Magnetic resonance angiography

Magnetic resonance angiography (MRA) is a group of techniques based on magnetic resonance imaging (MRI) to image blood vessels. Magnetic resonance angiography is used to generate images of arteries (and less commonly veins) in order to evaluate them for stenosis (abnormal narrowing), occlusions, aneurysms (vessel wall dilatations, at risk of rupture) or other abnormalities. MRA is often used to evaluate the arteries of the neck and brain, the thoracic and abdominal aorta, the renal arteries, and the legs (the latter exam is often referred to as a 'run-off'). Magnetic resonance angiography (MRA) is a group of techniques based on magnetic resonance imaging (MRI) to image blood vessels. Magnetic resonance angiography is used to generate images of arteries (and less commonly veins) in order to evaluate them for stenosis (abnormal narrowing), occlusions, aneurysms (vessel wall dilatations, at risk of rupture) or other abnormalities. MRA is often used to evaluate the arteries of the neck and brain, the thoracic and abdominal aorta, the renal arteries, and the legs (the latter exam is often referred to as a 'run-off'). A variety of techniques can be used to generate the pictures of blood vessels, both arteries and veins, based on flow effects or on contrast (inherent or pharmacologically generated). The most frequently applied MRA methods involve the use intravenous contrast agents, particularly those containing gadolinium to shorten the T1 of blood to about 250 ms, shorter than the T1 of all other tissues (except fat). Short-TR sequences produce bright images of the blood. However, many other techniques for performing MRA exist, and can be classified into two general groups: 'flow-dependent' methods and 'flow-independent' methods. One group of methods for MRA is based on blood flow. Those methods are referred to as flow dependent MRA. They take advantage of the fact that the blood within vessels is flowing to distinguish the vessels from other static tissue. That way, images of the vasculature can be produced. Flow dependent MRA can be divided into different categories: There is phase-contrast MRA (PC-MRA) which utilizes phase differences to distinguish blood from static tissue and time-of-flight MRA (TOF MRA) which exploits that moving spins of the blood experience fewer excitation pulses than static tissue, e.g. when imaging a thin slice. Time-of-flight (TOF) or inflow angiography, uses a short echo time and flow compensation to make flowing blood much brighter than stationary tissue. As flowing blood enters the area being imaged it has seen a limited number of excitation pulses so it is not saturated, this gives it a much higher signal than the saturated stationary tissue. As this method is dependent on flowing blood, areas with slow flow (such as large aneurysms) or flow that is in plane of the image may not be well visualized. This is most commonly used in the head and neck and gives detailed high-resolution images. It is also the most common technique used for routine angiographic evaluation of the intracranial circulation in patients with ischemic stroke. Phase-contrast (PC-MRA) can be used to encode the velocity of moving blood in the magnetic resonance signal's phase. The most common method used to encode velocity is the application of a bipolar gradient between the excitation pulse and the readout. A bipolar gradient is formed by two symmetric lobes of equal area. By definition, the total area (0th moment) of a bipolar gradient, G bip {displaystyle G_{ ext{bip}}} , is null: The bipolar gradient can be applied along any axis or combination of axes depending on the direction along which flow is to be measured (e.g. x). Δ Φ {displaystyle Delta Phi } , the phase accrued during the application of the gradient, is 0 for stationary spins: their phase is unaffected by the application of the bipolar gradient. For spins moving with a constant velocity, v x {displaystyle v_{x}} , along the direction of the applied bipolar gradient: The accrued phase is proportional to both v x {displaystyle v_{x}} and the 1st moment of the bipolar gradient, Δ m 1 {displaystyle Delta m_{1}} , thus providing a means to estimate v x {displaystyle v_{x}} . γ {displaystyle gamma } is the Larmor frequency of the imaged spins. To measure Δ Φ {displaystyle Delta Phi } , of the MRI signal is manipulated by bipolar gradients (varying magnetic fields) that are preset to a maximum expected flow velocity. An image acquisition that is reverse of the bipolar gradient is then acquired and the difference of the two images is calculated. Static tissues such as muscle or bone will subtract out, however moving tissues such as blood will acquire a different phase since it moves constantly through the gradient, thus also giving its speed of the flow. Since phase-contrast can only acquire flow in one direction at a time, 3 separate image acquisitions in all three directions must be computed to give the complete image of flow. Despite the slowness of this method, the strength of the technique is that in addition to imaging flowing blood, quantitative measurements of blood flow can be obtained. Whereas most of techniques in MRA rely on contrast agents or flow into blood to generate contrast (Contrast Enhanced techniques), there are also non-contrast enhanced flow-independent methods. These methods, as the name suggests, do not rely on flow, but are instead based on the differences of T1, T2 and chemical shift of the different tissues of the voxel. One of the main advantages of this kind of techniques is that we may image the regions of slow flow often found in patients with vascular diseases more easily. Moreover, non-contrast enhanced methods do not require the administration of additional contrast agent, which have been recently linked to nephrogenic systemic fibrosis in patients with chronic kidney disease and renal failure. Contrast-enhanced magnetic resonance angiography uses injection of MRI contrast agents and is currently the most common method of performing MRA. The contrast medium is injected into a vein, and images are acquired both pre-contrast and during the first pass of the agent through the arteries. By subtraction of these two acquisitions in post-processing, an image is obtained which in principle only shows blood vessels, and not the surrounding tissue. Provided that the timing is correct, this may result in images of very high quality. An alternative is to use a contrast agent that does not, as most agents, leave the vascular system within a few minutes, but remains in the circulation up to an hour (a 'blood-pool agent'). Since longer time is available for image acquisition, higher resolution imaging is possible. A problem, however, is the fact that both arteries and veins are enhanced at the same time if higher resolution images are required.