MR Advance Techniques. Vascular Imaging. Class II

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1 MR Advance Techniques Vascular Imaging Class II 1

2 Vascular Imaging There are several methods that can be used to evaluate the cardiovascular systems with the use of MRI. MRI will aloud to evaluate morphology and hemodynamic of the cardiovascular system

3 Conventional MRI Vascular Techniques MR Imaging techniques for vascular imaging include a number of imaging sequences based on: Spin Echo Fast Spin Echo Inversion Recovery Gradient Echo These pulse sequences are supplemented with a variety of options to enhance vascular imaging. Flow Compensation Pre-saturation bands Contrast enhance

4 Conventional MRI Vascular Techniques Flowing protons can produce either signal void or signal enhancement. They also produce contrast between vessels and the surrounding tissue.

5 Conventional MRI Vascular Techniques There two types of contrast in vascular imaging depending on the signal intensity from flowing blood: Black blood imaging Bright blood imaging

6 Black Blood Imaging Several techniques can be employed to produce images where vessels appear dark. They include: Spin echo acquisition GRE using pre-saturation pulses

7 Black Blood Imaging & SE In spin echo pulse sequence fast flowing blood will not received both 90 and 180 RF pulses. Consequently a signal void (dark signal) within the blood vessel will be produce.

8 Black Blood Imaging & SE The use of pre-saturation band will optimize BBI in SE 90º ½ TE (20 ms) 180º

9 Black Blood Imaging & FSE These technique follows the same principle of Spin Echo but it uses several rephasing 180 to reduce scan time.

10 Black Blood Imaging & GRE When fast scan is required (GRE) Black Blood imaging can be optimized with the application of presaturation pulses. Saturation pulses will eliminate phase ghosting and provides intraluminal signal void for excellent distinction between patent and obstructed vessels. Pre-saturation band Pre-saturation band

11 MRA Magnetic Resonance Angiography (MRA) enhances the signal from moving spins in flowing blood and suppressing the signal from stationary spins residing tissues. When stationary tissues are suppressed, the appearance of vasculature is enhanced by increase signal from fresh spins which flow into the imaging volume and received RF excitation for first time (inflow effect).

12 Magnetic Resonance Angiography MRA There are several techniques that utilize different phenomena to increase signal from flowing spins. Time of Flight MRA (TOF-MRA) Phase Contrast MRA (PC-MRA) Contrast Enhance MRA (CE-MRA)

13 Time of Flight MRA (TOF- MRA) TOF-MRA produces vascular contrast by manipulating the longitudinal magnetization of the stationary spins (Saturation). TOF-MRA uses incoherent gradient echo pulse sequences in combination with gradient moment nulling to enhance flow.

14 90º GRE

15 Flow Comp 1 ms 2 ms 3 ms

16 TOF MRA The TE should also be kept as low as possible to: Reduce Time of Flight effect and increase flow related enhancement and Reduce intra-voxel dephasing and subsequent phase ghosting and signal loss. 90º 180º

17 TOF-MRA TOF-MRA is most sensitive to flow that is perpendicular to the FOV and the slice.

18 TOF-MRA Any flow that is parallel to the slices can be saturated along with the stationary protons if the flow velocities are slow respect to the TR (in- plane flow saturation).

19 TOF-MRA TOF-MRA must be acquired counter current flow to the blood vessel of interest to maintain the entry slice phenomenon.

20 TOF MRA 1 100

21 Spatial Saturation The use of pre-saturation bands in TOF-MRA is important to limit our view to either the arteries or the veins.

22 Spatial Saturation The saturation band should be placed in a the position so that it will eliminate undesired signal from flowing protons.

23 Spatial Saturation The saturation band should be placed in a the position so that it will eliminate undesired signal from flowing protons. Pre-saturation band

24 Spatial Saturation The saturation bands used in TOF-MRI are walking pre-sats.

25 The TR is kept well bellow the T1 time of the stationary tissue so that T1 recovery is prevented. This saturates the stationary protons while the inflow effects from fully magnetized flowing fresh spins produces high vascular signal. Magnetization Transfer Contrast (MTC) is also used to suppress signal from background tissues. TOF-MRA

26 MTC Magnetization Transfer Contrast (MTC) is use to saturate water bound to macromolecules. If this water becomes saturated the overall background signal intensity will drop and the image will look darker (less SNR). T1-MTC + + GAD

27 TOF-MRA A disadvantage of TOF-MRA is the high signal intensity in some background tissues, especially those with short T1 relaxation times (fat). Other tissue that may appear bright during TOF-MRA is blood components with short T1 times, such as methemoglobin. They can be a problem in distinguishing sub-acute hemorrhage from flowing blood in TOF-MRA.

