Simultaneous Highly Efficient Contrast-Free Lumen and Vessel Wall MR Imaging for Anatomical Assessment of Aortic Disease

Camila Munoz; Anastasia Fotaki; Alina Hua; Reza Hajhosseiny; Karl P. Kunze; Tevfik F. Ismail; Radhouene Neji; Kuberan Pushparajah; René M. Botnar; Claudia Prieto

doi:10.1002/jmri.28613

Simultaneous Highly Efficient Contrast-Free Lumen and Vessel Wall MR Imaging for Anatomical Assessment of Aortic Disease

Camila Munoz^*, Anastasia Fotaki, Alina Hua, Reza Hajhosseiny, Karl P. Kunze, Tevfik F. Ismail, Radhouene Neji, Kuberan Pushparajah, René M. Botnar, Claudia Prieto

^*Corresponding author for this work

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Abstract

Background: Bright-blood lumen and black-blood vessel wall imaging are required for the comprehensive assessment of aortic disease. These images are usually acquired separately, resulting in long examinations and potential misregistration between images. Purpose: To characterize the performance of an accelerated and respiratory motion-compensated three-dimensional (3D) cardiac MRI technique for simultaneous contrast-free aortic lumen and vessel wall imaging with an interleaved T2 and inversion recovery prepared sequence (iT2Prep-BOOST). Study Type: Prospective. Population: A total of 30 consecutive patients with aortopathy referred for a clinically indicated cardiac MRI examination (9 females, mean age ± standard deviation: 32 ± 12 years). Field Strength/Sequence: 1.5-T; bright-blood MR angiography (diaphragmatic navigator-gated T2-prepared 3D balanced steady-state free precession [bSSFP], T2Prep-bSSFP), breath-held black-blood two-dimensional (2D) half acquisition single-shot turbo spin echo (HASTE), and 3D bSSFP iT2Prep-BOOST. Assessment: iT2Prep-BOOST bright-blood images were compared to T2prep-bSSFP images in terms of aortic vessel dimensions, lumen-to-myocardium contrast ratio (CR), and image quality (diagnostic confidence, vessel sharpness and presence of artifacts, assessed by three cardiologists on a 4-point scale, 1: nondiagnostic to 4: excellent). The iT2Prep-BOOST black-blood images were compared to 2D HASTE images for quantification of wall thickness. A visual comparison between computed tomography (CT) and iT2Prep-BOOST was performed in a patient with chronic aortic dissection. Statistical Tests: Paired t-tests, Wilcoxon signed-rank tests, intraclass correlation coefficient (ICC), Bland–Altman analysis. A P value < 0.05 was considered statistically significant. Results: Bright-blood iT2Prep-BOOST resulted in significantly improved image quality (mean ± standard deviation 3.8 ± 0.5 vs. 3.3 ± 0.8) and CR (2.9 ± 0.8 vs. 1.8 ± 0.5) compared with T2Prep-bSSFP, with a shorter scan time (7.8 ± 1.7 minutes vs. 12.9 ± 3.4 minutes) while providing a complementary 3D black-blood image. Aortic lumen diameter and vessel wall thickness measurements in bright-blood and black-blood images were in good agreement with T2Prep-bSSFP and HASTE images (<0.02 cm and <0.005 cm bias, respectively) and good intrareader (ICC > 0.96) and interreader (ICC > 0.94) agreement was observed for all measurements. Data Conclusion: iT2Prep-BOOST might enable time-efficient simultaneous bright- and black-blood aortic imaging, with improved image quality compared to T2Prep-bSSFP and HASTE imaging, and comparable measurements for aortic wall and lumen dimensions. Evidence Level: 2. Technical Efficacy: Stage 2.

