Renal artery blood flow: quantitation with phase-contrast MR imaging with and without breath holding

PURPOSE: To compare the accuracy of 16-frame cine phase-contrast (PC) magnetic resonance (MR) imaging with those of two breath-hold PC techniques in the measurement of renal artery blood flow. MATERIALS AND METHODS: In vitro flow measurements were performed in a segment of harvested human artery embedded in gel. For the cine PC acquisition, respiratory motion was simulated. In eight subjects with recently obtained para-amino-hippurate-clearance renal blood flow data, renal artery flow measurements were subsequently performed with two breath-hold imaging techniques and with cine PC imaging during shallow respiration. RESULTS: Breath-hold sequences were significantly more accurate than conventional cine PC sequences both in vitro (P < .005) and in vivo (P < .05). Cine PC imaging tended to overestimate flow (in vivo mean, 24.47% +/- 9.94), reflecting artifactual enlargement of the apparent vessel size. CONCLUSION: Reliable blood flow measurements in the renal artery are possible with breath-hold PC MR imaging.     

The effect of blood viscoelasticity on pulsatile flow in stationary and axially moving tubes

An analytical solution for pulsatile flow of a generalized Maxwell fluid in straight rigid tubes, with and without axial vessel motion, has been used to calculate the effect of blood viscoelasticity on velocity profiles and shear stress in flows representative of those in the large arteries. Measured bulk flow rate Q waveforms were used as starting points in the calculations for the aorta and femoral arteries, from which axial pressure gradient delta P waves were derived that would reproduce the starting Q waves for viscoelastic flow. The delta P waves were then used to calculate velocity profiles for both viscoelastic and purely viscous flow. For the coronary artery, published delta P and axial vessel acceleration waveforms were used in a similar procedure to determine the separate and combined influences of viscoelasticity and vessel motion. Differences in local velocities, comparing viscous flow to viscoelastic flow, were in all cases less than about 2% of the peak local velocity. Differences in peak wall shear stress were less than about 3%. In the coronary artery, wall shear stress differences between viscous and viscoelastic flow were small, regardless of whether axial vessel motion was included. The shape of the wall shear stress waveform and its difference, however, changed dramatically between the stationary and moving vessel cases. The peaks in wall shear stress difference corresponded with large temporal gradients in the combined driving force for the flow.     

New and future developments in cerebrovascular ultrasound, magnetic resonance angiography, and related techniques

Four-dimensional (4D) analysis of atherosclerotic plaque and wall motion, the application of 4D ultrasound to the study of atherogenesis, and the incorporation of ultrasound data into flow models for simulation of cerebrovascular hemodynamics are new frontiers in diagnostic ultrasound that use computer vision and optical flow techniques to exploit the full potential of real-time imaging and Doppler studies. New approaches to improve blood vessel delineation with ultrasound include application of contrast agents, harmonic imaging, and red blood cell density imaging. An assessment of the potential clinical utility of these new developments in cerebrovascular ultrasound requires an analysis of comparable trends in magnetic resonance (MR) technology, eg, rapid advances in the fields of MR angiography, dynamic contrast-enhanced MR, and MR diffusion imaging. Likewise, the value of ultrasound techniques for the measurement of blood flow to evaluate cerebrovascular hemodynamics must be compared to related methods in magnetic resonance, such as dynamic MR inflow tracking. This article addresses several new and future developments in cerebrovascular ultrasound and discusses their relative merits in terms of ongoing research in the field of magnetic resonance angiography, imaging, and related techniques.     

An image processing scheme to quantitatively extract and validate hyoid bone motion based on real-time ultrasound recordings of swallowing

An image processing technique with associated hardware was developed to quantitatively extract hyoid bone motion from realtime submandibular ultrasound images recorded during the swallowing act. Videofluorographic imaging, the "gold standard" of swallowing studies, was recorded simultaneously and synchronized to the ultrasound. Hyoid position obtained from the ultrasound was validated based on the videofluorography using personal computer-based image processing methods.     

