Coronary angiography by real-time MRI with adaptive averaging.

Cardiac and respiratory motion present significant challenges for MR coronary angiography, which have not been completely resolved to date by either breath-holding or respiratory navigation. Adaptive averaging during real-time MRI may provide a useful alternative to these techniques. In this method, cross-correlation is used to automatically identify those real-time imaging frames in which the vessel is present, and to determine the location of the vessel within each frame. This information is then used for selective averaging of frames to increase the signal-to-noise ratio and to improve visualization of the vessel. The correlation theorem was employed to raise the speed of this algorithm by up to two orders of magnitude. Segmenting data collection and reconstruction into subimages allows the extension of this technique to higher spatial resolution. Adaptive averaging provides a robust method for coronary MRI which requires no breath-holding, navigation, or ECG gating.

Glenohumeral relationships during physiologic shoulder motion and stress testing: initial experience with open MR imaging and active imaging-plane registration.

PURPOSE: To test the hypotheses that open dynamic magnetic resonance (MR) imaging can (a) be used to evaluate and define normal shoulder motion in active joint motion and muscle contraction and (b) be used in conjunction with physical examination. MATERIALS AND METHODS: With an open-configuration, 0.5-T MR imaging system and active image-plane tracking, 10 shoulders were studied in five asymptomatic subjects to establish normal patterns of glenohumeral motion during abduction and adduction and internal and external rotation. Preliminary studies of physical examination during MR imaging, in which a physician examiner applied mechanical force to the humeral head, were also performed. RESULTS: During abduction and adduction and internal and external rotation maneuvers with active subjects muscle contraction, the humeral head remained precisely centered on the glenoid fossa in all asymptomatic subjects, which is in agreement with findings of previous radiographic studies. Application of force to the humeral head by an examiner was associated with as much as 6 mm of anterior translation and 13 mm of posterior translation. CONCLUSION: Dynamic MR imaging of the glenohumeral joint is possible over a wide range of physiologic motion in vertically open systems. Use of an MR tracking coil enabled accurate tracking of the anatomy of interest. These preliminary measurements of normal glenohumeral motion patterns begin to establish normal ranges of motion and constitute a necessary first step in characterizing pathologic motion in patients with common clinical problems such as instability and impingement.

Active MR tracking on a 0.2 Tesla MR imager.

An active MR tracking system was implemented on a 0.2 Tesla open MRI system. Interventional devices with receive-only microcoils at their tips were developed and investigated on the scanner. Microcoils having a diameter of about 1 mm and 20 turns were found to provide sufficient signal-to-noise ratios for stable tracking. Positional accuracy and precision were found to be acceptable under practical conditions. Simulation of MR-guided biopsy using biplane images with tracking was performed in a gelatin phantom and dog livers. Successful tracking of catheters with integrated microcoils was also demonstrated in the aorta and IVC of live dogs.

Joint motion in an open MR unit using MR tracking.

A system for active scan plane guidance during kinematic magnetic resonance (MR) examination of joint motion was developed utilizing an external tracking coil and MR tracking software. In a phantom study and during upright, weight-bearing, physiologic knee flexion, the external tracking coil maintained the scan plane through desired structures. Thus, MR tracking provides a robust method to guide the scan plane during MR imaging of active joint motion.

Interactive coronary MRI.

The acquisition of complete three-dimensional (3D), segmented gradient-echo data sets to visualize the coronary arteries can be both time consuming and sensitive to motion, even with use of multiple breath-holding or respiratory gating. An alternate hybrid approach is demonstrated here, in which real-time interactive imaging is first used to locate an optimal oblique coronary scan plane. Then, a limited number of contiguous slices are acquired around that plane within a breath-hold with use of two-dimensional (2D) segmented gradient-echo imaging. Dual inversion nulling is used to suppress fat and myocardium. Finally, if needed, a limited reformat of the data is performed to produce images from relatively long sections of the coronaries. This approach yields relatively rapid visualization of portions of the coronary tree. Several different methods are compared for interactively moving the scan plane.

Visualization of vascular guidewires using MR tracking.

MR tracking of a vascular guidewire sized for a .035-inch (.89-mm) catheter lumen was performed. The guidewire was actively tracked by incorporation of a miniature radiofrequency (RF) receive coil built into its tip. After in vitro validation, simultaneous tracking of the guidewire and a catheter was performed in the aortic and abdominal vessels of a swine at 1.5 T. The ability to track such a small device and the ability to simultaneously track multiple devices are significant steps towards vascular interventions under MR guidance.

