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Time-resolved Three-dimensional Contrast-enhanced MR Angiography of the Peripheral Vessels¹

¹ From the Depts of Radiology (J.S.S., T.W.K., F.R.K., R.F., T.M.G.), Med Physics (T.J.C., F.R.K., R.F., C.A.M., T.M.G.), and Surgery (D.M.H.), Univ of Wisconsin-Madison Med School, Wis. Received Jul 27, 2001; revision requested Sep 4; revision received Dec 19; accepted Feb 19, 2002. Supported by NIH R01 HL51370 and Nycomed-Amersham. Address correspondence to T.J.C., Depts of Radiology and Biomedical Engineering, Northwestern University, 448 E Ontario St, Ste 700, Chicago, IL 60611 (e-mail: t-carroll@northwestern.edu).

View larger version (47K): [in a new window]   Figure 1a. DSA and TRICKS angiographic visualization of the peroneal arteries in a 59-year-old man. (a) Peak arterial time frames from a 3D TRICKS examination (7.8/1.7) performed by using fast contrast agent injection (1.5 mL/sec). Composite image of coronal maximum intensity projections from the 3D TRICKS examination demonstrates the anatomic coverage typically achieved in a three-station protocol. Multiple stenoses (arrows) in both superficial femoral arteries are seen and were confirmed at x-ray DSA. Brackets in the lower station enclose the region of interest magnified in b and c. (b) Coronal maximum intensity projections from the distal station of a 3D TRICKS examination (7.8/1.7) demonstrate normal peroneal arteries (arrows) bilaterally. Trifurcation vessels are well visualized despite the modulation artifact that resulted from the fast injection rate and manifested as a ghost artifact along the length of the vessels. (c) DSA image demonstrates left peroneal artery filling (thick arrow), but the right distal peroneal artery is absent (thin arrow). The right distal peroneal artery was judged to be occluded by both readers.

View larger version (92K): [in a new window]   Figure 1b. DSA and TRICKS angiographic visualization of the peroneal arteries in a 59-year-old man. (a) Peak arterial time frames from a 3D TRICKS examination (7.8/1.7) performed by using fast contrast agent injection (1.5 mL/sec). Composite image of coronal maximum intensity projections from the 3D TRICKS examination demonstrates the anatomic coverage typically achieved in a three-station protocol. Multiple stenoses (arrows) in both superficial femoral arteries are seen and were confirmed at x-ray DSA. Brackets in the lower station enclose the region of interest magnified in b and c. (b) Coronal maximum intensity projections from the distal station of a 3D TRICKS examination (7.8/1.7) demonstrate normal peroneal arteries (arrows) bilaterally. Trifurcation vessels are well visualized despite the modulation artifact that resulted from the fast injection rate and manifested as a ghost artifact along the length of the vessels. (c) DSA image demonstrates left peroneal artery filling (thick arrow), but the right distal peroneal artery is absent (thin arrow). The right distal peroneal artery was judged to be occluded by both readers.

View larger version (108K): [in a new window]   Figure 1c. DSA and TRICKS angiographic visualization of the peroneal arteries in a 59-year-old man. (a) Peak arterial time frames from a 3D TRICKS examination (7.8/1.7) performed by using fast contrast agent injection (1.5 mL/sec). Composite image of coronal maximum intensity projections from the 3D TRICKS examination demonstrates the anatomic coverage typically achieved in a three-station protocol. Multiple stenoses (arrows) in both superficial femoral arteries are seen and were confirmed at x-ray DSA. Brackets in the lower station enclose the region of interest magnified in b and c. (b) Coronal maximum intensity projections from the distal station of a 3D TRICKS examination (7.8/1.7) demonstrate normal peroneal arteries (arrows) bilaterally. Trifurcation vessels are well visualized despite the modulation artifact that resulted from the fast injection rate and manifested as a ghost artifact along the length of the vessels. (c) DSA image demonstrates left peroneal artery filling (thick arrow), but the right distal peroneal artery is absent (thin arrow). The right distal peroneal artery was judged to be occluded by both readers.

