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Biomedical subjects

F Schick

Publications and source records attributed to F Schick.

At least 37 records · Page 2Linked to original sources
PubMed2000

Magnetic resonance osteodensitometry in human heel bones: correlation with quantitative computed tomography using different measuring parameters.

RATIONALE AND OBJECTIVES: Density of trabecular bone structures in human heel bones was assessed by 3D magnetic resonance (MR) gradient echo imaging (GEI) with multiple echoes. Different spatial resolutions were applied to investigate the influence of the pixel size on signal characteristics in GEI and to find suitable measuring parameters for a maximum correlation between GEI and bone mineral density obtained by quantitative computed tomography (QCT). METHODS: Thirty-five patients aged 31 to 65 years with suspected osteoporosis underwent MR and QCT examinations of the heel bones. The MR protocol included 3D GEI with three echo times (TE1 = 9.3, TE2 = 27.9, and TE3 = 46.5 ms) and isotropic pixel sizes of (0.6 mm)3, (1.2 mm)3, and (2.4 mm)3. Several subregions in the heel bones were analyzed. For determination of signal reduction with increasing TE, signal intensity ratios were calculated pixelwise from images with TE2/TE1 and TE3/TE1. RESULTS: All examinations showed that the T2*-related signal decrease was more pronounced for lower spatial resolution. In the dorsal part of the heel bones, the correlation between signal ratios in GEI and QCT-based bone mineral density values was between r = -0.86 for a spatial resolution of (0.6 mm)3 and r = -0.73 for (2.4 mm)3. Areas with low trabecular density in the ventral part of the heel bones showed clearly lower correlation coefficients (-0.65 < r < -0.67). CONCLUSIONS: Spatial resolution in 3D GEI clearly influences the T2*-related signal characteristics. Despite measuring different physical properties of spongy bone by GEI and QCT, a relatively high correlation between GEI with small pixel sizes and QCT was obtained in the dorsal part of the heel bones, but not in the ventral part with partly thickened trabeculae and irregular distribution. However, standardized measuring protocols with preferably small pixel sizes (as low as [0.6 mm]3) should be applied, and correlation curves must be determined, dependent on the actual bone marrow site, before clinical routine MR osteodensitometry becomes possible.

Absorptiometry, Photon↗
PubMed2000

Magnetic resonance imaging guided corticosteroid injection of the sacroiliac joints in patients with therapy resistant spondyloarthropathy: a pilot study.

OBJECTIVE: To evaluate magnetic resonance imaging (MRI) guided corticosteroid injections of inflamed sacroiliac (SI) joints in patients with spondyloarthropathy with therapy resistant sacroiliitis. METHODS: We performed 16 injections in 9 patients on an outpatient basis (6 men, 3 women, mean age at onset 24.7 +/- 7.5 yrs). All patients had MRI guided injection of 40 mg triamcinolone acetonide into SI joints using an open 0.2 Tesla unit. Before and 3 months after corticosteroid injection they underwent an MRI examination with a closed 1.5 Tesla unit. RESULTS: Seven of 9 patients reported subjective improvement that lasted at least a mean of 10.8 +/- 5.6 months. Subchondral bone marrow edema on fat suppressed images resolved in 8 patients after corticosteroid injection. CONCLUSION: MRI guided corticosteroid injection of SI joints appears to be an effective and safe procedure without exposure to radiation. It is a useful therapeutic modality, especially in young patients with severe isolated sacroiliitis.

Adolescent↗
PubMed1999

Excitation of narrow frequency bands with reduced relaxation-related signal losses: methodology and preliminary applications.

