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Low-dose contrast-enhanced time-resolved angiography with stochastic trajectories with iterative reconstruction (IT-TWIST-MRA) in brain arteriovenous shunt

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Abstract

Objectives

To assess the feasibility of low-dose contrast-enhanced four-dimensional (4D) time-resolved angiography with stochastic trajectories (TWIST) with iterative reconstruction (hereafter IT-TWIST-MRA) covering the whole brain and to compare IT-TWIST-MRA and TWIST-MRA with reference to digital subtraction angiography (DSA) in the evaluation of arteriovenous shunts (AVS).

Methods

Institutional Review Board approval was obtained for this observational study, and the requirement for written informed consent was waived. Twenty-nine patients with known AVS underwent TWIST-MRA on a 3-T MRI scanner, using low-dose injection (0.02 mmol/kg) of gadolinium-based contrast agent (GBCA) with each of Fourier and iterative reconstruction between September 2016 and October 2019. Visual evaluation of image quality was conducted for delineation of (a) the normal cerebral arteries and veins and (b) AVS feeder, shunt, and drainer vessels. Region-of-interest evaluation was conducted to evaluate bolus sharpness and baseline signal fluctuation in the signal intensity of the cerebral vessels. We compared the detection of AVS between TWIST-MRA and IT-TWIST-MRA. The paired-samples Wilcoxon test was used to test the differences between TWIST-MRA and IT-TWIST-MRA.

Results

Visualization scores for normal vasculature and AVS angioarchitecture were significantly better for images produced using IT-TWIST-MRA than those using TWIST-MRA. Peak signal and the enhancement slope of the time-intensity curve were significantly higher for IT-TWIST-MRA than for TWIST-MRA, except for the superior sagittal sinus (SSS). Baseline intensity fluctuation was significantly lower for IT-TWIST-MRA than for TWIST, except for SSS.

Conclusions

IT-TWIST-MRA yields clinically feasible 4D MR-DSA images and delineates AVS even with low-dose GBCA.

Key Points

• Iterative reconstruction significantly improves the image quality of TWIST-MRA covering the whole brain.

• The short temporal footprint and denoising effect of iterative reconstruction enhances the quality of 4D-MRA.

• IT-TWIST-MRA yields clinically feasible images of AVS with low-dose GBCA.

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Abbreviations

4D-MR-DSA:

Four-dimensional magnetic resonance digital subtraction angiography

AVF:

Arteriovenous fistula

AVM:

Arteriovenous malformation

AVS:

Arteriovenous shunts

DSA:

Digital subtraction angiography

GBCA:

Gadolinium-based contrast agents

ICA:

Internal carotid artery

ICC:

Intraclass correlation coefficients

ICH:

Intracranial hemorrhage

IT-TWIST-MRA:

Time-resolved angiography with interleaved stochastic trajectories with iterative reconstruction

MCA:

Middle cerebral artery

MSC:

Maximal signal change

SSS:

Superior sagittal sinus

TWIST-MRA:

Time-resolved angiography with interleaved stochastic trajectories

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Funding

This work was supported by JSPS KAKENHI Grant Number JP18K07711, 19K17266, 21K15623, 21K15826, and The Kyoto University Research Fund for Young Scientist Start-Up) FY2020.

Author information

Author notes

  1. A.S. and R.S. contributed equally to this work.

Authors and Affiliations

  1. Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Akihiko Sakata, Ryo Sakamoto, Yasutaka Fushimi, Satoshi Nakajima, Takuya Hinoda, Sonoko Oshima & Yuji Nakamoto

  2. Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany

    Jens Wetzl & Michaela Schmidt

  3. Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan

    Masakazu Okawa, Kazumichi Yoshida & Susumu Miyamoto

Authors
  1. Akihiko Sakata
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  2. Ryo Sakamoto
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  3. Yasutaka Fushimi
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Corresponding author

Correspondence to Yasutaka Fushimi.

Ethics declarations

Ethics approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This retrospective study was approved by local institutional review boards and written informed consent was waived.

Conflict of interest

All authors declare that they have no conflict of interest, except Michaela Schmidt and Jens Wetzl who are employees of Siemens Healthcare GmbH.

Guarantor

The scientific guarantor of this publication is Yuji Nakamoto.

Statistics and Biometry

No complex statistical methods were necessary for this paper.

Methodology

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  • performed at one institution

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Sakata, A., Sakamoto, R., Fushimi, Y. et al. Low-dose contrast-enhanced time-resolved angiography with stochastic trajectories with iterative reconstruction (IT-TWIST-MRA) in brain arteriovenous shunt. Eur Radiol 32, 5392–5401 (2022). https://doi.org/10.1007/s00330-022-08678-7

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  • DOI: https://doi.org/10.1007/s00330-022-08678-7

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