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Highly accelerated time-of-flight magnetic resonance angiography using spiral imaging improves conspicuity of intracranial arterial branches while reducing scan time

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Abstract

Objective

To systematically compare time-of-flight magnetic resonance angiography (TOF-MRA) acquired with Compressed SENSE (TOF-CS) to spiral imaging (TOF-Spiral) for imaging of brain-feeding arteries.

Methods

Seventy-one patients (60.2 ± 19.5 years, 43.7% females, 28.2% with pathology) who underwent TOF-MRA after implementation of a new scanner software program enabling spiral imaging were analyzed retrospectively. TOF-CS (standard sequence; duration ~ 4 min) and the new TOF-Spiral (duration ~ 3 min) were acquired. Image evaluation (vessel image quality and detectability, diagnostic confidence (1 (diagnosis very uncertain) to 5 (diagnosis very certain)), quantitative measurement of aneurysm diameter or degree of stenosis according to North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria) was performed by two readers. Quantitative assessments of pathology were compared to computed tomography angiography (CTA) or digital subtraction angiography (DSA).

Results

TOF-CS showed higher image quality for intraosseous and intradural segments of the internal carotid artery while TOF-Spiral better depicted small intracranial vessels like the anterior choroidal artery. All vessel pathologies were correctly identified by both readers for TOF-CS and TOF-Spiral with high confidence (TOF-CS (4.4 ± 0.6 and 4.3 ± 0.8), TOF-Spiral (4.3 ± 0.7 and 4.3 ± 0.8)) and good inter-reader agreement (Cohen’s kappa > 0.8). Quantitative assessments of aneurysm size or stenosis did not significantly differ between TOF-CS or TOF-Spiral and CTA or DSA (p > 0.05).

Conclusions

TOF-Spiral for imaging of brain-feeding arteries enables reductions in scan time without drawbacks in diagnostic confidence. A combination of spiral imaging and CS may help to overcome shortcomings of both sequences alone and could further reduce acquisition times in the future.

Key Points

• TOF-MRA with Compressed SENSE is superior in depicting arteries at the skull base while spiral TOF-MRA is able to better depict small intracranial vessels.

• Both TOF-MRA with Compressed SENSE and TOF-MRA with spiral imaging provide high diagnostic confidence for detection of pathologies of brain-feeding arteries.

• Spiral TOF-MRA is faster (by 25% for the sequence used in this study) than TOF-MRA with Compressed SENSE, thus enabling clear reductions in scan time for the clinical setting.

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Abbreviations

ACA:

Anterior cerebral artery

AChA:

Anterior choroidal artery

BA:

Basilar artery

CS:

Compressed SENSE

CTA:

Computed tomography angiography

DSA:

Digital subtraction angiography

FOV:

Field of view

ICA:

Internal carotid artery

ICC:

Intraclass correlation coefficient

κ :

Kappa

MCA:

Middle cerebral artery

MIP:

Maximum intensity projection

MRA:

Magnetic resonance angiography

MRI:

Magnetic resonance imaging

NASCET:

North American Symptomatic Carotid Endarterectomy Trial

PACS:

Picture archiving and communication system

PCA:

Posterior cerebral artery

PCOM:

Posterior communicating artery

R1:

Reader 1

R2:

Reader 2

SNR:

Signal-to-noise ratio

SUCA:

Superior cerebellar artery

TE:

Echo time

TR:

Repetition time

TOF:

Time-of-flight

VA:

Vertebral artery

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Acknowledgments

The authors of this manuscript declare relationships to Philips Healthcare, whose products and services were related to the subject matter of the article.

Funding

The authors state that this work has not received any specific funding.

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Author notes

  1. Tobias Greve and Nico Sollmann contributed equally to this work.

Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany

    Tobias Greve, Nico Sollmann, Claus Zimmer & Jan S. Kirschke

  2. TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Nico Sollmann & Jan S. Kirschke

  3. Health Systems Philips Switzerland, Seestr. 87, 8810, Horgen, Switzerland

    Andreas Hock, Silke Hey, Velmurugan Gnanaprakasam & Marco Nijenhuis

Authors
  1. Tobias Greve
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  3. Andreas Hock
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Corresponding author

Correspondence to Tobias Greve.

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Guarantor

The scientific guarantor of this publication is Jan Kirschke, MD.

Conflict of interest

The authors of this manuscript declare relationships to Philips Healthcare, whose products and services were related to the subject matter of the article. AH, SH, VG, and MN are employees of Philips Health Systems, Switzerland. JK received research grant from Nvidia, speaker honoraria from Philips Healthcare, and travel support from Kaneka Europe. CZ received speaker honoraria from Philips Healthcare and Bayer, as well as compensation for clinical trials from Biogen Idec, Quintiles, MSD, Boehringer Ingelheim, Inventive Health Clinical, and Advance Cor. TG and NS have nothing to declare.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because of its retrospective character and the analysis being based only on data acquired during clinical routine.

Ethical approval

Institutional review board approval was obtained (registration number: 1/19S).

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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Greve, T., Sollmann, N., Hock, A. et al. Highly accelerated time-of-flight magnetic resonance angiography using spiral imaging improves conspicuity of intracranial arterial branches while reducing scan time. Eur Radiol 30, 855–865 (2020). https://doi.org/10.1007/s00330-019-06442-y

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