Original language	English
Journal	Journal of Magnetic Resonance Imaging
Early online date	9 Feb 2023
DOIs	https://doi.org/10.1002/jmri.28613
Publication status	E-pub ahead of print - 9 Feb 2023

Keywords

aortic MR angiography
multicontrast imaging
vessel wall imaging

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10.1002/jmri.28613

Magnetic Resonance Imaging - 2023 - MunozFinal published version, 6.52 MBLicence: CC BY

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@article{11fac10f169d448a9cebdddedf2d0767,

title = "Simultaneous Highly Efficient Contrast-Free Lumen and Vessel Wall MR Imaging for Anatomical Assessment of Aortic Disease",

abstract = "Background: Bright-blood lumen and black-blood vessel wall imaging are required for the comprehensive assessment of aortic disease. These images are usually acquired separately, resulting in long examinations and potential misregistration between images. Purpose: To characterize the performance of an accelerated and respiratory motion-compensated three-dimensional (3D) cardiac MRI technique for simultaneous contrast-free aortic lumen and vessel wall imaging with an interleaved T2 and inversion recovery prepared sequence (iT2Prep-BOOST). Study Type: Prospective. Population: A total of 30 consecutive patients with aortopathy referred for a clinically indicated cardiac MRI examination (9 females, mean age ± standard deviation: 32 ± 12 years). Field Strength/Sequence: 1.5-T; bright-blood MR angiography (diaphragmatic navigator-gated T2-prepared 3D balanced steady-state free precession [bSSFP], T2Prep-bSSFP), breath-held black-blood two-dimensional (2D) half acquisition single-shot turbo spin echo (HASTE), and 3D bSSFP iT2Prep-BOOST. Assessment: iT2Prep-BOOST bright-blood images were compared to T2prep-bSSFP images in terms of aortic vessel dimensions, lumen-to-myocardium contrast ratio (CR), and image quality (diagnostic confidence, vessel sharpness and presence of artifacts, assessed by three cardiologists on a 4-point scale, 1: nondiagnostic to 4: excellent). The iT2Prep-BOOST black-blood images were compared to 2D HASTE images for quantification of wall thickness. A visual comparison between computed tomography (CT) and iT2Prep-BOOST was performed in a patient with chronic aortic dissection. Statistical Tests: Paired t-tests, Wilcoxon signed-rank tests, intraclass correlation coefficient (ICC), Bland–Altman analysis. A P value < 0.05 was considered statistically significant. Results: Bright-blood iT2Prep-BOOST resulted in significantly improved image quality (mean ± standard deviation 3.8 ± 0.5 vs. 3.3 ± 0.8) and CR (2.9 ± 0.8 vs. 1.8 ± 0.5) compared with T2Prep-bSSFP, with a shorter scan time (7.8 ± 1.7 minutes vs. 12.9 ± 3.4 minutes) while providing a complementary 3D black-blood image. Aortic lumen diameter and vessel wall thickness measurements in bright-blood and black-blood images were in good agreement with T2Prep-bSSFP and HASTE images (<0.02 cm and <0.005 cm bias, respectively) and good intrareader (ICC > 0.96) and interreader (ICC > 0.94) agreement was observed for all measurements. Data Conclusion: iT2Prep-BOOST might enable time-efficient simultaneous bright- and black-blood aortic imaging, with improved image quality compared to T2Prep-bSSFP and HASTE imaging, and comparable measurements for aortic wall and lumen dimensions. Evidence Level: 2. Technical Efficacy: Stage 2.",

keywords = "aortic MR angiography, multicontrast imaging, vessel wall imaging",

author = "Camila Munoz and Anastasia Fotaki and Alina Hua and Reza Hajhosseiny and Kunze, {Karl P.} and Ismail, {Tevfik F.} and Radhouene Neji and Kuberan Pushparajah and Botnar, {Ren{\'e} M.} and Claudia Prieto",