View larger version (41K): [in a new window]   Figure 2a. Efficacy of TRICKS imaging demonstrated in a 69-year-old man with aortic occlusion. (a) Composite of coronal maximum intensity projection images from the peak arterial time frames of a 3D TRICKS examination (7.8/1.7) show the entire lower extremity vascular tree (note aortoiliac occlusions). Arrow points to occlusion of the right superficial femoral artery. (b) Correlating DSA image shows aortic occlusion (arrow). (c) DSA image shows collateral vessels establishing flow through the common femoral arteries (arrows). (d) Runoff DSA image shows minimal opacification of vessels (arrows), particularly in the right leg. (e) Advantages of time-resolved acquisition are reflected in 3D TRICKS time frames (7.8/1.7) demonstrating the peak arterial filling of the aortorenal arteries just above the occlusion at 28 seconds (short arrows) and the maximum signal intensity of the common femoral arteries at 42 seconds (long arrows). (f) Coronal maximum intensity projection 3D TRICKS time frames (7.8/1.7) acquired 28-91 seconds after contrast agent injection from the distal runoff station. The left leg is only intermittently filled, and the right leg becomes more obscured by veins in later time frames. The imaging of runoff vessels in this patient probably would have been problematic with use of a non-time-resolved approach.

View larger version (123K): [in a new window]   Figure 2b. Efficacy of TRICKS imaging demonstrated in a 69-year-old man with aortic occlusion. (a) Composite of coronal maximum intensity projection images from the peak arterial time frames of a 3D TRICKS examination (7.8/1.7) show the entire lower extremity vascular tree (note aortoiliac occlusions). Arrow points to occlusion of the right superficial femoral artery. (b) Correlating DSA image shows aortic occlusion (arrow). (c) DSA image shows collateral vessels establishing flow through the common femoral arteries (arrows). (d) Runoff DSA image shows minimal opacification of vessels (arrows), particularly in the right leg. (e) Advantages of time-resolved acquisition are reflected in 3D TRICKS time frames (7.8/1.7) demonstrating the peak arterial filling of the aortorenal arteries just above the occlusion at 28 seconds (short arrows) and the maximum signal intensity of the common femoral arteries at 42 seconds (long arrows). (f) Coronal maximum intensity projection 3D TRICKS time frames (7.8/1.7) acquired 28-91 seconds after contrast agent injection from the distal runoff station. The left leg is only intermittently filled, and the right leg becomes more obscured by veins in later time frames. The imaging of runoff vessels in this patient probably would have been problematic with use of a non-time-resolved approach.

View larger version (169K): [in a new window]   Figure 2c. Efficacy of TRICKS imaging demonstrated in a 69-year-old man with aortic occlusion. (a) Composite of coronal maximum intensity projection images from the peak arterial time frames of a 3D TRICKS examination (7.8/1.7) show the entire lower extremity vascular tree (note aortoiliac occlusions). Arrow points to occlusion of the right superficial femoral artery. (b) Correlating DSA image shows aortic occlusion (arrow). (c) DSA image shows collateral vessels establishing flow through the common femoral arteries (arrows). (d) Runoff DSA image shows minimal opacification of vessels (arrows), particularly in the right leg. (e) Advantages of time-resolved acquisition are reflected in 3D TRICKS time frames (7.8/1.7) demonstrating the peak arterial filling of the aortorenal arteries just above the occlusion at 28 seconds (short arrows) and the maximum signal intensity of the common femoral arteries at 42 seconds (long arrows). (f) Coronal maximum intensity projection 3D TRICKS time frames (7.8/1.7) acquired 28-91 seconds after contrast agent injection from the distal runoff station. The left leg is only intermittently filled, and the right leg becomes more obscured by veins in later time frames. The imaging of runoff vessels in this patient probably would have been problematic with use of a non-time-resolved approach.

View larger version (188K): [in a new window]   Figure 2d. Efficacy of TRICKS imaging demonstrated in a 69-year-old man with aortic occlusion. (a) Composite of coronal maximum intensity projection images from the peak arterial time frames of a 3D TRICKS examination (7.8/1.7) show the entire lower extremity vascular tree (note aortoiliac occlusions). Arrow points to occlusion of the right superficial femoral artery. (b) Correlating DSA image shows aortic occlusion (arrow). (c) DSA image shows collateral vessels establishing flow through the common femoral arteries (arrows). (d) Runoff DSA image shows minimal opacification of vessels (arrows), particularly in the right leg. (e) Advantages of time-resolved acquisition are reflected in 3D TRICKS time frames (7.8/1.7) demonstrating the peak arterial filling of the aortorenal arteries just above the occlusion at 28 seconds (short arrows) and the maximum signal intensity of the common femoral arteries at 42 seconds (long arrows). (f) Coronal maximum intensity projection 3D TRICKS time frames (7.8/1.7) acquired 28-91 seconds after contrast agent injection from the distal runoff station. The left leg is only intermittently filled, and the right leg becomes more obscured by veins in later time frames. The imaging of runoff vessels in this patient probably would have been problematic with use of a non-time-resolved approach.

