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Improved black-blood imaging using DANTE-SPACE for simultaneous carotid and intracranial vessel wall evaluation.

ABSTRACT: The purpose of this study was to develop a three-dimensional black blood imaging method for simultaneously evaluating the carotid and intracranial arterial vessel walls with high spatial resolution and excellent blood suppression with and without contrast enhancement.The delay alternating with nutation for tailored excitation (DANTE) preparation module was incorporated into three-dimensional variable flip angle turbo spin echo (SPACE) sequence to improve blood signal suppression. Simulations and phantom studies were performed to quantify image contrast variations induced by DANTE. DANTE-SPACE, SPACE, and two-dimensional turbo spin echo were compared for apparent signal-to-noise ratio, contrast-to-noise ratio, and morphometric measurements in 14 healthy subjects. Preliminary clinical validation was performed in six symptomatic patients.Apparent residual luminal blood was observed in five (pre-contrast) and nine (post-contrast) subjects with SPACE and only two (post-contrast) subjects with DANTE-SPACE. DANTE-SPACE showed 31% (pre-contrast) and 100% (post-contrast) improvement in wall-to-blood contrast-to-noise ratio over SPACE. Vessel wall area measured from SPACE was significantly larger than that from DANTE-SPACE due to possible residual blood signal contamination. DANTE-SPACE showed the potential to detect vessel wall dissection and identify plaque components in patients.DANTE-SPACE significantly improved arterial and venous blood suppression compared with SPACE. Simultaneous high-resolution carotid and intracranial vessel wall imaging to potentially identify plaque components was feasible with a scan time under 6 min. Magn Reson Med 75:2286-2294, 2016. © 2015 Wiley Periodicals, Inc.

SUBMITTER: Xie Y

PROVIDER: S-EPMC4706507 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Improved black-blood imaging using DANTE-SPACE for simultaneous carotid and intracranial vessel wall evaluation.

Xie Yibin Y Yang Qi Q Xie Guoxi G Pang Jianing J Fan Zhaoyang Z Li Debiao D

Magnetic resonance in medicine 20150708 6

<h4>Purpose</h4>The purpose of this study was to develop a three-dimensional black blood imaging method for simultaneously evaluating the carotid and intracranial arterial vessel walls with high spatial resolution and excellent blood suppression with and without contrast enhancement.<h4>Methods</h4>The delay alternating with nutation for tailored excitation (DANTE) preparation module was incorporated into three-dimensional variable flip angle turbo spin echo (SPACE) sequence to improve blood sig ...[more]

PMID: 26152900

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Project description:BackgroundIntracranial aneurysms and intracranial atherosclerosis are prevalent cerebrovascular diseases, and individuals with atherosclerosis have a higher incidence of aneurysms than those without atherosclerosis. However, few studies have conducted combined analyses to investigate the potential association between intracranial aneurysms and intracranial atherosclerosis. This retrospective cross-sectional study aimed to investigate the association between the characteristics of the aneurysm wall and intracranial large arterial plaque using high-resolution vessel wall imaging (HR-VWI).MethodsHospitalized patients diagnosed with anterior circulation unruptured intracranial aneurysms (UIAs), who were diagnosed at Huashan Hospital of Fudan University in Shanghai, China, between March 2016 to February 2018, were consecutively recruited for this study. The patients' pre-treatment HR-VWI images and 3D time-of-flight magnetic resonance angiography (3D-TOF-MRA) images were collected. The patients and UIAs were divided into two groups according to the presence or absence of plaque in the M1 segment of the middle cerebral artery (MCA). Clinical information and aneurysm characteristics were compared between the two groups. Aneurysm wall enhancement (AWE) and M1 plaque were graded on scales of 0 to 2 on HR-VWI. Based on the gradings, the correlation between AWE and the M1 plaques was analyzed.ResultsA total of 109 patients with 128 saccular UIAs in the anterior circulation were enrolled in the study. Of the patients, there were 56 patients (with 65 UIAs) in the group with M1 plaque and 53 patients (with 63 UIAs) in the group without plaque. There were significant differences between the two groups in terms of both their clinical information (age and hypertension) and aneurysm characteristics (AWE pattern and AWE degree). The grades of the AWE patterns and the AWE degrees of the UIAs were higher in the group with M1 plaque than in the group without plaque. In the M1 plaque group, the grade of M1 plaque was positively correlated with the grade of AWE pattern (correlation coefficient R=0.41, P=0.001) and the grade of AWE degree (correlation coefficient R=0.50, P<0.001).ConclusionsMCA atherosclerosis plaque was associated with the AWE of saccular aneurysms. When evaluating UIAs, attention should also be paid to the large arterial wall, which may assist in assessing the stability of the aneurysm and enable better decision making.

