High-field MR imaging in pediatric congenital heart disease: initial results.

BACKGROUND: Comprehensive assessment of pediatric congenital heart disease (CHD) at any field strength mandates evaluation of both vascular and dynamic cardiac anatomy for which diagnostic quality contrast-enhanced magnetic resonance angiography (CEMRA) and cardiac cine are crucial. OBJECTIVE: To determine whether high-resolution (HR) CEMRA and steady-state free precession (SSFP) cine can be performed reliably at 3.0 T in children with CHD and to compare the image quality to similar techniques performed at 1.5 T. MATERIALS AND METHODS: Twenty-eight patients with a median age of 5 months and average weight 9.0 ± 7.8 kg with suspected or known CHD were evaluated at 3.0 T. SSFP cine (n = 86 series) and HR-CEMRA (n = 414 named vascular segments) were performed and images were scored for image quality and artifacts. The findings were compared to those of 28 patients with CHD of similar weight who were evaluated at 1.5 T. RESULTS: Overall image quality on HR-CEMRA was rated as excellent or good in 96% (397/414) of vascular segments at 3.0 T (k = 0.49) and in 94% (349/371) of vascular segments at 1.5 T (k = 0.36). Overall image quality of SSFP was rated excellent or good in 91% (78/86) of cine series at 3.0 T (k = 0.55) and in 81% (87/108) at 1.5 T (k = 0.47). Off-resonance artifact was common at both field strengths, varied over the cardiac cycle and was more prevalent at 3.0 T. At 3.0 T, off-resonance dark band artifact on SSFP cine was absent in 3% (3/86), mild in 69% (59/86), moderate in 27% (23/86) and severe in 1% (1/86) of images; at 1.5 T, dark band artifact was absent in 16% (17/108), mild in 69% (75/108), moderate in 12% (13/108) and severe in 3% (3/108) of cine images. The signal-to-noise ratio and contrast-to-noise ratio of both SSFP cine and HR-CEMRA images were significantly higher at 3.0 T than at 1.5 T (P < 0.001). CONCLUSION: Signal-to-noise ratio and contrast-to-noise ratio of high-resolution contrast-enhanced magnetic resonance angiography and SSFP cine were higher at 3.0 T than at 1.5 T. Artifacts on SSFP cine were cardiac phase specific and more prevalent at 3.0 T such that frequency-tuning was required in one-third of exams. In neonates, high spatial resolution CEMRA was highly reliable in defining extracardiac vascular anatomy.

Computed tomography angiography of lower extremities in the emergency room for evaluation of patients with gunshot wounds.

OBJECTIVE: To assess the role of CT angiography in the evaluation of patients with lower extremity gunshot wounds in the emergency room. MATERIALS AND METHODS: Eighty patients (73 male, 7 female, mean age 26 years) underwent CT angiography for the evaluation of lower extremity gunshot injuries. Imaging was conducted on the basis of standardized protocols utilizing 16-slice and 64-slice multidetector systems and images were qualitatively graded and assessed for various forms of arterial injury. RESULTS: CT angiography findings indicative of arterial injury were observed in 24 patients (30%) and a total of 43 arterial injuries were noted; the most common form was focal narrowing/spasm (n = 16, 37.2%); the most common artery involved was the superficial femoral artery (n = 12, 50%). In qualitative assessment of images based on a 4-point grading system, both readers considered CT angiography diagnostically excellent (grade 4) in most cases. Surgical findings were consistent with CT angiography and follow-up of patients' medical records showed no arterial injuries in patients with normal findings on initial imaging. CONCLUSION: Our findings demonstrate that CT angiography is an effective imaging modality for evaluation of lower extremity gunshot wounds and could help limit more invasive procedures such as catheter angiography to a select group of patients. KEY POINTS: • CT angiography efficiently evaluates lower extremity gunshot wounds. • CT angiography provides image quality sufficiently reliable for assessment of gunshot injuries. • CT angiography could help limit invasive procedures to select patients.

Characterization of hepatic adenoma and focal nodular hyperplasia with gadoxetic acid.

