Synopsis
Contrast
enhanced and non-contrast enhanced MR angiography represent the two main methods
for delineation of vessels. In contrast enhanced MRA, classically spatial
resolution and temporal resolution have to be balanced against each other. View
sharing and central read out of k-space have been introduced for subsecond acquisition
of high resolution dynamics. This technique has a broad spectrum of clinical
applications. In non-contrast MRA the classical approaches time-of-flight and
phase contrast angiography suffered from long acquisition time and were prone
to flow artifacts in regions with non-laminar flow. Application of balanced steady
state free precession with flow sensitive dephasing allows for selective
delineation of arteries with high signal intensity and high spatial resolution
without flow related artefacts. This technique has already been demonstrated to
be of high clinical impact in many vessel territories including the upper and
lower extremities. The
targeted audience of this talk are physicians, interested in gaining insights
into the different techniques of MR angiography. Advantages of the different
approaches will be highlighted in order to enable the audience to select the appropriate
approach depending on vessel territory and clinical question.
Summary:
Contrast enhanced and non-contrast enhanced MR angiography represent the two
main methods for delineation of vessels. In contrast enhanced MRA, classically
spatial resolution and temporal resolution have to be balanced against each
other. View sharing and central read out of k-space have been introduced for subsecond
acquisition of high resolution dynamics. This technique has a broad spectrum of
clinical applications. In non-contrast MRA the classical approaches
time-of-flight and phase contrast angiography suffered from long acquisition
time and were prone to flow artifacts in regions with non-laminar flow.
Application of balanced steady state free precession with flow sensitive
dephasing allows for selective delineation of arteries with high signal
intensity and high spatial resolution without flow related artefacts. This
technique has already been demonstrated to be of high clinical impact in many
vessel territories including the upper and lower extremities.
MRA
can generally be subdivided into techniques with and without application of
contrast media. Contrast enhanced MRA is usually carried out with T1-weighted
spoiled gradient echo sequences and central k-space reads out. Methods such as
TWIST (time resolved angiography with interleaved stochastic readout) or TRICKS
(time resolved imaging of contrast kinetics) allow for subsecond resolution,
while spatial resolution is preserved. In general a trade of between time
resolution and spatial resolution has to be balanced according to the clinical
question. While information regarding
contrast is contained in the central part of k-space, information regarding
sharpness of vessel borders and small branches is present in the peripheral parts of k-space. View-sharing
is a technique , which makes use of the
non linearity of information contained in k-space. Usually, first a
non-contrast enhanced high resolution frame is obtained. While the contrast
bolus travels through the vessel territory the central parts of k-space are read
out and imaging reconstruction is performed with data from the non contrast
frame and the later obtained frames. Periodically the peripheral parts of
k-space are read out and used for image reconstruction. This approach is termed
view-sharing and affords for high temporal and spatial resolution. A combination of the standard approach and
TWIST has been clinically established for assessment of run of vessels of the lower
leg. Nevertheless such techniques display only the vessel lumen, similar to
conventional angiography. They should be applied for indications, which
otherwise would apply for conventional imaging, such as assessing for vessel
occlusion or stenosis, or delineation of the feeding and run of vessels in
malformations. If the vessel wall must be delineated, other approaches should
be preferred.
Time-of-flight
and phase contrast angiography are the two classical non-contrast techniques
for MRA. Both methods suffered from length of acquisition and artefacts,
associated with non laminar flow. More recently alternatives, such as fast spin
echo sequences using the high signal intensity of inflowing spins have been
adapted for larger vessel territories such as the lower legs. Arterial spin
labeling is a technique, that allows for selectively delineation of flow,
provided by a given artery. In principle, a pulse is applied for labeling of
inflowing blood. Which provides high signal intensity in the imaged region.
Selective labeling of carotid arteries provides information regarding potential
vessel dominance for intracranial perfusion.
The balanced
steady state free precession (SSFP) sequence is the sequence with the highest
signal intensity due to the use of signal obtained from stimulated echo, spin
echo and free-precession decay. This inherent high signal intensity renders
this sequence highly suited for non-contrast MRA. By using flow sensitive
dephasing, this sequence can be applied for selectively delineation of arterial
flow. Acquisition is ECG triggered and
one frame is acquired in systole while the other is obtained in diastole.
Subtraction of both frames affords for excellent background subtraction and
almost zero signal from venous vessels, while the arteries remain bright.
Acknowledgements
No acknowledgement found.References
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