28 TOF-MRA TOF-MRA can be acquired in 2D and 3D. 2D is acquired slice by slice 3D is acquired in a volumetric acquisition

29 3D TOF-MRA 3D TOF-MRA offers high SNR and thin contiguous slices for good resolution. However spins in vessels with slow flow can be saturated in volume imaging.

30 3D TOF-MRA Advantages High resolution for small vessels More effective in high velocity flow areas Disadvantages Saturation of in-plane flow Small area of coverage

31 2D TOF-MRA 2D TOF is optimal in areas of: More effective in slow flow areas (carotids bifurcation, peripheral vascular and venous systems) When a large area of coverage is required 3D 2D

32 2D TOF-MRA Advantages Large area of coverage More effective in slow flow areas Disadvantages Lower resolution Saturation of in-plane flow (Less than 3D) Venetian blind artifact

33 TOF-MRA T1 Balance GRE (Minimize TOF effects) Flow Comp (Reduce intra-voxel dephasing) Slices perpendicular to the blood Vessels Counter- Current Flow (maximize entry slice) Opposite Pre-Sat (Saturate blood) MTC (Suppress Background Tissues) Very short TR to saturate stationary protons Very short TE to reduce TOF and intra voxel dephasing in flowing protons.

34 Phase Contrast MRA Phase Contrast MRA (PC-MRA) uses velocity differences, and hence the phase shifts in moving spins to provide image contrast in flowing vessels. The variation in phase originates from physiological conditions such as systolic and diastolic velocity changes. Phase shift can also be generated by a pulse sequence.

35 Cardiac Gaiting Cardiac gating monitors cardiac motion by coordinating the excitation pulse with R wave of the cardiac cycle. This achieved by using an electrical signal generated by the cardiac motion to trigger each excitation pulse.

36 PC-MRA The accumulation of flow induced phase shift is proportional to the velocity of the flow. There is direct correlation between velocity and signal intensity. More velocity more signal.

37 PC-MRA Phase shift will be achieved by the phase encoding gradient, the velocity of flow with the use of a bipolar gradient in two different acquisitions. This method of phase shift is called Phase Contrast MRA. Phase contrast provides information about: Flow velocity Vascular anatomy Flow direction

38 PC-MRA

39 PC-MRA The additional gradient used to produce the phase difference between moving spins is called velocity encoding gradient (VENC). Phase contrast MRA is sensitive to flow in any direction within the image volume

40 VENC The application of the VENC is based on the velocity of the flow of the area of interest, measured in cm/sec. High venc factors of the PC angiogram (more than 40 cm/sec) will selectively image the arteries (PCA - arteriography), whereas a venc factor of 20 cm/sec will perform the veins and sinuses (PCV or MRV - venography). Blood Vessel Aorta Pulmonary Artery Superior Vena Cava Portal Vein Flow Velocity 92 cm/sec 63 cm/sec cm/sec 20 cm/sec

41 PC-MRA Advantages Sensitive to a variety of flow velocities Sensitive to flow within FOV Reduce intravoxel dephasing Increase background suppression Magnitude and phase images Disadvantages Long imaging times More sensitive to turbulence

42 CE-MRA A major problem with TOF MRA is that it is prone to in-plane flow (flowing protons will saturate) and the long scan times in large areas of coverage.

43 CE-MRA To overcome this, a combination of 3D imaging with IV contrast enhancement (Gadolinium) with rapid dynamic imaging may be used.

44 CE-MRA CE-MRA is a more invasive technique where a bolus injection of contrast medium is followed by a 3D T1 fast gradient echo sequence.

