We performed technical optimization followed by a pilot clinical study of quiescent-interval single-shot MR angiography for peripheral vascular disease. Quiescent-interval single-shot MR angiography acquires data using a modified electrocardiographic (ECG)-triggered, fat suppressed, two-dimensional, balanced steady-state, free precession pulse sequence incorporating slice-selective saturation and a quiescent interval for maximal enhancement of inflowing blood. Following optimization at 1.5 T, a pilot study was performed in patients with peripheral vascular disease, using contrast-enhanced MR angiography as the reference standard. The optimized sequence used a quiescent interval of 228 ms, a/2 catalyzation of the steady-state magnetization, and center-to-out partial Fourier acquisition with parallel acceleration factor of 2. Spatial resolution was 2-3mm along the slice direction and 0.7-1mm in-plane before interpolation. Excluding stented arterial segments, the sensitivity, specificity, and positive and negative predictive values of quiescent-interval single-shot MR angiography for arterial narrowing greater than 50% or occlusion were 92.2%, 94.9%, 83.9%, and 97.7%, respectively. Quiescent-interval single-shot MR angiography provided robust depiction of normal peripheral arterial anatomy and peripheral vascular disease in less than 10 min, without the need to tailor the technique for individual patients. Moreover, the technique provides consistent image quality in the pelvic region despite the presence of respiratory and bowel motion. Magn Reson Med 63:951-958,

This work developed a three-dimensional (3D) diffusion-prepared segmented steady-steady free precession (DP-SSFP) cardiovascular magnetic resonance (CMR) sequence for black-blood (BB) thoracic aortic and carotid wall visualization. In 14 healthy volunteers, BB CMR of the thoracic aorta (n = 7) and carotid arteries (n = 7) was performed over 12 cm and 3 cm of transversal coverage, respectively, with a single 3D DP-SSFP acquisition and multiple two-dimensional (2D) slices using a T2-weighted (T2W) double inversion-recovery fast spin-echo (DIR-FSE) sequence. Arterial wall area (WA), lumen area (LA), and wall-lumen contrast-to-noise ratio (CNR) measured from the 3D DP-SSFP images were compared to those measured from the 2D T2W DIR-FSE images. Strong agreement in WA and LA between the two techniques was observed in the thoracic aorta (WA: intraclass correlation coefficient (ICC) = 0.866, LA: ICC = 0.993; p < 0.001 for both) and carotid arteries (WA: ICC = 0.939, LA: ICC = 0.991; p < 0.001 for both). Adjusted for slice thickness and number of slices, higher effective CNR per unit time (i.e., CNR efficiency) was attained with 3D DP-SSFP than 2D T2W DIR-FSE during thoracic aortic wall imaging (11.6 +/- 1.4 vs. 2.9 +/- 0.5; p < 0.001) and carotid artery wall imaging (10.1 +/- 1.9 vs. 3.1 +/- 0.5; p < 0.001). Diffusion-prepared segmented SSFP is a promising vessel wall CMR sequence that allows for 3D acquisition of thin and contiguous slices with BB image contrast.

It is well known that magnetic susceptibility variations lead to signal voids in MRI. However, recent work has shown that positive-contrast imaging of susceptibility-induced field variations can provide signal enhancements rather than signal losses. In this paper, we propose a new method for generating positive contrast from off-resonant spins with steady-state free precession (SSFP) magnetic resonance imaging. Based on theory and experiments, we demonstrate that positive-contrast images can be acquired in the presence of susceptibility-shift media with low flip angle excitations that are determined by the spin relaxation time constants of the imaging medium. Compared to other techniques, this technique is substantially faster and has low specific absorption rates, permitting high-field imaging. In addition to acquiring positive-contrast images, we also show that it is possible to suppress the imaging medium to desired levels; thereby allowing for simultaneous registration of the background details surrounding the susceptibility-shift media. Among practical applications, we anticipate that the proposed technique can potentially facilitate high field magnetic-resonance-based molecular imaging.

QISS nonenhanced MR angiography offers an alternative to currently used imaging tests for symptomatic chronic lower limb ischemia, for which the administration of iodinated or gadolinium-based contrast agents is contraindicated.

Both computed tomography (CT) angiography (CTA) and contrast-enhanced MR angiography (CEMRA) have proven to be useful and accurate cross-sectional imaging modalities over a wide range of vascular territories and vascular disorders. A key advantage of MRA is that, unlike CTA, it can be performed without the administration of a contrast agent. In this review article we consider the motivations for using noncontrast MRA, potential contrast mechanisms, imaging techniques, advantages, and drawbacks with respect to CTA and CEMRA, and the level of evidence for using the various MRA techniques. In addition, we explore new developments that promise to expand the reliability and range of clinical applications for noncontrast MRA, along with functional MRA capabilities not available with CTA or CEMRA.

