Vessel wall MR imaging in neuroradiology.

Vessel wall MR imaging (VW-MRI) has been introduced into clinical practice and applied to a variety of diseases, and its usefulness has been reported. High-resolution VW-MRI is essential in the diagnostic workup and provides more information than other routine MR imaging protocols. VW-MRI is useful in assessing lesion location, morphology, and severity. Additional information, such as vessel wall enhancement, which is useful in the differential diagnosis of atherosclerotic disease and vasculitis could be assessed by this special imaging technique. This review describes the VW-MRI technique and its clinical applications in arterial disease, venous disease, vasculitis, and leptomeningeal disease.

Insufficient slow-flow suppression mimicking aneurysm wall enhancement in magnetic resonance vessel wall imaging: a phantom study.

OBJECTIVE: MR vessel wall imaging (VWI) is increasingly performed in clinical settings to support treatment decision-making regarding intracranial aneurysms. Aneurysm wall enhancement after contrast agent injection is expected to be related to aneurysm instability and rupture status. However, the authors hypothesize that slow-flow artifacts mimic aneurysm wall enhancement. Therefore, in this phantom study they assess the effect of slow flow on wall-like enhancement by using different MR VWI techniques. METHODS: The authors developed an MR-compatible aneurysm phantom model, which was connected to a pump to enable pulsatile inflow conditions. For VWI, 3D turbo spin echo sequences-both with and without motion-sensitized driven equilibrium (MSDE) and delay alternating with nutation for tailored excitation (DANTE) preparation pulses-were performed using a 3-T MR scanner. VWI was acquired both before and after Gd contrast agent administration by using two different pulsatile inflow conditions (2.5 ml/sec peak flow at 77 and 48 beats per minute). The intraluminal signal intensity along the aneurysm wall was analyzed to assess the performance of slow-flow suppression. RESULTS: The authors observed wall-like enhancement after contrast agent injection, especially in low pump rate settings. Preparation pulses, in particular the DANTE technique, improved the performance of slow-flow suppression. CONCLUSIONS: Near-wall slow flow mimics wall enhancement in VWI protocols. Therefore, VWI should be carefully interpreted. Preparation pulses improve slow-flow suppression, and therefore the authors encourage further development and clinical implementation of these techniques.

Rapid inner-volume imaging in the steady-state with 3D selective excitation and small-tip fast recovery imaging.

PURPOSE: Develop a method for rapid three-dimensional inner-volume (IV), or reduced field-of-view, steady-state imaging. METHODS: Tailored radiofrequency pulses for exciting a three-dimensional IV were designed using a recently proposed algorithm and used in three different sequences: spoiled gradient echo, balanced steady-state free precession, and "small-tip fast recovery" (STFR) which uses a "tip-up" RF pulse after the readout to fast recover spins to the longitudinal axis. The inner- and outer-volume (OV) steady-state signals were analyzed. To demonstrate the potential utility of the proposed method, segmented stack-of-spirals reduced field-of-view images in a volunteer were acquired. RESULTS: For a given three-dimensional IV excitation pulse, STFR can achieve higher IV/OV signal ratio compared with spoiled gradient echo and balanced steady-state free precession. For spoiled gradient echo and balanced steady-state free precession, this ratio is significantly lower than that produced by a single IV excitation. For STFR, this ratio exceeds that produced by a single IV excitation, due to partial OV saturation produced by the nonspatially selective tip-up pulse. Reduced FOV STFR stack-of-spirals imaging with 2-fold under-sampling in both x-y and z is demonstrated. CONCLUSION: STFR provides an effective mechanism for OV suppression in steady-state IV imaging. The recently proposed joint pulse design method can be used in the STFR sequence to achieve fast reduced field-of-view imaging. Magn Reson Med 76:1217-1223, 2016. © 2015 Wiley Periodicals, Inc.

Array-compressed parallel transmit pulse design.

PURPOSE: To design array-compressed parallel transmit radiofrequency (RF) pulses and compare them to pulses designed with existing transmit array compression strategies. THEORY AND METHODS: Array-compressed parallel RF pulse design is proposed as the joint optimization of a matrix of complex-valued compression weights that relate a full-channel physical array to a reduced-channel virtual array, along with a set of RF pulses for the virtual array. In this way, the physics of the RF pulse application determine the coil combination weights. Array-compressed pulse design algorithms are described for four parallel transmit applications: accelerated two-dimensional spiral excitation, multislice RF shimming, small-tip-angle kT -points excitation, and slice-selective spokes refocusing. Array-compressed designs are compared in simulations and an experiment to pulses designed using four existing array compression strategies. RESULTS: In all cases, array-compressed pulses achieved the lowest root-mean-square excitation error among the array compression approaches. Low errors were generally achieved without increasing root-mean-square RF amplitudes or maximum local 10-gram specific absorption rate. Leave-one-out multisubject shimming simulations demonstrated that array-compressed RF shimming can identify useful fixed coil combination weights that perform well across a population. CONCLUSION: Array-compressed pulse design jointly identifies the transmit coil array compression weights and RF pulses that perform best for a specific parallel excitation application. Magn Reson Med 76:1158-1169, 2016. © 2015 Wiley Periodicals, Inc.

