Renovascular imaging in the NSF Era

Roditi, Giles; Maki, Jeffrey H.; Oliveira, George R.; Michaely, Henrik J.

doi:10.1002/jmri.21977

Cited by 38 publications

(23 citation statements)

References 79 publications

(93 reference statements)

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“…Concerns about a possible link between gadolinium-based contrast agents and nephrogenic systemic fibrosis (NSF) have brought into question the use of these agents for MRA (6,7). While this link has not yet been conclusively proven, a correlative association has been identified by several studies (8)(9)(10)(11)(12).…”

Section: Instructions On Receiving Creditmentioning

confidence: 99%

“…As a precaution, the U.S. Food and Drug Administration applied a black-box warning on gadolinium-based contrast agents in 2007 (13). Due to NSF concerns, it is recommended that special considerations be taken regarding the use of gadoliniumbased contrast agents, especially for renal-compromised patients (7,14,15). The confounding factor is that it is often the renal-compromised patients who are the patient population that needs an MRA examination.…”

Section: Instructions On Receiving Creditmentioning

confidence: 99%

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Non‐contrast enhanced MR angiography: Physical principles

Wheaton

Miyazaki

2012

Magnetic Resonance Imaging

130

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Noncontrast‐enhanced magnetic resonance angiography (NCE‐MRA) methods have been demonstrated in anatomies throughout the body. Previously established NCE‐MRA techniques suffered from long scan times or low sensitivity. Advances in hardware and software have made NCE‐MRA scan times clinically feasible. Recent concerns over the safety of gadolinium‐based contrast material combined with the expense of the material and its administration have generated a demand for NCE‐MRA. In response, several new NCE‐MRA methods have been developed. The physical mechanisms underlying five general classes of NCE‐MRA methods (inflow effect, flow‐dependency on cardiac phase, flow‐encoding, spin labeling, and relaxation) are explained. The original techniques of time‐of‐flight (TOF) and phase contrast MRA (PC‐MRA) are briefly introduced. New developments in NCE‐MRA, including hybrid of opposite‐contrast (HOP‐MRA), four dimensional PC‐MRA (4D Flow), cardiac‐gated 3D fast‐spin‐echo, flow‐sensitive dephasing (FSD), arterial spin labeling (ASL), and balanced steady‐state free‐precession (bSSFP) are highlighted. The primary applications, advantages, and limitations of established and emerging NCE‐MRA techniques are discussed. J. Magn. Reson. Imaging 2012;36:286–304. © 2012 Wiley Periodicals, Inc.

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Section: Instructions On Receiving Creditmentioning

confidence: 99%

Section: Instructions On Receiving Creditmentioning

confidence: 99%

Non‐contrast enhanced MR angiography: Physical principles

Wheaton

Miyazaki

2012

Magnetic Resonance Imaging

130

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“…Non-contrast MRA techniques have been used for several years, but have been generally overshadowed by the more popular contrast-enhanced techniques [10]. CT angiography is a proven tool in this domain.…”

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confidence: 99%

Is there a role for free breathing non-contrast steady-state free precession renal MRA imaging for assessing live donors? A preliminary study

Laurence

Ariff²,

Quest³

et al. 2012

The British Journal of Radiology

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Objective: Accurate pre-operative evaluation of renal vascular anatomy is essential for successful renal harvest in live donor transplantation. Non-contrast renal MR angiographic (MRA) techniques are potentially well suited to the screening of donors; however, their restricted imaging field of view (FOV) has previously been an important limitation. We sought to assess whether the addition of a large FOV balanced fast field echo (BFFE) steady-state free precession (SSFP) sequence to non-contrast SSFP MRA could overcome this problem. Comparison with contrast-enhanced MRA (CE MRA) and findings at surgery were performed. Methods: 22 potential renal donors each underwent SSFP and CE MRA. 11 out of 22 potential donors subsequently underwent a donor nephrectomy. Results: All images were diagnostic. Both SSFP MRA and CE MRA identified an equal number of arteries. Surgery confirmed two accessory renal arteries, both demonstrated with both imaging techniques. A third accessory vessel was identified with both techniques on a kidney contralateral to the donated organ. 6 out of 11 procured kidneys demonstrated early branch arteries at surgery, 5 out of 6 of which had been depicted on both SSFP and CE MRA. The median grading of image quality for main renal arteries was slightly better for CE MRA (p50.048), but for accessory vessels it was better for SSFP MRA. Conclusion: This pilot study indicates that by combining free-breathing SSFP MRA with large-FOV bFFE images, an accurate depiction of renal vascular anatomy without the need for intravenous contrast administration can be obtained, as compared with surgical findings and CE MRA. Living donor transplantation is becoming an increasingly important treatment option for end-stage renal failure (ESRF). The high prevalence of anatomical variants in renal vascular anatomy underscores the importance of accurate pre-operative evaluation of the vascular anatomy [1, 2], particularly in patients undergoing a laparoscopic approach, as the surgical field of view (FOV) is limited. Multiple renal arteries in the donor kidney result in a substantial increase in the risk of complications. Moreover, the presence of accessory arteries and early branches of the renal arteries, as well as variants in venous anatomy, can all affect the surgical decision for suitability for donor harvest [3,4].Although there has been some debate about the optimal imaging strategy for potential renal donors [5][6][7], with concerns raised over the ability of contrast-enhanced MR angiography (CE MRA) to detect all renal arteries [8], there is evidence to support the sole use of CE MRA for this purpose [9]. Non-contrast MRA techniques have been used for several years, but have been generally overshadowed by the more popular contrast-enhanced techniques [10]. CT angiography is a proven tool in this domain. It also has the ability to detect parenchymal abnormalities and calculi; however, its use of ionising radiation is a disadvantage that should be considered when evaluating a donor population [11,12].Balanced steady-...

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“…16,19 Unfortunately, concerns about a possible relationship between gadolinium-based contrast agents and nephrogenic systemic fibrosis (NSF) have brought into question the use of these agents for MRA. 20,21 Although this relationship has not been conclusively proven, an association has been seen in several studies. 22e26 In 2007, the US Food and Drug Administration issued a precautionary black-box warning on gadolinium agents, recommending special caution in their use, especially in renal-compromised patients.…”

Section: Discussionmentioning

confidence: 92%