Selective excitation of a narrow frequency band is usually obtained by a long-duration, symmetrical-shaped RF pulse or by a series of short pulses with a symmetrical envelope. In species with fast transverse relaxation, both approaches lead to marked signal losses. Asymmetrical excitations applying truncated shaped pulses or half-Gaussian envelopes for trains of equidistant hard pulses were reported to provide higher signal intensity, but the frequency response is clearly inferior to the corresponding symmetrical excitations. Methods allowing asymmetrical excitation, but excellent frequency response are described in the present work. An additional 90 degree pulse is applied after a train of equidistant hard pulses with a half-Gaussian envelope. Suitable timing in the entire sequence of pulses and a phase cycle with length 2 only for the additional 90 degree pulse combined with an even number of scans allow the removal of undesired transverse magnetization outside narrow frequency bands. Thus, a periodical excitation with a very small bandwidth is obtained. In imaging sequences with standard 2D Fourier reconstruction the new excitation strategies can be included to generate a normal image representing morphology beside a band pattern with chemical information, if an odd number of scans is used. The separation of both parts in the final image is based on the principle of alternated line scanning. Macroscopic and microscopic field inhomogeneities in tissue are assessable in a single experiment. Preliminary applications on specimens with limited homogeneity of the magnetic field and on human tissue are demonstrated.

Adult↗
PubMed1999

[Cardiac MRI for determining functional left ventricular parameters].

PURPOSE: To prove the accuracy of MR methods in the determination of left ventricular (LV) functional parameters and anatomy. MATERIALS AND METHODS: At 1.5 T, 20 healthy volunteers and 22 patients with aortic valvular disease (stenosis n = 15, regurgitation n = 7) were examined. Functional parameters like cardiac output, ejection fraction, end-diastolic volume, aortic flow maximum, and time interval from the R-wave to maximum flow were obtained using a velocity encoding 2D FLASH sequence (TR 24 ms, TE 5 ms, venc 250 cm/sec) and segmented breath-hold cine FLASH 2D technique (TR 100 ms, TE 4.8 ms, flip angle 25 degrees, temporal resolution 50 ms). Invasive measurements (Fick principle) served as gold standard, intra- and interobserver variability were determined. RESULTS: Differences of functional parameters between normal volunteers and patients were detectable at a high level of significance (p < 0.0001). For cardiac output a superior correlation with the gold standard was found using flow measurements (r = 0.66, p < 0.0007) compared to volumetric calculations from cine studies (r = 0.47, p < 0.02). Interobserver variability was 2.5 +/- 2.7%/4.5 +/- 6.9% (flow quantification/calculations from cine studies), intraobserver variability was 1.7 +/- 1.6%/3.3 +/- 2.2%. CONCLUSIONS: MRI is an appropriate tool for determining LV functional parameters and anatomy. Differences between normal volunteers and patients with aortic valvular disease can be detected reliably. Flow measurements turned out to be more accurate than calculations from cine images. Therefore, flow quantification techniques should be preferred for clinical use.

Adult↗
PubMed1999

[Optimization of numerical measurement parameters for ECG-triggered MRI snapshot-FLASH myocardial perfusion studies].

BACKGROUND AND AIMS: In MR examinations of myocardial perfusion by the use of Snapshot-FLASH sequences it is of major importance that the achievable signal difference between pre- and normal postcontrast myocardium be maximized. METHODS: In ECG-triggered Snapshot-FLASH sequences the signal intensity of the myocardium depends on the flip angle alpha, the inversion time TI and the trigger delay TD (both depending on the cardiac frequency f) for unchanged slice thickness (SL), matrix size (MA), repetition time (TR) and echo time (TE). Therefore a simulation of the signal behavior of pre- and postcontrast myocardium based on Bloch's equations was performed by varying the flip angle alpha, TI and TD for different cardiac frequencies in order to determine an optimized combination of the measurement parameters. RESULTS: In normal heart rates (50-70 beats/min) maximal signal differences between pre- and normal postcontrast myocardium can be reached for inversion times TI = 170-200 ms and a flip angle alpha = 11 degrees. For higher heart rates again alpha = 11 degrees and TI = 200-220 ms with shortened TD (TD = 0 for f > 90 beats/min) were found to be optimal. The calculated values were semiquantitatively confirmed in phantom and volunteer measurements. CONCLUSIONS: The described method allows cardiac frequency dependent optimization of the Snapshot-FLASH measurement parameters alpha, TI and TD in order to reach a maximum in signal contrast between normal and malperfused myocardium.