Segmented three-dimensional echo-planar flow imaging of the cervical carotid arteries

PURPOSE: To implement and assess the application of segmented three-dimensional echo-planar MR imaging time-of-flight flow sequences for studying the anatomy of the cervical carotid arteries at 1.5 T. METHODS: The 3-D echo-planar sequences were segmented along the in-plane phase-encoding direction. Echo train lengths (ETLs) of 3 and 5 and signal bandwidths of +/-25, +/-33, and +/-50 KHz were tested along with a conventional (ETL = 1) 3-D MR flow study in six healthy volunteers and in five patients with known arteriosclerotic disease involving the carotid bifurcation as confirmed by conventional angiography. The volunteer data were used to rank the techniques with respect to vessel dimension, vessel/background contrast, and quality by four trained neuroradiologists. For the patient studies, the percentage of stenoses was measured for all MR studies and compared against the conventional angiographic data using the criteria of the North American Symptomatic Carotid Endarterectomy Trial. RESULTS: Using Wilcoxon's test statistic and a significance level of .05, we found that the conventional MR flow examination was better than the segmented techniques and that the segmented techniques with ETL of 3 were superior to their counterparts with ETL of 5. For the ETL of 3 techniques, the high-bandwidth studies were inferior to their lower bandwidth counterparts; however, there was no significant difference between the performance of the medium- and low-bandwidth sequences. The patient data revealed that the segmented techniques consistently overestimated the severity of stenosis; however, in no instance did any of the segmented examinations erroneously indicate the presence of disease. CONCLUSIONS: The reduction in acquisition time and the zero false-positive rate we obtained suggest that segmented 3-D echo-planar MR flow techniques may be used as a screening/locating study for cervical carotid artery disease.     

Relationship between haemodynamics and morphology in pulmonary hypertension. A quantitative intravascular ultrasound study

BACKGROUND: Intravascular ultrasound imaging of the pulmonary arteries has been demonstrated to be a reliable method of quantifying vessel diameter, luminal area and pulsatility. Simultaneous measurement of flow velocity and its response to vasodilators allows the relationship between morphology and functional compromise to be studied, especially endothelial dysfunction. METHODS: In 51 patients (mean age = 49.8 +/- 12.6 years, 17 female) we performed right heart catheterization and simultaneous intravascular ultrasound of pulmonary artery branches. The patients were divided in two groups: group 1 with normal pulmonary artery pressure and pulmonary vascular resistance, and group 2 with pulmonary hypertension (peak pulmonary artery pressure > 30 mmHg and/or mean pulmonary artery pressure > 20 mmHg). Vessel wall and lumen were studied using a 2.9 F intravascular ultrasound catheter with a 30 MHz phased array transducer. Measurement of blood flow velocity was accomplished by a Doppler flow wire (0.018 inch). The maximal flow change during acetylcholine infusion (adjusted to 10(-6); 10(-5), and 10(-4) M concentration in the blood vessel) was measured. RESULTS: There were no significant differences between groups 1 and 2 with respect to age (48.5 +/- 14.3 years vs 50.3 +/- 12.3 years; P = ns), gender (4 female/8 male vs 13 female/26 male; P = ns), luminal area of the vessel segment in which the intravascular ultrasound measurements were obtained (11.8 +/- 6.1 mm2 vs 16.7 +/- 14.3 mm2; P = ns), internal diameter (3.9 +/- 1.2 mm vs 4.2 +/- 1.7 mm; P = ns), and external diameter (6.1 +/- 1.3 mm vs 6.9 +/- 2.1 mm; P = ns). Cross-sectional images of the pulmonary artery wall demonstrated a single ring with high echodensity with a thin inner layer regarded as intima in group 1. In contrast, the majority of patients (n = 35/39) in group 2 demonstrated a thickening of the intimal layer and/or a disturbance of layering of the echogenic arterial wall. The relative wall thickness was higher in group 2 than in group 1 (22.5 +/- 10.4% vs 15.3 +/- 6.5%; P < 0.05). There were no significant correlations between pulmonary artery pressure and wall thickness pulmonary artery pressure and area change in the cardiac cycle, acetylcholine-dependent increase in pulmonary flow and morphological changes in the vessel wall. CONCLUSION: We conclude that intravascular ultrasound is capable of detecting morphological changes in the pulmonary vessel wall in pulmonary hypertension and that vessel wall hypertrophy of small pulmonary segment arteries, as detected by intravascular ultrasound, is not predictive of functional vasodilatory response of resistance vessels of the same vessel area.     

