Feasibility and Robustness of 3T Magnetic Resonance Angiography Using Modified Dixon Fat Suppression in Patients With Known or Suspected Peripheral Artery Disease

Karl Jakob Weiss; Holger Eggers; Christian Stehning; Marc Kouwenhoven; Mithal Nassar; Burkert Pieske; Philipp Stawowy; Bernhard Schnackenburg; Sebastian Kelle

doi:10.3389/fcvm.2020.549392

Feasibility and Robustness of 3T Magnetic Resonance Angiography Using Modified Dixon Fat Suppression in Patients With Known or Suspected Peripheral Artery Disease

Front Cardiovasc Med. 2020 Oct 30:7:549392. doi: 10.3389/fcvm.2020.549392. eCollection 2020.

Authors

Karl Jakob Weiss^{1

2}, Holger Eggers³, Christian Stehning⁴, Marc Kouwenhoven⁵, Mithal Nassar^{1

6

7}, Burkert Pieske^{1

2

8}, Philipp Stawowy^{1

2}, Bernhard Schnackenburg⁴, Sebastian Kelle^{1

2

8}

Affiliations

¹ Department of Internal Medicine/Cardiology, German Heart Institute Berlin, Berlin, Germany.
² DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
³ Philips Research, Hamburg, Germany.
⁴ Philips Healthcare, Hamburg, Germany.
⁵ Philips Healthcare, Best, Netherlands.
⁶ Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁷ Department of Cardiology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
⁸ Department of Internal Medicine/Cardiology, Charité Virchow Klinikum, Berlin, Germany.

Abstract

Objective: Contrast-enhanced magnetic resonance angiography (CE-MRA) is a well-established non-invasive imaging technique for the assessment of peripheral artery disease (PAD). A subtractionless method using modified Dixon (mDixon) fat suppression showed superior image quality at 1.5T over the common subtraction method, using a three-positions stepping table approach with a single dose of contrast agent. The aim of this study was to investigate the feasibility of subtractionless first-pass peripheral MRA at 3T in patients with known or suspected PAD and to compare the performance in terms of vessel-to-background contrast (VBC), signal-to-noise ratio (SNR), and subjective image quality to conventional subtraction MRA. Methods: Ten patients [mean age 69 years ± 12 standard deviation (SD)] with known or suspected PAD were examined on a clinical 3T scanner (Ingenia, Philips Healthcare, Best, Netherlands) at three table positions using subtractionless and subtraction first-pass peripheral MRA. Two readers rated image quality on a four- point scale. Interobserver agreement was expressed in quadratic weighted κ values. VBC was assessed with a semi-automated process and SNR was compared in a healthy volunteer. Results: Subjective image quality was significantly better with the subtractionless method overall (mean image quality for mDixon imaging: 2.88 ± 0.32 SD vs. for subtraction imaging: 2.57 ± 0.48 SD; P < 0.001) and per table position (abdominal position: 2.88 ± 0.32 vs. 2.57 ± 0.48 SD; P < 0.001); upper leg position: (2.97 ± 0.15 SD vs. 2.68 ± 0.37 SD; P < 0.001; lower leg position: 2.60 ± 0.50 SD vs. 2.13 ± 0.60 SD; P < 0.001). Vessel-to-background contrast increased by 22% with the subtractionless method overall (mean VBC for mDixon imaging: 23.16 ± 8.4 SD vs. for subtraction imaging: 19.00 ± 8.1 SD; factor 1.22, P < 0.001). SNR was 82% higher with the subtractionless method (overall SNR gain 1.82; P < 0.001). Conclusion: This study demonstrated the feasibility and robustness of subtractionless first-pass peripheral MRA at 3T in patients with known or suspected PAD using a three- positions stepping table approach with a single dose of contrast agent. It showed increased image quality compared to the conventional subtraction method and superior performance in terms of SNR and vessel-to-background contrast.

Keywords: 3 Tesla; fat suppression MRI; image quality; magnetic resonance angiography; modified Dixon (mDixon); peripheral artery disease; signal-to-noise ratio; vessel-to-background contrast.