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Renal Arteries: Navigator-gated Balanced Fast Field-Echo Projection MR Angiography with Aortic Spin Labeling: Initial Experience¹

¹ From the Departments of Medicine, Cardiovascular Division (E.S., W.J.M., P.B., K.V.K., R.M.B., M.S.), and Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass; Department of Diagnostic Radiology, University Hospital, Technical University of Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany (E.S.); Philips Research Laboratory, Hamburg, Germany (P.B.); and Philips Medical Systems, Best, the Netherlands (R.M.B., M.S.). Received August 13, 2001; revision requested October 9; final revision received March 4, 2002; accepted April 3. E.S. supported in part by German Research Council grant SP 634/1-1. W.J.M. supported in part by American Heart Association Established Investigator grant 9740003N. Address correspondence to E.S. (e-mail: spuenti@rad.rwth-aachen.de).

View larger version (31K): [in a new window]   Figure 1. Schematic of the sequence elements for renal projection MR angiography. Twenty start-up cycles precede the 3D balanced fast field-echo (true FISP) portion of the sequence to obtain steady-state signal condition. The labeling delay is user defined. The local presaturation bands (REST) are preceded by the navigator for free-breathing data acquisition. SPOILER = radio-frequency spoiling, 2D = two-dimensional.

View larger version (31K): [in a new window]   Figure 2. Schematic depicts the basic principle of renal projection MR angiography (MRA). Two identical images acquired (A) without and (B) with aortic labeling pulse are complexly subtracted. As a result, only the labeled blood in the aorta and renal arteries contributes to the signal, whereas the venous signal and that of the surrounding tissue are suppressed. 2D = two-dimensional.

View larger version (86K): [in a new window]   Figure 3a. Transverse double-oblique renal projection MR angiograms in a healthy 36-year-old woman were obtained with the balanced fast field-echo sequence. (a) Anatomic image (single section), (b) subtracted image (single section), (c) and parallel maximum intensity projection, which shows both the main renal arteries and the branches with a high signal intensity (solid arrows). In b and c, signal from veins and the surrounding static tissue is completely suppressed; the superior mesenteric artery and the celiac trunk (dashed arrow) are also seen.

View larger version (65K): [in a new window]   Figure 3b. Transverse double-oblique renal projection MR angiograms in a healthy 36-year-old woman were obtained with the balanced fast field-echo sequence. (a) Anatomic image (single section), (b) subtracted image (single section), (c) and parallel maximum intensity projection, which shows both the main renal arteries and the branches with a high signal intensity (solid arrows). In b and c, signal from veins and the surrounding static tissue is completely suppressed; the superior mesenteric artery and the celiac trunk (dashed arrow) are also seen.

View larger version (70K): [in a new window]   Figure 3c. Transverse double-oblique renal projection MR angiograms in a healthy 36-year-old woman were obtained with the balanced fast field-echo sequence. (a) Anatomic image (single section), (b) subtracted image (single section), (c) and parallel maximum intensity projection, which shows both the main renal arteries and the branches with a high signal intensity (solid arrows). In b and c, signal from veins and the surrounding static tissue is completely suppressed; the superior mesenteric artery and the celiac trunk (dashed arrow) are also seen.

View larger version (69K): [in a new window]   Figure 4a. Double-oblique (a) transverse and (b) coronal balanced fast field-echo renal projection MR angiograms in a healthy 33-year-old woman. Main renal arteries and distal branches (arrows) are displayed with high signal intensity.

View larger version (69K): [in a new window]   Figure 4b. Double-oblique (a) transverse and (b) coronal balanced fast field-echo renal projection MR angiograms in a healthy 33-year-old woman. Main renal arteries and distal branches (arrows) are displayed with high signal intensity.

View larger version (57K): [in a new window]   Figure 5a. Arterial hypertension in a 64-year-old male patient. (a) Transverse double-oblique renal projection MR angiogram (balanced fast field-echo sequence) shows normal renal arteries (arrows) without stenosis. (b) Three-dimensional MR angiogram (transverse reconstruction) shows findings that confirm those in a.