Magnetic resonance angiography and magnetic resonance tomography in dissection of the vertebral artery

Vertebral artery dissection (VAD) is an important cause of posterior circulation stroke in young adults. Initial symptoms are often non-specific and diagnostic arteriography is not performed until neurological deficits are obvious. Since magnetic resonance tomography (MRT) is superior in the diagnosis of vertebrobasilar ischemia, we retrospectively analyzed the role of MRT and MR angiography (MRA) in the detection of dissections of the vertebral artery. Between 1989 and 1995 we identified 24 patients with a vertebral artery dissection and 1 patient with a basilar artery dissection (8 females and 17 males, 23-60 years of age, mean 41.2 years). The diagnosis of VAD (14 left VAD, 9 right VAD, 1 bilateral VAD, 1 basilar artery dissection) was established by specific arteriographical findings (DSA) or clinical and neuroradiological course. All patients underwent a combined MRT/MRA examination protocol at 1.5T that consisted of spin-echo imaging and time of flight MRA of the intra- and extracranial arteries using 2D Flash and 3D Fisp sequences. The MRT/MRA findings were correlated to DSA and ultrasound results. During the acute and subacute stage, MRT/MRA revealed abnormal findings in 21 of 22 dissected vessels (95.5%). There was one false-negative MRT/MRA in a patient with a V1 dissection (intimal flap without peripheral flow disturbances). In 7/22 VAD the MRT/MRA findings were rated specific (double lumen n = 1, mural hematoma n = 4, pseudoaneurysm n = 2). DAS was sensitive in 100% and ultrasound in 77.3%. Specific results were obtained by DSA in 8/ 22 VAD (36.4%) and in 7/22 VAD (30.4%) by MRT/MRA. When MRT/MRA and DSA results were combined, the specific findings increased to 43.5%. Follow-up examinations revealed recanalization in 52% of initially stenosed or occluded vertebral arteries; four patients developed a pseudoaneurysm, and two of them underwent ligation of the VAD. With this retrospective approach, we were able to show a high sensitivity of MRT/ MRA for the presence of disturbed flow in the dissected vertebral artery. The MRA projections tended to overestimate stenosis and were inferior to DSA in the appreciation of irregularities of the vessel wall. Identification of high-grade stenosis, especially in the presence of distal occlusion, was improved on the MRA source images. During the acute and subacute stage, the diagnosis of luminal thrombus can be difficult, because signal ambiguities exist between hemoglobin breakdown products and flow effects and adjacent fat tissues. The differentiation between luminal thrombus and mural hematoma requires interpretation of MRA source images, together with flow compensated spin-echo images. Additional fat suppressed images and flow presaturation may be required at the appropriate levels. The identification of mural hematoma is important, because this finding is considered specific and cannot be obtained with DSA. There is a complementary role of MRT/MRA and DSA for an improved overall specificity for vertebral artery dissection. A negative MRT/MRA result in a patient with appropriate symptoms, however, cannot exclude a dissection and should prompt DSA. On the other hand, a suggestive MRT/MRA result in the appropriate clinical context can replace DSA. The advantage of MRT/MRA is that the method offers a simultaneous diagnosis of posterior fossa ischemia and vertebral artery abnormalities. Therefore, MRT/MRA should be recommended in patients with suspected VAD and especially in those who have no definite neurological deficit. These patients will benefit greatly from early diagnosis and therapy. The fact that all our patients were diagnosed after neurological symptoms and that 64% of them have residual deficits gives an ethical and economical rationale for advocating early MRT/MRA in these patients.     

Classification of hemodynamic changes in renal artery stenosis using cine magnetic resonance phase contrast flow measurements

PURPOSE: To evaluate the use of high-temporal resolution cine MR phase-contrast flow measurements for assessment of flow dynamics in renal artery stenosis (RAS). MATERIAL AND METHODS: In a dog model, cine MR flow measurements were validated by comparing the MR flow data to an invasive transit-time ultrasound reference technique for different degrees of RAS. Cardiac-gated MR flow curves were recorded in 56 renal arteries of 28 patients with a temporal resolution of at least 32 ms. In all cases RAS was confirmed by digital subtraction angiography (DSA). Abnormalities of flow dynamics were assessed in the calculated flow curves using the MR parameters mean flow, maximum velocity, and time to systolic maximum. RESULTS: By means of the MR blood flow parameters high-grade stenoses (> 50%, n = 23) were detected with sensitivity of 100% and specificity of 94% with reference to DSA. The overall differentiation between stenoses (n = 37) and non-stenosed vessels (n = 19) revealed a sensitivity of 87% and a specificity of 100%. CONCLUSION: Analysis of cardiac-gated MR flow curves provides a non-invasive method to assess the hemodynamic significance of RAS and thus allows a functional evaluation in relation to the morphologic characteristics of the stenosis.     

