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A feasibility study of dual contrast blood image (DCBI) using balanced steady state free precession (B-SSFP) with phase sensitive inversion recovery (PSIR). Poster No.: C-0906 Congress: ECR 2015 Type: Scientific Exhibit Authors: T. Yoshida , Y. Katsumata , Y. Furukawa , M. Nozaki , T. 1 2 1 1 1 1 1 1 3 Nagasaki , M. Hirano , N. Kawauchi , T. Shirai , H. Saito ; 1 2 3 Tokyo/JP, Yokohama/JP, Sendai/JP Keywords: Image verification, Blood, Artifacts, Imaging sequences, MRAngiography, Vascular, Thorax, Cardiovascular system DOI: 10.1594/ecr2015/C-0906 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. 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Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myESR.org Page 1 of 16 Aims and objectives Various kinds of sequences of magnetic resonance angiography (MRA) are used to evaluate vascular lesions. These sequences are classified into two groups: bright blood (BriB) imaging sequences, and black blood (BlaB) ones. BriB images visualize intravascular lumens brighter than surrounding stationary tissues, 1), 2) and are useful for vascular morphology delineation . Representative BriB image sequences are time-of-flight (TOF), phase contrast angiography (PCA), contrast 3) enhancement MRA (CE-MRA) and balanced steady state free precession (B-SSFP) . BriB image sequences available have some problems (Table.1a). TOF is based on inflow, and is related to flow speed. TOF could not visualize vessels with flow out of setting 4) velocity . PC is based on the phase of blood flow. Flow velocity and flow direction affect the image quality of PCA. And scan times of PC are longer. CE-MRA require gadolinium5) based contrast agents . The use of gadolinium-based contrast agents in patients with renal dysfunction is reported as the risk of developing nephrogenic systemic #brosis 6) (NSF) . BlaB images visualize intravascular lumens darker than surrounding stationary tissues, and are useful for vessel wall delineation. Representative BlaB image sequences are single or double inversion recovery (IR) pre-pulse, variable refocusing flip angle (VRFA) and MSDE. BlaB image sequences available have some problems (Table.1b). BlaB images with IR pre-pulse generate null points by using inversion delay time (TI). Mismatch 7) of TI could degrade the image quality of BlaB images with IR pre-pulse . VRFA, using spin echo sequences, needs long scan times. MSDE sequences cold be degrade by 8) motion, such as blood flow or respiration . B-SSFP, frequently used as a BriB image sequence, is validated for high signal intensity 9)-12) and shorter scan times . Furthermore, B-SSFP using IR method is reported as a BlaB 13-14) image sequence that is not affected by blood flow velocity . B-SSFP could provide BriB images and BlaB images, however, there was no sequence to obtain both BriB images and BlaB images with B-SSFP at one time yet. This study is to evaluate the Page 2 of 16 sequence of dual contrast images (DCBI) using balanced steady state free precession with phase-sensitive inversion-recovery (PSIR-B-SSFP). Images for this section: Table 1: Bright blood (BriB) image and black blood (BlaB) image sequence table. a): BriB image sequence information and b): BlaB image sequence information. Page 3 of 16 Methods and materials <PSIR-B-SSFP sequence> PSIR-B-SSFP sequence was different from PSIR on two points (Fig. 1). One is the read out. The read out of PSIR-B-SSFP is not gradient echo, but balanced steady state free precession (B-SSFP). The other is flip angle (FA) of the second image. The FA of the second image is equal to the first image on PSIR-B-SSFP. PSIR-B-SSFP sequence (Fig. 1b) required two heartbeats to obtain images. An IR prepulsed image (IR modulus image: IRm image) with effective TI was obtained on the first heartbeat. This IR pre-pulse affected T1 value, and suppressed the signal intensity of selective tissues intended by set TI. Then a low contrast image, the reference image, was obtained with on the second heartbeat. The recovery of the longitudinal relaxation of the tissues advances on the reference image, and the tissue has positive signal on it. Then, correct real (CR) image with low phase error was