View larger version (117K): [in a new window]   Figure 2e. Efficacy of TRICKS imaging demonstrated in a 69-year-old man with aortic occlusion. (a) Composite of coronal maximum intensity projection images from the peak arterial time frames of a 3D TRICKS examination (7.8/1.7) show the entire lower extremity vascular tree (note aortoiliac occlusions). Arrow points to occlusion of the right superficial femoral artery. (b) Correlating DSA image shows aortic occlusion (arrow). (c) DSA image shows collateral vessels establishing flow through the common femoral arteries (arrows). (d) Runoff DSA image shows minimal opacification of vessels (arrows), particularly in the right leg. (e) Advantages of time-resolved acquisition are reflected in 3D TRICKS time frames (7.8/1.7) demonstrating the peak arterial filling of the aortorenal arteries just above the occlusion at 28 seconds (short arrows) and the maximum signal intensity of the common femoral arteries at 42 seconds (long arrows). (f) Coronal maximum intensity projection 3D TRICKS time frames (7.8/1.7) acquired 28-91 seconds after contrast agent injection from the distal runoff station. The left leg is only intermittently filled, and the right leg becomes more obscured by veins in later time frames. The imaging of runoff vessels in this patient probably would have been problematic with use of a non-time-resolved approach.

View larger version (86K): [in a new window]   Figure 2f. Efficacy of TRICKS imaging demonstrated in a 69-year-old man with aortic occlusion. (a) Composite of coronal maximum intensity projection images from the peak arterial time frames of a 3D TRICKS examination (7.8/1.7) show the entire lower extremity vascular tree (note aortoiliac occlusions). Arrow points to occlusion of the right superficial femoral artery. (b) Correlating DSA image shows aortic occlusion (arrow). (c) DSA image shows collateral vessels establishing flow through the common femoral arteries (arrows). (d) Runoff DSA image shows minimal opacification of vessels (arrows), particularly in the right leg. (e) Advantages of time-resolved acquisition are reflected in 3D TRICKS time frames (7.8/1.7) demonstrating the peak arterial filling of the aortorenal arteries just above the occlusion at 28 seconds (short arrows) and the maximum signal intensity of the common femoral arteries at 42 seconds (long arrows). (f) Coronal maximum intensity projection 3D TRICKS time frames (7.8/1.7) acquired 28-91 seconds after contrast agent injection from the distal runoff station. The left leg is only intermittently filled, and the right leg becomes more obscured by veins in later time frames. The imaging of runoff vessels in this patient probably would have been problematic with use of a non-time-resolved approach.

View larger version (160K): [in a new window]   Figure 3a. Insufficient vessel opacification at DSA in a 52-year-old man. (a) DSA image shows right iliac artery stenosis (thick arrows), but no left iliac artery opacification (thin arrows) is depicted. No femoral popliteal artery opacification was seen at a later DSA examination. (b) Three-dimensional TRICKS MR angiogram (7.8/1.7) shows right iliac artery stenosis (thick arrows). However, the left side shows retrograde filling of a stenotic external iliac artery (thin arrows) and a normal common femoral artery. (c) Three-dimensional TRICKS MR angiogram (7.8/1.7) shows normal left lower extremity arteries (arrows) past the left iliac occlusion.

View larger version (102K): [in a new window]   Figure 3b. Insufficient vessel opacification at DSA in a 52-year-old man. (a) DSA image shows right iliac artery stenosis (thick arrows), but no left iliac artery opacification (thin arrows) is depicted. No femoral popliteal artery opacification was seen at a later DSA examination. (b) Three-dimensional TRICKS MR angiogram (7.8/1.7) shows right iliac artery stenosis (thick arrows). However, the left side shows retrograde filling of a stenotic external iliac artery (thin arrows) and a normal common femoral artery. (c) Three-dimensional TRICKS MR angiogram (7.8/1.7) shows normal left lower extremity arteries (arrows) past the left iliac occlusion.

View larger version (110K): [in a new window]   Figure 3c. Insufficient vessel opacification at DSA in a 52-year-old man. (a) DSA image shows right iliac artery stenosis (thick arrows), but no left iliac artery opacification (thin arrows) is depicted. No femoral popliteal artery opacification was seen at a later DSA examination. (b) Three-dimensional TRICKS MR angiogram (7.8/1.7) shows right iliac artery stenosis (thick arrows). However, the left side shows retrograde filling of a stenotic external iliac artery (thin arrows) and a normal common femoral artery. (c) Three-dimensional TRICKS MR angiogram (7.8/1.7) shows normal left lower extremity arteries (arrows) past the left iliac occlusion.

