817 原著 3D-FSE MRA 1 伊豆野勇太 4 野田誠一郎 2 肥合康弘 4 豊成信幸 2 米田哲也 5 酒本司 3 沖川隆志 6 市川和幸 3 太田雄 2 冨口静二 Code No Evaluation of the D

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1 817 原著 3D-FSE MRA 1 伊豆野勇太 4 野田誠一郎 2 肥合康弘 4 豊成信幸 2 米田哲也 5 酒本司 3 沖川隆志 6 市川和幸 3 太田雄 2 冨口静二 Code No Evaluation of the Detectability of Vascular Stenosis Using Non-contrast Magnetic Resonance Angiography with Various Electrocardiographically-gated Three-dimensional Fast Spin Echo Sequences Yuta Izuno, 1 Yasuhiro Hiai, 2 Tetsuya Yoneda, 2 Takashi Okigawa, 3 Takeshi Ohta, 3 Seiichiro Noda, 4 Nobuyuki Toyonari, 4 Tsukasa Sakemoto, 5 Kazuyuki Ichikawa, 6 and Seiji Tomiguchi 2 1 Graduate School of Health Sciences, Kumamoto University (Current address: Department of Radiology, Fukuoka University Hospital) 2 Faculty of Life Sciences, Kumamoto University 3 Department of Radiology, Saiseikai Kumamoto Hospital 4 Department of Radiology, Kumamoto Chuo Hospital 5 Department of Radiology, Kyushu Medical Center 6 Department of Radiology, Kumamoto Medical Center Received August 9, 2011; Revision accepted May 9, 2012 Code No. 261 Summary Various three-dimensional fast spin echo (3D-FSE) sequences are used for non-contrast magnetic resonance angiography (MRA). Differences in the ability to detect vascular stenosis using these sequences, however, have not yet been evaluated. The purpose of this study is to evaluate the usefulness of each sequence for the detection of vascular stenosis by using a vascular phantom. The phantom consisting of silicon tubes with 30% and 70% stenosis of luminal diameter and fluids close to T 2 value of blood were used for the study. Non-contrast MRA with half-fourier acquisition single-shot turbo spin echo (HASTE)-noncontrast magnetic resonance angiography of arteries and veins (NATIVE), sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE)-NATIVE, fresh blood imaging (FBI) and triggered angiography non contrast enhanced (TRANCE) sequences was performed by using the phantom which can be varied in terms of the steady flow velocity. Each stenosis was quantitatively estimated by the stenosis index (SI) calculated from the signal intensities on acquired images. The signal intensity of the non-stenotic vascular site markedly decreased at more than a flow rate of 20 cm/s in all sequences. Significant decrease in the signal intensity was observed in the distal point from the stenosis area on these images acquired by using HASTE- NATIVE and FBI sequences. FBI and TRANCE sequences showed a more accurate SI for 30% stenosis than HASTE-NATIVE and SPACE-NATIVE sequences. SI for 70% stenosis was overestimated in all sequences at 5 cm/s of diastolic flow rate. In conclusion, the ability to detect vascular stenosis on non-contrast MRA image using 3D-FSE sequences depends on the image quality during diastolic phase in the cardiac cycle. FBI and TRANCE sequences are useful to detect the mild arterial stenosis. Key words: non-contrast magnetic resonance angiography (MRA), noncontrast magnetic resonance angiography of arteries and veins (NATIVE), fresh blood imaging (FBI), triggered angiography non contrast enhanced (TRANCE), stenosis *Proceeding author Vol. 68 No. 7 Jul 2012

2 818 Fig. 1 Vascular stenosis phantom. (a) Picture of vascular stenosis phantom (b) Illustration of vascular stenosis phantom (section view) (c) Overall picture of vascular stenosis phantom and steady flow pump 緒言 magnetic resonance angiography MRA gadolinium Gd MRA MRA MRA United States Food and Drug Administration; FDA Gd nephrogenic systemic fibrosis; NSF MRA 1 MRA MRA MRA gradient echo time of flight TOF phase contrast PC steady state free-precession SSFP 2 3 dimensional-fast spin echo 3D-FSE fresh blood imaging FBI 3 3D-FSE MRA 3 6 SE 3D 3D-FSE 3D-FSE noncontrast magnetic resonance angiography of arteries and veins NATIVE FBI triggered angiography non contrast enhanced TRANCE 1. 方法 1-1 MRI MAGNETOM Avanto 1.5 T slew rate SR 200 mt/m/ms 45 mt/m Excelart Vantage 1.5 T Power Plus Package SR 200 mt/m/ms 33 mt/m Achieva 1.5 T R2.6 SR 160 mt/m/ms 30 mt/m 6 mm Fig. 1 a b T 2 7 Gd 0.5 mmol/l

3 819 Table Scan parameters NATIVE (SPACE/HASTE) FBI TRANCE Acquisition matrix size / (phase encode frequency encode) Matrix size TE (ms) 55/ TR (ms) Slice thickness (mm) Slice per slab Flip angle (degree) Refocusing pulse (degree) FOV (mm) Echo space (ms) 3.12/ Echo train length 49/ Fat saturation pulse STIR STIR off Parallel imaging on off on Scan time (min) 3:00 3:30 3:00 3:38 T ms T ms Fig. 1 c 3D-FSE cm/s 8 25 cm/s cm/s Table 0 5 cm/s 0 cm/s cm/s 5 cm/s 25 cm/s 1-2 Table 3D-FSE variable flip angle sampling perfection with application optimized contrasts using different flip angle evolutions SPACE -NATIVE singleshot fast spin echo SSFSE half-fourier acquisition single-shot turbo spin echo HASTE -NATIVE half-fourier SSFSE fast advanced spin echo FASE FBI volumetric isotropic T 2-weighted acquisition VISTA variable flip angle TRANCE center alignment shifted alignment field of view FOV mm region of interest ROI 0 cm/s Relative signal intensity= 0 cm/s A B stenosis index; SI Vol. 68 No. 7 Jul 2012

