Ulrike I. Attenberger

Quantification of pulmonary blood flow and volume in healthy volunteers by dynamic contrast-enhanced magnetic resonance imaging using a parallel imaging technique.

Rationale and Objectives:We sought to optimize the dosage of a paramagnetic contrast medium (CM) for the quantification of pulmonary blood flow and volume by contrast-enhanced dynamic magnetic resonance imaging (MRI) using a parallel imaging technique and to prove the feasibility of the approach in healthy volunteers. Methods:In a phantom study, the dependency of signal increase on different concentrations of the CM gadodiamide was evaluated by means of an ultra-fast MRI sequence with a generalized autocalibrating partially parallel acquisition technique (acceleration factor = 2). Using the same sequence, measurements were performed in a healthy volunteer after administration of different CM dosages for contrast dosage optimization in vivo. Finally, perfusion measurements were performed in 16 healthy volunteers after the administration of the optimal CM dose. Signal-time curves were evaluated from the pulmonary artery and from predefined regions of the lung. Pulmonary regional blood volume (RBV) and flow (RBF) were estimated using an open 1-compartment model. Results:Phantom studies yielded a linear signal increase up to a concentration of 5.0 mmol/L gadodiamide. Results of contrast dosage optimization in vivo showed that the maximum CM dose providing a linear relationship between signal increase and CM concentration in the pulmonary artery of a healthy volunteer was approximately 0.05 mmol/kg-bw. Quantification of pulmonary blood volume and flow was reproducible in healthy volunteers, yielding mean values for the upper lung zones of 7.1 ± 2.3 mL/100 mL for RBV and 197 ± 97 mL/min/100 mL for RBF and for lower lung zones, 12.5 ± 3.9 mL/100 mL for RBV and 382 ± 111 mL/min/100 mL for RBF. Conclusions:If an adequate amount of gadodiamide and fast MR sequences are used, quantification of pulmonary blood flow and volume is feasible.

Diffusion tensor imaging of the kidney with parallel imaging: initial clinical experience.

Objective:To evaluate the clinical feasibility of diffusion tensor imaging (DTI) of the kidney in volunteers and patients with renal diseases. Material and Methods:Ten volunteers and 22 patients (mean age, 56 ± 14.3) with renal masses and renal artery stenosis underwent breath-hold coronal fat-saturated echo-planar DTI (as provided by the manufacturer, 6 diffusion directions, diffusion weightings b = 0 and 300 s/mm2, repetition time 730 ms/echo time 72 ms; 5 slices; slice thickness, 6 mm; inplane resolution, 2.1 × 2.1 mm2; acquisition time, 26 seconds) of the kidneys at 1.5 T (MAGNETOM Avanto, Siemens Medical Solutions, Erlangen, Germany). The parallel imaging technique, generalized autocalibrating partially parallel acquisitions with an acceleration factor 2, was applied. Using the commercially available Syngo DTI task card software, regions of interests were placed in the cortex, medulla, and in renal masses if present. Fractional anisotropy (FA) and apparent diffusion coefficients (ADC) were determined, and tractography was used to visualize the renal diffusion properties. Statistical analysis was performed using the Wilcoxon signed-rank sum test and paired t tests. Results:In all volunteers, FA was significantly (P < 0.01) higher in the medulla (0.36 ± 0.03) than in the cortex (0.21 ± 0.02), whereas the ADC was significantly (P < 0.01) higher in the cortex (2.43 ± 0.19) than in the medulla (2.16 ± 0.22). Tractography typically revealed a radial preferred direction of medullary diffusion basically reflecting medullary flow. FA/ADC of simple renal cysts (n = 8) was 0.14 ± 0.05/2.86 ± 0.15. Renal cell carcinoma (n = 10) showed a wide FA range from 0.11 to 0.56. Using tractography, the structural organization of renal cell carcinoma such as pseudocapsules could be visualized. In 1 patient with unilateral high-grade renal artery stenosis, the cortical ADC of the affected kidney was lower than on the contralateral side (1.77/2.27) and the FA was increased (0.33/0.18). The FA of the medulla was increased (0.70/0.41) and the ADC decreased (1.43/1.90). Conclusions:Using parallel imaging, DTI measurements of the kidneys are feasible within a single breath-hold with good discrimination between cortex and medulla. Parallel imaging allows more slices and a superior resolution. DTI measurements of the kidney allows visualization of medullary flow, in pathology ADC and FA were altered. Further investigations will be required to evaluate the role of DTI for studying and monitoring renal ultrastructure.