MR angiography with three-dimensional MR digital subtraction angiography

We have developed a time-resolved, contrast-enhanced, volume-imaging technique for magnetic resonance (MR) angiography, known as three-dimensional (3D) MR digital subtraction angiography (DSA). This technique greatly improves MR angiogram quality because it combines the injection of a contrast agent with the ability to image the temporal passage of this agent and, thereby, obviates the need for timing scans or other complicated synchronization schemes. Three-dimensional MR DSA also represents a potential improvement in the sense that, relative to DSA and computed tomography (CT) angiography, the contrast agent is less toxic. Additionally, unlike CT angiography, images may be acquired during the passage of the contrast agent. Therefore, 3D MR DSA shows the sequential passage of contrast through the arterial and venous system, followed by uptake in various organs. Unlike conventional DSA, 3D MR DSA imaging acquires full volume datasets, which allows subsequent reprojection and reformatting. Because images are obtained at approximately 2-6 s time intervals using a temporal aperture on the order of several seconds, motion (such as respiration) causes only a temporary disruption of image quality, similar to that observed in MR fluoroscopy. These temporal characteristics also make the proposed sequence insensitive to variations in the shape and timing of the contrast-pass curve. Although the individual time-resolved images will have somewhat decreased signal-to-noise ratio (SNR) relative to nontime-resolved scans collected in the same acquisition time, the SNR improvement due to the gadolinium appears to accommodate this trade-off. Additionally, if motion between successive images is small, then the full suite of temporal processing schemes, previously investigated in connection with DSA and time-resolved two-dimensional (2D) MR, such as mask mode subtraction, simple matched filtering and Eigen filtering, can be used to obtain composite images. These derived images generally have an increased SNR or negligible venous signal if an arterial-phase image is not obtained in the early time-resolved images. In summary, 3D MR DSA will significantly advance MR angiography because of the following intrinsic advantages: (1) improved signal-to-noise, (2) scan orientation may be chosen independently of the direction of blood flow, (3) uniform vascular signal, even from regions of complex flow, (4) minimization of motion artifacts, (5) greatly reduced sensitivity to variation in the shape and timing of the contrast bolus, (6) ability to be reformatted or reprojected, and (7) ability to apply a variety of temporal postprocessing techniques.     

Analysis of systematic and random error in MR volumetric flow measurements

The spatial aspects of error in 2D MR cine phase-velocity mapping are considered in order to define acquisition strategies which will minimize error in measuring volumetric flow. Error was separated into two categories: systematic and random. Potential sources of systematic error examined were intravoxel phase dispersion (IVPD), partial volume effects, misalignment of flow axis and flow-encoding gradients, and improper choice of vessel voxels for flux calculations. Random error was addressed using analysis of propagation of variance. Analytical expressions for sources of error were derived; and computer models were used to test the analytical models. Flow phantom studies examining error in MR volumetric flow measurements were performed and compared with error predicted by the analytical models. Expected error in several clinical situations of interest was then derived to find appropriate acquisition strategies. Spatial resolution, signal to noise ratio, velocity sensitivity and the ratio of the modulus of moving isochromats to that of static isochromats were found to be the most important parameters in controlling error and were found to cause competing effects with respect to systematic and random error.     