Computer Graphics↗
PubMed1999

[Diagnosis of renal artery stenosis in 1.0 T using 3D phase contrast magnetic resonance angiography and dynamic contrast medium perfusion].

PURPOSE: To assess renal artery stenosis (RAS) by 3D phase contrast (PC) MR angiography and dynamic perfusion imaging of the kidneys. METHODS: On a standard 1.0 T MR imaging system (Magnetom Expert, Siemens), 32 patients with angiographically proven unilateral RAS were examined using a 3D PC sequence (TR 40 ms/TE 9 ms/venc 30 cm/s). An ECG-gated Turbo-FLASH 2D sequence (TR 4.5 ms/TE 2.2 ms/TIeff. 400 ms) was applied to study the first pass of paramagnetic contrast agent (0.1 mmol Gd-DTPA/kg) through the kidneys. Signal intensity (SI) over time curves of the renal cortex were obtained and evaluated considering temporal relation and percentage of maximum SI compared to the aorta and normal kidneys. Analysis of the MRA was performed by two independent blinded readers. The gold-standard DSA was interpreted by consensus reading of two experienced radiologists. RESULTS: RAS was detected by 3D PC MRA with a sensitivity of 93% and specificity of 81% (ppv 82%, npv 93%, accuracy 87%, kappa = 0.61). Maximum SI in RAS was significantly decreased (p < 0.001-0.0001). A temporally delayed enhancement of 1.5 +/- 1.3 s was found for RAS > 75% (p < 0.002) but not for RAS < 75% (p > 0.1). CONCLUSIONS: 3D PC MRA is capable of detecting RAS in a high percentage of patients. Dynamic perfusion imaging of the kidneys, applied additionally, can confirm the diagnosis and give valuable information about the hemodynamic relevance of RAS in suspected unilateral disease.

Contrast Media↗
PubMed1999

[MR tomography of the bone marrow changes after high-dosage chemotherapy and autologous peripheral stem-cell transplantation].

PURPOSE: Evaluation of MR standard imaging and short time inversion recovery (STIR) imaging to assess changes in red bone marrow cellularity after high-dose chemotherapy (HDC) and peripheral blood stem cells transplantation (PBSCT). MATERIALS AND METHODS: Sixty-one magnetic resonance (MR) studies were performed in 15 patients (8 female and 7 male, average age 45 years) who received HDC and PBSCT for therapy of either a solid tumor or multiple myeloma. All patients underwent MR examinations of the lumbar region and both femora with T1- and T2-weighted turbo spin-echo (TSE) and STIR sequences at predefined time intervals. Qualitative analysis of the signal intensity was performed by consensus reading of four radiologists. MR results were correlated with results of blood smears and marrow histology. RESULTS: STIR sequences demonstrated marked changes in signal intensity not only until the aplasia occurred but also during bone marrow repopulation. An increased signal intensity was observed after HDC in 13/15 patients (87%), followed by a decrease in signal intensity immediately after aplasia in 14/15 patients (93%). Signal intensity further changed parallel to marrow engraftment in 11/15 patients (73%). T2-TSE only showed clear changes during repopulation in 8/15 patients (53%). The individual course of the signal in T1-TSE was markedly inhomogeneous. CONCLUSIONS: STIR sequences show bone marrow edema during aplasia and marrow cellularity during reconstitution and are suitable for characterisation of red bone marrow after HDC and autologous PBSCT.

Adult↗
PubMed1999

Measurement of intracellular triglyceride stores by H spectroscopy: validation in vivo.