Renal BOLD-MRI does not reflect renal function in chronic kidney disease

Renal blood oxygen level-dependent magnetic resonance imaging (BOLD-MRI) is a noninvasive fast technique to characterize renal function. Here we evaluated the impact of renal function on the relaxation rate (R2(*)) in the cortex and medulla to provide baseline data for further use of renal BOLD-MRI. This parameter was evaluated in 400 patients scheduled for abdominal imaging who underwent transversal blood oxygen level-dependent measurements with a multi-echo gradient-echo sequence with 12 echo times. The loss of phase coherence (T2(*)) maps were generated in which kidney regions of interest were selected to differentiate the medulla and cortex, and R2(*) was equated to 1/T2(*). Individual R2(*) values were, in turn, correlated to the eGFR (MDRD formula of 280 patients with available serum creatinine measurements), age, and gender each for 1.5 and 3.0 T field-strength scans of 342 patients. At both the field strengths, no significant differences in R2(*) of the cortex and medulla were found between patient gender, age, eGFR, or between different stages of chronic kidney disease determined using the KDOQI system. Thus, BOLD-MRI of a non-specific patient population failed to discriminate between the patients with various stages of chronic kidney disease.

An Image-based Approach to Understanding the Physics of MR Artifacts

As clinical magnetic resonance (MR) imaging becomes more versatile and more complex, it is increasingly difficult to develop and maintain a thorough understanding of the physical principles that govern the changing technology. This is particularly true for practicing radiologists, whose primary obligation is to interpret clinical images and not necessarily to understand complex equations describing the underlying physics. Nevertheless, the physics of MR imaging plays an important role in clinical practice because it determines image quality, and suboptimal image quality may hinder accurate diagnosis. This article provides an image-based explanation of the physics underlying common MR imaging artifacts, offering simple solutions for remedying each type of artifact. Solutions that have emerged from recent technologic advances with which radiologists may not yet be familiar are described in detail. Types of artifacts discussed include those resulting from voluntary and involuntary patient motion, magnetic susceptibility, magnetic field inhomogeneities, gradient nonlinearity, standing waves, aliasing, chemical shift, and signal truncation. With an improved awareness and understanding of these artifacts, radiologists will be better able to modify MR imaging protocols so as to optimize clinical image quality, allowing greater confidence in diagnosis.

Measuring perfusion and permeability in renal cell carcinoma with dynamic contrast-enhanced MRI: A pilot study

To retrospectively assess an improved quantitative methodology with separate assessment of perfusion and permeability for characterization of primary renal cell carcinoma (RCC) and monitoring antiangiogenic treatment.

CAIPIRINHA-Dixon-TWIST (CDT)-volume-interpolated breath-hold examination (VIBE): a new technique for fast time-resolved dynamic 3-dimensional imaging of the abdomen with high spatial resolution.

PurposeThe purpose of this study was to assess the feasibility and image quality of a novel, highly accelerated T1-weighted sequence for time-resolved imaging of the abdomen during the first pass of contrast media transit using controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) under sampling, view-sharing techniques, and Dixon water-fat separation (CAIPRINHA–Dixon–time-resolved imaging with interleaved stochastic trajectories–volumetric interpolated breath-hold examination [CDT-VIBE]). Materials and MethodsIn this retrospective, institutional review board–approved study, 47 patients (median age, 62 years; 25 men, 22 women) scanned on a 3.0-T magnetic resonance system (Skyra; Siemens) were included. The CDT-VIBE (repetition time/echo time1/echo time2, 4.1/1.33/2.56 milliseconds; acquisition time, 29 seconds) was used in place of the standard arterial phase acquisition and started 15 seconds after the injection of 0.1 mmol/kg Gd-DOTA (Dotarem, Guerbet). Within 29 seconds, 14 high spatial resolution (1.2 × 1.2 × 3 mm3) 3-dimensional data sets were acquired and reconstructed using view sharing (temporal resolution, 2.1 seconds). The CDT-VIBE images were evaluated independently by 2 blinded, experienced radiologists with regard to image quality and the number of hepatic arterial–dominant phases present on an ordinal 5-point scale (5, excellent; 1, nondiagnostic). Added diagnostic information with CDT-VIBE relative to portal venous phase VIBE was assessed. ResultsIn all patients, CDT-VIBE measurements were successfully acquired. The image quality was diagnostic in 46 of the 47 patients. Both readers assessed the highest image quality present in the data sets with a median score of 4 (range, 3–5 for both readers; &kgr;, 0.789) and the worst image quality with a median score of 3 (range, 1–4 for both readers; &kgr;, 0.689). With a range between 1 and 8 (median, 5), hepatic arterial–dominant data sets (of the 14 acquired) were obtained in each case. There was an added diagnostic value with CDT-VIBE in 10 of the 47 patients (21%). ConclusionsThe CDT-VIBE is a robust approach allowing, for the first time, dynamic imaging of the upper abdomen with high temporal resolution and preservation of high spatial resolution.

