Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Department of Radiology, Clinical Medical College, Yangzhou University, Yangzhou, China.
J Magn Reson Imaging. 2021 Sep;54(3):938-949. doi: 10.1002/jmri.27629. Epub 2021 May 20.
Flow related artifacts in continuous arterial spin labeling (cASL) zero-echo-time (ZTE) magnetic resonance angiography (MRA) could influence the vasculature visualization.
To investigate the clinical feasibility for the intracranial artery diseases assessment by utilizing hybrid ASL-ZTE-MRA (hASL-ZTE-MRA).
Prospective, technical development.
Sixty-seven subjects with known/suspected cerebrovascular diseases.
FIELD STRENGTH/SEQUENCE: Gradient echo based cASL-/hASL- ZTE-MRA at 3.0 T.
Subjective/objective evaluation for sound-levels. Image quality (IQ), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were analyzed within artery segments. Stenotic grading, aneurysm measurement, and signal intensity of lesions were further analyzed.
Kolmogorov-Smirnov test for data normality check. Between two MRAs: Wilcoxon signed-rank test for sound experience/IQ ratings analysis; Paired t test for SNR/CNR comparison. One-way analysis of variance for sound intensity comparison. For stenosis grading/aneurysm measurement: Kendall's W test/intraclass correlation coefficient (ICC) for interobserver agreement test within each modality, weighted kappa statistics/ICC for intermodality agreement test between each MRA and computed tomography angiography.
Sound-level perception/intensity was similar (P = 0.86, P = 0.55) between MRAs. The mean IQ score for hASL-ZTE-MRA was on diagnostic scale and slightly higher (P < 0.05) than that of cASL-ZTE-MRA. hASL-ZTE-MRA provided higher (P < 0.05) SNR/CNR than that of cASL-ZTE-MRA. Signal uniformity was improved on hASL-ZTE-MRA, particularly among the anterior circulation (P < 0.05). Comparing to cASL-ZTE-MRA, on hASL-ZTE-MRA, stenotic lesions were accurately assessed; flow in the stent or aneurysm remnant was better depicted (P < 0.05); AVM nidus was preferred with increased SNR (P < 0.05). No significant differences for the aneurysm measurement were found between MRAs (P = 0.95), in addition to the slightly higher SNR (P < 0.05) on hASL-ZTE-MRA.
Comparing to cASL-ZTE-MRA, hASL-ZTE-MRA is robust and feasible for the evaluation of intracranial artery diseases with diagnostic IQ, improved vessel contrast, and better signal heterogeneity.
2 TECHNICAL EFFICACY: 2.
在连续动脉自旋标记（cASL）零回波时间（ZTE）磁共振血管造影（MRA）中，与流动相关的伪影可能会影响血管可视化。
利用混合 ASL-ZTE-MRA（hASL-ZTE-MRA）评估颅内动脉疾病的临床可行性。
前瞻性、技术发展。
67 名已知/疑似脑血管疾病患者。
场强/序列：3.0T 梯度回波基于 cASL-/hASL-ZTE-MRA。
对声音水平进行主观/客观评估。分析动脉节段内的图像质量（IQ）、信噪比（SNR）和对比噪声比（CNR）。进一步分析狭窄分级、动脉瘤测量和病变信号强度。
Kolmogorov-Smirnov 检验用于数据正态性检验。两种 MRA 之间：Wilcoxon 符号秩检验用于声音体验/IQ 评分分析；配对 t 检验用于 SNR/CNR 比较。方差分析用于声音强度比较。对于狭窄分级/动脉瘤测量：Kendall's W 检验/组内相关系数（ICC）用于每种模态的观察者间一致性检验，加权卡帕统计/ICC 用于每种 MRA 和计算机断层血管造影之间的观察者间一致性检验。
两种 MRA 的声音感知/强度相似（P=0.86，P=0.55）。hASL-ZTE-MRA 的平均 IQ 评分处于诊断范围内，略高于 cASL-ZTE-MRA（P<0.05）。hASL-ZTE-MRA 提供的 SNR/CNR 高于 cASL-ZTE-MRA（P<0.05）。hASL-ZTE-MRA 改善了信号均匀性，尤其是在前循环（P<0.05）。与 cASL-ZTE-MRA 相比，hASL-ZTE-MRA 可准确评估狭窄病变；更好地描绘支架或动脉瘤残端内的血流（P<0.05）；AVM 巢提高 SNR 更有优势（P<0.05）。两种 MRA 之间的狭窄病变评估无显著差异（P=0.95），hASL-ZTE-MRA 仅 SNR 略高（P<0.05）。
与 cASL-ZTE-MRA 相比，hASL-ZTE-MRA 具有稳健性和可行性，可用于评估颅内动脉疾病，具有诊断性 IQ、改善的血管对比度和更好的信号异质性。
2 技术功效：2.