We validate the use of 1H magnetic resonance spectroscopy (MRS) to quantitatively differentiate between adipocyte and intracellular triglyceride (TG) stores by monitoring the TG methylene proton signals at 1.6 and 1.4 ppm, respectively. In two animal models of intracellular TG accumulation, intrahepatic and intramyocellular TG accumulation was confirmed histologically. Consistent with the histological changes, the methylene signal intensity at 1.4 ppm increased in both liver and muscle, whereas the signal at 1.6 ppm was unchanged. In response to induced fat accumulation, the TG concentration in liver derived from 1H MRS increased from 0 to 44.9 +/- 13.2 micromol/g, and this was matched by increases measured biochemically (2.1 +/- 1.1 to 46.1 +/- 10.9 micromol/g). Supportive evidence that the methylene signal at 1.6 ppm in muscle is derived from investing interfascial adipose tissue was the finding that, in four subjects with generalized lipodystrophy, a disease characterized by absence of interfacial fat, no signal was detected at 1.6 ppm; however, a strong signal was seen at 1.4 ppm. An identical methylene chemical shift at 1.4 ppm was obtained in human subjects with fatty liver where the fat is located exclusively within hepatocytes. In experimental animals, there was a close correlation between hepatic TG content measured in vivo by 1H MRS and chemically by liver biopsy [R = 0.934; P <.0001; slope 0.98, confidence interval (CI) 0.70-1.17; y-intercept 0.26, CI -0.28 to 0. 70]. When applied to human calf muscle, the coefficient of variation of the technique in measuring intramyocellular TG content was 11.8% in nonobese subjects and 7.9% in obese subjects and of extramyocellular (adipocyte) fat was 22.6 and 52.5%, respectively. This study demonstrates for the first time that noninvasive in vivo 1H MRS measurement of intracellular TG, including that within myocytes, is feasible at 1.5-T field strengths and is comparable in accuracy to biochemical measurement. In addition, in mixed tissue such as muscle, the method is clearly advantageous in differentiating between TG from contaminating adipose tissue compared with intramyocellular lipids.

Adipose Tissue↗
PubMed1999

Renal MR angiography at 1.0 T: three-dimensional (3D) phase-contrast techniques versus gadolinium-enhanced 3D fast low-angle shot breath-hold imaging.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic usefulness of three different MR angiographic techniques at 1.0 T. SUBJECTS AND METHODS: In 22 patients with renal artery stenosis confirmed at intraarterial catheter angiography, we also performed unenhanced and gadolinium-enhanced three-dimensional phase-contrast MR angiography and gadolinium-enhanced single breath-hold three-dimensional fast low-angle shot MR angiography. We determined circulation time to optimize signal acquisition in gadolinium-enhanced breath-hold MR angiography after bolus injection of contrast material. RESULTS: Sensitivity, defined as the detection of a hemodynamically significant stenosis (>50% luminal narrowing), was 85% for enhanced phase-contrast MR angiography, 91% for gadolinium-enhanced MR angiography, and 95% for unenhanced phase-contrast MR angiography. The combination of unenhanced phase-contrast MR angiography and gadolinium-enhanced MR angiography yielded 100% sensitivity for hilar artery stenoses. There were 13 false-positive findings with unenhanced phase-contrast MR angiography, 10 with enhanced phase-contrast MR angiography, and four with gadolinium-enhanced MR angiography (specificity: 38%, 52%, and 79%, respectively). Accessory renal arteries were not seen on unenhanced or enhanced phase-contrast MR angiography (0/8 patients) but were detected with gadolinium-enhanced MR angiography in five of the eight patients. Interobserver agreement (kappa = .62) was best with gadolinium-enhanced MR angiography. The quality of the images was unsatisfactory for adequate evaluation of segmental renal arteries with all three MR angiographic techniques. CONCLUSION: A combination of unenhanced phase-contrast MR angiography and gadolinium-enhanced MR angiography at 1.0 T proved useful as a screening protocol for renal artery stenosis.