View larger version (59K): [in a new window]   Figure 5b. Arterial hypertension in a 64-year-old male patient. (a) Transverse double-oblique renal projection MR angiogram (balanced fast field-echo sequence) shows normal renal arteries (arrows) without stenosis. (b) Three-dimensional MR angiogram (transverse reconstruction) shows findings that confirm those in a.

View larger version (51K): [in a new window]   Figure 6a. Arterial hypertension in a 68-year-old female patient suspected of having renal artery disease. Double-oblique (a) transverse and (b) coronal renal projection MR angiograms (balanced fast field-echo sequence) show occlusion of the left renal artery (arrowhead) and proximal stenosis (arrows) of the right renal artery close to the ostium. (c) Transverse and (d) coronal 3D MR angiogram reconstructions show consistent findings (labeled as in a).

View larger version (58K): [in a new window]   Figure 6b. Arterial hypertension in a 68-year-old female patient suspected of having renal artery disease. Double-oblique (a) transverse and (b) coronal renal projection MR angiograms (balanced fast field-echo sequence) show occlusion of the left renal artery (arrowhead) and proximal stenosis (arrows) of the right renal artery close to the ostium. (c) Transverse and (d) coronal 3D MR angiogram reconstructions show consistent findings (labeled as in a).

View larger version (83K): [in a new window]   Figure 6c. Arterial hypertension in a 68-year-old female patient suspected of having renal artery disease. Double-oblique (a) transverse and (b) coronal renal projection MR angiograms (balanced fast field-echo sequence) show occlusion of the left renal artery (arrowhead) and proximal stenosis (arrows) of the right renal artery close to the ostium. (c) Transverse and (d) coronal 3D MR angiogram reconstructions show consistent findings (labeled as in a).

View larger version (126K): [in a new window]   Figure 6d. Arterial hypertension in a 68-year-old female patient suspected of having renal artery disease. Double-oblique (a) transverse and (b) coronal renal projection MR angiograms (balanced fast field-echo sequence) show occlusion of the left renal artery (arrowhead) and proximal stenosis (arrows) of the right renal artery close to the ostium. (c) Transverse and (d) coronal 3D MR angiogram reconstructions show consistent findings (labeled as in a).

View larger version (57K): [in a new window]   Figure 7a. Arterial hypertension in a 60-year-old male patient. (a) Transverse double-oblique renal projection MR angiogram (balanced fast field-echo sequence) shows moderate stenosis (arrowhead) of the proximal left main renal artery and high-grade (solid arrow) and low-grade (dashed arrow) stenoses of a right branch vessel. (b) Three-dimensional MR angiogram (transverse reconstruction) and (c) conventional MR angiogram show consistent findings (labeled as in a).

View larger version (78K): [in a new window]   Figure 7b. Arterial hypertension in a 60-year-old male patient. (a) Transverse double-oblique renal projection MR angiogram (balanced fast field-echo sequence) shows moderate stenosis (arrowhead) of the proximal left main renal artery and high-grade (solid arrow) and low-grade (dashed arrow) stenoses of a right branch vessel. (b) Three-dimensional MR angiogram (transverse reconstruction) and (c) conventional MR angiogram show consistent findings (labeled as in a).

View larger version (62K): [in a new window]   Figure 7c. Arterial hypertension in a 60-year-old male patient. (a) Transverse double-oblique renal projection MR angiogram (balanced fast field-echo sequence) shows moderate stenosis (arrowhead) of the proximal left main renal artery and high-grade (solid arrow) and low-grade (dashed arrow) stenoses of a right branch vessel. (b) Three-dimensional MR angiogram (transverse reconstruction) and (c) conventional MR angiogram show consistent findings (labeled as in a).

View larger version (24K): [in a new window]   Figure 8. Bar graph depicts signal-to-noise ratio (SNR) of the aorta, renal arteries (ren art), and renal veins (ren ven) and contrast-to-noise ratio (CNR) of the renal arteries to the renal veins (ren art/ven) and renal arteries to the surrounding soft tissue (muscle) (ren art/soft) in the anatomic (white bars) and projection (black bars) MR angiograms. Error bars represent + 1 SD.