Technical requirements, biophysical considerations and protocol optimization with magnetic resonance angiography using blood-pool agents

In order to maximize the potential benefits of contrast-enhanced magnetic resonance angiography, careful attention must be paid to the choice of hardware, data acquisition and processing, and to the choice of contrast agent. Typically, contrast-enhanced magnetic resonance angiography uses parallel-imaging techniques, which shorten the acquisition time, enhance spatial resolution and reduce artefacts. The timing of data acquisition is crucial for maximal enhancement of the arteries: for optimal arterial depiction, the centre of k-space should be acquired at the time of peak concentration of contrast agent in the arterial bed being investigated, and a number of k-space acquisition techniques are available to achieve this. SENSE or GRAPPA techniques can be used to facilitate parallel-imaging reconstruction of either the image data or k-space data, respectively. Gadolinium contrast agents shorten the proton relaxation times (most importantly T1) of blood, thereby increasing the signal-to-noise ratio and enhancing differentiation between blood vessels and other tissues. The blood-pool (intravascular) contrast agent gadofosveset trisodium (Vasovist, Bayer Schering Pharma AG, Berlin, Germany) is reversibly protein-bound in human plasma. This results in a marked increase in relaxivity, and hence a strong T1 shortening effect compared with other gadolinium-based contrast agents. Furthermore, the blood retention time of gadofosveset trisodium is substantially prolonged compared with conventional contrast agents. As a result, gadofosveset trisodium permits both first-pass and steady-state imaging.