(MRA) Magnetic resonance angiography is a medical imaging technique to visualize blood filled structures, including arteries, veins and the heart chambers. This MRI technique creates soft tissue contrast between blood vessels and surrounding tissues primarily created by flow, rather than displaying the vessel lumen. There are bright blood and black blood MRA techniques, named according to the appearance of the blood vessels. With this different MRA techniques both, the blood flow and the condition of the blood vessel walls can be seen. Flow effects in MRI can produce a range of artifacts. MRA takes advantage of these artifacts to create predictable image contrast due to the nature of flow.
Technical parameters of the MRA sequence greatly affect the sensitivity of the images to flow with different velocities or directions, turbulent flow and vessel size.
This are the three main types of MRA:
All angiographic techniques differentially enhance vascular MR signal. The names of the bright blood techniques TOF and PCA reflect the physical properties of flowing blood that were exploited to make the vessels appear bright. Contrast enhanced magnetic resonance angiography creates the angiographic effect by using an intravenously administered MR contrast agent to selectively shorten the T1 of blood and thereby cause the vessels to appear bright on T1 weighted images.
MRA images optimally display areas of constant blood flow-velocity, but there are many situations where the flow within a voxel has non-uniform speed or direction. In a diseased vessel these patterns are even more complex. Similar loss of streamline flow occurs at all vessel junctions and stenoses, and in regions of mural thrombosis. It results in a loss of signal, due to the loss of phase coherence between spins in the voxel.
This signal loss, usually only noticeable distal to a stenosis, used to be an obvious characteristic of MRA images. It is minimized by using small voxels and the shortest possible TE. Signal loss from disorganized flow is most noticeable in TOF imaging but also affects the PCA images.
Indications to perform a magnetic resonance angiography (MRA):
Conventional angiography or computerized tomography angiography (CT angiography) may be needed after MRA if a problem (such as an aneurysm) is present or if surgery is being considered.

See also Magnetic Resonance Imaging MRI.

(TOF) The time of flight angiography is used for the imaging of vessels. Usually the sequence type is a gradient echo sequences 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 equilibrium magnetization 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 presaturation slab 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.

See also Magnetic Resonance Angiography and Contrast Enhanced Magnetic Resonance Angiography.

(PC) Phase contrast sequences are the basis of MRA techniques utilizing the change in the phase shifts of the flowing protons in the region of interest to create an image. Spins that are moving along the direction of a magnetic field gradient receive a phase shift proportional to their velocity.
In a phase contrast sequence two data sets with a different amount of flow sensitivity are acquired. This is usually accomplished by applying gradient pairs, which sequentially dephase and then rephase spins during the sequence. Both 2D and 3D acquisition techniques can be applied with phase contrast MRA.
The first data set is acquired with a flow compensated sequence, i. e. without flow sensitivity. The second data set is acquired with a flow sensitive sequence. The amount of flow sensitivity is controlled by the strength of the bipolar gradient pulse pair, which is incorporated into the sequence. Stationary tissue undergoes no effective phase change after the application of the two gradients. Caused by the different spatial localization of flowing blood to stationary tissue, it experiences a different size of the second bipolar gradient compared to the first. The result is a phase shift.
The raw data from the two data sets are subtracted. By comparing the phase of signals from each location in the two sequences the exact amount of motion induced phase change can be determined to have a map where pixel brightness is proportional to spatial velocity.
Phase contrast images represent the signal intensity of the velocity of spins at each point within the field of view. Regions that are stationary remain black while moving regions are represented as grey to white.
The phase shift is proportional to the spin's velocity, and this allows the quantitative assessment of flow velocities. The difference MRI signal has a maximum value for opposite directions. This velocity is typically referred to as venc, and depends on the pulse amplitude and distance between the gradient pulse pair. For velocities larger than venc the difference signal is decreased constantly until it gets zero. Therefore, in a phase contrast angiography it is important to correctly set the venc of the sequence to the maximum flow velocity which is expected during the measurement. High venc factors of the PC angiogram (more than 40 cm/sec) will selectively image the arteries (PCA - arteriography), whereas a venc factor of 20 cm/sec will perform the veins and sinuses (PCV or MRV - venography).

See also Flow Quantification, Contrast Enhanced MR Venography, Time of Flight Angiography, Time Resolved Imaging of Contrast Kinetics.

The FEER method was the first clinically useful flow quantification method using phase effects, from which all spin phase related flow quantification techniques currently in use are derived.
In this sequence a gradient echo is measured after a gradient with flow compensation. The measured signal phase should be zero for all pixels. A deviation from gradient symmetry by shifting the gradient ramp slightly away from the symmetry condition will impart a defined phase shift to the magnetization vectors associated with spins from pixels with flow.
Slight stable variations in the magnetic field across the imaging volume will prevent the phase angle from being uniformly zero throughout the volume in the flow-compensated image. The first image (acquired without gradient shift) serves as reference, defining the values of all pixel phase angles in the flow (motion) compensated sequence. Ensuing images with gradient phase shifts imparted in each of the 3 spatial axes will then permit measurement of the 3 components of the velocity vector v = (vx, vy, vz) by calculating the respective phases px, py and pz by simply subtracting the pixel phases measured in the compensated image from the 3 images with a well defined velocity sensitization.
The determination of all 3 components of the velocity vector requires the measurement of 4 images.
The phase quantification requires an imaging time four times longer than the simple measurement of a phase image and associated magnitude image. If only one arbitrary flow direction is of interest, it suffices to acquire the reference image plus one image velocity sensitized in the arbitrary direction of interest.

See also Flow Quantification.

The spins flow with the blood through a slice and experience a RF pulse. If they flow out of the slice by the time the signal is recorded (because the repetition time (TR) is asynchronous with the pulsatile flow), the flowing blood produces intravascular signal void by 'time of flight' effects, turbulent dephasing and first echo dephasing. The liquid flow occasionally produces an intravascular high signal intensity due to flow related enhancement, even echo rephasing and diastolic pseudogating.

See also Flow Artifact and Flow Effects.