• Korean Journal of Radiology
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• v.23 no.2
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• pp.246-255
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• 2022

Objective: To determine the usefulness of Silent MR angiography (MRA) for evaluating intracranial aneurysms treated with stent-assisted coil embolization. Materials and Methods: Ninety-nine patients (101 aneurysms) treated with stent-assisted coil embolization (Neuroform atlas, 71 cases; Enterprise, 17; LVIS Jr, 9; and Solitaire AB, 4 cases) underwent time-of-flight (TOF) MRA and Silent MRA in the same session using a 3T MRI system within 24 hours of embolization. Two radiologists independently interpreted both MRA images retrospectively and rated the image quality using a 5-point Likert scale. The image quality and diagnostic accuracy of the two modalities in the detection of aneurysm occlusion were further compared based on the stent design and the site of aneurysm. Results: The average image quality scores of the Silent MRA and TOF MRA were 4.38 ± 0.83 and 2.78 ± 1.04, respectively (p < 0.001), with an almost perfect interobserver agreement. Silent MRA had a significantly higher image quality score than TOF MRA at the distal internal carotid artery (n = 57, 4.25 ± 0.91 vs. 3.05 ± 1.16, p < 0.001), middle cerebral artery (n = 21, 4.57 ± 0.75 vs. 2.19 ± 0.68, p < 0.001), anterior cerebral artery (n = 13, 4.54 ± 0.66 vs. 2.46 ± 0.66, p < 0.001), and posterior circulation artery (n = 10, 4.50 ± 0.71 vs. 2.90 ± 0.74, p = 0.013). Silent MRA had superior image quality score to TOF MRA in the stented arteries when using Neuroform atlas (4.66 ± 0.53 vs. 3.21 ± 0.84, p < 0.001), Enterprise (3.29 ± 1.59 vs. 1.59 ± 0.51, p = 0.003), LVIS Jr (4.33 ± 1.89 vs. 1.89 ± 0.78, p = 0.033), and Solitaire AB stents (4.00 ± 2.25 vs. 2.25 ± 0.96, p = 0.356). The interpretation of the status of aneurysm occlusion exhibited significantly higher sensitivity with Silent MRA than with TOF MRA when using the Neuroform Atlas stent (96.4% vs. 14.3%, respectively, p < 0.001) and LVIS Jr stent (100% vs. 20%, respectively, p = 0.046). Conclusion: Silent MRA can be useful to evaluate aneurysms treated with stent-assisted coil embolization, regardless of the aneurysm location and type of stent used.

• Progress in Medical Physics
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• v.23 no.3
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• pp.177-187
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• 2012

Magnetic resonance angiography (MRA) techniques are widely used in diagnosis of vascular disorders such as hemadostenosis and aneurism. Especially, phase contrast (PC) MRA technique, which is a typical non contrast-enhanced MRA technique, provides not only the anatomy of blood vessels but also flow velocity. In this study, we developed the 2- and 3-dimensional PC MRA pulse sequences for a low magnetic field MRI system. Vessel images were acquired using 2D and 3D PC MRA and the velocities of the blood flow were measured in the superior sagittal sinus, straight sinus and the confluence of the two. The 2D PC MRA provided the good quality of vascular images for large vessels but the poor quality for small ones. Although 3D PC MRA gave more improved visualization of small vessels than 2D PC MRA, the image quality was not enough to be used for diagnosis of the small vessels due to the low SNR and field homogeneity of the low field MRI system. The measured blood velocities were $25.46{\pm}0.73cm/sec$, $24.02{\pm}0.34cm/sec$ and $26.15{\pm}1.50cm/sec$ in the superior sagittal sinus, straight sinus and the confluence of the two, respectively, which showed good agreement with the previous experimental values. Thus, the developed PC MRA technique for low field MRI system is expected to provide the useful velocity information to diagnose the large brain vessels.

• Journal of radiological science and technology
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• v.30 no.3
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• pp.265-270
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• 2007

The purpose of this study was to evaluate the possibility of utilizing MT pulse at CE-TOF-MRA in patients with cerebral infarction. MRA using time-of-flight(TOF) technique with varying offset frequencies (0, 600, 1,200, and 1,800 Hz) magnetization transfer were performed in 10 patients with cerebral infarction at 3.0T MR scanner. CE-TOF-MRA and TOF-SPGR in normal vessel shown decreased SNR and increased CNR. The highest CNR in narrowing vessel shown at CE-TOF-MRA using 600 and 1,200 Hz offset frequencies. CNR in stenosis vessel increased dependent on using offset frequencies. The occlusion was clearly shown, and the highest CNR in occlusion shown at CE-TOF-MRA using 1,800 Hz offset frequencies. There was no shape variation in narrowing vessel or no visualizing vessel.