Evaluation of pulmonary vascular anatomy and blood flow by magnetic resonance

Rapidly evolving magnetic resonance (MR) imaging techniques provide noninvasive approaches to evaluating morphology and quantitative physiologic information about blood flow in the pulmonary circulation. Important clinical applications currently include the preoperative and postoperative evaluation of congenital abnormalities, assessment of vascular involvement by extrinsic and intrinsic tumors, identification of central thromboemboli, and diagnosis of vascular lung lesions. Ongoing refinements in pulmonary MR angiography may make it possible to use the technique for the noninvasive detection of acute pulmonary emboli in the near future. Quantitative measurements based upon MR flow-encoding sequences are promising for the evaluation of patients with abnormal degrees or distributions of pulmonary blood flow, for example, those with unilateral lung transplants or pulmonary arterial stenoses. MR contrast agents currently under development also show promise for quantitative measurements of regional pulmonary ventilation and perfusion. The coupling of high-resolution anatomic and functional images renders MR a uniquely attractive and powerful method for evaluating the pulmonary vasculature.     

Correction to flow rate--pressure drop relation in coronary angioplasty: steady streaming effect

The changed flow pattern of pulsatile blood flow in a catheterized stenosed artery has been studied through a mathematical model. The study takes into account the effect of the movement of the flexible catheter influenced by the pulsatile nature of the flow. The contribution of the steady streaming effect brings into focus the existence of a non-zero mean pressure drop in addition to the one predicted by the linear theory -- a fact overlooked by the previous authors. Thus our results are intended to provide a correction to the mean pressure drop usually calculated by neglecting the non-linear inertia terms. The calculations based on the geometry and the flow conditions representing a real physiological situation as closely as possible suggest that depending upon the values of k (where k is the ratio of the catheter size to vessel size) ranging from 0.2 to 0.5 mean pressure drop increases for any frequency parameter. In addition, it is found that depending upon the material properties, a thin catheter experiencing small oscillations due to the flow conditions is likely to influence in the same way as a thicker catheter which remains fairly stationary inside the artery. The results are sensitive to the shape of the wall geometry and will be different for different wall geometries even if the cross-sectional area reduction at the peak of stenosis is kept the same. Interesting streamline patterns depict distinct boundary layer characteristics both at the artery wall and catheter wall. Finally, the effect of catheterization and its movement on various physiologically important flow characteristics-mean pressure drop, impedance, wall stress is studied for different range of catheter size and frequency parameter.     

Combined MRI and CFD analysis of fully developed steady and pulsatile laminar flow through a bend

A combined MR and computational fluid dynamics (CFD) study is made of flow in a simple phantom laboratory flow rig consisting of a 180 degree bend with straight entry and exit sections. The aim was to investigate the potential of the use of MRI-linked CFD simulations for in vivo use. To this end, the experiment was set up for both steady and pulsatile laminar flow conditions, with Reynolds and Dean numbers and Womersley pulsatility parameter representative of resting flow in the human aorta. The geometrical images of the pipe and the velocity images at entry to the bend were used as boundary conditions for CFD simulations of the flow. The CFD results for both steady and pulsatile cases compared favorably with velocity images obtained at exit from the bend. Additional information such as pressure and wall shear stress, which either could not be measured adequately via MRI, or could not be measured at all, was also extracted from the simulation. Overall, the results were sufficiently promising to justify pursuing subsequent in vivo studies.     

Measurement of coronary flow reserve and its role in patient care

Coronary anatomy and myocardial blood flow are major determinants of clinical symptomatology and survival in patients with coronary artery disease. While coronary anatomy has been successfully assessed by coronary angiography and intravascular ultrasound imaging, measurements of coronary blood flow are more difficult and their prognostic value has not been definitively evaluated. Measurements of coronary flow reserve (CFR), defined as maximal hyperemic flow divided by resting flow, have been used to assess the functional significance of coronary artery lesions. However, functional assessment of epicardial coronary lesions is limited by several factors, such as diffuse coronary artery disease, small-vessel disease, regional variations in myocardial flow, endothelial dysfunction, and left ventricular hypertrophy. CFR can be measured by several techniques, each one with distinct advantages and limitations, which are discussed in this review. An important distinction is between techniques that measure coronary blood flow (e.g., positron emission tomography) and those that measure blood flow velocity (e.g., Doppler catheters), from which coronary velocity reserve (CVR) is calculated. Although clinical CFR measurements have been possible for over fifteen years, their implementation in patient care has been slow due to several factors including the requirement for a sophisticated technology, the difficult interpretation of CFR results, and the limited knowledge of their prognostic value. While a normal CFR in patients with single vessel coronary disease is associated with a good prognosis, the converse has not been established, i.e., that there is a critical reduction in CFR that requires interventional treatment. A recent study (DEBATE) showed a decrease in the incidence of cardiac events at 6 months after coronary balloon angioplasty in patients with a post-procedural percent diameter stenosis < 35% and a CVR > 2.5. The complex relation between coronary anatomy, myocardial perfusion, and patient outcome have enormous implications for both patient care and health costs, which need to be addressed in future prospective trials.     