note = "Funding Information: Grant Support: The authors acknowledge financial support from: 1) BHF PG/18/59/33955 and RG/20/1/34802 2) EPSRC EP/V044087/1, EP/P001009/1, EP/P032311/1, EP/P007619, 3) Wellcome EPSRC Centre for Medical Engineering (NS/A000049/1), 4) Millennium Institute for Intelligent Healthcare Engineering ICN2021_004, FONDECYT 1210637 and 1210638, and 5) the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) license to any Author Accepted Manuscript version arising from this submission. Publisher Copyright: {\textcopyright} 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.",

year = "2023",

month = feb,

day = "9",

doi = "10.1002/jmri.28613",

language = "English",

journal = "Journal of Magnetic Resonance Imaging",

issn = "1522-2586",

publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Simultaneous Highly Efficient Contrast-Free Lumen and Vessel Wall MR Imaging for Anatomical Assessment of Aortic Disease

AU - Munoz, Camila

AU - Fotaki, Anastasia

AU - Hua, Alina

AU - Hajhosseiny, Reza

AU - Kunze, Karl P.

AU - Ismail, Tevfik F.

AU - Neji, Radhouene

AU - Pushparajah, Kuberan

AU - Botnar, René M.

AU - Prieto, Claudia

N1 - Funding Information: Grant Support: The authors acknowledge financial support from: 1) BHF PG/18/59/33955 and RG/20/1/34802 2) EPSRC EP/V044087/1, EP/P001009/1, EP/P032311/1, EP/P007619, 3) Wellcome EPSRC Centre for Medical Engineering (NS/A000049/1), 4) Millennium Institute for Intelligent Healthcare Engineering ICN2021_004, FONDECYT 1210637 and 1210638, and 5) the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) license to any Author Accepted Manuscript version arising from this submission. Publisher Copyright: © 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.

PY - 2023/2/9

Y1 - 2023/2/9

N2 - Background: Bright-blood lumen and black-blood vessel wall imaging are required for the comprehensive assessment of aortic disease. These images are usually acquired separately, resulting in long examinations and potential misregistration between images. Purpose: To characterize the performance of an accelerated and respiratory motion-compensated three-dimensional (3D) cardiac MRI technique for simultaneous contrast-free aortic lumen and vessel wall imaging with an interleaved T2 and inversion recovery prepared sequence (iT2Prep-BOOST). Study Type: Prospective. Population: A total of 30 consecutive patients with aortopathy referred for a clinically indicated cardiac MRI examination (9 females, mean age ± standard deviation: 32 ± 12 years). Field Strength/Sequence: 1.5-T; bright-blood MR angiography (diaphragmatic navigator-gated T2-prepared 3D balanced steady-state free precession [bSSFP], T2Prep-bSSFP), breath-held black-blood two-dimensional (2D) half acquisition single-shot turbo spin echo (HASTE), and 3D bSSFP iT2Prep-BOOST. Assessment: iT2Prep-BOOST bright-blood images were compared to T2prep-bSSFP images in terms of aortic vessel dimensions, lumen-to-myocardium contrast ratio (CR), and image quality (diagnostic confidence, vessel sharpness and presence of artifacts, assessed by three cardiologists on a 4-point scale, 1: nondiagnostic to 4: excellent). The iT2Prep-BOOST black-blood images were compared to 2D HASTE images for quantification of wall thickness. A visual comparison between computed tomography (CT) and iT2Prep-BOOST was performed in a patient with chronic aortic dissection. Statistical Tests: Paired t-tests, Wilcoxon signed-rank tests, intraclass correlation coefficient (ICC), Bland–Altman analysis. A P value < 0.05 was considered statistically significant. Results: Bright-blood iT2Prep-BOOST resulted in significantly improved image quality (mean ± standard deviation 3.8 ± 0.5 vs. 3.3 ± 0.8) and CR (2.9 ± 0.8 vs. 1.8 ± 0.5) compared with T2Prep-bSSFP, with a shorter scan time (7.8 ± 1.7 minutes vs. 12.9 ± 3.4 minutes) while providing a complementary 3D black-blood image. Aortic lumen diameter and vessel wall thickness measurements in bright-blood and black-blood images were in good agreement with T2Prep-bSSFP and HASTE images (<0.02 cm and <0.005 cm bias, respectively) and good intrareader (ICC > 0.96) and interreader (ICC > 0.94) agreement was observed for all measurements. Data Conclusion: iT2Prep-BOOST might enable time-efficient simultaneous bright- and black-blood aortic imaging, with improved image quality compared to T2Prep-bSSFP and HASTE imaging, and comparable measurements for aortic wall and lumen dimensions. Evidence Level: 2. Technical Efficacy: Stage 2.

