Dynamic quantitative nonenhanced magnetic resonance angiography of the abdominal aorta and lower extremities using cine fast interrupted steady-state in combination with arterial spin labeling: a feasibility study

J Cardiovasc Magn Reson. 2019 Sep 2;21(1):55. doi: 10.1186/s12968-019-0562-3.

Abstract

Background: Cine fast interrupted steady-state in combination with arterial spin labeling is a recently described nonenhanced magnetic resonance angiography (MRA) technique that relies on bolus tracking for time-resolved digital subtraction angiography-like displays of blood flow patterns. We evaluated the feasibility of applying this technique to display in-plane flow patterns in two regions: the abdominal aorta and lower extremity peripheral arteries.

Methods: We performed an institutional review board-approved study in healthy subjects and patients. In 7 healthy subjects, in-plane flow was imaged at 4 stations ranging from the lower legs to the aorto-iliac bifurcation (junction of the distal thigh and upper calf, mid-thigh, junction of the upper thigh and pelvis, upper pelvis). In 5 healthy subjects and 6 patients without abdominal aortopathy, images were acquired through the suprarenal abdominal aorta. Ten patients with known peripheral arterial disease and two patients with stable disease of the abdominal aorta were also evaluated. Peak velocity was compared at each of the 4 stations for cine fast interrupted steady-state in combination with arterial spin labeling and two-dimensional cine phase contrast in patients with normal vessels.

Results: In-plane flow patterns were well visualized in all peripheral arterial stations and in the abdominal aorta, providing a high quality display of hemodynamic patterns along extensive lengths of the vessels. There was very strong positive correlation (r = 0.952, P < 0.05) and excellent agreement (intraclass correlation coefficient, 0.935; 95% confidence interval, 0.812-0.972) between peak flow velocities measured by cine fast interrupted steady-state in combination with arterial spin labeling and two-dimensional cine phase contrast. In 10 patients with peripheral artery disease and 2 patients with aortic pathology, cine fast interrupted steady-state in combination with arterial spin labeling provided a visual demonstration of abnormal hemodynamics.

Conclusion: This feasibility study suggests that cine fast interrupted steady-state in combination with arterial spin labeling provides an efficient, high quality and physiologically accurate display of in-plane flow patterns over extensive lengths of the lower extremity peripheral arteries, which can be difficult to achieve using other MRA techniques.

Keywords: Angiography; Fast interrupted steady-state; Flow measurement; Magnetic resonance imaging; Peripheral artery disease; Quiescent interval slice-selective.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aorta, Abdominal / diagnostic imaging*
  • Aorta, Abdominal / physiopathology
  • Blood Flow Velocity
  • Case-Control Studies
  • Cineangiography*
  • Feasibility Studies
  • Female
  • Humans
  • Lower Extremity / blood supply*
  • Magnetic Resonance Angiography*
  • Male
  • Middle Aged
  • Perfusion Imaging / methods*
  • Predictive Value of Tests
  • Regional Blood Flow
  • Reproducibility of Results
  • Spin Labels*
  • Time Factors
  • Vascular Diseases / diagnostic imaging*
  • Vascular Diseases / physiopathology

Substances

  • Spin Labels