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Ungated nonenhanced radial quiescent interval slice-selective (QISS) magnetic resonance angiography of the neck: Evaluation of image quality.

Authors
  • Koktzoglou, Ioannis1, 2
  • Aherne, Emily A1, 3
  • Walker, Matthew T1, 2
  • Meyer, Joel R1, 2
  • Edelman, Robert R1, 3
  • 1 Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.
  • 2 University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
  • 3 Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Type
Published Article
Journal
Journal of Magnetic Resonance Imaging
Publisher
Wiley (John Wiley & Sons)
Publication Date
Dec 01, 2019
Volume
50
Issue
6
Pages
1798–1807
Identifiers
DOI: 10.1002/jmri.26781
PMID: 31077477
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Standard-of-care time-of-flight (TOF) techniques for nonenhanced magnetic resonance angiography (NEMRA) of the carotid bifurcation and other cervical arteries often provide nondiagnostic image quality due to motion and flow artifacts. To perform an initial evaluation of an ungated radial quiescent-interval slice-selective (QISS) technique for NEMRA of the neck, in comparison with 2D TOF and contrast-enhanced magnetic resonance angiography (CEMRA). Retrospective. Sixty patients referred for neck MR angiography. Ungated radial QISS at 3T. Three radiologists scored image quality of 18 arterial segments using a 4-point scale (1, nondiagnostic; 2, fair; 3, good; 4, excellent), and two radiologists graded proximal internal carotid stenosis using five categories (<50%, 50-69%, 70-99%, occlusion, nondiagnostic). Friedman tests with post-hoc Wilcoxon signed-rank tests; unweighted Gwet's AC1 statistic; tests for equality of proportions. Ungated radial QISS provided image quality that significantly exceeded 2D TOF (mean scores of 2.7 vs. 2.0, 2.7 vs. 2.2, and 2.9 vs. 2.3; P < 0.001, all comparisons), while CEMRA provided the best image quality (mean scores of 3.6, 3.7, and 3.5 for the three reviewers). Interrater agreement of image quality scores was substantial for CEMRA (AC1 = 0.70, P < 0.001), and moderate for QISS (AC1 = 0.43, P < 0.001) and TOF (AC1 = 0.41, P < 0.001). Compared with TOF, QISS NEMRA provided a significantly higher percentage of diagnostic segments for all three reviewers (91.0% vs. 71.7%, 93.5% vs. 72.9%, 95.5% vs. 85.2%; P < 0.0001) and demonstrated better agreement with CEMRA for grading of proximal internal carotid stenosis (AC1 = 0.94 vs. 0.73 for reviewer 1, P < 0.05; AC1 = 0.89 vs. 0.68 for reviewer 2, P < 0.05). In this initial study, ungated radial QISS significantly outperformed 2D TOF for the evaluation of the neck arteries, with overall better image quality and more diagnostic arterial segments, and improved agreement with CEMRA for grading stenosis of the proximal internal carotid artery. 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1798-1807. © 2019 International Society for Magnetic Resonance in Medicine.

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