Adult↗
PubMed1999

Association of increased intramyocellular lipid content with insulin resistance in lean nondiabetic offspring of type 2 diabetic subjects.

Insulin resistance plays an important role in the pathogenesis of type 2 diabetes; however, the multiple mechanisms causing insulin resistance are not yet fully understood. The aim of this study was to explore the possible contribution of intramyocellular lipid content in the pathogenesis of skeletal muscle insulin resistance. We compared insulin-resistant and insulin-sensitive subjects. To meet stringent matching criteria for other known confounders of insulin resistance, these individuals were selected from an extensively metabolically characterized group of 280 first-degree relatives of type 2 diabetic subjects. Some 13 lean insulin-resistant and 13 lean insulin-sensitive subjects were matched for sex, age, BMI, percent body fat, physical fitness, and waist-to-hip ratio. Insulin sensitivity was determined by the hyperinsulinemic-euglycemic clamp method (for insulin-resistant subjects, glucose metabolic clearance rate [MCR] was 5.77+/-0.28 ml x kg(-1) x min(-1) [mean +/- SE]; for insulin-sensitive subjects, MCR was 10.15+/-0.7 ml x kg(-1) x min(-1); P<0.002). Proton magnetic resonance spectroscopy (MRS) was used to measure intramyocellular lipid content (IMCL) in both groups. MRS studies demonstrated that in soleus muscle, IMCL was increased by 84% (11.8+/-1.6 vs. 6.4+/-0.59 arbitrary units; P = 0.008 ), and in tibialis anterior muscle, IMCL was increased by 57% (3.26+/-0.36 vs. 2.08+/-0.3 arbitrary units; P = 0.017) in the insulin-resistant offspring, whereas the extramyocellular lipid content and total muscle lipid content were not statistically different between the two groups. These data demonstrate that in these well-matched groups of lean subjects, IMCL is increased in insulin-resistant offspring of type 2 diabetic subjects when compared with an insulin-sensitive group matched for age, BMI, body fat distribution, percent body fat, and degree of physical fitness. These results indicate that increased IMCL represents an early abnormality in the pathogenesis of insulin resistance and suggest that increased IMCL may contribute to the defective glucose uptake in skeletal muscle in insulin-resistant subjects.

Adult↗
PubMed1999

[In-vivo 1H-MR spectroscopy: the determination of the intra- and extramyocellular lipid content depending on the insulin effect in the direct offspring of type-2 diabetics].

PURPOSE: Differentiation and assessment of intra- (IMCL) and extramyocellular lipids (EMCL) in offspring of type II diabetic subjects by means of 1H-MR spectroscopy. METHODS: Out of a group of more than 250 metabolically characterized offspring of type II diabetics, twenty subjects were selected and matched for anthropometric parameters. Glucose clamp was performed prior to MRS in all subjects for metabolic characterization. Ten individuals were classified as insulin resistant (MCR < 7 ml/kg/min) and ten were found to be insulin sensitive (MCR > 7 ml/kg/min). MRS was performed in the tibialis anterior muscle and in the soleus muscle. RESULTS: For insulin resistant individuals the MRS results revealed a higher IMCL content in both muscles. In the tibialis anterior muscle IMCL was increased by 1.6 fold (arbitrary units +/- SEM: 3.2 +/- 0.4 vs 2.0 +/- 0.3; p < 0.01) and in the soleus muscle by 2.0 fold (arbitrary units +/- SEM: 13.0 +/- 1.9 vs 6.6 +/- 0.9; p < or = 0.01). There was no correlation between EMCL and MCR in the soleus muscle. In addition, no relationship between the amount of IMCL and the subcutaneous fat layer was found. CONCLUSIONS: A significantly increased intramyocellular lipid content in insulin resistant offspring of type II diabetic subjects was assessed non-invasively by 1H-MR spectroscopy.

Adult↗
PubMed1999

Ultrafast diffusion-sensitive MR imaging of brain on an open scanner at 0.2 T.

