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European Radiology

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01-05-2017 | Vascular-Interventional

Non-contrast 3D black blood MRI for abdominal aortic aneurysm surveillance: comparison with CT angiography

Authors: Chengcheng Zhu, Bing Tian, Joseph R. Leach, Qi Liu, Jianping Lu, Luguang Chen, David Saloner, Michael D. Hope

Published in: European Radiology | Issue 5/2017

Abstract

Objectives

Management of abdominal aortic aneurysms (AAAs) is based on diameter. CT angiography (CTA) is commonly used, but requires radiation and iodinated contrast. Non-contrast MRI is an appealing alternative that may allow better characterization of intraluminal thrombus (ILT). This study aims to 1) validate non-contrast MRI for measuring AAA diameter, and 2) to assess ILT with CTA and MRI.

Method

28 patients with AAAs (diameter 50.7 ± 12.3 mm) underwent CTA and non-contrast MRI. MRI was acquired at 3 T using 1) a conventional 3D gradient echo (GRE) sequence and 2) a 3D T₁-weighted black blood fast-spin-echo sequence. Two radiologists independently measured the AAA diameter. The ratio of signal of ILT and adjacent psoas muscle (ILT_r = signal_ILT/signal_Muscle) was quantified.

Results

Strong agreement between CTA and non-contrast MRI was shown for AAA diameter (intra-class coefficient > 0.99). Both approaches had excellent inter-observer reproducibility (ICC > 0.99). ILT appeared homogenous on CTA, whereas MRI revealed compositional variations. Patients with AAAs ≥5.5 cm and <5.5 cm had a variety of distributions of old/fresh ILT types.

Conclusions

Non-contrast 3D black blood MRI provides accurate and reproducible AAA diameter measurements as validated by CTA. It also provides unique information about ILT composition, which may be linked with elevated risk for disease progression.

Key Points

• Non-contrast MRI is an appealing alternative to CTA for AAA management.

• Non-contrast MRI can accurately measure AAA diameters compared to CTA.

• MRI affords unique characterization of intraluminal thrombus composition.

Kent KC, Zwolak RM, Egorova NN et al (2010) Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg 52:539–548CrossRefPubMed

Derubertis BG, Trocciola SM, Ryer EJ et al (2007) Abdominal aortic aneurysm in women: prevalence, risk factors, and implications for screening. J Vasc Surg 46:630–635CrossRefPubMed

LeFevre ML (2014) Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 161:281–290CrossRefPubMed

Beales L, Wolstenhulme S, Evans JA, West R, Scott DJ (2011) Reproducibility of ultrasound measurement of the abdominal aorta. Br J Surg 98:1517–1525CrossRefPubMed

Nguyen VL, Leiner T, Hellenthal FA et al (2014) Abdominal aortic aneurysms with high thrombus signal intensity on magnetic resonance imaging are associated with high growth rate. Eur J Vasc Endovasc Surg 48:676–684CrossRefPubMed

Behr-Rasmussen C, Grondal N, Bramsen MB, Thomsen MD, Lindholt JS (2014) Mural thrombus and the progression of abdominal aortic aneurysms: a large population-based prospective cohort study. Eur J Vasc Endovasc Surg 48:301–307CrossRefPubMed

Stenbaek J, Kalin B, Swedenborg J (2000) Growth of thrombus may be a better predictor of rupture than diameter in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 20:466–469CrossRefPubMed

Wolf YG, Thomas WS, Brennan FJ, Goff WG, Sise MJ, Bernstein EF (1994) Computed tomography scanning findings associated with rapid expansion of abdominal aortic aneurysms. J Vasc Surg 20:529–535, discussion 535–528CrossRefPubMed

Speelman L, Schurink GW, Bosboom EM et al (2010) The mechanical role of thrombus on the growth rate of an abdominal aortic aneurysm. J Vasc Surg 51:19–26CrossRefPubMed

10.

Metaxa E, Kontopodis N, Tzirakis K, Ioannou CV, Papaharilaou Y (2015) Effect of intraluminal thrombus asymmetrical deposition on abdominal aortic aneurysm growth rate. J Endovasc Ther 22:406–412CrossRefPubMed

11.

Vorp DA, Lee PC, Wang DH et al (2001) Association of intraluminal thrombus in abdominal aortic aneurysm with local hypoxia and wall weakening. J Vasc Surg 34:291–299CrossRefPubMed

12.

Kazi M, Thyberg J, Religa P et al (2003) Influence of intraluminal thrombus on structural and cellular composition of abdominal aortic aneurysm wall. J Vasc Surg 38:1283–1292CrossRefPubMed

13.

Martinez-Pinna R, Madrigal-Matute J, Tarin C et al (2013) Proteomic analysis of intraluminal thrombus highlights complement activation in human abdominal aortic aneurysms. Arterioscler Thromb Vasc Biol 33:2013–2020CrossRefPubMed

14.