Project description:PURPOSE:This study is to compare the accuracy of four different black-blood T2 mapping sequences in carotid vessel wall. METHODS:Four different black-blood T2 mapping sequences were developed and tested through phantom experiments and 17 healthy volunteers. The four sequences were: 1) double inversion-recovery (DIR) prepared 2D multi-echo spin-echo (MESE); 2) DIR-prepared 2D multi-echo fast spin-echo (MEFSE); 3) improved motion-sensitized driven-equilibrium (iMSDE) prepared 3D FSE and 4) iMSDE prepared 3D fast spoiled gradient echo (FSPGR). The concordance correlation coefficient and Bland-Altman statistics were used to compare the sequences with a gold-standard 2D MESE, without blood suppression in phantom studies. The volunteers were scanned twice to test the repeatability. Mean and standard deviation of vessel wall T2, signal-to-noise (SNR), the coefficient of variance and interclass coefficient (ICC) of the two scans were compared. RESULTS:The phantom study demonstrated that T2 measurements had high concordance with respect to the gold-standard (all r values >0.9). In the volunteer study, the DIR 2D MEFSE had significantly higher T2 values than the other three sequences (P < 0.01). There was no difference in T2 measurements obtained using the other three sequences (P > 0.05). iMSDE 3D FSE had the highest SNR (P < 0.05) compared with the other three sequences. The 2D DIR MESE has the highest repeatability (ICC: 0.96, [95% CI: 0.88-0.99]). CONCLUSION:Although accurate T2 measurements can be achieved in phantom by the four sequences, in vivo vessel wall T2 quantification shows significant differences. The in vivo images can be influenced by multiple factors including black-blood preparation and acquisition method. Therefore, a careful choice of acquisition methods and analysis of the confounding factors are required for accurate in vivo carotid vessel wall T2 measurements. From the settings in this study, the iMSDE prepared 3D FSE is preferred for the future volunteer/patient scans.

Project description:Background and purposeIntracranial atherosclerotic disease is a common cause of stroke worldwide. Intracranial vessel wall magnetic resonance imaging may be able to identify imaging biomarkers of symptomatic plaque. We performed a meta-analysis to evaluate the strength of association of imaging features of symptomatic plaque leading to downstream ischemic events. Effects on the strength of association were also assessed accounting for possible sources of bias and variability related to study design and magnetic resonance parameters.MethodsPubMed, Scopus, Web of Science, EMBASE, and Cochrane databases were searched up to October 2019. Two independent reviewers extracted data on study design, vessel wall magnetic resonance imaging techniques, and imaging end points. Per-lesion odds ratios (OR) were calculated and pooled using a bivariate random-effects model. Subgroup analyses, sensitivity analysis, and evaluation of publication bias were also performed.ResultsTwenty-one articles met inclusion criteria (1750 lesions; 1542 subjects). Plaque enhancement (OR, 7.42 [95% CI, 3.35-16.43]), positive remodeling (OR, 5.60 [95% CI, 2.23-14.03]), T1 hyperintensity (OR, 2.05 [95% CI, 1.27-3.32]), and surface irregularity (OR, 4.50 [95% CI, 1.39-8.57]) were significantly associated with downstream ischemic events. T2 signal intensity was not significant (P=0.59). Plaque enhancement was significantly associated with downstream ischemic events in all subgroup analyses and showed stronger associations when measured in retrospectively designed studies (P=0.02), by a radiologist as a rater (P<0.001), and on lower vessel wall magnetic resonance imaging spatial resolution sequences (P=0.02).ConclusionsPlaque enhancement, positive remodeling, T1 hyperintensity, and surface irregularity emerged as strong imaging biomarkers of symptomatic plaque in patients with ischemic events. Plaque enhancement remained significant accounting for sources of bias and variability in both study design and instrument. Future studies evaluating plaque enhancement as a predictive marker for stroke recurrence with larger sample sizes would be valuable.