We describe new strategies for fast diffusion-sensitive MR imaging of ischemic brain or spinal cord lesions. The methods provide diagnostic image quality in less than 1 s per section and are used in conjunction with low-field-strength open MR scanners. Single-shot sequences combine diffusion-sensitive preparation with a modified fast spin-echo data acquisition. Results are presented from healthy volunteers and from two patients with recent and older ischemic brain lesions.

Adult↗
PubMed1998

Simultaneous highly selective MR water and fat imaging using a simple new type of spectral-spatial excitation.

In a recent contribution [MRM 38:269-274 (1997)], it was reported that an excitation by a series of sinc-shaped slice-selective RF pulses with binomial amplitude ratios and complete spin refocusing between consecutive pulses leads to water- or fat-selective images of high quality. A method for simultaneous water and fat imaging in multislice operation is presented based on the principle of alternated line scanning and linear superposition of several excitations. For example, a 1 - 3 - 3 - 1 pulse train with suitable interpulse delays results in a water-selective excitation, whereas a 1 - 3 - 3 - 1 train leads to a selective excitation of fat (transmitter frequency corresponds with the Larmor frequency of water protons). Phase cycling of the excitation (1 - 3 - 3 - 1 for the even line numbers in k-space, but 1 - 3 - 3 - 1 for the odd line numbers) causes a shift of n/2 lines in phase-encode direction for the fat signals in an n x m matrix. The principle of linear superposition explains why an excitation of 2 - 0 - 6 - 0 for the even lines and 0 - 6 - 0 - 2 for the odd lines results in a final image with unshifted water signals and shifted fat signals. Both water and fat portions are simultaneously exhibited and separated without any signal loss. Examples recorded by a gradient-echo sequence demonstrate the potential of the new technique that allows a reduction of up to 50% of measuring time compared with former frequency-selective imaging methods.

Adipose Tissue↗
PubMed1998

Influence of pulse angle variations on stimulated echo acquisition mode proton nuclear magnetic resonance spectra of AB spin systems: theory and experiments with citrate.

The influence of pulse angle variations in the localization sequence stimulated echo acquisition mode (STEAM) on the signal of strongly coupled AB spin systems has been examined. Experimental 1H nuclear magnetic resonance (NMR) spectra of citrate were recorded on a 1.5 T whole-body imager. Theoretically calculated spectra were generated, with good correlation to experimental results. The dependence of the signal intensity on sequence timing and pulse angles was calculated analytically. For longer sequence timings, the ratio of the signal intensity from citrate to the signal intensity from uncoupled nuclei depends strongly on the applied flip angles. The shape of spectra also changes with varying flip angles. These effects are clearly less pronounced for STEAM than for point resolved spectroscopy (PRESS). The results have to be considered for quantitative measurements of citrate in spectroscopic investigations as, e.g. of prostate neoplasms.

Acetic Acid↗
PubMed1998

Signal losses in diffusion preparation: comparison between spin-echo, stimulated echo and SEASON.

Diffusion-weighted magnetic resonance imaging and spectroscopy commonly apply a spin-echo or stimulated echo preparation including sensitizing field gradients. The article reports on a systematic numerical approach to an optimum diffusion preparation considering undesired signal losses caused by relaxation. A large range of possible applications on whole-body units and animal scanners is covered. Instructions for an optimized type and timing of the diffusion preparation are provided for the readership, based on the desired diffusion weighting (b-value), the available maximum field gradient amplitudes, the RF pulse durations and gradient ramp times, and the relaxation characteristics of the specimen (or tissue) of interest. In addition, a new type of diffusion preparation named SEASON (simultaneous Spin-Echo And Stimulated echO preparatioN) is introduced and compared with spin-echo and stimulated echo diffusion preparation. It is demonstrated that spin-echo preparation is superior to stimulated echo preparation in all cases with T2 approximately T1 and in all cases with relatively low diffusion weighting resulting in short duration of diffusion sensitizing gradients delta << T2. For tissues with T2 << T1 (as musculature or red bone marrow) stimulated echo preparation becomes superior to spin-echo preparation for high ratios b/A2 (h-value indicates diffusion weighting, A is the maximum gradient amplitude). The new SEASON technique allows a higher yield in signal intensity compared to spin-echo or stimulated echo preparations in clinically relevant cases.

