Utility of noncontrast‐enhanced time‐resolved four‐dimensional MR angiography with a vessel‐selective technique for intracranial arteriovenous malformations

Fujima, Noriyuki; Osanai, Toshiya; Shimizu, Yukie; Yoshida, Atsushi; Harada, Taisuke; Nakayama, Naoki; Kudo, Kohsuke; Houkin, Kiyohiro; Shirato, Hiroki

doi:10.1002/jmri.25222

Cited by 27 publications

(19 citation statements)

References 19 publications

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“…Currently, TOF-MRA is the MR imaging technique conventionally used to depict intracranial arteries. However, there are known major limitations to the use of TOF-MRA for the delineation of cerebrovascular disorders, such as pseudoocclusions, 15 the inaccurate detection of aneurysms 16 and the nidus and draining veins in AVMs, 17 and collateral vessels in Moyamoya disease. 18 The resultant signal losses are mainly due to saturation secondary to slow flow or phase-dispersion effects caused by turbulent flow, 19 which account for the overestimation or inaccuracy of TOF-MRA observed in our study.…”

Section: Discussionmentioning

confidence: 99%

Validation of Zero TE–MRA in the Characterization of Cerebrovascular Diseases: A Feasibility Study

Shang

Dou³

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Zero TE-MRA is less sensitive to field heterogeneity, complex flow, and acquisition noise. This study aimed to prospectively validate the feasibility of zero TE-MRA for cerebrovascular diseases assessment, compared with TOF-MRA. MATERIALS AND METHODS: Seventy patients suspected of having cerebrovascular disorders were recruited. Sound levels were estimated for each MRA subjectively and objectively in different modes. MRA image quality was estimated by 2 neuroradiologists. The degree of stenosis (grades 0-4) and the z-diameter of aneurysms (tiny group Յ3 mm and large group Ͼ3 mm) were measured for further quantitative analysis. CTA was used as the criterion standard. RESULTS: Zero TE-MRA achieved significantly lower subjective perception and objective noise reduction (37.53%). Zero TE-MRA images showed higher signal homogeneity (3.29 Ϯ 0.59 versus 3.04 Ϯ 0.43) and quality of venous signal suppression (3.67 Ϯ 0.47 versus 2.75 Ϯ 0.46). The intermodality agreement was higher for zero TE-MRA than for TOF-MRA (zero TE, 0.90; TOF, 0.81) in the grading of stenosis. Zero TE-MRA had a higher correlation than TOF-MRA (zero TE, 0.84; TOF, 0.74) in the tiny group and a higher consistency with CTA (intraclass correlation coefficient, 0.83; intercept, Ϫ0.5084-1.1794; slope Ϫ0.4952 to Ϫ0.2093) than TOF-MRA (intraclass correlation coefficient, 0.64; intercept, 0.7000-2.6133; slope Ϫ1.0344 to Ϫ0.1923). Zero TE-MRA and TOF-MRA were comparable in the large group. Zero TE-MRA had more accurate details than TOF-MRA of AVM and Moyamoya lesions. CONCLUSIONS: Compared with TOF-MRA, zero TE-MRA achieved more robust performance in depicting cerebrovascular diseases. Therefore, zero TE-MRA was shown to be a promising MRA technique for further routine application in the clinic in patients with cerebrovascular diseases. ABBREVIATIONS: ASL ϭ arterial spin-labeling; AVM ϭ arteriovenous malformation; MRA ϭ magnetic resonance angiography; CTA ϭ computed tomography angiography; CE ϭ contrast-enhanced; TOF ϭ time-of-flight; zTE ϭ zero echo time; MIP ϭ maximum intensity projection; VR ϭ volume rendering; MCA ϭ middle cerebral artery; ICA ϭ internal carotid artery

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Section: Discussionmentioning

confidence: 99%

Validation of Zero TE–MRA in the Characterization of Cerebrovascular Diseases: A Feasibility Study

Shang

Dou³

et al. 2019

AJNR Am J Neuroradiol

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“…The same selective labeling approach can be used for 4D-MRA, 59 and an application to intracranial AVM patients was reported. 17 The advantage of the use of PASL for vessel-selective labeling is its sharp profile between the labeled and non-labeled area, which can clearly separate the targeted artery from other arteries. However, due to nonselectivity in the inferior-superior direction (except for the limited coverage of the RF-transmit coil), it can frequently result in unwanted inclusion of other non-targeted arteries, for example, due to tortuous vascular anatomy.…”

Section: Vessel-selective Labelingmentioning

confidence: 99%

“…Additionally, it should be also noted that, in dynamic CE-MRA and X-ray DSA, the contrast agent will be injected using a power-injector at a high-speed, which may cause an altered blood flow from the normal physiological condition. 17 In contrast, the information obtained by ASL-based 4D-MRA potentially reflects the natural physiological blood flow condition.…”

Section: Introductionmentioning

confidence: 99%

Intracranial 3D and 4D MR Angiography Using Arterial Spin Labeling: Technical Considerations