45 3D-Fast Gradient Echo Very fast pulse sequence have been developed that can acquire a volume (3D) in a single breath hold. These usually employs coherent or incoherent GE. To be able to scan faster: Only one portion of the TE will be read (partial echo) TE will be reduce to the minimum (.7 ms) Only portion of the RF is applied (partial flip angle) Very short TR will be used

46 Fast Gradient Echo In addition, fast gradient echo acquisition are useful when temporal resolution is required. This is specifically important after the administration of contrast selecting fast gradient echo permits dynamic imaging of the blood vessels. Arterial phase (20 sec) Venous phase (40 sec)

47 CE-MRA This sequence is general timed to the arterial phase and the repeated several times to acquired images during intermediate and venous phases of the vascular system (Temporal Resolution or Dynamic imaging).

48 Technical consideration: Injection bolus (hand injection vs power injector) Scan timing (estimating, test injection, or bolus tracking) Image parameters (adequate coverage, SNR, and fat suppression)

49 Hand Injection

50 Power Injector

51 Bolus Detection Testing Bolus Bolus tracking Smart Prep or Fluoro-triggering

52 1 sec Testing Bolus 2 sec 10 sec 3 sec 10 sec K-space 19 sec 10 sec 20 sec 25 sec

53 On this technique the voxel Will send a signal to start Scanning Bolus Tracking

54 Live visualization of contrast, tech will Start scanning when Contrast arrives ROI

55 Cylindrical Filling This type of filling is mostly used when image contrast and signal are required in the early phases of the examination. It is very popular in contrast enhance MRA.

56 Contrast Enhance MRA Advantages Sometimes it is advantageous to acquired images in the plane that best covers the anatomy. For example, to cover the ascending and descending aortic arch the Sagittal plane is optimal. Coronal plane will be a better option to visualize the abdominal aorta and the renal arteries.

57 20 SLICES Scan Time 3D=TR x PES x NEX x # Slices 40 SLICES

58 CE MRA 40 SLICES 20 SLICES

59 CE & In-plane Flow 3D 2D CE

60 2D TOF MRA CE-MRV

61 Digital Subtraction MRA (DS-MRA) Digital subtraction is a technique used to remove signal from stationary protons on the image an enhance the signal from protons in blood stream. These technique can be applied with different purposes (Original + gad) Original Gad - =

62 Digital Subtraction MRA (DS-MRA) Digital subtraction MRA produces the contrast from moving spins during two acquisitions one during systole and the second one during diastole. These are subtracted to remove the signal from the stationary spins, leaving behind an image of only moving spins. Systole Diastole Subtraction - =

63 Digital Subtraction MRA (DS-MRA) For DS to be effective the subtracted images must have the same: FOV Slice thickness Matrix PES FES

64 MIP Images that result from the TOF MRA are called source images. They are reconstructed using a mathematical algorithm call Maximum Intensity Projection (MIP) also known as Maximum intensity pixel (MIP) or Image Viewer Intensifier (IVI) Source Image 3D Image

65 MIP The maximum intensity projection algorithm is responsible for projecting the brightest pixels, from anatomical stack, to generate an image of projected view of the vessels of interest.

66

67 MIP is the process by 2D images (source images) are reconstructed to a 3D image.

68

69 MIP

70

71 RT Side Posterior Circulation LT Side

72

73 Digital Subtraction MIP combine with digital subtraction will help to view specific enhancing phases. Venous phase Arterial phase Portal phase - =

74 Post Processing Techniques Digital Subtraction MRA reformats/reconstructions Maximum intensity pixel (MIP) (Plain + gad) Plain Gad MIP - =

75 Flow Related Artifacts Flow Artifacts Flow Void Entry Slice Pulsatile Flow Artifact (Time of Flight Phenomena) (Entry Slice Phenomenon) (Intra-Voxel Dephasing)

76 Maximize Flood Void Increase TE Increase flow velocity Decrease slice thickness

77 Minimize Flood Void Decrease TE Decrease flow velocity Increase slice thickness

78 Entry Slice Phenomenon Maximize Increase TR Increase flow velocity Decrease slice thickness Counter current acquisition Minimize Decrease TR Decrease flow velocity Increase slice thickness

79 Pulsatile Flow Maximize Increase TE Increase flow velocity Increase voxel volume Minimize Decrease TE Decrease flow velocity Decrease voxel volume Flow Compensation (BBI) Pre-Sat bands (DBI)

80 Gradient Moment Rephasing 1 ms 2 ms 3 ms

81 Pre-saturation band Pre-saturation band

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