ISMRM 23rd Annual Meeting & Exhibition 30 May - 05 June 2015 Toronto, Ontario, Canada

Combined Educational & Scientific Session

Cardiovascular MRA With & Without Contrast

SKILL LEVEL: Intermediate

ORGANIZERS: Daniel B. Ennis, Ph.D. & Harald Kramer, M.D.

Thursday 4 June 2015

Overview
The invited clinical talks in this session will address the principal clinical indications, target territories, and protocols for contrast enhanced (CE) and non-contrast enhanced (non-CE) magnetic resonance angiography (MRA). Scientific talks selected from the submitted abstracts will present the latest research advances in both CE-MRA and non-CE MRA.

Target Audience
Attendees with a working knowledge of clinical MRA and the physical principals of MRA and MRI will benefit from this session by extending their current knowledge into new and emerging techniques.

Educational Objectives
As a result of attending this course, participants should be able to:
Distinguish the principle clinical indications for contrast enhanced and non-contrast enhanced magnetic resonance angiography;
Recommend protocols for contrast enhanced and non-contrast enhanced magnetic resonance angiography; and
Integrate an advanced understanding of clinical MRA into their clinical workflow and research projects.

PROGRAM
Moderators: Vincent B. Ho, M.D., M.B.A., Bernd J. Wintersperger, M.D.
16:00   Contrast Enhanced MRA: Why, Where, and How?
J. Paul Finn, M.D.
16:30 0972.   
Three-Station Fluoroscopic Tracking 3D Bolus Chase MRA with Optimized Accelerations
Paul T. Weavers1, Eric A Borisch1, Phillip M. Young1, Phillip J. Rossman1, Thomas C. Hulshizer1, and Stephen J. Riederer1
1Radiology, Mayo Clinic, Rochester, Minnesota, United States

Real-time fluoroscopic tracking and triggering in stepping table bolus chase CE-MRA has been enabled through advances in receiver coil and parallel imaging technology. This work details advances in anatomy specific receiver arrays designed to support high accelerations as well as optimized patient specific parallel imaging acceleration factors. The two advanced combined allow for increases in the acceleration factor of up to 50%.

16:42 0973.   Ferumoxytol in Pediatric Congenital Heart Disease: Initial Results with 4D Multiphase Steady State Imaging of Contrast (MUSIC) Enhancement
Kim-Lien Nguyen1,2, Fei Han2, Daniel Z. Brunengraber2, Stanislas Rapacchi2, Ihab Ayad2,3, Gary Satou2,4, Peng Hu2, and J. Paul Finn2
1Division of Cardiology, Greater Los Angeles VA Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles, CA, United States,2Diagnostic Cardiovascular Imaging Laboratory, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States,3Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, Los Angeles, CA, United States, 4Division of Pediatric Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States

We propose a new paradigm for cardiovascular imaging in congenital heart disease using 4-dimensional, multiphase, steady-state imaging with contrast enhancement (MUSIC) with ferumoxytol.

16:54   Non-Contrast Enhanced MRA: Why, Where, and How?
Ruth P. Lim, MBBS, Mmed, FRANZCR, MS
17:24 0974.   Clinical Assessment of a Non-contrast MR Angiography Protocol for the Pre-Transplant Evaluation of the Liver Vasculature
Jeremy Douglas Collins1, Edouard Semaan1, Zoran Stankovic2, Riad Salem1, Maria Carr1, Michael Markl1,3, and James Christian Carr1
1Radiology, Northwestern University, Chicago, IL, United States, 2Radiology, University Hospital, Freiberg, Germany, 3Biomedical Engingeering, Northwestern University, Evanston, Illinois, United States

Chronic renal insufficiency commonly accompanies end-stage liver disease affecting 18-39% of patients. Renal insufficiency adversely impacts the pre-transplant liver vascular assessment, which is necessary to determine suitability for liver transplantation. A comprehensive non-contrast enhanced MRA protocol using a combination of different techniques enables complete assessment of the liver vasculature in the majority of patients. Our study evaluates the performance of a non-contrast MRA protocol for the pre-liver transplant vascular evaluation, using contrast-enhanced MRA as the standard of reference.

17:36 0975.   Non-contrast enhanced MR angiography in the calf: A comparison between Flow-sensitive dephasing prepared steady-state free precession and quiescent-interval single-shot in patients with diabetes - video not available
Hanwei Chen1, Na Zhang2,3, and Xin Liu2,3
1Department of Radiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China, 2Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology of Chinese Academy of Sciences, Shenzhen, Guangdong, China, 3Shenzhen Key Laboratory for MRI, Shenzhen, Guangdong, China

Two non-contrast enhanced magnetic resonance angiography (NCE-MRA) techniques based on steady-state free precession (SSFP), namely flow-sensitive dephasing (FSD) and quiescent-interval single-shot (QISS), have been proposed to achieve higher signal to noise ratio (SNR) of arterial blood and less flow artifacts existed inherently in TSE-based NCE-MRA. The purpose of this study was to compare the image quality and diagnostic accuracy of the FSD and QISS techniques for the detection of lower extremity arterial stenosis in a diabetic patient cohort, using conventional high resolution contrast-enhanced MRA (CE-MRA) as the reference standard.

17:48 0976.   
Bicuspid Valve Morphology Determines the Position of Elevated Velocity and WSS: 4D Flow MRI in 202 Subjects
Pim van Ooij1,2, Ian G Murphy2, Alexander L Powell2, Maria Carr2, Wouter V Potters1, Colleen Clennon3, Jeremy D Collins2, James C Carr2, S Chris Malaisrie4, Patrick M McCarthy3, Michael Markl2,5, and Alex J Barker2
1Radiology, Academic Medical Center, Amsterdam, Netherlands, 2Radiology, Northwestern University, Chicago, IL, United States, 3Division of Cardiac Surgery, Northwestern University, Chicago, IL, United States, 4Medicine-Cardiology, Northwestern University, Chicago, IL, United States, 5Northwestern University, Biomedical Engineering, Chicago, IL, United States

Bicuspid valve (BAV) patients are known to express two different types of aortic dilation: 1) with involvement of the root or 2) dilation of the distal aorta. In this 4D flow MRI study, 140 BAV patients are compared with 60 volunteers. With advanced postprocessing techniques (cohort-averaged and P-value maps) it is shown that differences in BAV opening lead to differences in velocity and WSS expression that may be related to the different types of dilation.

18:00   Adjournment & Meet the Teachers