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Dark-Blood MRI of the Thoracic Aorta with 3D Diffusion-Prepared Steady-State Free Precession: Initial Clinical Evaluation

¹ Department of Radiology, Northwestern University Feinberg School of Medicine, 448 E Ontario St., Suite 700, Chicago, IL 60611.
² Department of Biomedical Engineering, Northwestern University McCormick School of Engineering, Chicago, IL.
³ Present address: Department of Radiology, Evanston Northwestern Healthcare, Walgreen Jr. Bldg., 2650 Ridge Ave., Suite G507, Evanston, IL 60201.
⁴ Present address: Texas Radiology Associates, Plano, TX.

View larger version (19K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Sequence diagram for 3D diffusionprepared steady-state free precession (SSFP) sequence. Prospective ECG gating is used with data acquisition during diastole. Diffusion and fat-saturation preparations are applied before segmented 3D SSFP acquisition. Center-out phase encoding is used to achieve dark appearance of blood and fat.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —82-year-old man with suspected aortic dissection. Axial localizer MR image shows left anterior oblique slab orientation through thoracic aorta acquired with 3D diffusion-prepared steady-state free precession and 3D contrast-enhanced MR angiography sequences.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —82-year-old man with suspected aortic dissection. MR angiogram shows locations of orthogonal dimension measurements. 1 = sinotubular junction, 2 = mid ascending aorta, 3 = proximal aortic arch, 4 = distal aortic arch.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —54-year-old man with suspected aortic aneurysm. Left anterior oblique diffusion-prepared steady-state free precession (SSFP) MR image shows fusiform ascending aortic aneurysm (arrow). Given that diffusion-prepared SSFP imaging was performed under free-breathing conditions, faint striplike artifact present near arrowhead is likely ghost arising from anterior chest wall. Mean image quality score for aortic wall is 5 (lumen, 3).

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —54-year-old man with suspected aortic aneurysm. Contrast-enhanced MR angiogram shows fusiform ascending aortic aneurysm. Mean image quality score for aortic wall is 1 (lumen, 4).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —84-year-man with suspected aortic dissection. (Reprinted with permission from Kirpalani A, Koktzoglou I, Dill K, Carroll T, Li D, Carr J. Diffusion-weighted 3D dark blood SSFP imaging of the thoracic aorta: initial clinical evaluation. Proceedings of the International Society of Magnetic Resonance in Medicine. Seattle, WA: ISMRM, 2006:651 [26]) Left anterior oblique diffusion-prepared steady-state free precession MR image shows irregular and ulcerative atherosclerotic plaque (arrow) in descending thoracic aorta. Morphologic features of plaque are better appreciated than in B. Inset shows 3D axial image through plaque (arrow). Mean image quality score for aortic wall is 5 (lumen, 4).

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —84-year-man with suspected aortic dissection. (Reprinted with permission from Kirpalani A, Koktzoglou I, Dill K, Carroll T, Li D, Carr J. Diffusion-weighted 3D dark blood SSFP imaging of the thoracic aorta: initial clinical evaluation. Proceedings of the International Society of Magnetic Resonance in Medicine. Seattle, WA: ISMRM, 2006:651 [26]) Contrast-enhanced MR angiogram shows irregular and ulcerative atherosclerotic plaque in descending thoracic aorta. Mean image quality score for aortic wall is 2.5 (lumen, 4.5).

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —46-year-old woman with suspected aortic involvement of vascular tumor. Left anterior oblique diffusion-prepared steady-state free precession MR image shows invasive mass (arrows) eroding through anterior wall of descending thoracic aorta. Insets correspond to adjacent slices within 3D slab. Extent of vessel wall involvement is better appreciated than in B. Mean image quality score for aortic wall is 5 (lumen, 4).

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —46-year-old woman with suspected aortic involvement of vascular tumor. Contrast-enhanced MR angiogram shows invasive mass eroding through anterior wall of descending thoracic aorta. Mean image quality score for aortic wall is 1.5 (lumen, 4.5).

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —59-year-old woman with suspected vasculitis. Left anterior oblique diffusion-prepared steady-state free precession MR image shows diffuse thickening of aortic wall, which led to diagnosis of giant cell arteritis. Biopsy of temporal artery confirmed diagnosis. Mean image quality score for aortic wall is 5 (lumen, 4.5).

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —59-year-old woman with suspected vasculitis. Contrast-enhanced MR angiogram shows normal appearance. Mean image quality score for aortic wall is 2 (lumen, 2.5).

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —59-year-old woman with suspected vasculitis. Coronal maximum intensity projection of time-resolved MR angiogram shows bilateral subclavian stenosis and further implicates vasculitic involvement.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Aortic diameter measurements with 3D diffusion-prepared steady-state free precession (SSFP) MRI and contrast-enhanced MR angiography. Scatterplot shows linear relation (r = 0.971, power > 0.99, p < 0.05) between 3D diffusion-prepared SSFP and contrast-enhanced MR angiographic measurements. Regression line slope, 1.018; intercept, –0.089. Intraclass correlation coefficient, 0.969 (p < 0.0001).

View larger version (16K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Aortic diameter measurements with 3D diffusion-prepared steady-state free precession (SSFP) MRI and contrast-enhanced MR angiography. Bland-Altman plot shows limits of agreement. For difference (diffusion-prepared SSFP minus contrast-enhanced MR angiography) in aortic diameter measured with both techniques, 95% CI is –0.349 to 0.280 cm. At statistical power of 0.8, no significant bias is detected. Bias line slope, 0.048; intercept, –0.180; r = 0.195; p = 0.09.

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