Diffusion↗
PubMed1998

High-resolution cardiac imaging using an interleaved 3D double slab technique.

A three-dimensional (3D) gradient-echo sequence with interleaved double-slab excitation was developed and optimized for the requirements in pediatric cardiac imaging. For this purpose high contrast between blood and myocardium signal should be obtained without the use of contrast agents. An acceptable measuring time for a large region examined with high spatial resolution should be achieved as well, especially with regard to the small structures of the heart and vessels of infants. The presented approach works with gradient moment nulling and a short echo time of 5.5 ms resulting in generally high signal intensity and only minor signal losses due to turbulent flow. The sequence allows simultaneous ECG-gated recording of two separately excited slabs with small thickness (10 mm) and with a distance of several centimeters between them. Thus, common effects of presaturation in 3D imaging can be avoided, although a relatively short measuring time is achievable. In order to get a 3D data set with good signal homogeneity of blood and of the other structures across a large volume of interest several double-slab measurements with suitable positions must be performed. The latter aspect is especially important for postprocessing techniques as multiple planar reconstruction and maximum intensity projection. Examples of applications of the new technique and appropriately postprocessed images are presented allowing demonstration even of subtle cardiac malformations.

Artifacts↗
PubMed1998

Gd-enhanced 3D phase-contrast MR angiography and dynamic perfusion imaging in the diagnosis of renal artery stenosis.

The objective of this study was to investigate the role of contrast enhancement using a three-dimensional (3D) phase-contrast (PC) magnetic resonance (MR) sequence (3D PC-MRA) and to assess the value of a dynamic MR perfusion study of the kidneys to determine the hemodynamic relevance of unilateral renal artery stenosis (RAS). Seventeen patients with unilateral RAS were examined on a standard 1.0 T imaging system using a phase shift and magnitude sensitive 3D PC sequence (TR=160 ms, TE=9 ms, venc. 30 cm/s). Following the initial pre-contrast 3D PC-MRA a dynamic first pass perfusion study was performed using a Turbo-FLASH 2D sequence (TR=4.5 ms, TE=2.2 ms, TI=400 ms) after bolus injection of 0.15 mmol gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)/kg body weight. The 3D PC-MRA was then repeated during infusion of 0.15 mmol Gd-DTPA/kg body weight. Evaluation by three independent readers was based on maximum intensity projection images. Source images were rendered on request. Signal intensity (SI) over time curves of the renal cortex were obtained from the dynamic perfusion study and analyzed for maximum signal enhancement as well as temporal relationship to the aortic SI curve. Results from 3D PC-MRA revealed a sensitivity (pre-/post-contrast) of 100%/89%, specificity of 76%/63%, positive predictive value of 80%/69 %, negative predictive value of 90%/78%, and accuracy of 85%/75% (p=0.07). Interobserver agreement was kappa=0.61/kappa=0.47 (pre/post Gd-DTPA), respectively. Increased signal-to-noise was present in all segments of the renal arteries post contrast (p=0.0003). This came along with image degradation due to aliasing and elevated SI of venous flow that partially obscured the renal arteries. Dynamic SI curves showed a significantly decreased maximum SI in RAS (p=0.01-0.001). A temporal delay of cortical signal intensity enhancement could not be confirmed in this setting. Gd-enhanced 3D PC-MRA did not yield a superior diagnostic value in the diagnosis of RAS compared to pre-contrast measurements. Dynamic perfusion imaging of the kidneys, in combination with 3D PC-MRA, can contribute additional information in suspected unilateral RAS.

Aged↗