ISMRM 24th Annual Meeting & Exhibition • 07-13 May 2016 • Singapore

Weekend Educational Course: Cardiovascular MRI: Vascular Flow & Angiography

Skill Level: Basic to Intermediate

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

Saturday 07 May 2016

An introduction to the vascular MRI examination. The sessions will review the basic principles and applications of contrast and non-contrast enhanced MRA techniques from both a technical and clinical perspective. The course will also explain the differences in both technique and application of static and dynamic MRA compared to 2D and 4D flow imaging.

Target Audience
Clinicians, scientists and engineers who wish to discriminate between the various techniques available for vascular imaging and their appropriate application in clinical practice.

Educational Objectives
Upon completion of this course, participants should be able to:

  • Describe and critique the basic vascular MRI examination from a clinical and technical perspective and evaluate how their own practice could be improved;
  • Critically assess the various MRA and flow imaging techniques and reflect on their current clinical practice; and
  • Compare and contrast between angiographic and flow imaging techniques and reflect on their own practice.

Moderator: Martin Graves
      The Basic Vascular MRI Exam  
Contrast & Non-contrast Enhanced Methods - Technical Perspectives - Permission Withheld
Mitsue Miyazaki1
1Toshiba Medical Research Institution, Vernon Hills, IL, United States

Both contrast enhanced (CE) and non-contrast enhanced (NCE) MRA techniques are introduced. In CE-MRA, developing trends including bolus timing estimation, temporal and spatial resolution improvement, and low dose gadolinium (Gd) MRA are revisited. In NCE-MRA, recent developments, including inflow, flow-dependent, and spin labeling techniques are introduced. Clinical applications of these NCE-MRA techniques are also demonstrated.

Contrast & Non-contrast Enhanced Methods - Clinical Applications
James Carr1
This presentation will demonstrate the technical and clinical applications of contrast enhanced and non-contrast magnetic resonance angiography (MRA). MRA is routinely used to evaluate the vasculature in a non–invasive fashion. Contrast enhanced MRA can be implemented as a conventional timed flow arrest protocol or as time resolved dynamic imaging.  The technical aspects of both of these approaches will be described in detail. Several different Gadolinium based contrast agents are routinely used for CEMRA including both extracellular and blood pool agents. Methods for optimal utilization of contrast agents for MRA will be described. Because of the risk of NSF with gadolinium use in patients with renal failure, there has been renewed interest in non contrast MRA techniques. Several of these NCMRA approaches will be discussed. Through a series of case presentations, this talk will attempt to illustrate the optimal use of all of these techniques in clinical practice. At the end of this lecture, attendees should understand the basic technical principles for CEMRA and NCMRA and will also be more familiar with the appropriate clinical indications for using these techniques.

Break & Meet the Teachers
      The Advanced Vascular MRI Exam  
Definition of Terms: Static & Dynamic CE-MRA & 2D/4D Flow
Oliver Wieben1
1Depts. of Medical Physics & Radiology, University of Wisconsin-Madison, Madison, WI, United States
Over the last decades, many methodological advances have been introduced to expand the capabilities of anatomical and functional MRA beyond the basic MR acquisition principles. These innovations provide new opportunities and challenges. Here we will review several key concepts with a special focus on their terminology, protocol choices available to the clinical and research user, and implications on the resulting images in the context of contrast-enhanced MRA and flow MRI.

Practical Challenges of MRA & Flow
Alex J Barker1
1Radiology, Northwestern University, Chicago, IL, United States
MRA and phase contrast flow measurements involve the measurement of moving bodies, specifically blood (or in some cases CSF). Motion will produces artifact in MR images. While some of these artifacts are advantageous for the purpose of MRA (TOF) and flow images, unanticipated motion will degrade the quality of the exam. This educational section will discuss the practical considerations and challenges when protocolling MRA and flow measurements.

Break & Meet the Teachers
Clinical Applications of MRA
Winfried Willinek1
1Department of Radiology, Neuroradiology, Sonography and Nuclear Medicine
Clinical Applications of 2D & 4D Flow
Alejandro Roldan-Alzate
Conventional flow-sensitive magnetic resonance imaging (MRI) using two-dimensional (2D) slice selection, cardiac gating, and phase contrast (PC) velocity encoding in one direction is an excellent quantitative alternative to measure blood flow in different vascular territories.  Recent advances allow for the acquisition of MRI data sets with three-directional velocity encoding over a 3D volume throughout the cardiac cycle in clinically feasible scan times of 20 minutes and less. This presentation will discuss clinical applications of 2D and 4D flow MRI.

Adjournment & Meet the Teachers

The International Society for Magnetic Resonance in Medicine is accredited by the Accreditation Council for
Continuing Medical Education to provide continuing medical education for physicians.