Comparison of contrast-enhanced T1-weighted imaging using DANTE-SPACE, PETRA, and MPRAGE: a clinical evaluation of brain tumors at 3 Tesla.

BACKGROUND: We aimed to compare the performance of three contrast-enhanced T1-weighted three-dimensional (3D) magnetic resonance (MR) sequences to detect brain tumors at 3 Tesla. The three sequences were: (I) delay alternating with nutation for tailored excitation sampling perfection with application-optimized contrasts using different flip angle evolution (DANTE-SPACE), (II) pointwise encoding time reduction with radial acquisition (PETRA), and (III) magnetization-prepared rapid acquisition with gradient echo (MPRAGE). METHODS: This study involved 77 consecutive patients, including 34 patients with known primary brain tumors and 43 patients suspected of intracranial metastases. All patients underwent each of the three sequences with comparable spatial resolution and acquisition time post-injection. Signal-to-noise ratios (SNRs) for gray matter (GM) and white matter (WM), contrast-to-noise ratios (CNRs) for lesion/GM, lesion/WM, and GM/WM were quantitatively compared. Two radiologists determined the total number of enhancing lesions by consensus. Intraclass correlation coefficients (ICCs) between the two radiologists for metastases presence, qualitative ratings for image quality, and acoustic noise level of each sequence were assessed. RESULTS: Among the three sequences, SNRs and CNRs between lesions and surrounding parenchyma were highest using DANTE-SPACE, but CNRWM/GM was the lowest with DANTE-SPACE. SNRs for PETRA images were significantly higher than those for MPRAGE (P<0.001). CNRs between lesions and surrounding parenchyma were similar for PETRA and MPRAGE (P>0.05). Significantly more brain metastases were detected with DANTE-SPACE (n=94) compared with MPRAGE (n=71) and PETRA (n=72). The ICCs were 0.964 for MPRAGE, 0.975 for PETRA, and 0.973 for DANTE-SPACE. Qualitative scores for lesion imaging using DANTE-SPACE were significantly higher than those obtained with PETRA and MPRAGE (P=0.002 and P=0.004, respectively). The acoustic noise level for PETRA (64.45 dB) was significantly lower than that for MPRAGE (78.27 dB, P<0.01) and DANTE-SPACE (80.18 dB, P<0.01). CONCLUSIONS: PETRA achieves comparable detection of brain tumors with MPRAGE and is preferred for depicting osseous metastases and meningeal enhancement. DANTE-SPACE with blood vessel suppression showed improved detection of cerebral metastases compared with MPRAGE and PETRA, which could be helpful for the differential diagnosis of tumors.

Three-dimensional arterial spin labeling imaging with a DANTE preparation pulse.

On arterial spin-labeled (ASL) images, areas of bright intravascular signal will appear when the post labeling delay time is shorter than arterial transit time. Vascular suppression (VS) schemes reduce artefactual bright signal by dephasing intravascular labeled spins. However, existing VS methods, such as Motion-Sensitized Driven-Equilibrium (MSDE), decrease the uniformity of the signal intensity distribution and extend the echo time. The purpose of this study is to compare VS using a Delays Alternating with Nutation for Tailored Excitation (DANTE) preparation pulse, with MSDE for ASL imaging on a flow phantom and volunteer data. In the phantom study, the signal decay pattern of moving water was similar for both methods. In the volunteer study, the bright intravascular signal artifact was decreased by both methods. However right-left differences in signal intensity were smaller using DANTE-prepared ASL. The proposed DANTE-prepared ASL sequence has a vessel suppression effect while maintaining a uniform signal intensity distribution. This study indicates that DANTE is a potentially useful method for vessel suppression in ASL imaging.

Conventional and high-resolution vessel wall MRI of intracranial aneurysms: current concepts and new horizons.

Intracranial aneurysms are heterogeneous in histopathology and imaging appearance. The biological behavior of different types of aneurysms is now known to depend on the structure and physiology of the aneurysm wall itself in addition to intraluminal flow and other luminal features. Aneurysm wall structure and imaging markers of physiology such as aneurysm wall enhancement have been assessed in many prior investigations using conventional-resolution MRI. Recently, high-resolution vessel wall imaging (HR-VWI) techniques with MRI have been introduced. Reports of findings on high-resolution imaging have already emerged for many types of aneurysms demonstrating detailed characterization of wall enhancement, thickness, and components, but many questions remain unexplored. This review discusses the key HR-VWI literature to date. Aneurysm wall findings on conventional-resolution MRI are also discussed as these may help one understand the potential utility and findings on HR-VWI for various aneurysm types. The authors have illustrated these points with several examples demonstrating both features already described in the literature and novel cases demonstrating the potential for future clinical and research applications.