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Non-Contrast Enhanced MR Angiography (NCE-MRA) of the Calf: A Direct Comparison between Flow-Sensitive Dephasing (FSD) Prepared Steady-State Free Precession (SSFP) and Quiescent-Interval Single-Shot (QISS) in Patients with Diabetes.

ABSTRACT: To compare the image quality and diagnostic performance of two non-contrast enhanced MR angiography (NCE-MRA) techniques using flow-sensitive dephasing (FSD) prepared steady-state free precession (SSFP) and quiescent-interval single-shot (QISS) for the calf arteries in patients with diabetes.Twenty six patients underwent the two NCE-MRA techniques followed by contrast-enhanced MRA (CE-MRA) of lower extremity on a 1.5T MR system. Image quality scores, arterial stenosis scores, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel sharpness, and diagnostic accuracy for detecting more than 50% arterial stenosis were evaluated and statistically compared using CE-MRA as the reference standard.All examinations were performed successfully. Of the total 153 calf arterial segments obtained in the 26 patients, FSD and QISS showed no significant difference in the number of diagnostic arterial segments (151 [98%] vs. 147 [96%], respectively, P>0.05). The image quality of FSD was higher than that of QISS in the peroneal artery and posterior tibial artery (P<0.05), but no significant difference in the anterior tibial artery (P>0.05). SNR and CNR of FSD were higher than those of QISS (P<0.01), while FSD showed comparable vessel sharpness compared with QISS (P>0.05). The time efficiency of SNR and CNR between FSD and QISS showed no significant difference when taking into account the times for FSD-related scout scans. There was no difference in sensitivity (95% vs. 93%, P>0.05) and negative predictive value (98% vs. 97%, P>0.05) between FSD and QISS for detecting stenosis greater than 50%. However, FSD showed higher specificities (99% vs. 92%, P<0.05) and diagnostic accuracy (98% vs. 92%, P<0.05) compared to QISS.Both FSD and QISS had similar high sensitivity and negative predictive value for detecting calf arteries with over 50% stenosis, but FSD showed slightly higher diagnostic specificity and better depiction of arterial lesions due to its isotropic submillimeter spatial resolution. QISS, being an easier to use and less time-consuming technique, could be a method of choice for rapid screening of arterial disease of the lower extremity.

SUBMITTER: Zhang N

PROVIDER: S-EPMC4452776 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Project description:To compare the image quality and degree of vessel narrowing at flow-sensitive dephasing (FSD) magnetic resonance (MR) angiography of the hands with those at contrast material-enhanced MR angiography of the hands in patients with systemic sclerosis.In a single-center study with institutional review board approval and HIPAA compliance, six healthy volunteers and six patients with systemic sclerosis were imaged at 1.5-T nonenhanced FSD MR angiography followed by contrast-enhanced MR angiography. Sixteen vascular segments in four vessel groups were evaluated for image quality and assessed semiquantitatively for stenosis degree by using Likert scales. The nonparametric Wilcoxon signed rank test was used to perform pairwise comparisons of the MR angiographic techniques. P < .05 indicated statistical significance.Performing FSD MR angiography, as compared with time-resolved MR angiography and high-spatial-resolution MR angiography, improved the image quality for all arterial segments combined in the control (mean score, 2.9 [FSD] vs 3.7 [time-resolved technique] and 3.1 [high-spatial-resolution technique]) and patient (mean score, 4.0 [FSD] vs 4.2 [time-resolved technique] and 4.3 [high-spatial-resolution technique]) groups. In the control subjects, FSD angiography depicted proper digital artery stenosis that was less severe (mean grade, 0.7) than that seen with the time-resolved (mean grade, 1.6) and high-spatial-resolution (mean grade, 1.0) techniques. In the patient group, FSD angiography depicted lower degrees of stenosis, with a lower mean grade for all segments combined (1.3) compared with the corresponding mean grades for time-resolved (1.5) and high-spatial-resolution (1.8) MR angiography.Preliminary data indicate that the proposed nonenhanced FSD MR angiographic technique is an improvement over existing contrast-enhanced techniques for evaluation of the hand vasculature in vasospastic disorders of the hand. Further technical improvements and a systematic clinical study are warranted.

Project description:OBJECTIVES:Assessment of thoracic aortic dimensions with non-ECG-triggered contrast-enhanced magnetic resonance angiography (CE-MRA) is accompanied with motion artefacts and requires gadolinium. To avoid both motion artefacts and gadolinium administration, we evaluated the similarity and reproducibility of dimensions measured on ECG-triggered, balanced steady-state free precession (SSFP) MRA as alternative to CE-MRA. METHODS:All patients, with varying medical conditions, referred for thoracic aortic examination between September 2016 and March 2018, who underwent non-ECG-triggered CE-MRA and SSFP-MRA (1.5 T) were retrospectively included (n = 30). Aortic dimensions were measured after double-oblique multiplanar reconstruction by two observers at nine landmarks predefined by literature guidelines. Image quality was scored at the sinus of Valsalva, mid-ascending aorta and mid-descending aorta by semi-automatically assessing the vessel sharpness. RESULTS:Aortic dimensions showed high agreement between non-ECG-triggered CE-MRA and SSFP-MRA (r = 0.99, p < 0.05) without overestimation or underestimation of aortic dimensions in SSFP-MRA (mean difference, 0.1 mm; limits of agreement, -?1.9 mm and 1.9 mm). Intra- and inter-observer variabilities were significantly smaller with SSFP-MRA for the sinus of Valsalva and sinotubular junction. Image quality of the sinus of Valsalva was significantly better with SSFP-MRA, as fewer images were of impaired quality (3/30) than in CE-MRA (21/30). Reproducibility of dimensions was significantly better in images scored as good quality compared to impaired quality in both sequences. CONCLUSIONS:Thoracic aortic dimensions measured on SSFP-MRA and non-ECG-triggered CE-MRA were similar. As expected, SSFP-MRA showed better reproducibility close to the aortic root because of lesser motion artefacts, making it a feasible non-contrast imaging alternative. KEY POINTS:• SSFP-MRA provides similar dimensions as non-ECG-triggered CE-MRA. • Intra- and inter-observer reproducibilities improve for the sinus of Valsalva and sinotubular junction with SSFP-MRA. • ECG-triggered SSFP-MRA shows better image quality for landmarks close to the aortic root in the absence of cardiac motion.

Dataset Information

Non-Contrast Enhanced MR Angiography (NCE-MRA) of the Calf: A Direct Comparison between Flow-Sensitive Dephasing (FSD) Prepared Steady-State Free Precession (SSFP) and Quiescent-Interval Single-Shot (QISS) in Patients with Diabetes.

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