4 820 Fig. 2 The result: variation in signal intensity for change in flow velocity. 9 SI=(1 A/B) 100(%) 0 cm/s SI 5 cm/s 25 cm/s 0 cm/s SI Fig. 3 Images of each sequence. 2. 結果 : 各撮像シーケンスの流速による影響の検討 2-1 Fig cm/s HASTE-NATIVE SPACE-NATIVE Fig. 3 Variable flip angle HASTE-NATIVE FBI Fig. 4 Subtraction images acquired by different systolic velocity (30% stenosis). 2-2 Fig. 4 0 cm/s 5 cm/s 25 cm/s 30 5 cm/s 25 cm/s Fig. 5 0 cm/s SI 20 cm/s SI NATIVE 2 10 cm/s 0 cm/s 25 cm/s SI Fig FBI

5 821 Fig. 5 The result: variation in signal intensity for change in flow velocity. (a) 30% stenosis (b) 70% stenosis a b Fig. 6 The result: stenosis index (diastolic velocity: 0 cm/s, systolic velocity: 25 cm/s). (a) 30% stenosis (b) 70% stenosis a b TRANCE 30 Fig. 6 a Fig. 6 b Fig. 7 5 cm/s 25 cm/s 30 SI TRANCE 3. 考察 : 各撮像シーケンスの流速による影響の検討 3-1 high-velocity signal loss FSE SE 10 SE Fig. 7 The result: stenosis index of 30% stenosis (diastolic velocity: 5 cm/s, systolic velocity: 25 cm/s) Vol. 68 No. 7 Jul 2012

6 cm/s high-velocity signal loss FSE RF high-velocity signal loss cm/s 5 cm/s 11 5 cm/s Fig. 4 NATIVE 5 cm/s 25 cm/s Fig cm/s SI signal to noise ratio SNR SI 0 cm/s 5 cm/s 5 cm/s TRANCE FBI 5 cm/s 2 SI 12, 13 TRANCE FBI FBI spoiled gradient pulse 2, T 9

7 823 Fig. 8 Illustration of hemodynamics at outflow region. 3-3 Fig. 8 Fig. 3 Reynold s number; Re Re= ρ v d η ρ g/cm 3 v cm/s d cm η g/cm s T 2 variable flip angle HASTE-NATIVE FBI variable flip angle 4. 結語 MRA 3D-FSE SI 5 cm/s SI 0 cm/s 謝辞 Vol. 68 No. 7 Jul 2012

8 824 参考文献 1 Thomsen HS. Nephrogenic systemic fibrosis: a serious late adverse reaction to gadodiamide. Eur Radiol 2006; 16(12): Miyazaki M, Lee VS. Nonenhanced MR angiography. Radiology 2008; 248(1): Miyazaki M, Sugiura S, Tateishi F, et al. Non-contrastenhanced MR angiography using 3D ECG-synchronized half-fourier fast spin echo. J Magn Reson Imaging 2000; 12(5): Urata J, Miyazaki M, Wada H, et al. Clinical evaluation of aortic diseases using nonenhanced MRA with ECG-triggered 3D half-fourier FSE. J Magn Reson Imaging 2001; 14(2): Miyazaki M, Takai H, Sugiura S, et al. Peripheral MR angiography: separation of arteries from veins with flowspoiled gradient pulses in electrocardiography-triggered three-dimensional half-fourier fast spin-echo imaging. Radiology 2003; 227(3): Ono A, Murase K, Taniguchi T, et al. Deep vein thrombosis using noncontrast-enhanced MR venography with electrocardiographically gated three-dimensional half-fourier FSE: preliminary experience. Magn Reson Med 2009; 61(4): Stanisz GJ, Odrobina EE, Pun J, et al. T1, T2 relaxation and magnetization transfer in tissue at 3T. Magn Reson Med 2005; 54(3): T MRI 3D-FSE MRA 2010; 66(8): Palmer SK, Zamudio S, Coffin C, et al. Quantitative estimation of human uterine artery blood flow and pelvic blood flow redistribution in pregnancy. Obstet Gynecol 1992; 80(6): Bradley WG, Waluch V, Lai KS, et al. The appearance of rapidly flowing blood on magnetic resonance images. AJR Am J Roentgenol 1984; 143(6): Lisanti CJ, Douglas DB. Effects of breath-hold and cardiac cycle on the MRI appearance of the aorta and inferior vena cava in T 2 abdominal imaging. AJR Am J Roentgenol 2009; 192(5): Lim RP, Hecht EM, Xu J, et al. 3D nongadoliniumenhanced ECG-gated MRA of the distal lower extremities: preliminary clinical experience. J Magn Reson Imaging 2008; 28(1): Hoey ET, Ganeshan A, Puni R, et al. Fresh blood imaging of the peripheral vasculature: an emerging unenhanced MR technique. AJR Am J Roentgenol 2010; 195(6): 図表の説明 Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 a b c 30 SI a 30 b 70 SI 0 cm/s 25 cm/s a 30 b SI 5 cm/s 25 cm/s Table

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