MRI and MR angiography of vertebral artery dissection

A review of 4,500 angiograms yielded 11 patients with dissection of the vertebral arteries who had MRI and (in 4 patients) MR angiography (MRA) in the acute phase of stroke. One patient with incidental discovery at arteriography of asymptomatic vertebral artery dissection and two patients with acute strokes with MRI and MRA findings consistent with vertebral artery dissection were included. Dissection occurred after neck trauma or chiropractic manipulation in 4 patients and was spontaneous in 10. Dissection involved the extracranial vertebral artery in 9 patients, the extra-intracranial junction in 1, and the intracranial artery in 4. MRI demonstrated infarcts in the brain stem, cerebellum, thalamus or temporo-occipital regions in 7 patients with extra- or extra-intracranial dissections and a solitary lateral medullary infarct in 4 patients (3 with intracranial and 1 with extra-intracranial dissection). In 2 patients no brain abnormality related to vertebral artery dissection was found and in one MRI did not show subarachnoid haemorrhage revealed by CT. Intramural dissecting haematoma appeared as crescentic or rounded high signal on T1-weighted images in 10 patients examined 3-20 days after the onset of symptoms. The abnormal vessel stood out in the low signal cerebrospinal fluid in intracranial dissections, whereas it was more difficult to detect in extracranial dissections because of the intermediate-to-high signal of the normal perivascular structures and slow flow proximal and distal to the dissection. In two patients examined within 36 h of the onset, mural thickening was of intermediate signal intensity on T1-weighted images and high signal on spin-density and T2-weighted images. MRA showed abrupt stenosis in 2 patients and disappearance of flow signal at and distal to the dissection in 5. Follow-up arteriography, MRI or MRA showed findings consistent with occlusion of the dissected vessel in 6 of 8 patients.     

Validation of a new transit time ultrasound flowmeter for measuring blood flow in colonic mesenteric arteries

OBJECTIVE: To validate a transit time ultrasound flowmeter (CardioMed CM 4000) for measuring blood flow in isolated colonic mesenteric arteries. DESIGN: Experimental and clinical study. SETTING: Teaching hospital, Denmark. ANIMALS AND SUBJECTS: One female pig, and 6 patients being operated on for carcinoma of the sigmoid colon and rectum. INTERVENTIONS: Volume blood flow measured by Cardiomed CM 4000 and pump withdrawal flow recordings. MAIN OUTCOME MEASURES: Correlation between the two methods. RESULTS: There was good agreement between transit time flow recordings and pump withdrawal flow recordings (correlation coefficient of 1.0). Of the differences between the two methods, 95% were between -0.16 ml min(-1) and 1.29 ml min(-1), mean 0.57 ml min(-1), or (in percentages) 105, 95% lying between 97-115. There was also good reproducibility in transit time flow recordings, the mean difference between repeated measurements being 0.06 ml min(-1), 95% lying between -0.66 ml min(-1) and 0.78 ml min(-1). CONCLUSION: Ultrasound transit time flow recordings gave precise measurements of blood flow in isolated colonic mesenteric arteries.     

MR angiography of the portal venous system: techniques, interpretation, and clinical applications

Magnetic resonance (MR) angiography is a noninvasive means of assessing the portal venous system that has potential advantages over currently used modalities. Time-of-flight and phase-contrast MR angiography are useful techniques that differ fundamentally in their means of data acquisition but are comparable in their ability to demonstrate normal anatomy as well as abnormalities of the portal venous system. Occasionally, artifacts caused by respiratory motion, implanted metallic devices or surgical clips, in-plane saturation, or areas of complex flow are seen at MR angiography of the portal venous system. However, most artifacts can easily be identified as such and either remedied or ignored. In addition, the suppression of signal from surrounding soft tissues may result in poor detection of parenchymal lesions. The utility of standard projection angiograms and source images can be increased through the use of intravenously administered contrast material and postprocessing techniques such as partial-volume maximum intensity projection reconstructions and shaded surface renderings. In addition to providing information on portal venous anatomy and portosystemic collateral vessels, MR angiography of the portal vein has clinical application in portal venous thrombosis and stenosis, liver transplantation, and the evaluation and planning of surgical and transjugular intrahepatic portosystemic shunts.     