MR imaging-guided intravascular procedures: initial demonstration in a pig model.

With use of an open 1.5-T magnetic resonance (MR) imager and a tracking catheter, the authors successfully placed the catheter into the left or right sacral artery in pigs. The tracking catheter comprised a 5.3-F percutaneous transluminal angioplasty catheter with a small copper radio-frequency coil in its tip. With use of the coil as an antenna, the catheter tip position was projected in real time onto MR angiography road maps in two planes. Guidance of placement of the catheter with the MR angiography road maps allowed successful embolization, balloon occlusion, and transjugular intrahepatic puncture of the portal system. Specialized catheters can be tracked in vivo to allow MR guidance in intravascular interventional procedures.

Real-time biplanar needle tracking for interventional MR imaging procedures.

PURPOSE: To evaluate real-time biplanar tracking of a specially designed needle with magnetic resonance (MR) imaging guidance. MATERIALS AND METHODS: The needle is made of polyetheretherketone and has a miniature radio-frequency coil incorporated into the tip. Tracking software on two workstations is used to compute three-dimensional coordinates of the coil and to display the position as a moving symbol in two imaging planes. Validation of needle tracking was performed in a harvested human liver. T2-weighted fast spin-echo images were used to target a 1-cm cyst. Success of needle placement was confirmed with aspiration and with updated gradient-recalled-echo images. RESULTS: The cyst was successfully targeted from different approaches. Tracking procedures were monitored in real time simultaneously on two separate images. CONCLUSION: Real-time biplanar needle tracking may prove to be useful for both diagnostic and therapeutic interventional MR imaging procedures.

Intravascular MR tracking catheter: preliminary experimental evaluation.

OBJECTIVE: This article reports on the preliminary evaluation of a new technique for guiding intravascular interventional procedures with MR imaging. Active real-time position monitoring of catheters with MR imaging is made possible by incorporating a small RF coil into the tip of the catheter. The purpose of this study was to evaluate the practicability and localizing precision of this MR catheter tracking technique in vitro and in vivo in comparison with fluoroscopy. MATERIALS AND METHODS: Feed cables employing a 0.9-mm-diameter coaxial cable, a 0.5-mm-diameter partially shielded coaxial cable, and a twisted pair cable attaching RF coils at the catheter tip to a coaxial plug at the catheter base were assessed. Further, miniature copper loop RF coils of two, three, and four turns were tested. In vitro validation of MR tracking was achieved by using a phantom consisting of a water-filled harvested segment of human aorta and iliac arteries embedded in gel. Accuracy of catheter placement was compared with MR and fluoroscopy. Subsequently, the MR tracking technique was evaluated in a swine model using a prototype 5-French MR tracking catheter. RESULTS: A fully shielded coaxial cable was found to be crucial for localizing the attached RF coil by means of the tracking technique. The number of coil turns had a lesser impact. Positions of the catheter tip measured with the MR technique and with fluoroscopy correlated well (r > .98), with a 6-mm 95% confidence interval of positional differences. Active real-time tracking of the coil-tipped catheters was achieved both in vitro and in vivo. The 5-French tracking catheter was successfully placed in the splenic and renal arteries of the swine. CONCLUSION: Robust in vivo tracking and accurate placement of catheters equipped with miniature RF coils are possible with MR imaging.

Noninvasive measurement of renal hemodynamic functions using gadolinium enhanced magnetic resonance imaging.

A technique for the assessment of single kidney hemodynamic functions utilizing a novel MR pulse sequence in conjunction with MR contrast material administration is described. Renal extraction fraction (EF) is derived by measuring the concentration of the incoming contrast agent in the renal artery and the outgoing concentration in the renal vein. The glomerular filtration rate (GFR) can then be determined by the product of EF and renal plasma flow. A modified inversion recovery MR pulse sequence is used to measure the T1 of moving blood. This pulse sequence uses a spatially nonselective inversion pulse. A series of small flip angle detection pulses are then used to monitor the recovery of longitudinal spin magnetization in an image plane intersecting the renal vessels. The recovery rate is measured in each vessel and the T1 of blood determined. These T1 measurements are then used to determine the ratio of contrast concentration in the renal arteries and veins. Blood flow measurements can be obtained simultaneously with T1 measurements by inserting flow-encoding magnetic field gradients into the pulse sequence. Preliminary results in human volunteers suggest the feasibility of noninvasively determining hemodynamic functions with magnetic resonance.