Project description:BackgroundThree-dimensional (3D) whole-brain vessel wall imaging (VWI) has demonstrated exquisite image quality for delineating intracranial atherosclerotic disease (ICAD) and reliability for quantifying normal vessel dimensions. However, its reliability in quantifying plaque morphology remains unknown.PurposeTo evaluate the plaque morphologic quantification reliability of 3D whole-brain VWI in patients via comparison with 3D targeted VWI and 2D turbo spin-echo (TSE).Study typeProspective.PopulationThirty-three patients with symptomatic ICAD.Field strength/sequenceA 3D and 2D TSE acquired at 3.0 T.AssessmentEach participant underwent two VWI sessions with an interval of 7-10 days. Three readers identified in consensus all the plaques on both whole-brain and targeted 3D VWI. Their lumen and vessel wall area and volume, plaque burden, percent stenosis, and vessel wall remodeling were measured for by two independent readers. At each culprit plaque determined by a radiologist, the lumen and vessel wall area, plaque burden, plaque-to-wall contrast ratio (CR), and plaque enhancement ratio (ER) were measured for 2D and 3D VWI methods.Statistical testsIntra-class correlation coefficient (ICC) was used to evaluate for 3D VWI's interobserver/intraobserver agreement, interscan repeatability, and agreement with 2D TSE in each plaque morphologic measurements. Paired t test was performed for detecting the differences in plaque-to-wall CR and plaque ER between the two 3D methods.ResultsEighty-four plaques were detected by both 3D VWI methods. Whole-brain VWI provided excellent interobserver/intraobserver agreement (ICCs: 0.79-0.99/0.95-0.99), interscan repeatability (ICCs: 0.85-0.99), agreement with 2D TSE (ICC: 0.80-0.94) in all morphologic measurements. ICCs of whole-brain VWI (0.79-0.99) were higher or equal to those of targeted VWI (0.76-0.99). The plaque-to-wall CR and plaque ER were significantly higher on whole-brain VWI than on targeted VWI.Data conclusionThe 3D whole-brain VWI provides excellent interobserver/intraobserver agreement, interscan repeatability, and agreement with 2D TSE in plaque morphologic quantification of ICAD and outperforms 3D targeted VWI.Level of evidence2 TECHNICAL EFFICACY STAGE: 2.