Peripheral Arterial Occlusive Disease: Evaluation of a High Spatial and Temporal Resolution 3-T MR Protocol with a Low Total Dose of Gadolinium versus Conventional Angiography

PURPOSE To evaluate a peripheral magnetic resonance (MR) angiographic protocol combining continuous table movement (CTM) MR angiography of the entire runoff vasculature with time-resolved (TWIST) 3-T MR angiography of the calves with a total gadolinium dose of 0.1 mmol per kilogram of body weight. MATERIALS AND METHODS In this retrospective institutional review board-approved study, 31 consecutive patients (22 men, nine women; mean age, 65 years ± 14 [standard deviation]) with peripheral arterial occlusive disease who had undergone a low-dose MR angiographic protocol that consisted of CTM MR angiography (repetition time msec/echo time msec, 2.4/1.0; 21° flip angle; voxel size, 1.2 mm(3); gadolinium dose, 0.07 mmol per kilogram of body weight) and TWIST MR angiography (2.8/1.1; 20° flip angle; voxel size, 1.1 mm(3); temporal resolution, 4.8-5.5 sec, gadolinium dose, 0.03 mmol/kg), as well as digital subtraction angiography (DSA), were included. Two radiologists rated image quality and stenosis degree on four-point scales. The accuracy of stenosis gradation and, specifically, the detection of high-grade stenoses (stenosis of 70%-99%) with CTM MR angiography alone and with the combined protocol were compared with accuracy of stenosis gradation and detection of high-grade stenoses with DSA. Means and standard deviations were calculated for all data. Interobserver agreement was determined with κ statistics. Positive and negative predictive values, sensitivity, specificity, and overall diagnostic accuracy were calculated for CTM MR angiography alone and for the combined protocol. RESULTS For CTM MR angiography, image quality was good or excellent in 95.9% of vessel segments; for TWIST MR angiography, image quality was good or excellent in 94.3% and 97.8% of vessel segments for readers 1 and 2, respectively. The combined protocol resulted in high overall diagnostic accuracy of more than 80% for detection of stenosis and diagnostic accuracy of 93.5% for detection of high-grade vessel stenosis. Inclusion of TWIST MR angiography increased diagnostic value over that achieved with CTM MR angiography alone. CONCLUSION A combined MR angiographic approach in which a low total gadolinium dose (0.1 mmol/kg) is used yields excellent image quality and is accurate in the diagnosis of peripheral arterial stenosis.

Feasibility of gadofosveset-enhanced steady-state magnetic resonance angiography of the peripheral vessels at 3 Tesla with Dixon fat saturation.

Introduction:To investigate the feasibility and image quality of gadofosveset-enhanced steady-state peripheral MR-angiography using Dixon fat saturation in comparison to spectral fat saturation. Materials and Methods:After Institutional Review Board (IRB) approval, 10 healthy volunteers underwent peripheral MR-angiography at 3.0 T during the steady state 50 minutes after gadofosveset injection. A steady-state-adapted volume interpolated breathhold examination sequence with an isotropic spatial resolution of 1 mm was acquired with 2-point Dixon fat saturation (DixFS, acquisition time 52 seconds) and with conventional, spectral fat saturation (SFS, acquisition time 58 seconds). The quality of the images was rated on an ordinal 4-point scale (4, very good) by 2 radiologists in consensus. The signal-to-noise ratios (SNRs) of the vessels, the fat, and the muscles as well as the contrast-to-noise-ratio (CNR) between vessels, fat, and muscle were determined. Paired P tests were performed for statistical analysis with a significance level of P < 0.05. Results:Diagnostic image quality was achieved in all examinations. The image quality of the DixFS images was rated superior (median 4) over the SFS images (median 3; P = 0.03). The SNR of muscles and vessels was 40% higher with DixFS (P < 0.008), whereas the SNR of fat was decreased by 40.3% from 40.7 with SFS to 22.4 with DixFS (P < 0.0001). The CNR (fat/muscle) of the DixFS images of 84.1/71.7 was significantly higher than the CNR of the SFS images of 47.7/47.4 (P < 0.001). Discussion:Two-point Dixon fat suppression for MR-angiography during the steady state after the administration of gadofosveset is feasible with superior image quality and more than 50% increase in CNR (fat/muscle) compared with spectral fat saturation without an additional time penalty.

