Virtual monoenergetic images from spectral detector CT as a surrogate for conventional CT images: Unaltered attenuation characteristics with reduced image noise.

OBJECTIVE: This study aimed to identify the energy level of virtual monoenergetic images (VMI) that closest represents conventional images (CI) in order to demonstrate that these images provide improved image quality in terms of noise and Signal-to-noise ratio (SD/SNR) while attenuation values (HU) remain unaltered as compared to CI. METHODS: 60 and 30 patients with contrast-enhanced (CE) and non-enhanced (NCE) spectral detector CT (SDCT) of the abdomen were included in this retrospective, IRB-approved study. CI and VMI of 66-74 keV as well as quantitative iodine maps were reconstructed (Q-IodMap). Two regions of interest were placed in each: pulmonary trunk, abdominal aorta, portal vein, liver, pancreas, renal cortex left/right, psoas muscle, (filled) bladder and subcutaneous fat. For each reconstruction, HU and SD were averaged. ΔHU and SNR (SNR = HU/SD) were calculated. Q-IodMap were considered as confounder for ΔHU. In addition, two radiologists compared VMI of 72 keV and CI in a forced-choice approach regarding image quality. RESULTS: In NCE studies, no significant differences for any region was found. In CE studies, VMI72keV images showed lowest ΔHU (HUliver CI/VMI72keV: 104 ±â€¯18/103 ±â€¯17, p ≥ 0.05). Iodine containing voxels as indicated by Q-IodMap resulted in an over- and underestimation of attenuation in lower and higher VMI energies, respectively. Image noise was lower in VMI images (e.g. muscle: CI/ VMI72keV: 15.3 ±â€¯3.3/12.3 ±â€¯2.9 HU, p ≤ 0.05). Hence, SNR was significantly higher in VMI72keV compared to CI (e.g. liver 3.8 ±â€¯0.6 vs 3.0 ±â€¯0.8, p ≤ 0.05). In visual analysis, VMI72keV were preferred over CI at all times. CONCLUSIONS: VMI72keV show improved SD/SNR characteristics while the attenuation remains unaltered as compared to CI.

Estimation and visualization of regional and global pulmonary perfusion with 3D magnetic resonance angiography.

The purposes of this work were to estimate regional and global pulmonary perfusion and display pulmonary vasculature in 10 postoperative lung transplant patients using breath-hold, contrast-enhanced (0.2 mmol/kg, Gd DTPA-BMA, Omniscan, Nycomed, Inc., Princeton, NJ), three-dimensional (3D) magnetic resonance angiography (MRA) with specially designed double-variable-angle uniform signal excitation (VUSE) radio frequency (RF) pulses. Double-VUSE scans imaged both lungs simultaneously during contrast agent injection and provided both qualitative and quantitative information about pulmonary perfusion. Double-VUSE pulses clearly displayed healthy and diseased vessels. There was a strong correlation between contrast-enhanced double-VUSE MRA flow estimates and those measured from nuclear scans for global or whole lung (R(2) = 0.95; P = 0.000002) and upper, central, and lower thirds of the lung (R(2) = 0.89, 0.92, and 0.86, respectively; P < 0.001 for each region). In conclusion, 3D MRA using VUSE pulses in combination with a contrast agent is a valuable tool for the assessment of pulmonary perfusion that simultaneously acquires data for both the qualitative display of pulmonary vessels and the quantification of regional and global differential pulmonary blood flow.

Evaluation of radiofrequency pulses and contrast agent doses for use in 3D pulmonary magnetic resonance angiography.

Ten healthy volunteers were imaged with breath-hold, three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) using single-variable-angle uniform signal excitation (VUSE), double-VUSE, and flat radiofrequency (RF) pulses with various doses of contrast agent. The ability of each technique to display pulmonary vasculature was evaluated. Images were segmented to isolate lungs, and maximum intensity projections (MIPs) were computed. All MIPs were assigned an image quality (IQ) rating, and signal-to-noise ratios (SNRs) were measured in pulmonary vessels. Without contrast agent, subsegmental vessels were displayed in single- and double-VUSE images while no vessels were visible in flat images. With equal doses of contrast agent, SNRs and IQ ratings were comparable for images obtained with VUSE and flat pulses. In addition, single-VUSE pulses produced more uniform signal from vessels than flat pulses in contrast-enhanced images. The results indicate that non-contrast-enhanced 3D TOF pulmonary MRA with VUSE RF pulses may be a useful screening tool. In addition, contrast-enhanced 3D TOF MRA with VUSE pulses may be useful as a stand-alone technique for assessing the pulmonary vasculature or as an adjunct to contrast-enhanced 3D TOF MRA with flat pulses. J. Magn. Reson. Imaging 10:929-938, 1999.

Quantitative 3D VUSE pulmonary MRA.

The purposes of this study were to quantitatively evaluate a free-breathing three-dimensional (3D) variable angle uniform signal excitation (VUSE) magnetic resonance angiography (MRA) technique in normal volunteers, to demonstrate breathold 3D VUSE MRA in a normal volunteer, and to investigate the ability of the free-breathing 3D VUSE MRA technique to quantify differential flow in lung transplant patients. A free-breathing 3D VUSE MRA pulse sequence was run on the right lungs of 15 normal volunteers and both lungs of eight single or double lung transplant patients. A breathold scan was also used on one volunteer. No contrast agents were used. Normal lung MRA images were analyzed for maximum level of branching observed and minimum distance between distal vessels seen and the pleura. In patients, differential flow was determined with a program that counted the number of MRA pixels over a threshold signal level in each lung. These values were compared to radionuclide perfusion (Q) scan results. Average observed branching order in normal lung images was 5.9 +/- 0.7. Average distance between the most peripheral vessels seen and the pleura was 0.9 cm. Differential blood flow measured by pulmonary MRA was well correlated with that measured by Q scan (R2 = 0.84, p < 0.005). In addition to providing good visualization of normal pulmonary vessels, this technique was demonstrated to provide accurate estimates of differential blood flow in lung transplant patients free of serious lung scarring.

Atherosclerotic plaque components in human aortas contrasted by ex vivo imaging using fast spin-echo magnetic resonance imaging and spiral computed tomography.

RATIONALE AND OBJECTIVES: Imaging techniques that distinguish atherosclerotic plaque components may be useful in identifying the nature of the atherosclerotic lesion and determining the best method of treatment for obstructive vascular mining the best method of treatment for obstructive vascular disease. This study compares fast spin-echo (FSE) magnetic resonance (MR) and spiral computed tomography (CT) images of excised human atherosclerotic aortas to determine which imaging technique provides the best contrast between plaque components ex vivo. METHODS: Aortas were imaged using four FSE sequences in MR with and without frequency-selective fat saturation, and using spiral CT without contrast. The average signal intensity of a region of calcification, thrombosis, fatty plaque, and normal vessel wall was measured on all images and compared. RESULTS: The use of fat saturation pulses in MR did not significantly alter the signal from atherosclerotic plaque for the sequences used. Proton density-weighted FSE sequences that collected early echoes were better than other FSE sequences and CT at differentiating calcification from all soft tissues. T2-weighted FSE sequences that collected later echoes were best at soft-tissue discrimination. CONCLUSIONS: The FSE techniques used were superior to nonenhanced spiral CT in discriminating plaque components ex vivo, including calcification.