• Journal of KIISE:Software and Applications
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• v.30 no.9
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• pp.821-828
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• 2003

The virtual angioscopy was implemented using MR angiography image of carotid artery Inside of the carotid artery is one of the body region not accessible by real optical endoscopy but can be visualized with virtual endoscopy. In order to determine the navigation path, we segmented the common carotid artery and internal carotid artery from the MR angiography image. We used the coordinates as a navigation path for virtual camera that were calculated from medial axis transformation. We used the perspective projection and marching cube algorithm to render the surface from volumetric MRA image data. A stroke occurs when brain cells die because of decreased blood flow to the brain. The carotid artery is the primary blood vessel that supplies the blood flow to the brain. Therefore, the carotid artery stenosis is the primary reason of stroke. The virtual angioscopy is highly recommended as a diagnosis tool with which the specific Place of stenosis can be identified and the degree of stenosis can be measured qualitatively. Also, the virtual angioscopy can be used as an education and training tool for endoscopist and radiologist.

• Proceedings of the KSMRM Conference
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• 2001.11a
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• pp.139-139
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• 2001

목적： 경동맥 분지부에서 내경동맥 협착에 대한 평가에 있어서 삼차원 조영증강 자기공명혈관조영술의 정확도를 알아보고자 하였다. 대상 및 방법： 삼차원 조영증강 자기공명혈관조영술(3D Contrast-enhanced MRA)과 디지털감산혈관 조영술(Digital Subtraction Angiography, DSA)을 모두 시행한 35명의 환자, 68예의 내경동맥을 분석하였다. 내경동맥 협착의 측정은 North American Symptomatic Carotid Endarterectom Trial (NASCET) 기준을 이용하였다. 두 가지 검사에서 협착 정도를 경도(mild：0-29％), 중등도(moderate：30-69％), 심한 협착(severe：70-99％), 완전 폐색(occlusion：100％)등 네 그룹으로 나누었다. 두 명의 관찰자(A,B)가 DSA에서 측정한 협착 정도를 기준으로 3D Contrast-enhanced MRA에서 측정한 협착 정도를 비교하여 두 검사 방법간에 판정 일치율과 차이점을 분석하였다.

• Proceedings of the KSMRM Conference
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• 2003.10a
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• pp.97-97
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• 2003

Contrast-enhanced MR angiography (CE-MRA) gradually occupies its position as a primary evaluation tool forsteno-occlusive disease of supra-aortic cervical arteries. It has several advantages over time-of-flight (TOF) technique such as shorter imaging time, less saturation effect, and less flow- and motion-related artifacts. Diverse methods of k-space sampling, imaging sequences, and strategies for image acquisitiontiming have been introduced since its early clinical application. Especially, methods of k-space sampling and image acquisition timing are very important to achieve maximal arterial enhancement and suppress venous signal while maintaining large scan coverage and high spatial resolution. In addition, regardless of several advantages over TOF technique, it still has a tendency to overestimate the degree of stenosis in patients with carotid or vertebralartery disease. In this exhibit, we will overview the current techniques of CE-MRA with special attention to methods of k-space sampling and image acquisition timing. We will also discuss diagnostic accuracy of CE-MRA in patients with supra-aortic cervical artery stenosis and artifacts frequently misinterpreted as steno-occlusive lesion on CE-MRA.

• Journal of Radiation Protection and Research
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• v.40 no.4
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• pp.277-282
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• 2015

This study was to investigate the effects of the hot compress pack on alleviating local muscular discomfort, stiffness in limbs as well as the chronic pains such as migraine in terms of hemodynamics. In this study, the hot compress band was put on the neck and the local physiological change on the stimulation site and the cranial blood circulation change were examined. We recruited healthy volunteers (n=8, mean age: 32.13 (4.61)), who participated in the magnetic resonance imaging (MRI) study. Local skin color and temperature were measured for the local effect of the hot compress band and the changes of intra-cranial and extra-cranial blood vessels were examined with MR angiography (MRA) images. The skin temperature increased from $36.4^{\circ}C$ at the rest condition to $36.7^{\circ}C$ and $37.1^{\circ}C$ after 15 min and 30 min stimulation, respectively. The change of the extra-cranial blood vessels between pre-stimulation and post-stimulation of 30 min was significantly increased (+38.8%), while the change of the intra-cranial blood vessels was negligible. In this study, we demonstrated that the hot compress band on the neck yielded the increase of local skin temperature on the stimulation site and it made an effect on the extracranial circulation. In conclusion, the stimulation with a hot compress could facilitate the blood circulation, causing to relieve the muscular discomfort, stiffness in limbs as well as the chronic pains such as migraine.