Purpose To develop a navigator technique enabling free-breathing acquisition to afford sufficient signal averaging for quantitative renal perfusion measurement using arterial spins labeling (ASL) MRI. Methods A novel two-dimensional (2D) navigator technique was implemented in concert with FAIR (flow-sensitive alternating inversion recovery) preparation and True-FISP (true fast imaging with steady possession) readout. The navigator images were obtained with a low resolution FLASH (fast low angle shot) readout at end of each ASL acquisition. A retrospective algorithm was developed to automatically detect respiratory motion for selective signal averaging. The 2D navigator-gated FAIR True-FISP was performed in ten healthy volunteers and five patients with chronic kidney disease (CKD). Results Excellent image quality and comparable cortical perfusion rates (healthy: 276 ± 28 ml/100g/min, patients: 155 ± 25 ml/100g/min) to literature values were obtained. An average of three-fold SNR improvement was obtained in the 2D navigator-gated approach compared to the breath-hold acquisition in the healthy volunteers. Good image quality was achieved in patients while the results from breath-hold acquisition were unusable. The quantitative perfusion rates were significantly lower in CKD patients compared to the healthy volunteers. Conclusion 2D navigator-gated free breathing ASL is feasible and offers a non-invasive method to evaluate renal perfusion both in healthy subjects and those with CKD.

Purpose: To assess a swallowing-compensated, three-dimensional (3D) diffusion-prepared segmented steady-state free precession (3D Nav-D-SSFP) technique for carotid wall MRI with 0.6-mm isotropic spatial resolution, and its utility for semiautomated carotid wall morphometry. Materials and Methods:The carotid arteries of seven healthy volunteers (N ϭ 14) were imaged with 3D Nav-D-SSFP and black-blood T2-weighted (T2w) two-dimensional (2D) fast spin-echo (FSE). Carotid wall-lumen contrast-tonoise ratio (CNR) was measured with both sequences. Measurement of carotid wall area (WA) and lumen area (LA) made in a semiautomated manner off of the 3D Nav-D-SSFP images were compared to those made manually. Results:Adjusted for voxel volume and number of slices, a near six-fold improvement in CNR per unit time was achieved with 3D Nav-D-SSFP relative to 2D T2w FSE (P Ͻ 0.001). Manual and semiautomated measurements of carotid WA and LA on the 3D Nav-D-SSFP images were highly correlated (intraclass correlation coefficient (ICC) ϭ 0.961 and 0.996, respectively; P Ͻ 0.001).Conclusion: 3D Nav-D-SSFP is a time-efficient, swallowing-compensated, black-blood technique that lends itself for semiautomated measurements of carotid WA and LA that are in good agreement with manual measurements. CAROTID ATHEROSCLEROSIS is a well established risk factor for ischemic stroke. Research has suggested that the structure and composition of carotid atheroma may help identify plaques at risk for rupture and thrombosis. Noninvasive MRI of carotid atheroma has gained popularity in the past decade, since reports have shown that blood-suppressed (i.e., black-blood) MR imaging is capable of depicting and characterizing carotid atherosclerotic plaques in vivo (1-5).To date, black-blood MR techniques used to depict the carotid arterial wall have predominantly consisted of two-dimensional (2D) fast spin-echo (FSE) acquisitions (3). 2D FSE acquisitions coupled with blood-suppressing double inversion-recovery (DIR) preparations have been used for this purpose since these techniques generally provide excellent black-blood image contrast, high imaging signal-to-noise ratio (SNR), and imaging time on the order of a minute for acquisition of a single slice; the latter are short enough to render these techniques less susceptible to patient swallowing motion artifacts. In comparison, three-dimensional (3D) MR imaging techniques, although potentially superior to 2D methods in terms of achievable imaging spatial resolution and SNR, have two significant limitations for carotid arterial wall assessment relative to their 2D counterparts, including suboptimal blood signal suppression and longer imaging times (6 -8). These limitations render 3D carotid vessel wall imaging methods more prone to plaque-mimicking blood flow artifacts (9) and image-distorting motion artifacts (10), respectively.Diffusion-prepared segmented steady-state free precession (SSFP) MR imaging has recently been proposed as a technique that allows for time-efficient imaging of the aortic and carotid ...

OBJECTIVE The joint guidelines of the American College of Cardiology and American Heart Association support the use of contrast-enhanced MR angiography (CEMRA) to diagnose the location and degree of stenosis in patients with known or suspected peripheral arterial disease (PAD). The high prevalence of chronic renal impairment in diabetic patients with PAD and the need for high doses of gadolinium-based contrast agents place them at risk for nephrogenic systemic fibrosis. The purpose of our study was to evaluate the accuracy of the rapid technique of quiescent-interval single-shot (QISS) unenhanced MR angiography (MRA) compared with CEMRA for the diagnosis in diabetic patients referred with symptomatic chronic PAD. SUBJECTS AND METHODS This prospective two-center study evaluated 25 consecutive diabetic patients with documented or suspected symptomatic PAD. Both centers used identical imaging protocols. Images were independently analyzed by two radiologists. A subgroup analysis was performed of patients who were also assessed with digital subtraction angiography (DSA) as part of the standard-of-care protocol before revascularization. RESULTS For this study, 775 segments were analyzed. On a per-segment basis, the mean values of the diagnostic accuracy of unenhanced MRA compared with reference CEMRA for two reviewers, reviewers 1 and 2, were as follows: sensitivity, 87.4% and 92.1%; specificity, 96.8% and 96.0%; positive predictive value, 90.8% and 94.0%; and negative predictive value, 95.5% and 94.6%. Substantial agreement was found when overall DSA results were compared with QISS unenhanced MRA (κ = 0.68) and CEMRA (κ = 0.63) in the subgroup of patients who also underwent DSA. There was almost perfect agreement between the two readers for stenosis scores, with Cohen’s kappa values being greater than 0.80 for both MRA techniques. CONCLUSION The results of our study indicate that QISS unenhanced MRA is an accurate noncontrast alternative to CEMRA for showing clinically significant arterial disease in patients with diabetes with symptomatic PAD.