Simultaneous Highly Efficient Contrast‐Free Lumen and Vessel Wall MR Imaging for Anatomical Assessment of Aortic Disease

Abstract

BackgroundBright‐blood lumen and black‐blood vessel wall imaging are required for the comprehensive assessment of aortic disease. These images are usually acquired separately, resulting in long examinations and potential misregistration between images.PurposeTo characterize the performance of an accelerated and respiratory motion‐compensated three‐dimensional (3D) cardiac MRI technique for simultaneous contrast‐free aortic lumen and vessel wall imaging with an interleaved T2 and inversion recovery prepared sequence (iT2Prep‐BOOST).Study TypeProspective.PopulationA total of 30 consecutive patients with aortopathy referred for a clinically indicated cardiac MRI examination (9 females, mean age ± standard deviation: 32 ± 12 years).Field Strength/Sequence1.5‐T; bright‐blood MR angiography (diaphragmatic navigator‐gated T2‐prepared 3D balanced steady‐state free precession [bSSFP], T2Prep‐bSSFP), breath‐held black‐blood two‐dimensional (2D) half acquisition single‐shot turbo spin echo (HASTE), and 3D bSSFP iT2Prep‐BOOST.AssessmentiT2Prep‐BOOST bright‐blood images were compared to T2prep‐bSSFP images in terms of aortic vessel dimensions, lumen‐to‐myocardium contrast ratio (CR), and image quality (diagnostic confidence, vessel sharpness and presence of artifacts, assessed by three cardiologists on a 4‐point scale, 1: nondiagnostic to 4: excellent). The iT2Prep‐BOOST black‐blood images were compared to 2D HASTE images for quantification of wall thickness. A visual comparison between computed tomography (CT) and iT2Prep‐BOOST was performed in a patient with chronic aortic dissection.Statistical TestsPaired t‐tests, Wilcoxon signed‐rank tests, intraclass correlation coefficient (ICC), Bland–Altman analysis. A P value < 0.05 was considered statistically significant.ResultsBright‐blood iT2Prep‐BOOST resulted in significantly improved image quality (mean ± standard deviation 3.8 ± 0.5 vs. 3.3 ± 0.8) and CR (2.9 ± 0.8 vs. 1.8 ± 0.5) compared with T2Prep‐bSSFP, with a shorter scan time (7.8 ± 1.7 minutes vs. 12.9 ± 3.4 minutes) while providing a complementary 3D black‐blood image. Aortic lumen diameter and vessel wall thickness measurements in bright‐blood and black‐blood images were in good agreement with T2Prep‐bSSFP and HASTE images (<0.02 cm and <0.005 cm bias, respectively) and good intrareader (ICC > 0.96) and interreader (ICC > 0.94) agreement was observed for all measurements.Data ConclusioniT2Prep‐BOOST might enable time‐efficient simultaneous bright‐ and black‐blood aortic imaging, with improved image quality compared to T2Prep‐bSSFP and HASTE imaging, and comparable measurements for aortic wall and lumen dimensions.Evidence Level2.Technical EfficacyStage 2.