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Published on: October 7, 2021
Non-contrast MR angiography of pelvic arterial vasculature using the Quiescent interval slice selective (QISS)
Patrick Ghibes1,2, Sasan Partovi3, Christoph Artzner4
1Department for Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany. Patrick.ghibes@med.uni-tuebingen.de.
Abstract:
To evaluate Quiescent Interval Slice Selective (QISS) balanced steady-state free precession (bSSFP) and QISS fast low-angle shot (FLASH) sequences for non-contrast Magnetic Resonance Angiography (MRA) of iliac arteries regarding image quality and diagnostic confidence in order to establish these sequences in daily clinical practice. A prospective study of healthy subjects (n = 10) was performed. All subjects underwent the QISS MRI protocol with bSSFP und FLASH sequences. Vessel contrast-to-background ratio (VCBR) were measured in pre-defined vessel segments. Image quality and diagnostic confidence was assessed using a Likert scale (five-point scale). Inter-reader agreement was determined using Cohen's kappa coefficient (κ). Ten healthy subjects (median age 29 years, IQR: 26.25 to 30 years) were included in this prospective study. Median MR examination time was 2:05 min (IQR 1:58 to 2:16) for QISS bSSFP and 4:11 min (IQR 3:57 to 4:32) for QISS FLASH. Both sequences revealed good VCBR in all examined vessel segments. VCBR (muscle tissue) were marginally higher for FLASH sequences (e.g., 0.82 vs. 0.78 in the right femoral artery, p = 0.035*), while bSSFP sequence showed significantly higher VCBR (fat tissue) in the majority of examined arterials vessels (e.g., 0.78 vs. 0.62 in right femoral artery, p = 0.001*). The image quality and diagnostic confidence of both sequences were rated as good to excellent. Moderate to good inter-reader agreement was found. QISS MRA using bSSFP and FLASH sequences are diagnostic for visualization of iliac arterial vasculature. The QISS bSSFP sequence might offer advantages due to the markedly shorter exam time and superior visualization of smaller vessels. The QISS FLASH sequence seems to be a robust alternative for non-contrast MRA since it is less sensitive to magnetic field inhomogeneities.
Insights
Quiescent Interval Slice Selective (QISS) balanced steady-state free precession (bSSFP) and fast low-angle shot (FLASH) magnetic resonance angiography (MRA) sequences provide diagnostic visualization of iliac arteries. QISS bSSFP offers faster imaging and better small vessel detail, while QISS FLASH is a robust alternative.
Area of Science:
- Radiology
- Medical Imaging
- Cardiovascular Imaging
Background:
- Non-contrast Magnetic Resonance Angiography (MRA) is crucial for evaluating iliac arteries.
- Quiescent Interval Slice Selective (QISS) techniques offer potential for non-contrast MRA.
- Evaluating different QISS sequences is essential for clinical adoption.
Purpose of the Study:
- To compare Quiescent Interval Slice Selective (QISS) balanced steady-state free precession (bSSFP) and QISS fast low-angle shot (FLASH) sequences for non-contrast MRA of iliac arteries.
- To assess image quality, diagnostic confidence, and examination time for these sequences.
- To determine the suitability of these sequences for daily clinical practice.
Main Methods:
- A prospective study involving 10 healthy subjects was conducted.
- Subjects underwent non-contrast MRA of iliac arteries using both QISS bSSFP and QISS FLASH sequences.
- Vessel contrast-to-background ratio (VCBR), image quality, and diagnostic confidence were quantitatively and qualitatively assessed.
Main Results:
- Both QISS bSSFP and QISS FLASH sequences demonstrated good Vessel Contrast-to-Background Ratios (VCBR) in all examined iliac artery segments.
- QISS bSSFP sequences had significantly higher VCBR with fat tissue and markedly shorter examination times (2:05 min) compared to QISS FLASH (4:11 min).
- Image quality and diagnostic confidence were rated as good to excellent for both sequences, with moderate to good inter-reader agreement.
Conclusions:
- QISS MRA using both bSSFP and FLASH sequences is diagnostic for visualizing the iliac arterial vasculature.
- The QISS bSSFP sequence may be advantageous due to its shorter scan time and superior visualization of smaller vessels.
- QISS FLASH serves as a reliable alternative for non-contrast MRA, particularly in situations with magnetic field inhomogeneities.
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