View larger version (30K): [in a new window]   Figure 4a. (a) Receiver operating characteristic curves for detection of occlusion by readers 1 (Az = 0.90) and 2 (Az = 0.95) after pooling over location and injection rate. (b) Receiver operating characteristic curves for detection of significant stenosis (ie, at least one 50% stenosis) by readers 1 (Az = 0.87) and 2 (Az = 0.91) after pooling over location and injection rate.

View larger version (32K): [in a new window]   Figure 4b. (a) Receiver operating characteristic curves for detection of occlusion by readers 1 (Az = 0.90) and 2 (Az = 0.95) after pooling over location and injection rate. (b) Receiver operating characteristic curves for detection of significant stenosis (ie, at least one 50% stenosis) by readers 1 (Az = 0.87) and 2 (Az = 0.91) after pooling over location and injection rate.

View larger version (39K): [in a new window]   Figure 5a. (a) Receiver operating characteristic curves for detection of occlusion above the knee with fast (Az = 0.95) and slow (Az = 0.98) contrast agent injections indicate a trend toward higher sensitivity and specificity with the slow injection rate examinations. (b) Receiver operating characteristic curves indicate a similar trend for detection of occlusion below the knee with fast (Az = 0.87) and slow (Az = 0.95) injections. (c) Receiver operating characteristic curves for detection of significant stenosis (ie, at least one 50% stenosis) above the knee with fast (Az = 0.91) and slow (Az = 0.95) contrast agent injections indicate a trend toward higher sensitivity and specificity with slow injection rate examinations. (d) Receiver operating characteristic curves indicate a similar trend for detection of significant stenosis below the knee with fast (Az = 0.83) and slow (Az = 0.89) injections.

View larger version (40K): [in a new window]   Figure 5b. (a) Receiver operating characteristic curves for detection of occlusion above the knee with fast (Az = 0.95) and slow (Az = 0.98) contrast agent injections indicate a trend toward higher sensitivity and specificity with the slow injection rate examinations. (b) Receiver operating characteristic curves indicate a similar trend for detection of occlusion below the knee with fast (Az = 0.87) and slow (Az = 0.95) injections. (c) Receiver operating characteristic curves for detection of significant stenosis (ie, at least one 50% stenosis) above the knee with fast (Az = 0.91) and slow (Az = 0.95) contrast agent injections indicate a trend toward higher sensitivity and specificity with slow injection rate examinations. (d) Receiver operating characteristic curves indicate a similar trend for detection of significant stenosis below the knee with fast (Az = 0.83) and slow (Az = 0.89) injections.

View larger version (40K): [in a new window]   Figure 5c. (a) Receiver operating characteristic curves for detection of occlusion above the knee with fast (Az = 0.95) and slow (Az = 0.98) contrast agent injections indicate a trend toward higher sensitivity and specificity with the slow injection rate examinations. (b) Receiver operating characteristic curves indicate a similar trend for detection of occlusion below the knee with fast (Az = 0.87) and slow (Az = 0.95) injections. (c) Receiver operating characteristic curves for detection of significant stenosis (ie, at least one 50% stenosis) above the knee with fast (Az = 0.91) and slow (Az = 0.95) contrast agent injections indicate a trend toward higher sensitivity and specificity with slow injection rate examinations. (d) Receiver operating characteristic curves indicate a similar trend for detection of significant stenosis below the knee with fast (Az = 0.83) and slow (Az = 0.89) injections.

View larger version (41K): [in a new window]   Figure 5d. (a) Receiver operating characteristic curves for detection of occlusion above the knee with fast (Az = 0.95) and slow (Az = 0.98) contrast agent injections indicate a trend toward higher sensitivity and specificity with the slow injection rate examinations. (b) Receiver operating characteristic curves indicate a similar trend for detection of occlusion below the knee with fast (Az = 0.87) and slow (Az = 0.95) injections. (c) Receiver operating characteristic curves for detection of significant stenosis (ie, at least one 50% stenosis) above the knee with fast (Az = 0.91) and slow (Az = 0.95) contrast agent injections indicate a trend toward higher sensitivity and specificity with slow injection rate examinations. (d) Receiver operating characteristic curves indicate a similar trend for detection of significant stenosis below the knee with fast (Az = 0.83) and slow (Az = 0.89) injections.