Project description:BACKGROUND AND PURPOSE:Our goal is to determine the added value of intracranial vessel wall magnetic resonance imaging (IVWI) in differentiating nonocclusive vasculopathies compared with luminal imaging alone. METHODS:We retrospectively reviewed images from patients with both luminal and IVWI to identify cases with clinically defined intracranial vasculopathies: atherosclerosis (intracranial atherosclerotic disease), reversible cerebral vasoconstriction syndrome, and inflammatory vasculopathy. Two neuroradiologists blinded to clinical data reviewed the luminal imaging of defined luminal stenoses/irregularities and evaluated the pattern of involvement to make a presumed diagnosis with diagnostic confidence. Six weeks later, the 2 raters rereviewed the luminal imaging in addition to IVWI for the pattern of wall involvement, presence and pattern of postcontrast enhancement, and presumed diagnosis and confidence. Analysis was performed on per-lesion and per-patient bases. RESULTS:Thirty intracranial atherosclerotic disease, 12 inflammatory vasculopathies, and 12 reversible cerebral vasoconstriction syndrome patients with 201 lesions (90 intracranial atherosclerotic disease, 64 reversible cerebral vasoconstriction syndrome, and 47 inflammatory vasculopathy lesions) were included. For both per-lesion and per-patient analyses, there was significant diagnostic accuracy improvement with luminal imaging+IVWI when compared with luminal imaging alone (per-lesion: 88.8% versus 36.1%; P<0.001 and per-patient: 96.3% versus 43.5%; P<0.001, respectively). There was substantial interrater diagnostic agreement for luminal imaging+IVWI (?=0.72) and only slight agreement for luminal imaging (?=0.04). Although there was a significant correlation for both luminal and IVWI pattern of wall involvement with diagnosis, there was a stronger correlation for IVWI finding of lesion eccentricity and intracranial atherosclerotic disease diagnosis than for luminal imaging (?=0.69 versus 0.18; P<0.001). CONCLUSIONS:IVWI can significantly improve the differentiation of nonocclusive intracranial vasculopathies when combined with traditional luminal imaging modalities.

Project description:BackgroundThe black-blood (BB) technique was developed to suppress the signal from blood and cerebrospinal fluid (CSF) to provide improved depiction of vessel walls.PurposeThe aim was to compare three-dimensional turbo spin echo T1-weighted imaging (3D TSE T1WI) with or without two BB techniques (delay alternating with nutation for tailored excitation [DANTE], and improved motion-sensitized driven equilibrium [iMSDE]) for high-resolution magnetic resonance imaging (HR-MRI) of the vessel walls of intracranial arteries.Study typeProspective.PopulationFourteen healthy volunteers who underwent 3D T1WI for examination of intracranial vessel walls.Field strength/sequence3 Tesla, 3D TSE T1WI (SPACE and BrainVIEW) and BB (DANTE and iMSDE).AssessmentSPACE with or without DANTE, and BrainVIEW with or without iMSDE, were acquired in each subject. Two neuroradiologists independently assessed image quality, vessel wall delineation, BB effect, CSF, and acceptability using visual scoring systems, and measured signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in vessel walls, lumen, and CSF, while blinded to the presence and type of BB technique used.Statistical testsRepeated measures ANOVA or Friedman tests were performed for the comparisons, followed by Bonferroni correction.ResultsThe 3T T1WI sequences without BB are significantly superior in vessel wall delineation (P = 0.001). Black CSF scores were lower in SPACE with DANTE than SPACE without DANTE, and in BrainVIEW without iMSDE than SPACE without DANTE (P < 0.001). However, there were no significant differences in BB effect, image quality, and acceptability between the four 3D T1WI sequences (p > .05). The SNRVessel wall, CNRWall-Lumen, and CNRWall-CSF were higher (all p < .001) on SPACE with and without DANTE than on BrainVIEW with and without iMSDE. SNRLumen were higher (all p < .001) on BrainVIEW with and without iMSDE than on SPACE with and without DANTE. SNRCSF was higher (all p < .001) on BrainVIEW with iMSDE than on SPACE with DANTE.Data conclusionBoth 3D TSE T1WI sequences were acceptable for intracranial vessel wall evaluation, with or without BB techniques. Therefore, BB techniques may not necessarily be required with 3D TSE T1WI with a long ETL and TR (below 1160 ms).

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Improved black-blood imaging using DANTE-SPACE for simultaneous carotid and intracranial vessel wall evaluation.

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Improved black-blood imaging using DANTE-SPACE for simultaneous carotid and intracranial vessel wall evaluation.

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