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High-Spatial-Resolution Multistation MR Angiography with Parallel Imaging and Blood Pool Contrast Agent: Initial Experience¹

¹ From the Department of Clinical Radiology, Ludwig-Maximilians University of Munich, Grosshadern Campus, Marchioninistr 15, 81377 Munich, Germany (K.N., H.K., C.G., D.C., O.D., M.F.R., S.O.S.); EPIX Pharmaceuticals, Cambridge, Mass (M.H., P.C.); and Siemens Medical Solutions, Erlangen, Germany (S.A.). Received January 11, 2006; revision requested March 9; revision received April 13; accepted May 17; final version accepted June 16. Supported by EPIX Pharmaceuticals. Address correspondence to K.N. (e-mail: Konstantin.Nikolaou{at}med.uni-muenchen.de).

View larger version (15K): [in this window] [in a new window] [Download PPT slide]   Figure 1: Outline description of the study subjects.

View larger version (85K): [in this window] [in a new window] [Download PPT slide]   Figure 2: First-pass and steady-state MR angiograms in 28-year-old healthy man. A1, A2, First-pass coronal maximum intensity projections. During arterial first pass of gadofosveset trisodium, pure arterial phase images of, A1, carotid arteries (3.4/1.3 [repetition time msec/echo time msec], 30° flip angle), and, A2, calf vessels (4.3/1.4, 25° flip angle) were obtained after a single injection of contrast agent, with an isotropic spatial resolution of 1.000 mm3. B1–B3, Steady-state coronal MPRs. During steady-state imaging of the calf vessels, increasing spatial resolutions of, B1, 1.00-mm (1.000-mm3) (4.3/1.4, 25° flip angle); B2, 0.80-mm (0.512-mm3) (4.3/1.4, 25° flip angle); and, B3, 0.42-mm (0.074-mm3) (7.5/2.5, 25° flip angle) voxel lengths were acquired. The data set with highest spatial resolution (B3) depicts the smallest calf vessels in great detail while maintaining a very high signal-to-noise ratio. C, D, Steady-state 20-mm-thick coronal maximum intensity projections of the thoracic and abdominal vessels (4.3/1.4, 25° flip angle).

View larger version (97K): [in this window] [in a new window] [Download PPT slide]   Figure 3: Discrimination of arterial and venous vessels in the lower leg on paracoronal MPRs obtained along the course of the vessels in 30-year-old healthy man. Magnified views of anterotibial artery (vessel in the center) accompanied by two veins (vessels to the left and right) are shown at increasing spatial resolutions—specifically, isotropic voxel lengths of, A, 1.0 mm; B, 0.8 mm; C, 0.5 mm; and, D, 0.4 mm. SI profiles at the bottom of each image were measured along the horizontal line perpendicular to the vascular structures. With increasing spatial resolution, the profile of the central arterial vessel is delineated more clearly, proving that the level of differentiation between arterial and venous vessels on steady-state images is dependent on the spatial resolution. a.u. = arbitrary units.

View larger version (9K): [in this window] [in a new window] [Download PPT slide]   Figure 4: Receiver operating characteristic analysis curve illustrates the accuracy of gadofosveset trisodium–enhanced MR angiography, relative to the reference-standard imaging modalities, in diagnosing the disease state of 180 vessels (30 supraaortic, 10 renal, 140 peripheral runoff), including 37 cases of significant (75%) stenosis.

View larger version (175K): [in this window] [in a new window] [Download PPT slide]   Figure 5a: Images in 54-year-old man with long history of diabetes and increasing claudication of right leg. (a, b) Coronal steady-state gadofosveset trisodium–enhanced MR image (a) and magnified view (b) of thigh and knee (4.3/1.4, 25° flip angle) at 0.125-mm3 spatial resolution show large aneurysm of right distal superficial femoral artery, with complete occlusion of vessel, which is substituted by collateral vessels (arrow). A small aneurysm (arrowhead) of the distal superficial femoral artery without significant stenosis is also seen in left leg. (c) Curved MPRs show course of distal superficial femoral artery and popliteal artery in right and left legs, sites of vessel occlusion (arrows) in right leg, and vessel wall irregularities in left leg. Contrast-enhanced venous structures like the right popliteal vein (arrowhead) do not interfere in making the clinical diagnosis. (d) Findings on state-of-the-art MR angiogram of lower leg vessels enhanced with a conventional MR contrast agent (reference standard) and obtained at 1-mm3 spatial resolution confirm superficial femoral artery occlusion on right side, but image fails to depict details of aneurysms on both sides, as in c.

