MR Angiography of the Body (eBook)

Copyright Page 4
Foreword 5
Preface 6
Contents 7
Part I: Image Acquisition Technique and Sequences 9
Chapter 1 10
Flo-Based MRA 10
1.1 Time of Flight (TOF) MR Angiography 11
1.2 Phase Contrast (PC) MR Angiography 11
1.3 T2-Based MR Angiography 12
References 12
Chapter 2 14
MR Angiography Contrast Agents 14
2.1 Magnetic Properties 14
2.2 Relaxivity 15
2.2.1 Paramagnetic Contrast Agents 15
2.2.2 Superparamagnetic and Ferromagnetic Contrast Agents 15
2.3 Susceptibility Effect 16
2.4 Contrast Agents for Vascular Imaging 16
2.4.1 Paramagnetic Gadolinium Agents 16
2.4.1.1 Extracellular Fluid Agents 16
2.4.1.2 Blood-Pool Agents 18
2.4.2 Superparamagnetic Ultrasmall Iron Oxide Particles 20
2.5 Safety 21
2.6 Future Perspectives 22
2.6.1 Contrast Agent Use at High Field 22
2.6.2 Other Contrast Agents 22
2.6.2.1 Gadolinium-Based Particulate Agents 22
2.6.2.2 Hyperpolarized Contrast Agents 22
2.6.2.3 Chemical Exchange Saturation Transfer (CEST) 22
References 23
Chapter 3 24
Image Acquistion Technique and Sequences Contrast-Enhanced MRA 24
3.1 Introduction 25
3.2 Basic Principle of CE-MRA 25
3.3 Contrast Administration Strategy 26
3.4 Imaging and Acquisition Technique 26
3.4.1 Fast 3D Gradient Echo Sequences and Acquisition Technique 26
3.4.2 Parallel Imaging 28
3.4.3 Time-Resolved CE-MRA 28
3.4.4 Steady-State Imaging 28
3.5 k-Space Filling Strategies 30
3.6 Conclusions 32
References 32
Chapter 4 33
Artifacts in MR-Angiography 33
4.1 Introduction 33
4.2 Classifi cation 34
4.3 Radiofrequency Artifacts 34
4.4 Flow Artifacts 34
4.4.1 Turbulence’s Artifact 34
4.4.2 The Artifact Due to Saturation 35
4.5 Hinge Artifact 35
4.6 Geometric Artifacts 36
4.6.1 The Hypointensity Linear Horizontal Artifact 36
4.6.2 The Artifact Due to Noninclusion of the Vase in the Excited Volume 36
4.7 Magnetic Susceptibility Artifacts 36
4.8 Maki Artifact 37
4.9 Vascular Blurring 37
4.10 Patient Artifacts 37
4.11 Artifacts from Postprocessing 38
4.11.1 The Artifact Due to Projection of Background Noise 38
4.11.2 Step Artifact 39
References 39
Chapter 5 40
Image Processing 40
5.1 Introduction 40
5.2 Multiplanar Reformation (MPR) 40
5.3 Maximun Intensity Projection (MIP) 42
5.4 Shaded Surface Display (SSD) 44
5.5 Volume Rendering (VR) 45
5.6 Virtual Endoscopy (VE) 46
References 48
Part II: Clinical Applications 50
Chapter 6 51
Radiologic Vascular Anatomy 51
6.1 The Arteries 51
6.1.1 The Arteries of the Head, Neck, and Thorax 52
6.1.1.1 The Thoracic Aorta 52
Visceral Branches 56
Parietal Branches 56
6.1.1.2 The Pulmonary Arterles 56
6.1.2 The Abdominal Arteries 57
6.1.2.1 Visceral Branches 57
6.1.2.2 Parietal Branches 60
6.1.2.3 Terminal Branches 60
6.1.3 The Arteries of the Limb 61
6.1.3.1 Upper Limp 61
6.1.3.2 Lower Limb 63
The Femoral Artery 63
The Profunda Femoris Artery 63
The Popllteal Artery 64
The Anterior Tibial Artery 65
The Posterior Tibial Artery 65
The Peroneal Artery 65
6.2 The Veins 66
6.2.1 Veins of the Head, Neck, and Thorax 67
6.2.1.1 The Superior Vena Cava 67
6.2.1.2 The Pulmonary Veins 69
6.2.1.3 The Veins of the Heart 69
6.2.2 The Veins of the Abdomen and Pelvis 69
6.2.2.1 The Portal System of Veins 71
6.2.3 The Veins of the Limbs 73
6.2.3.1 The Veins of the Upper Limb 73
6.2.3.2 The Veins of the Lower Limb 74
References 75
Chapter 7 76
Neck Vessels 76
7.1 Technical Considerations 77
7.2 Subclavian Arteries 80
7.3 Carotid Arteries 81
7.3.1 Atherosclerotic Disease 81
7.3.2 Dissection 85
7.4 Vertebral Arteries 86
7.4.1 Atherosclerosis 86
7.4.2 Dissection 86
References 87
Chapter 8 89
Thoracic Aorta and Pulmonary Vessels 89
8.1 Introduction 89
8.2 Thoracic Aorta 90
8.2.1 Spectrum and Prevalence of Disease 90
8.2.2 Normal Aortic Anatomy 90
8.3 MR Technique 91
8.3.1 Contrast-Enhanced Magnetic Resonance Angiography (CE-MRA) 91