Simultaneous detection of multiple components of motion with MRI.

OBJECTIVE: Simultaneous detection of two or more components of motion using new magnetic resonance pulse sequences was investigated. MATERIALS AND METHODS: The technique employs Fourier phase encoding to encode the first component, and phase contrast detection to encode the second. Although the technique can be generalized to any number of spatial dimensions and motional orders, applications in which one or two spatial dimensions are obtained with a single Fourier velocity or acceleration dimension are most likely to be useful. For example, Fourier-encoded velocity and phase-contrasted acceleration information can be combined into the same image. RESULTS: Several variations of the pulse sequence were investigated in phantoms and human volunteers. The first variation acquired images having an appearance similar to that of Fourier velocity-encoded images in which signal displacement is proportional to velocity, but with pixel intensity determined by acceleration. In another variation two spatial dimensions were acquired with a third dimension that uses Fourier velocity encoding to measure axial velocity within a curved tube. Radial velocity components were determined simultaneously with a second velocity-encoding gradient pulse. CONCLUSION: The phantom and in vivo results presented here suggest that simultaneous detection of two or more components of motion is feasible.

Real-time acquisition, display, and interactive graphic control of NMR cardiac profiles and images.

A highly interactive MRI scanner interface has been developed that allows, for the first time, real-time graphic control of one-dimensional (1D) and two-dimensional (2D) cardiac MRI exams. The system comprises a Mercury array processor (AP) in a Sun SPARCserver with two connections to the MRI scanner, a data link that passes the NMR data directly to the AP as they are collected, and a control link that passes commands from the Sun to the scanner to redirect the imaging pulse sequence in real time. In the 1D techniques, a cylinder or "pencil" of magnetization is repeatedly excited using gradient-echo or spin-echo line-scan sequences, with the magnetization read out each time along the length of the cylinder, and a scrolling display generated on the Sun monitor. Rubber-band lines drawn on the scout image redirect the pencil or imaging slice to different locations, with the changes immediately visible in the display. M-mode imaging, 1D flow imaging, and 2D fast cardiac imaging have been demonstrated on normal volunteers using this system. This platform represents an operator-"friendly" way of directing real-time imaging of the heart.

Reduction of artifacts from breathing and peristalsis in phase-contrast MRA of the chest and abdomen.

Strategies for the acquisition of temporally resolved phase-contrast angiography are described and demonstrated. Projections are acquired through the entire thickness of the subject permitting excitation geometries to be independent of image orientation. Minimal delays are used between the acquisition of oppositely flow-encoded data resulting in fewer artifacts from movement of nominally stationary tissue. A protocol that suppresses artifacts from both peristalsis and breathing is presented for the aortic arch and iliac arteries.

Real-time position monitoring of invasive devices using magnetic resonance.

Techniques which can be used to follow the position of invasive devices in real-time using magnetic resonance (MR) are described. Tracking of an invasive device is made possible by incorporating one or more small RF coils into the device. These coils detect MR signals from only those spins near the coil. Pulse sequences which employ nonselective RF pulses to excite all nuclear spins within the field-of-view are used. Readout magnetic field gradient pulses, typically applied along one of the primary axes of the imaging system, are then used to frequency encode the position of the receive coil(s). Data are Fourier transformed and one or more peaks located to determine the position of each receiver coil in the direction of the applied field gradient. Subsequent data collected on orthogonal axes permits the localization of the receiver coil in three dimensions. The process can be repeated rapidly and the position of each coil can be displayed in real-time.

A method of coronary MR angiography.

Procedures for the in vivo detection of coronary (and pulmonary) vessels using MR angiographic techniques were investigated. The most successful technique used gradient-recalled thin slice acquisitions that were gated to the cardiac cycle. The resulting data sets consist of three spatial dimensions and one time dimension. Acquisition of four dimensions of data proved necessary to obtain useful images of small vessels located on the moving myocardium.

Simultaneous acquisition of phase-contrast angiograms and stationary-tissue images with Hadamard encoding of flow-induced phase shifts.

A technique for the simultaneous acquisition of three-dimensional phase-contrast angiograms and stationary-tissue images is described. Hadamard multiplexed encoding of flow information permits image acquisition times that are a third shorter than those of previous phase-contrast methods. The encoding scheme described also enables differentiation of flow-induced phase shifts from phase shifts due to resonance offset conditions such as field inhomogeneities and chemical shift. Display strategies that combine this phase information with the flow image are described.