WARNING: NEPHROGENIC SYSTEMIC FIBROSIS
Gadolinium-based contrast agents increase the risk for nephrogenic systemic fibrosis (NSF) in patients with acute or chronic severe renal insufficiency (glomerular filtration rate less than 30 mL/min/1.73m2), or acute renal insufficiency of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period.
(DIR or DIRT1) Double inversion recovery T1 measurement is a T1 weightedblack blood MRA sequence in which the signal from blood is suppressed. The inversion time to suppress blood is described as the duration between the initial inversion pulse and time point that the longitudinal magnetization of blood reaches the zero point. The readout starts at the blood suppressioninversion time (BSP TI) and blood in the imaging slice gives no signal. This inversion time is around 650 ms with a 60 beat per minute heart rate at 1.5 T.
The TI can be decreased by using a wider receive bandwidth, shorter echo train length and/or narrow trigger window. Wide bandwidth also decreases the blurring caused by long echo trains at the expense of signal to noise ratio. In case of in plane or slow flow the suppression of the signal from blood may be incomplete. With increased TE or change of the image plane the blood suppression can be improved.
Double inversion recovery is a breath hold technique with one image per acquisition used in cardiovascular imaging. The patient is instructed to hold the breath in expiration (if not possible also inspiration can be taken), so that the end diastolic volume in the cardiac chambers would be the same during entire scanning. DIR provides fine details of the boundary between the lumen and the wall of the cardiac chambers and main vascular and heart structures, pericardium, and mediastinal tissues.