PURPOSE: To characterize imaging features of histologically proven hepatic adenoma (HA) as well as histologically and/or radiologically proven focal nodular hyperplasia (FNH) using delayed hepatobiliary MR imaging with 0.05 mmol/kg gadoxetic acid. MATERIALS AND METHODS: Five patients with six HAs with histological correlation were retrospectively identified on liver MRI studies performed with gadoxetic acid, and T1-weighted imaging acquired during the delayed hepatobiliary phase. Additionally, 23 patients with 34 radiologically diagnosed FNH lesions (interpreted without consideration of delayed imaging) were identified, two of which also had histological confirmation. Signal intensity ratios relative to adjacent liver were measured on selected imaging sequences. RESULTS: All six hepatic adenomas (100%), which had histological confirmation, demonstrated hypointensity relative to adjacent liver on delayed imaging. Furthermore, all of the FNH (including 34 radiologically proven, 2 of which were also histologically proven) were either hyperintense (23/34, 68%) or isointense (11/34, 32%) relative to the adjacent liver on delayed imaging. None of the FNHs were hypointense relative to liver. CONCLUSION: Distinct imaging characteristics of HA versus FNH on delayed gadoxetic acid-enhanced MRI, with adenomas being hypointense and FNH being iso- or hyperintense on delayed imaging may improve specificity for characterization, and aid in the differentiation of these two lesions.

Design of a birdcage array for lower extremity angiography.

PURPOSE: To investigate the application of a coil array consisting of multiple birdcages for bolus chase magnetic resonance angiography (MRA) of the lower extremities. MATERIALS AND METHODS: The prototype consisted of four birdcage coils; two adjacent birdcages for thigh imaging, and two for calf imaging. Decoupling between adjacent coils was achieved using shared capacitors. Bench measurements and MR images were used to evaluate the decoupling scheme. Image signal-to-noise ratios (SNR) were compared between the birdcage array and four commercially available coils. Contrast-enhanced imaging experiments were performed on 10 volunteers and parallel imaging was simulated. This study was approved by the local institutional review board and written informed consent was obtained from each volunteer. RESULTS: Capacitive decoupling resulted in a reduction in signal leakage. The calf birdcages provided an 84% SNR improvement over a four element array, while the thigh birdcages provided a 53% improvement. Angiographic images illustrated the utility of the coil for peripheral MRA. Parallel imaging was demonstrated with a two-fold reduction factor. CONCLUSION: Birdcage coils were demonstrated to be valuable for lower extremity imaging due to their homogenous sensitivity, good SNR, and cylindrical geometry. Coupling was controlled using shared capacitors that allowed a single birdcage to encompass each leg individually, providing a novel approach to signal reception for peripheral imaging.

Peripheral magnetic resonance angiography with a multi-compartment curved leg wrap for thigh compression.

A curved urethane rf-welded leg wrap with multi-compartment inflation was developed for optimal thigh compression to suppress venous enhancement during peripheral magnetic resonance angiography (MRA). In 49 patients with suspected peripheral vascular disease, bilateral thigh leg wraps were inflated to 60 mm Hg just prior to mask imaging of 3D bolus chase peripheral MRA at 1.5 T using 45 mL gadolinium contrast agent. The time from contrast arrival in the abdominal aorta to venous enhancement in the calf was measured by repeating the calf station at approximately 30 second intervals until venous contamination was observed. The mean time to venous enhancement with thigh compression was 108 +/- 35 s, ranging from 40 to 181 s. In 64 out of 98 legs (65%), veins did not enhance even after repeating the calf station 3 times. In 10 legs (10%), venous enhancement was identified on the first phase of the calf station including 2 legs with cellulitis. However, the enhancing veins tended to be superficial and did not substantially interfere with visualization of calf arteries. This preliminary experience with a curved multi-compartment leg wrap for thigh compression shows high quality MRA with a long window of arterial enhancement and a minimum of venous contamination.

Superficial femoral artery occlusive disease severity correlates with MR cine phase-contrast flow measurements.

PURPOSE: To evaluate how cine phase-contrast (PC) flow data correlate with the severity of peripheral vascular disease (PVD). MATERIALS AND METHODS: Flow waveforms were obtained in 48 patients proximal and distal to superficial femoral artery (SFA) disease using the 2D cine PC technique with velocity encoding (venc) = 100 cm/second. Flow data were correlated with SFA disease severity and compared with data from nine healthy volunteers. RESULTS: Of 96 arterial segments in 48 patients, 26 were patent or only mildly stenotic, 35 had moderate-to-severe stenosis, and 35 were occluded. The flow patterns tended to become low-resistant below severe stenoses or occlusion. The mean peak flow velocity above/below SFA lesions was significantly higher in patients with severe disease (1.9 +/- 1.0, P = 0.01) or occlusion (2.0 +/- 1.0, P = 0.003) compared to normal volunteers (1.4 +/- 0.6). The delay in peak velocity below the lesions showed a significant positive correlation with lesion severity (r = 0.65, P < 0.001). The mean flow volume ratio above/below SFA lesions was greater in patients with occluded vessels compared to normal volunteers (3.9 and 2.3 respectively; P = 0.04). CONCLUSION: Cine PC flow waveform changes across atherosclerotic lesions correlate with disease severity. This may help determine which lesions are hemodynamically significant.