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Off-resonance magnetic resonance angiography improves visualization of in-stent lumen in peripheral nitinol stents compared to conventional T1-weighted acquisitions: an in vitro comparison study

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Abstract

To compare the value of inversion recovery with on-resonant water suppression (IRON) to conventional T1-weighted (T1w) MRA and computed tomography angiography (CTA) for visualization of peripheral nitinol stents. We visualized 14 different peripheral nitinol stents in vitro both using Gadolinium (Gd) and ultrasmall superparamagnetic iron nanoparticles (USPIOs) for conventional T1w and IRON-MRA using clinical grade 1.5T MR scanner and iodinated contrast material for CTA using a 256-slice CT scanner. Parameter assessment included signal- and contrast-to-noise ratio (S/CNR), relative in-stent signal and artificial lumen narrowing. X-ray angiography served as gold standard for diameter assessment. Gd-enhanced IRON-MRA exhibited highest in-stent SNR and CNR values compared to conventional T1w MRA (IRON (Gd/USPIO): SNR = 30 ± 3/21 ± 2, CNR = 23 ± 2/14 ± 1; T1w: SNR = 16 ± 1/14 ± 2, CNR = 12 ± 1/10 ± 1, all p < 0.05). Furthermore, IRON-MRA achieved highest relative in-stent signal both using Gd and USPIO (IRON (Gd/USPIO): 121 ± 8 %/103 ± 6 %; T1w: 73 ± 2 %/66 ± 4 %; CTA: 84 ± 6 %, all p < 0.05). However, artificial lumen narrowing appeared similar in all imaging protocols (IRON (Gd/USPIO): 21 ± 3 %/21 ± 2 %; T1w: 16 ± 4 %/17 ± 3 %; CTA: 19 ± 2 %, all p = NS). Finally, IRON-MRA provided improvement of the in-stent lumen visualization with an ‘open-close-open’ design, which revealed a complete in-stent signal loss in T1w MRA. IRON-MRA improves in-stent visualization in vitro compared to conventional T1w MRA and CTA. In light of the in vitro results with Gd-enhanced IRON-MRA, the clinical implementation of such an approach appears promising.

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Authors and Affiliations

  1. Clinic of Internal Medicine, Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Gitsios Gitsioudis, Philipp Fortner, Anna Missiou, Florian Andre, Oliver J. Müller, Hugo A. Katus & Grigorios Korosoglou

  2. Russell H. Morgan Department of Radiology and Radiological Sciences, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Matthias Stuber

  3. Center for Biomedical Imaging (CIBM), University Hospital Lausanne, Lausanne, Switzerland

    Matthias Stuber

Authors
  1. Gitsios Gitsioudis
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  2. Philipp Fortner
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  3. Matthias Stuber
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  4. Anna Missiou
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  8. Grigorios Korosoglou
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Correspondence to Gitsios Gitsioudis.

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10554_2016_955_MOESM1_ESM.docx

Supplementary material 1. Figure 1 Phantoms for the assessment of optimum concentration of contrast materials. Identical stepwise increase of Gadolinium (Gd) and ultrasmall superparamagnetic nanoparticles (USPIO, P904) contrast materials were used for all images A.–D.. Comparable SNR/CNR values revealed for 2µmol/ml of both Gd and USPIOs (circled sample). IRON-MRA provides increasing signal strength for higher concentrations of USPIO than T1-weighted MRA (B.–D.). Arrows in D. indicate signal-enhanced characteristic dipolar structures. MRA indicates magnetic resonance angiography; IRON, inversion recovery with on-resonant water suppression. Figure 2 Schematic illustration of the stent phantom (mash) placed in a box filled with normal saline solution. Regions of interest (ROIs, red circles) for assessment of signal intensity (SI) are placed in three in-stent segments (one middle and two lateral segments, SIIn−Stent,1−3), one ROI placed in an intraluminal non-stented tube segment (SITube), one ROI placed in the adjacent saline solution (SISaline) and one ROI placed in the background (SIBackground). (DOCX 669 KB)

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Gitsioudis, G., Fortner, P., Stuber, M. et al. Off-resonance magnetic resonance angiography improves visualization of in-stent lumen in peripheral nitinol stents compared to conventional T1-weighted acquisitions: an in vitro comparison study. Int J Cardiovasc Imaging 32, 1645–1655 (2016). https://doi.org/10.1007/s10554-016-0955-4

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  • DOI: https://doi.org/10.1007/s10554-016-0955-4

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