View larger version (177K): [in this window] [in a new window] [Download PPT slide]   Figure 5b: Images in 54-year-old man with long history of diabetes and increasing claudication of right leg. (a, b) Coronal steady-state gadofosveset trisodium–enhanced MR image (a) and magnified view (b) of thigh and knee (4.3/1.4, 25° flip angle) at 0.125-mm3 spatial resolution show large aneurysm of right distal superficial femoral artery, with complete occlusion of vessel, which is substituted by collateral vessels (arrow). A small aneurysm (arrowhead) of the distal superficial femoral artery without significant stenosis is also seen in left leg. (c) Curved MPRs show course of distal superficial femoral artery and popliteal artery in right and left legs, sites of vessel occlusion (arrows) in right leg, and vessel wall irregularities in left leg. Contrast-enhanced venous structures like the right popliteal vein (arrowhead) do not interfere in making the clinical diagnosis. (d) Findings on state-of-the-art MR angiogram of lower leg vessels enhanced with a conventional MR contrast agent (reference standard) and obtained at 1-mm3 spatial resolution confirm superficial femoral artery occlusion on right side, but image fails to depict details of aneurysms on both sides, as in c.

View larger version (107K): [in this window] [in a new window] [Download PPT slide]   Figure 5c: Images in 54-year-old man with long history of diabetes and increasing claudication of right leg. (a, b) Coronal steady-state gadofosveset trisodium–enhanced MR image (a) and magnified view (b) of thigh and knee (4.3/1.4, 25° flip angle) at 0.125-mm3 spatial resolution show large aneurysm of right distal superficial femoral artery, with complete occlusion of vessel, which is substituted by collateral vessels (arrow). A small aneurysm (arrowhead) of the distal superficial femoral artery without significant stenosis is also seen in left leg. (c) Curved MPRs show course of distal superficial femoral artery and popliteal artery in right and left legs, sites of vessel occlusion (arrows) in right leg, and vessel wall irregularities in left leg. Contrast-enhanced venous structures like the right popliteal vein (arrowhead) do not interfere in making the clinical diagnosis. (d) Findings on state-of-the-art MR angiogram of lower leg vessels enhanced with a conventional MR contrast agent (reference standard) and obtained at 1-mm3 spatial resolution confirm superficial femoral artery occlusion on right side, but image fails to depict details of aneurysms on both sides, as in c.

View larger version (138K): [in this window] [in a new window] [Download PPT slide]   Figure 5d: Images in 54-year-old man with long history of diabetes and increasing claudication of right leg. (a, b) Coronal steady-state gadofosveset trisodium–enhanced MR image (a) and magnified view (b) of thigh and knee (4.3/1.4, 25° flip angle) at 0.125-mm3 spatial resolution show large aneurysm of right distal superficial femoral artery, with complete occlusion of vessel, which is substituted by collateral vessels (arrow). A small aneurysm (arrowhead) of the distal superficial femoral artery without significant stenosis is also seen in left leg. (c) Curved MPRs show course of distal superficial femoral artery and popliteal artery in right and left legs, sites of vessel occlusion (arrows) in right leg, and vessel wall irregularities in left leg. Contrast-enhanced venous structures like the right popliteal vein (arrowhead) do not interfere in making the clinical diagnosis. (d) Findings on state-of-the-art MR angiogram of lower leg vessels enhanced with a conventional MR contrast agent (reference standard) and obtained at 1-mm3 spatial resolution confirm superficial femoral artery occlusion on right side, but image fails to depict details of aneurysms on both sides, as in c.

View larger version (147K): [in this window] [in a new window] [Download PPT slide]   Figure 6a: Images in 65-year-old man with transient ischemic attacks. (a) Coronal maximum intensity projection of first-pass gadofosveset trisodium–enhanced MR data at spatial resolution of 1.0 mm3 shows significant stenosis (arrow) in proximal right internal carotid artery. (b) Findings on color-coded Doppler US image (reference standard), showing 75% or greater stenosis with a maximal flow velocity of 1.7 m/sec, confirm the findings in a. (c) Findings on MPRs, on which first-pass data (3.4/1.3, 30° flip angle) are compared with steady-state data (6.5/2.2, 25° flip angle), also confirm the internal carotid artery stenosis (arrows) seen in a.

View larger version (107K): [in this window] [in a new window] [Download PPT slide]   Figure 6b: Images in 65-year-old man with transient ischemic attacks. (a) Coronal maximum intensity projection of first-pass gadofosveset trisodium–enhanced MR data at spatial resolution of 1.0 mm3 shows significant stenosis (arrow) in proximal right internal carotid artery. (b) Findings on color-coded Doppler US image (reference standard), showing 75% or greater stenosis with a maximal flow velocity of 1.7 m/sec, confirm the findings in a. (c) Findings on MPRs, on which first-pass data (3.4/1.3, 30° flip angle) are compared with steady-state data (6.5/2.2, 25° flip angle), also confirm the internal carotid artery stenosis (arrows) seen in a.

View larger version (75K): [in this window] [in a new window] [Download PPT slide]   Figure 6c: Images in 65-year-old man with transient ischemic attacks. (a) Coronal maximum intensity projection of first-pass gadofosveset trisodium–enhanced MR data at spatial resolution of 1.0 mm3 shows significant stenosis (arrow) in proximal right internal carotid artery. (b) Findings on color-coded Doppler US image (reference standard), showing 75% or greater stenosis with a maximal flow velocity of 1.7 m/sec, confirm the findings in a. (c) Findings on MPRs, on which first-pass data (3.4/1.3, 30° flip angle) are compared with steady-state data (6.5/2.2, 25° flip angle), also confirm the internal carotid artery stenosis (arrows) seen in a.