Magnetic resonance imaging and the reduction of motion artifacts: review of the principles

Magnetic resonance (MR) imaging is a non-invasive diagnostic tool which is widely used nowadays. In this paper, the basic principles of MR imaging are explained and it is shown how images can be reconstructed in case of standard 2D Fourier Transform (2DFT) imaging. Several aspects of MR signal encoding are described. Unfortunately, motion of the patient during a magnetic resonance experiment often causes severe artifacts in the images. For example, in 2DFT imaging blurring and ghosting are seen and the appearance of motion artifacts remains one of the major drawbacks in MR imaging. Several methods to reduce motion artifacts in MR imaging have been proposed in the past. An overview of the principles on which these methods are based is given in this paper. Both post-processing methods and techniques that rely on gating or the use of alternative acquisition schemes such as projection reconstruction are discussed.     

Changes in blood flow velocity and diameter of the middle cerebral artery during hyperventilation: assessment with MR and transcranial Doppler sonography

PURPOSE: To compare blood flow velocity changes within the middle cerebral artery (MCA) during hyperventilation, as measured with by both transcranial Doppler sonography and MR imaging, with the diameter of the MCA as measured with MR imaging alone. METHODS: The studies were performed in six healthy volunteers ranging in age from 22 to 31 years (mean, 27 years). Transcranial Doppler sonography was carried out with a range-gated 2-MHz transducer. MR examinations were done on a 1.5-T imaging unit. MR angiography was performed using the time-of-flight technique. MR flow measurements were carried out by using the phase-mapping technique with an ECG-triggered phase-contrast sequence. RESULTS: During hyperventilation, the mean blood flow velocity of the proximal MCA declined by 49.6% +/- 5.7 (mean +/- standard deviation) as measured with Doppler sonography, and by 47% +/- 4.6 as measured with MR flow calculation. The diameter of the MCA (3.4 +/- 0.3 mm) remained unchanged on MR imaging studies (3.3 +/- 0.3 mm). CONCLUSION: We found a good correlation between relative flow velocity changes measured by transcranial Doppler sonography and MR techniques. MR imaging revealed no significant changes in the diameter of the proximal MCA during normal versus hyperventilation. Relative changes in flow velocity in the MCA would thereby reflect relative changes in cerebral blood flow, at least during hyperventilation.     

Comparison of steady-state diffusion and transit time ultrasonic measurements of umbilical blood flow in the chronic fetal sheep preparation

OBJECTIVE: Our purpose was to measure umbilical blood flow continuously by use of a transit time ultrasonic flow transducer and to compare the blood flow measurements with the steady-state diffusion method in the chronic fetal sheep preparation. STUDY DESIGN: We compared umbilical blood flow measurements calculated by the steady-state diffusion method with ethanol as the diffusing substance and with the transit time ultrasonic flow transducer placed on the common umbilical artery in five chronically prepared fetal sheep. RESULTS: There was no statistical difference between measurements of umbilical blood flow measured by the flow transducer versus the steady-state diffusion method, 600 +/- 22 versus 664 +/- 56 ml per minute (mean +/- SEM) (p = 0.23). The mean coefficient of variation within each study was 13.6% for the steady-state diffusion method versus 4.1% for the transit time flow transducer. Umbilical blood flow variance was significantly lower as measured by the flow transducer compared with the diffusion method (p < 0.0001). There were no differences in umbilical blood flow per kilogram or fetal oxygen uptake between the two methods. CONCLUSION: We conclude that umbilical blood flow can be measured continuously under steady-state conditions by use of a transit time flow transducer. Because of the lower variability in the flow transducer-obtained measurements, we speculate that the flow transducer may differentiate alterations in umbilical blood flow with greater precision in chronic preparations. This may be advantageous for measuring absolute changes in fetal substrate uptake, especially under non-steady-state conditions.