Evaluation of a modified Stejskal-Tanner diffusion encoding scheme, permitting a marked reduction in TE, in diffusion-weighted imaging of stroke patients at 3 T.

Purpose:To evaluate a modified Stejskal-Tanner diffusion gradient pulsing scheme that applies diffusion encoding during the entire time between the 2 requisite radiofrequency pulses, shortening TE. Materials and Methods:Seventeen healthy volunteers and 15 patients with acute and early subacute infarcts were evaluated at 3 T utilizing: a conventional bipolar gradient double spin echo planar imaging diffusion weighted imaging with a parallel imaging factor of 2 (p2) and a modified Stejskal-Tanner short TE (sTE) SE echo planar imaging diffusion weighted imaging with parallel imaging factors of 2, 3, and 4. Signal-to-noise ratio (SNR) and susceptibility-induced spatial distortions were quantified, and a blinded reader ranked scans in terms of susceptibility artifact and overall preference. Results:The sTE sequence allowed a shortening in TE of 18 to 28 milliseconds versus the standard bipolar gradient sequence. SNRs were generally not significantly different among the sTE scans because of compensation by number of scan averages. By using twice the number of averages, the SNR with the bipolar gradient sequence was not significantly different from that of the sTE sequences in patients. sTE scans with higher parallel imaging factors demonstrated less susceptibility-related artifact. The blinded reader ranked the p3 or p4 sTE scans most preferred and the bipolar gradient scans least or tied for least preferred in every case. Conclusions:Utilization of the sTE modified Stejskal-Tanner sequence markedly improves SNR—an increase that may be used with parallel imaging to improve overall scan quality whereas maintaining reasonable scan times and SNR.

Highly accelerated T1-weighted abdominal imaging using 2-dimensional controlled aliasing in parallel imaging results in higher acceleration: a comparison with generalized autocalibrating partially parallel acquisitions parallel imaging.

PurposeThe purpose of this study was to evaluate the feasibility and technical quality of an abdominal 3-dimensional interpolated breath-hold (volumetric interpolated breath-hold examination [VIBE]) magnetic resonance examination using the new parallel acquisition technique, controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA). Materials and MethodsIn this institutional review board–approved study, 15 volunteers underwent an abdominal magnetic resonance imaging examination including axial unenhanced 3-dimensional VIBE sequences with the conventional parallel acquisition technique, generalized autocalibrating partially parallel acquisitions parallel imaging (GRAPPA), with an acceleration factor (R) of 2, 3, 4, and 2 × 2 in comparison with a CAIPIRINHA-VIBE sequence with an acceleration factor of 2 × 2. Images were evaluated regarding the overall image quality, liver edge sharpness, and parallel imaging artifacts. Signal-to-noise ratio was evaluated using 2 different methods. In a second study population, 17 patients were examined with our new routine protocol for abdominal imaging that now comprises VIBE sequences with CAIPIRINHA with R = 2 × 2. ResultsIn the volunteer population, the overall image quality of CAIPIRINHA with R = 2 × 2 was significantly higher compared with GRAPPA with R = 3, 4, and 2 × 2 (P < 0.05). There were significantly less parallel imaging artifacts with CAIPIRINHA with R = 2 × 2 (P < 0.05). Acquisition time varied between 21.1 (GRAPPA with R = 2, 320 matrix) and 6.9 seconds (CAIPIRINHA with R = 2 × 2, 256 matrix). Signal-to-noise ratio performance of CAIPIRINHA with R = 2 × 2 was superior to GRAPPA with R = 3, 4, and 2 × 2. In the patient population, VIBE sequences with CAIPIRINHA with R = 2 × 2 showed consistently good image quality, minimal motion artifacts, and minimal parallel imaging artifacts. ConclusionsThe CAIPRINHA-VIBE with an acceleration factor of R = 2 × 2 is feasible in a clinical setting and is characterized by fast and robust imaging with an image quality comparable with a 2-fold acceleration with GRAPPA.