Suzuki

Fujima

Osch

2020

MRMS

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In the 1980's some of the earliest studies of arterial spin labeling (ASL) MRI have demonstrated its ability to generate MR angiography (MRA) images. Thanks to many technical improvements, ASL has been successfully moving its position from the realm of research into the clinical area, albeit more known as perfusion imaging than as MRA. For MRA imaging, other techniques such as time-of-flight, phase contrast MRA and contrast-enhanced (CE) MRA are more popular choices for clinical applications. In the last decade, however, ASL-MRA has been experiencing a remarkable revival, especially because of its non-invasive nature, i.e. the fact that it does not rely on the use of contrast agent. Very importantly, there are additional benefits of using ASL for MRA. For example, its higher flexibility to achieve both high spatial and temporal resolution than CE dynamic MRA, and the capability of vessel specific visualization, in which the vascular tree arising from a selected artery can be exclusively visualized. In this article, the implementation and recent developments of ASL-based MRA are discussed; not only focusing on the basic sequences based upon pulsed ASL or pseudo-continuous ASL, but also including more recent labeling approaches, such as vessel-selective labeling, velocity-selective ASL, vessel-encoded ASL and time-encoded ASL. Although these ASL techniques have been already utilized in perfusion imaging and their usefulness has been suggested by many studies, some additional considerations should be made when employing them for MRA, since there is something more than the difference of the spatial resolution of the readout sequence. Moreover, extensive discussion is included on what readout sequence to use, especially by highlighting how to achieve high spatial resolution while keeping scan-time reasonable such that the ASL-MRA sequence can easily be included into a clinical examination.

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“…For example, vessel‐selective imaging that exclusively visualizes the downstream arterial tree of an individually targeted artery, can be achieved by applying spatially‐selective labeling pulses. Several previous studies report the usefulness of such vessel‐selective MRA, for example, for detecting the feeding arteries of an AVM . Also, ASL has a higher flexibility to achieve both high temporal and spatial resolution, because it is not limited to capture all necessary information during the first passage of a bolus of contrast agent.…”

Section: Introductionmentioning

confidence: 99%

“…Several previous studies report the usefulness of such vessel-selective MRA, for example, for detecting the feeding arteries of an AVM. 1,2 Also, ASL has a higher flexibility to achieve both high temporal and spatial resolution, because it is not limited to capture all necessary information during the first passage of a bolus of contrast agent. Therefore, ASL data acquisition can be repeated until sufficient information is acquired to achieve the desired spatial and temporal resolution.…”

Section: Introductionmentioning

confidence: 99%

Acceleration of vessel‐selective dynamic MR Angiography by pseudocontinuous arterial spin labeling in combination with Acquisition of ConTRol and labEled images in the Same Shot (ACTRESS)

Suzuki

Okell

Fujima

et al. 2018

Magnetic Resonance in Med

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Purpose The recently introduced “Acquisition of ConTRol and labEled imaging in the Same Shot” (ACTRESS) approach was designed to halve the scan time of arterial spin labeling (ASL) ‐based 4D‐MRA by obtaining both labeled and control images in a single Look‐Locker readout. However, application for vessel‐selective labeling remains difficult. The aim of this study was to achieve a combination of ACTRESS and vessel‐selective labeling to halve the scan time of vessel‐selective 4D‐MRA. Methods By Bloch equation simulations, Look‐Locker pseudocontinuous‐ASL (pCASL) was optimized to achieve constant static tissue signal across the multidelay readout, which is essential for the ACTRESS approach. Additionally, a new subtraction scheme was proposed to achieve visualization of the inflow phase even when labeled blood will have already arrived in the distal arteries during the first phase acquisition due to the long duration of the pCASL labeling module. In vivo studies were performed to investigate the signal variation of the static tissue, as well as to assess image quality of vessel‐selective 4D‐MRA with ACTRESS. Results In in vivo studies, the mean signal variation of the static tissue was 8.98% over the Look‐Locker phases, thereby minimizing the elevation of background signal. This allowed visualization of peripheral arteries and slowly arriving arterial blood with image quality as good as conventional pCASL within half the acquisition time. Vessel‐selective pCASL‐ACTRESS enabled the separated visualization of vessels arising from internal and external carotid arteries within this shortened acquisition time. Conclusion By combining vessel‐selective pCASL and ACTRESS approach, 4D‐MRA of a single targeted arterial tree was achieved in a few minutes.

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Utility of noncontrast‐enhanced time‐resolved four‐dimensional MR angiography with a vessel‐selective technique for intracranial arteriovenous malformations

Abstract: Purpose: To evaluate the utility of a vessel-selective four-dimensional (4D) magnetic resonance angiography (MRA) technique for the evaluation of intracranial arteriovenous malformations (AVMs). Materials and Methods:Twelve AVM patients were evaluated retrospectively.

Cited by 27 publications

References 19 publications

Validation of Zero TE–MRA in the Characterization of Cerebrovascular Diseases: A Feasibility Study

Validation of Zero TE–MRA in the Characterization of Cerebrovascular Diseases: A Feasibility Study

Intracranial 3D and 4D MR Angiography Using Arterial Spin Labeling: Technical Considerations

Acceleration of vessel‐selective dynamic MR Angiography by pseudocontinuous arterial spin labeling in combination with Acquisition of ConTRol and labEled images in the Same Shot (ACTRESS)

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