obtained from first and the second heartbeat images with phase collection (Fig.2). Therefore, CR image had a good 15) 16) contrast image when TI null varied . Used MRI scanners was a 1.5 T system (Philips Achieva). SENSE 8ch Head coil (Experiment 1) and 32ch SENSE-Cardiac Torso coil (Experiment 2) were used. Optimal imaging parameters were evaluated on the basic evaluation using handmade blood phantom (Experiment 1). Then the volunteer image was taken based upon the optimal imaging parameters, and the impact of blood flow was evaluated (Experiment 2). Used sequences on both experiments were as follows: 2D PSIR-B-SSFP TR/ TE=3.6ms/1.78ms, water fat shift=0.3, Image resolutions (M×P×S) =1.78×1.78×6mm, Physiology cardiac trigger (+) and Scan Time = 3.6sec/slice. Experiment 1: IR modulus (IRm), Correct Real (CR) and Modulus (Mod) image of the blood phantom (T1:1034ms, T2:260ms) were obtained by PSIR-B-SSFP in varying flip angle (FA), TI and Shot Interval (SI). The signal intensities of the phantom images were evaluated. The results were used to determine the optimal parameters for DCBI. Page 4 of 16 Experiment2: Institutional Review Board approved this study. Transverse and sagittal mages of the thoracic aorta were taken on 10 volunteers. Transverse covered from aorta arch to the tail end of heart, and within the limits of whole heart and aorta for sagittal. Images were taken with various TI and SI. Signal intensities of ascending aorta, aortic arch, descending aorta, pulmonary artery, right ventricle, and left atrium were measured. Images for this section: Fig. 1: Pulse sequence diagrams of (a) phase sensitive inversion recovery (PSIR) based gradient echo and (b) phase sensitive inversion recovery balanced steady state free precession (PSIR-B-SSFP) sequences. (a) In the PSIR sequence, 2 heart beats per inversion recovery pre-pulse were required. RF pulse flip angle of 2nd image read out was considerably lower than that of 1st image read out. (b) In the PSIR-B-SSFP sequence, RF pulse flip angles of 1st and 2nd image read out were equal. Page 5 of 16 Fig. 2: Representative real relaxation curves on phase sensitive inversion recovery balanced steady state free precession (PSIR-B-SSFP# sequence. 1st and 2nd images were inversion recovery modulus (IRm) image (a) and modulus (Mod) image (b). Corrected real (CR) image was calculated from 1st and 2nd images. Magnetization of all tissue is affected by inversion recovery pre-pulse. Magnetization of object# on 1st and 2nd images were recovered to positive. Magnetization of object# on 1st image was negative, and that on 2nd images was recovered to positive. Page 6 of 16 Results Experiment 1: Signal intensity (SI) of the blood phantom were positive on the IRm image with TI<500ms (Fig.3) and Mod image with any TI (Fig.4). IRm image had the highest signal intensity when TI=shortest (Fig.3). Therefore, BriB image could be obtained on the IRm image with TI<500ms and Mod image with any TI with PSIR-B-SSFP. SI of the blood phantom were negative on the CR image with TI#500ms (Fig.3-4). BlaB image could be obtainedon the CR image with TI#500ms. Experiment 2: Signal intensity (SI) on the images of the volunteer showed positive signal intensities on IRm and modulus images, and negative signal intensities on CR images (Figs. 5, 6). Flow direction had little effect on signal intensities (Figs. 5, 6). Average scan time for PSIR-B-SSFP sequence was 70sec with 25slices transverse and 42sec with 15slices sagittal. DCB image (i.e. BriB and BlaB) can be obtained at one time by PSIR-B-SSFP (Fig.7). Discussion IRm image and Mod image of PSIR-B-SSFP could provide BriB images. IRm image with the shortest TI generated higher signal intensity than Mod image (Fig.2~4). IRm image was influenced by IR pre-pulse because signal intensity of IRm image varied with TI. Mod image had the constant signal intensity with increasing TI. Mod image of the second heartbeat has little influence by IR pre-pulse, and might have the same signal intensity as the normal B-SSFP. Page 7 of 16 CR image could provide BlaB image. CR image is calculated from IRm and Mod images, and this calculation might result this signal intensity decrease (Fig.3). The signal intensity of blood phantom on