Nchimi A, Courtois A, El Hachemi M et al (2016) Multimodality imaging assessment of the deleterious role of the intraluminal thrombus on the growth of abdominal aortic aneurysm in a rat model. Eur Radiol 26:2378–2386CrossRefPubMed

15.

Richards JM, Semple SI, MacGillivray TJ et al (2011) Abdominal aortic aneurysm growth predicted by uptake of ultrasmall superparamagnetic particles of iron oxide: a pilot study. Circ Cardiovasc Imaging 4:274–281CrossRefPubMed

16.

Veldhoen S, Behzadi C, Derlin T et al (2015) Exact monitoring of aortic diameters in Marfan patients without gadolinium contrast: intraindividual comparison of 2D SSFP imaging with 3D CE-MRA and echocardiography. Eur Radiol 25:872–882CrossRefPubMed

17.

Zhu C, Haraldsson H, Faraji F et al (2016) Isotropic 3D black blood MRI of abdominal aortic aneurysm wall and intraluminal thrombus. Magn Reson Imaging 34:18–25CrossRefPubMed

18.

Li L, Miller KL, Jezzard P (2012) DANTE-prepared pulse trains: a novel approach to motion-sensitized and motion-suppressed quantitative magnetic resonance imaging. Magn Reson Med 68:1423–1438CrossRefPubMed

19.

Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310CrossRefPubMed

20.

Brady AR, Thompson SG, Fowkes FG, Greenhalgh RM, Powell JT (2004) Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation 110:16–21CrossRefPubMed

21.

Kuo PH, Kanal E, Abu-Alfa AK, Cowper SE (2007) Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. Radiology 242:647–649CrossRefPubMed

22.

Goshima S, Kanematsu M, Kondo H et al (2013) Preoperative planning for endovascular aortic repair of abdominal aortic aneurysms: feasibility of nonenhanced MR angiography versus contrast-enhanced CT angiography. Radiology 267:948–955CrossRefPubMed

23.

Guirguis-Blake JM, Beil TL, Senger CA, Whitlock EP (2014) Ultrasonography screening for abdominal aortic aneurysms: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 160:321–329CrossRefPubMed

24.

den Hartog AW, Franken R, de Witte P et al (2013) Aortic disease in patients with Marfan syndrome: aortic volume assessment for surveillance. Radiology 269:370–377CrossRef

25.

Hope MD, Hope TA, Zhu C et al (2015) Vascular imaging with ferumoxytol as a contrast agent. AJR Am J Roentgenol 205:W366–W373CrossRefPubMedPubMedCentral

26.

Li ZY, Sadat U, J UK-I et al (2010) Association between aneurysm shoulder stress and abdominal aortic aneurysm expansion: a longitudinal follow-up study. Circulation 122:1815–1822

27.

Roy J, Labruto F, Beckman MO, Danielson J, Johansson G, Swedenborg J (2008) Bleeding into the intraluminal thrombus in abdominal aortic aneurysms is associated with rupture. J Vasc Surg 48:1108–1113CrossRefPubMed

28.

Zhu C, Haraldsson H, Tian B et al (2016) High resolution imaging of the intracranial vessel wall at 3 and 7 T using 3D fast spin echo MRI. MAGMA 29:559–570CrossRefPubMed

29.

Chu B, Kampschulte A, Ferguson MS et al (2004) Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke 35:1079–1084CrossRefPubMed

30.

Zhu C, Sadat U, Patterson AJ, Teng Z, Gillard JH, Graves MJ (2014) 3D high-resolution contrast enhanced MRI of carotid atheroma--a technical update. Magn Reson Imaging 32:594–597CrossRefPubMed

31.

Teng Z, Feng J, Zhang Y et al (2015) Layer- and direction-specific material properties, extreme extensibility and ultimate material strength of human abdominal aorta and aneurysm: a uniaxial extension study. Ann Biomed Eng 43:2745–2759CrossRefPubMedPubMedCentral

32.

O'Leary SA, Kavanagh EG, Grace PA, McGloughlin TM, Doyle BJ (2014) The biaxial mechanical behaviour of abdominal aortic aneurysm intraluminal thrombus: classification of morphology and the determination of layer and region specific properties. J Biomech 47:1430–1437CrossRefPubMed

33.

Sadat U, Teng Z, Young VE et al (2011) Impact of plaque haemorrhage and its age on structural stresses in atherosclerotic plaques of patients with carotid artery disease: an MR imaging-based finite element simulation study. Int J Cardiovasc Imaging 27:397–402CrossRefPubMed

Title: Non-contrast 3D black blood MRI for abdominal aortic aneurysm surveillance: comparison with CT angiography
Authors: Chengcheng Zhu
Bing Tian
Joseph R. Leach
Qi Liu
Jianping Lu
Luguang Chen
David Saloner
Michael D. Hope
Publication date: 01-05-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 5/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-016-4559-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Non-contrast 3D black blood MRI for abdominal aortic aneurysm surveillance: comparison with CT angiography

Abstract

Objectives

Method

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Method

Results

Conclusions

Key Points

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