8.3.2 Contrast Injection Synchronization 92
8.3.3 Contrast Dose and Administration 92
8.3.4 Image Processing 93
8.3.5 Black Blood Techniques 93
8.3.6 Bright Blood Techniques 94
8.3.7 Fundamental Sequences 94
8.4 Normal MR Aortic Anatomy 93 95
8.5 Aortic Diseases 95
8.5.1 Aortic Aneurysm 95
8.5.1.1 Clinical Findings 95
8.5.1.2 Histopathology 95
8.5.1.3 MR Features 96
8.5.1.4 Differential Diagnosis 97
8.5.2 Aortic Dissection and Intramural Hematoma 98
8.5.2.1 Clinical Findings 98
8.5.2.2 Histopathology 99
8.5.2.3 MR Features 99
8.6 Trauma 100
8.7 Vascular Thoracic Outlet Syndrome 100
8.8 Post EVAR Evaluation 100
8.9 Pulmonary Vessels 102
8.9.1 Normal MR Pulmonary Vessels Anatomy 102
8.9.2 Bronchial Artery Anatomy 103
8.9.3 Magnetic Resonance Imaging and Magnetic Resonance Angiography 103
8.9.3.1 Perfusion Imaging and Ventilation 104
8.9.3.2 Time-Resolved MRA 104
8.9.3.3 BFFE Imaging 104
8.9.3.4 Thrombus Imaging 105
8.9.3.5 Blood-Pool Imaging 105
References 105
Chapter 9 107
Heart and Coronary Arteries 107
9.1 Introduction 107
9.2 Technological Requirements 108
9.3 Pulse Sequence Aspects 109
9.3.1 Cardiac and Respiratory Motion Suppression 109
9.3.2 Making a Good Contrast 109
9.3.3 From 2D to 3D: Whole Heart CMRA 110
9.3.4 New Benefi ts from Parallel Imaging 111
9.3.5 Contrast Agents to Improve Image Quality 112
9.4 Clinical Applications 112
9.5 MRA Coronary Stenting and Bypass 113
9.6 Functional Evaluation of Coronary Arteries and Bypass 114
9.7 Conclusion 115
References 115
Chapter 10 117
Abdominal Aorta and Renal Arteries 117
10.1 Introduction 117
10.2 Technical Approaches 118
10.2.1 CEMRA 118
10.2.2 Phase Contrast 118
10.2.3 Perfusion 119
10.2.4 Balanced Fast Gradient Echo 119
10.2.5 Arterial Spin Labeling (ASL) 119
10.3 Clinical Applications 119
10.3.1 Abdominal Aorta 119
10.3.1.1 Atherosclerotic and Infl ammatory Aneurysms 119
10.3.1.2 Infected Aneurysm 120
10.3.1.3 Dissection 121
10.3.1.4 Aortic Occlusion and Leriche’s Syndrome 121
10.3.1.5 Control of Vascular Stents and Endoleak 121
10.3.1.6 Retroperitoneal Fibrosis and Erdheim-Chester Disease 122
10.3.2 Renal Arteries 123
References 127
Chapter 11 128
Peripheral Vessels 128
11.1 Introduction 128
11.2 Lower Limb 129
11.2.1 Steno-Occlusive Disease 130
11.2.1.1 Leriche’s Syndrome 132
11.2.2 Aneurysms 132
11.2.2.1 Popliteal Aneurysms 133
11.2.2.2 Femoral Aneurysms 133
11.2.3 Popliteal Entrapment 133
11.3 Upper Limb 134
11.3.1 Steno-Occlusive Disease 136
11.3.1.1 Subclavian Steal Syndrome 137
11.3.2 Aneurysms 137
11.3.2.1 Subclavian Aneurysms 137
11.3.3 Takayasu’s Arteritis 137
11.3.4 Thoracic Outlet Syndrome 140
References 140
Part III: Special Topics: Transplants 143
Chapter 12 144
MRA in Liver and in Orthotopic Liver Transplants 144
12.1 MRA in Liver 144
12.1.1 Introduction 144
12.1.2 Vascular Anatomy 145
12.1.3 Vascular Imaging 146
12.1.4 MR Angiography 147
12.1.4.1 MRA Study Technique 148
12.1.4.2 MRA Postprocessing 149
12.2 MRA in Orthotopic Liver Transplants 149
12.2.1 Introduction 149
12.2.2 Surgery in Orthotopic Liver Transplants 149
12.2.3 Complications After Orthotopic Liver Transplants 149
12.2.3.1 Vascular Complications 150
12.2.3.2 Vascular Complications: Imaging 152
12.2.4 MR Angiography in OLT 152
12.3 Conclusions 153
References 153
Chapter 13 155
MRA in Transplanted Pancreas and Kidneys 155
13.1 Introduction 155
13.2 Vascular Anatomy in Transplants 156
13.2.1 Pancreas 156
13.2.2 Kidney 156
13.3 Transplants and Diagnostic Imaging 156
13.4 MR Angiography 157
13.4.1 Study Technique 157
13.5 MR Angiography and Vascular Complications of Pancreatic Transplant 158
13.6 MR Angiography and Vascular Complications of Kidney Transplant 161
13.7 Conclusion 165
References 165
Subject Index 167
List of Contributors 172
Medical Radiology 176
Diagnostic Imaging 176
Medical Radiology 178
Radiation Oncology 178