echo method. If the view angle of each echo is the same, then the acquired angiograms can be added to enhance the signal-to-noise ratio. Another pulse sequence simultaneously obtains two or more angiograms, sensitive to orthogonal flow components of the overall blood flow. These angiograms are then added to give an angiogram which is sensitive to flow in all directions.