(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.

With this magnetic resonance angiography technique flowing blood appears dark.
MR black blood techniques have been developed for cardiovascular imaging to improve segmentation of myocardium from the blood pool. Black blood MRA techniques decrease the signal from blood with reference to the myocardium and make it easier to perform cardiac chamber segmentation.
ECG gated spin echo sequences with presaturation pulses for magnetization preparation will show strong intravascular signal loss due to flow effects when appropriate imaging conditions including spatial presaturation are used. The sequence use the flow void effect as blood passes rapidly through the selected slice.
For dark blood preparation, a pair of nonselective and selective 180° inversion pulses are used, followed by a long inversion time to null signal from inflowing blood. A second selective inversion pulse can also be applied with short inversion time to null the fat signal. These in cardiac imaging used black blood techniques are referred to as double inversion recovery T1 measurement turbo spin echo or fast spin echo, and double-inversion recovery STIR.

(CE MRA) Contrast enhanced MR angiography is based on the T1 values of blood, the surrounding tissue, and paramagnetic contrast agent.
T1-shortening contrast agents reduces the T1 value of the blood (approximately to 50 msec, shorter than that of the surrounding tissues) and allow the visualization of blood vessels, as the images are no longer dependent primarily on the inflow effect of the blood. Contrast enhanced MRA is performed with a short TR to have low signal (due to the longer T1) from the stationary tissue, short scan time to facilitate breath hold imaging, short TE to minimize T2* effects and a bolus injection of a sufficient dose of a gadolinium chelate.
Images of the region of interest are performed with 3D spoiled gradient echo pulse sequences. The enhancement is maximized by timing the contrast agent injection such that the period of maximum arterial concentration corresponds to the k-space acquisition. Different techniques are used to ensure optimal contrast of the arteries e.g., bolus timing, automatic bolus detection, bolus tracking, care bolus. A high resolution with near isotropic voxels and minimal pulsatility and misregistration artifacts should be striven for. The postprocessing with the maximum intensity projection (MIP) enables different views of the 3D data set.
Unlike conventional MRA techniques based on velocity dependent inflow or phase shift techniques, contrast enhanced MRA exploits the gadolinium induced T1-shortening effects. CE MRA reduces or eliminates most of the artifacts of time of flight angiography or phase contrast angiography. Advantages are the possibility of in plane imaging of the blood vessels, which allows to examine large parts in a short time and high resolution scans in one breath hold. CE MRA has found a wide acceptance in the clinical routine, caused by the advantages:

(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 encoding gradient. 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, phase contrast angiographic techniques tend to be 4 times slower than TOF techniques with the same matrix.

See also Phase Contrast Sequence, Magnetic Resonance Angiography, Contrast Enhanced Magnetic Resonance Angiography, Flow Effects and Flow Quantification.

(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.