IRm image decreased with IR pre-pulse, and was null at TI=500ms. It is assumed that signal intensity of IRm image with TI<500ms is actually decreasing. As a result, signal intensities of CR image, calculated from IRm and Mod images, become negative. PSIR-BSSFP provided DCB images on volunteer study (Fig.7). Flow velocities and directions had little influence on image qualities. However, the influence of miss registration of phase map caused by arrhythmia and free breathing has not been clarified in this study. Images for this section: Page 8 of 16 Fig. 3: Signal intensity (SI) of blood phantom with various flip angles (FAs) and inversion times (TIs). Inversion recovery modulus (IRm) and correct real (CR) image by phase sensitive inversion recovery balanced steady state free precession (PSIR-B-SSFP). Fig. 4: Signal intensity (SI) of blood phantom with various flip angles (FAs) and inversion times (TIs). Modulus (Mod) and correct real (CR) image by phase sensitive inversion recovery balanced steady state free precession (PSIR-B-SSFP). Page 9 of 16 Fig. 5: Signal intensity (SI) of volunteer transversal images with various flow direction and inversion times (TIs). (a): inversion recovery modulus (IRm) images by phase sensitive inversion recovery balanced steady state free precession (PSIR-B-SSFP), (b): modulus (Mod) image by PSIR-B-SSFP and (c): CR image by PSIR-B-SSFP. The measurement of SI with red cross-circle is ascending aorta (asc-Ao) and yellow dot-circle is descending aorta (dis-Ao). Page 10 of 16 Fig. 6: Signal intensity (SI) of volunteer sagittal images with various flow direction and inversion times (TIs). (a): inversion recovery modulus (IRm) images by phase sensitive inversion recovery balanced steady state free precession (PSIR-B-SSFP), (b): modulus (Mod) image by PSIR-B-SSFP and (c): CR image by PSIR-B-SSFP. The measurement of SI with red allow is ascending aorta(asc-Ao), yellow allow is aorta arch(Ao-arch), light blue allow is descending aorta(dis-Ao), blue cross-circle is pulmonary artery(PA), purple dot-circle is right atrium(RA) and left atrium(LA). Page 11 of 16 Fig. 7: Volunteer images of transversal (upper) and sagittal (lower). Right side: bright blood images with inversion recovery modulus (IRm) images by phase sensitive inversion recovery balanced steady state free precession (PSIR-B-SSFP), middle: black blood images with CR image by PSIR-B-SSFP and left side: bright blood images withf modulus (Mod) image by PSIR-B-SSFP. M2D PSIR-B-TFE single shot TR/TE (ms) =3.1/1.54 TI (ms) =150 FA=90°water fat shift=0.3 Voxel size (M*P*S: mm) =1.48*1.88*8.0 Scan time=3.6sec/slice cardiac trigger (+) heat-rate=63bpm breath hold (+) Page 12 of 16 Conclusion PSIR-BSSFP is the method that provided dual contrast vessel Images at one time. PSIRB-SSFP provide bright blood image by IR modulus and modulus image, and black blood image by correct real image. Flow directions and velocities had little effect on image qualities of PSIR-BSSFP. Personal information Takashige Yoshida*, Yuki Furukawa, Department of Radio-technology, Tokyo Metropolitan Police Hospital, Tokyo, Japan; 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan *e-mail: [email protected] Nobuo Kawauchi Department of Radiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan; 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan Miho Nozaki, Tetsuro Shirai Department of Internal Medicine, Tokyo Metropolitan Police Hospital, Tokyo, Japan; 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan Yasutomo Katsumata Clinical Excellence Application Div, Asia Pacific MR Application Manager, Philips Electronics Japan, ltd; 2-13-37, Kounan, Minato-ku, Tokyo, 108-8507, Japan Takuma Nagasaki Nagasaki Research Institute; Page 13 of 16 98-55, Honmoku, Manzaka, Naka-ku, Yokohma, 231-0833, Japan Masaharu Hirano Department of Cardiovascular Medicine, Tokyo Medical University Hospital, Tokyo, Japan 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan Haruo Saito Division of Diagnostic Image Analysis, Graduate school of Medicine, Tohoku University, Miyagi, Japan 2-1, Seiryou-cho, Aoba-ku, Sendai-shi, Miyagi, 980-8575, Japan References 1) Matt AB, Kevin FK, Xiaohong JZ. 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