(MRI-CA, MRCA) The noninvasive imaging of the coronary arteries using magnetic resonance imaging of the heart.
For cardiac MRI-CA, high performance machines are necessary with minimum 40mT/m and 300μsec slew rate.
2D and 3D acquisition are used for fast gradient echosequences with techniques for minimizing cardiac and respiratory motion and suppressing the high signal of pericardial fat. The optimal sequences seem to be trueFISP, Balanced FFE or FIESTA with SMASH and SENSE techniques.
Respiratory motion is minimized for 3D acquisitions by using respiratory gating, especially using navigator echoes (Navigator Technique) to track diaphragmatic and cardiac movement. Optimization of MR technique can provide mapping of long segments of the coronary arteries. Blood pool agents are being applied to improve the reliability of coronary MR angiography. The major current clinical indication is the identification of coronary artery anomalies because the diagnostic accuracy's for identifying haemodynamically significant stenoses are variable depending of the image quality.
(PCA) With this method images of the blood flow-velocity (or any other movement of tissue) are produced.
The MRI signal contains both amplitude and phase information.
The phase information can be used with subtraction of images with and without a velocity encodinggradient. The signal will be directly proportional to the velocity because of the relation between blood flow-velocity and signal intensity.
This is the strength of PCA, complete suppression of stationary tissue (no velocity - no signal), the direct velocity of flow is being imaged, while in TOF (Inflow) angiography, tissue with short T1 (fat or methaemoglobin) might be visualized.
The strength of the gradient determines the sensitivity
to flow. It is set by setting the aliasing or encoding velocity (VENC). Unfortunately, phase sensitization can only be acquired along one axis at a time. Therefore, phasecontrast angiographic techniques tend to be 4 times slower than TOF techniques with the same matrix.
(TOF) The time of flight angiography is used for the imaging of vessels. Usually the sequence type is a gradient echosequences with short TR, acquired with slices perpendicular to the direction of blood flow.
The source of diverse flow effects is the difference between the unsaturated and presaturated spins and creates a bright vascular image without the invasive use of contrast media. Flowing blood moves unsaturated spins from outside the slice into the imaging plane. These completely relaxed spins have full equilibriummagnetization and produce (when entering the imaging plane) a much higher signal than stationary spins if a gradient echo sequence is generated. This flow related enhancement is also referred to as entry slice phenomenon, or inflow enhancement.
Performing a presaturationslab on one side parallel to the slice can selectively destroy the MR signal from the in-flowing blood from this side of the slice. This allows the technique to be flow direction sensitive and to separate arteriograms or venograms. When the local magnetization of moving blood is selectively altered in a region, e.g. by selective excitation, it carries the altered magnetization with it when it moves, thus tagging the selected region for times on the order of the relaxation times.
For maximum flow signal, a complete new part of blood has to enter the slice every repetition (TR) period, which makes time of flight angiography sensitive to flow-velocity. The choice of TR and slice thickness should be appropriate to the expected flow-velocities because even small changes in slice thickness influences the performance of the TOF sequence.
The use of sequential 2 dimensional Fourier transformation (2DFT) slices, 3DFT slabs, or multiple 3D slabs (chunks) are depending on the coverage required and the range of flow-velocities.
3D TOF MRA is routinely used for evaluating the Circle of Willis.
A type of MRA used to display slow flow across a large volume with a good resolution.
Two data volumes are measured; the flow-rephased images show bright signal, the flow-dephased image show dark flow, whereby in both data volumes the signal of the stationary tissue looks the same. The data volumes are subtracted and the signal intensity of flowing blood remains.