• Investigative Magnetic Resonance Imaging
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• v.2 no.1
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• pp.83-88
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• 1998

Purpose : Authors correlated the three-dimensional time-of-flight MRA signal intensity characteristics and flow profile simulated by computer in an experimental flow phantom model. Materials and Methods : The three-dimensional time-of-flight MRA was performed in a fusiform flow phantom and analyzed the flow signal. computer assisted flow simulation was performed in same flow geometry. The MRA signal intensity and flow velocity distribution and direction was compared. Results : The flow was depicted as homogeneous signal internsity in inlet and outlet area and inhomogeneous signal intensity in fusiform area. Typically, the flow was depicted as target appearance in transition area to outlet. Whereas mean signal internsity decreased slowly in fusiform area, it rapidly dropped and resumed in transition area to outlet. In computer assisted flow simulation, Whereas there were flow velocity decrease and flow direction change to peripheral in entrance to fusiform area, ther were rapid flow velocity resuming and flow direction change to central in transition area to outlet. Conclusion : The signal loss and target appearance in transition area to outlet is characteristic of fusiform flow. These signal changes correlate with abrupt flow velocity and direction change well.

• Investigative Magnetic Resonance Imaging
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• v.20 no.2
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• pp.105-113
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• 2016

Purpose: Susceptibility vessel sign (SVS) on gradient echo image, which is caused by MR signal loss due to arterial thrombosis, has been reported in acute middle cerebral artery (MCA) infarction. However, the reported sensitivity and diagnostic accuracy of SVS have been variable. Susceptibility-weighted imaging (SWI) is a newly developed MR sequence. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the SVS. The purpose of this study was to evaluate the diagnostic values of SWI for the detection of hyperacute MCA occlusion. Materials and Methods: Sixty-nine patients (37 males, 32 females; 46-89 years old [mean, 69.1]) with acute stroke involving the MCA territory underwent MR imaging within 6 hours after the symptom onset. MR examination included T2, FLAIR (fluid-attenuated inversion recovery), DWI, SWI, PWI (perfusion-weighted imaging), contrast-enhanced MR angiography (MRA) and contrast-enhanced T1. Of these patients, 28 patients also underwent digital subtraction angiography (DSA) within 2 hours after MR examination. Presence or absence of SVS on SWI was assessed without knowledge of clinical, DSA and other MR imaging findings. Results: On MRA or DSA, 34 patients (49.3%) showed MCA occlusion. Of these patients, SVS was detected in 30 (88.2%) on SWI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SWI were 88.2%, 97.1%, 96.8%, 89.5% and 92.8%, respectively. Conclusion: SWI was sensitive, specific and accurate for the detection of hyperacute MCA occlusion.

• Investigative Magnetic Resonance Imaging
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• v.22 no.3
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• pp.150-157
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• 2018

Purpose: To assess associations between morphological characteristics of intracranial arteries in time-of-flight MR angiography (TOF-MRA) and atherosclerotic risk factors. Materials and Methods: From January 2014 to October 2015, a total of 129 patients (65 men and 64 women) without intracranial arterial stenosis > 50% were included in this study. All MRIs were performed using a 3T machine with 3D TOF-MRA sequences. We evaluated irregularity, tortuosity, and dilatation of intracranial arteries in maximal intensity projection (MIP) of TOF-MRA. Subjects' risk factors for atherosclerosis including history of hypertension and diabetes were collected by reviewing their medical records. Associations between morphological characteristics and each known atherosclerosis risk factor were examined using univariate regression analysis. Multivariate regression models were built to determine combined association between those risk factors and morphologic changes of intracranial arteries. Results: In multivariate analysis, hypertension (coefficient [95% CI]: 0.162 [0.036, 0.289], P = 0.012) and absence of diabetes (coefficient [95% CI]: -0.159 [-0.296, -0.023], P = 0.022) were associated with large diameter of intracranial arteries. Males (coefficient [95% CI]: 0.11 [-0.006, 0.23], P = 0.062) and higher age (coefficient [95% CI]: 0.003 [-0.001, 0.008], P = 0.138) had marginal association with increased diameter. Tortuosity was associated with old age (OR: 1.04 [1.02, 1.07], P < 0.001). Irregular contour of intracranial arteries was significantly associated with old age (OR: 1.05 [1.02, 1.09], P = 0.004), presence of diabetes (OR: 2.88 [1.36, 6.15], P = 0.0058), and previous ischemic stroke (OR: 3.91 [1.41, 11.16], P = 0.0092). Conclusion: Morphological characteristics (irregularity, tortuosity, dilatation) of intracranial arteries seen in TOF-MRA might be associated with atherosclerotic risk factors in subjects with no or mild stenosis.