Insufficient slow-flow suppression mimicking aneurysm wall enhancement in magnetic resonance vessel wall imaging: a phantom study

Bart M.W. Cornelissen, Eva L. Leemans, Bram F. Coolen, Eva S. Peper, René van den Berg, Henk A. Marquering, Cornelis H. Slump, Charles B.L.M. Majoie

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    Abstract

    OBJECTIVE: MR vessel wall imaging (VWI) is increasingly performed in clinical settings to support treatment decision-making regarding intracranial aneurysms. Aneurysm wall enhancement after contrast agent injection is expected to be related to aneurysm instability and rupture status. However, the authors hypothesize that slow-flow artifacts mimic aneurysm wall enhancement. Therefore, in this phantom study they assess the effect of slow flow on wall-like enhancement by using different MR VWI techniques. METHODS: The authors developed an MR-compatible aneurysm phantom model, which was connected to a pump to enable pulsatile inflow conditions. For VWI, 3D turbo spin echo sequences-both with and without motion-sensitized driven equilibrium (MSDE) and delay alternating with nutation for tailored excitation (DANTE) preparation pulses-were performed using a 3-T MR scanner. VWI was acquired both before and after Gd contrast agent administration by using two different pulsatile inflow conditions (2.5 ml/sec peak flow at 77 and 48 beats per minute). The intraluminal signal intensity along the aneurysm wall was analyzed to assess the performance of slow-flow suppression. RESULTS: The authors observed wall-like enhancement after contrast agent injection, especially in low pump rate settings. Preparation pulses, in particular the DANTE technique, improved the performance of slow-flow suppression. CONCLUSIONS: Near-wall slow flow mimics wall enhancement in VWI protocols. Therefore, VWI should be carefully interpreted. Preparation pulses improve slow-flow suppression, and therefore the authors encourage further development and clinical implementation of these techniques.

    Original languageEnglish
    Article numberE19
    Pages (from-to)E19
    JournalNeurosurgical Focus
    Volume47
    Issue number1
    DOIs
    Publication statusPublished - 1 Jul 2019

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    Keywords

    • bpm = beats per minute
    • DANTE = delay alternating with nutation for tailored excitation
    • intracranial aneurysms
    • MCA = middle cerebral artery
    • MSDE = motion-sensitized driven equilibrium
    • slow flow
    • TSE = turbo spin echo
    • VENC = velocity encoding
    • vessel wall imaging
    • VWI = vessel wall imaging
    • WSS = wall shear stress

    Cite this

    Cornelissen, B. M. W., Leemans, E. L., Coolen, B. F., Peper, E. S., van den Berg, R., Marquering, H. A., ... Majoie, C. B. L. M. (2019). Insufficient slow-flow suppression mimicking aneurysm wall enhancement in magnetic resonance vessel wall imaging: a phantom study. Neurosurgical Focus, 47(1), E19. [E19]. https://doi.org/10.3171/2019.4.FOCUS19235