AB - Background: Bright-blood lumen and black-blood vessel wall imaging are required for the comprehensive assessment of aortic disease. These images are usually acquired separately, resulting in long examinations and potential misregistration between images. Purpose: To characterize the performance of an accelerated and respiratory motion-compensated three-dimensional (3D) cardiac MRI technique for simultaneous contrast-free aortic lumen and vessel wall imaging with an interleaved T2 and inversion recovery prepared sequence (iT2Prep-BOOST). Study Type: Prospective. Population: A total of 30 consecutive patients with aortopathy referred for a clinically indicated cardiac MRI examination (9 females, mean age ± standard deviation: 32 ± 12 years). Field Strength/Sequence: 1.5-T; bright-blood MR angiography (diaphragmatic navigator-gated T2-prepared 3D balanced steady-state free precession [bSSFP], T2Prep-bSSFP), breath-held black-blood two-dimensional (2D) half acquisition single-shot turbo spin echo (HASTE), and 3D bSSFP iT2Prep-BOOST. Assessment: iT2Prep-BOOST bright-blood images were compared to T2prep-bSSFP images in terms of aortic vessel dimensions, lumen-to-myocardium contrast ratio (CR), and image quality (diagnostic confidence, vessel sharpness and presence of artifacts, assessed by three cardiologists on a 4-point scale, 1: nondiagnostic to 4: excellent). The iT2Prep-BOOST black-blood images were compared to 2D HASTE images for quantification of wall thickness. A visual comparison between computed tomography (CT) and iT2Prep-BOOST was performed in a patient with chronic aortic dissection. Statistical Tests: Paired t-tests, Wilcoxon signed-rank tests, intraclass correlation coefficient (ICC), Bland–Altman analysis. A P value < 0.05 was considered statistically significant. Results: Bright-blood iT2Prep-BOOST resulted in significantly improved image quality (mean ± standard deviation 3.8 ± 0.5 vs. 3.3 ± 0.8) and CR (2.9 ± 0.8 vs. 1.8 ± 0.5) compared with T2Prep-bSSFP, with a shorter scan time (7.8 ± 1.7 minutes vs. 12.9 ± 3.4 minutes) while providing a complementary 3D black-blood image. Aortic lumen diameter and vessel wall thickness measurements in bright-blood and black-blood images were in good agreement with T2Prep-bSSFP and HASTE images (<0.02 cm and <0.005 cm bias, respectively) and good intrareader (ICC > 0.96) and interreader (ICC > 0.94) agreement was observed for all measurements. Data Conclusion: iT2Prep-BOOST might enable time-efficient simultaneous bright- and black-blood aortic imaging, with improved image quality compared to T2Prep-bSSFP and HASTE imaging, and comparable measurements for aortic wall and lumen dimensions. Evidence Level: 2. Technical Efficacy: Stage 2.

KW - aortic MR angiography

KW - multicontrast imaging

KW - vessel wall imaging

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U2 - 10.1002/jmri.28613

DO - 10.1002/jmri.28613

M3 - Article

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SN - 1522-2586

JO - Journal of Magnetic Resonance Imaging

JF - Journal of Magnetic Resonance Imaging

ER -

Simultaneous Highly Efficient Contrast-Free Lumen and Vessel Wall MR Imaging for Anatomical Assessment of Aortic Disease

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