Faculty Bibliography

PURPOSE: To perform qualitative and quantitative comparison of images in same patients undergoing CT enterography (CTE) with 100 kVp iterative reconstruction and 120 kVp filtered back projection. METHODS: In this retrospective study, 50 consecutive patients who underwent imaging with 100 kVp and iterative reconstruction (100-IR) and had prior imaging with 120 kVp filtered back projection (120-FBP) were included. Subjective image quality parameters were evaluated by two independent and blinded readers, with higher score implying better image quality. We developed a quantitative measure of image sharpness by measuring edge-width of the psoas-fat interface. Image noise was measured as a standard deviation of attenuation measurement in the homogeneous region of the subcutaneous fat. Image sharpness and noise were measured and compared between 100-IR and 120-FBP acquisitions. RESULTS: There was approximately 33% lower radiation dose as estimated by CTDIvol with 100-IR compared to 120-FBP (9.95 vs. 15.0; p < 0.0001). There were no significant differences in overall image quality, bowel wall sharpness, and subjective assessment of noise and artifact between 100-IR and 120-FBP for both readers. Mesenteric vessel clarity score was significantly higher with 100-IR for 1 reader (4.34 vs. 4.04; p = 0.008), but not for the second reader. There was higher image sharpness (1.62 vs. 1.89; p < 0.0001) and higher image noise (14.4 vs. 13.2; p = 0.020) with 100-IR compared to 120-FBP acquisition. CONCLUSIONS: CTE performed at 100 kVp with iterative reconstruction demonstrates dose reduction without significant impact on various measures of image quality when compared to conventional 120 kVp FBP.

Established as a method to study anatomic changes, such as renal tumors or atherosclerotic vascular disease, magnetic resonance imaging (MRI) to interrogate renal function has only recently begun to come of age. In this review, we briefly introduce some of the most important MRI techniques for renal functional imaging, and then review current findings on their use for diagnosis and monitoring of major kidney diseases. Specific applications include renovascular disease, diabetic nephropathy, renal transplants, renal masses, acute kidney injury, and pediatric anomalies. With this review, we hope to encourage more collaboration between nephrologists and radiologists to accelerate the development and application of modern MRI tools in nephrology clinics.

OBJECTIVE. The purpose of this study was to evaluate split renal function, estimate single-kidney renal function, and identify cause of obstruction in patients with ureteropelvic junction (UPJ) obstruction by using contrast-enhanced dynamic MR renography (MRR). MATERIALS AND METHODS. Seventeen patients with UPJ obstruction underwent MRR and diuresis nuclear renography. Nuclear renography assessment of split renal function and mechanical versus functional obstruction served as the reference standard. The Baumann-Rudin model for determining glomerular filtration rate (GFR) was applied to generate single-kidney renal function (SK-GFRMRR) from MRR cortical and medullary enhancement curves. MRR split renal function of the right kidney (SK-GFRMRR of the right kidney normalized to the sum of SK-GFRMRR of both kidneys) was compared with nuclear renography. The MRR estimate of total GFR (eGFRMRR) was compared with that derived from Modification of Diet in Renal Disease (MDRD) formula (eGFRMDRD). Renal pelvic rate of signal intensity change (PUR) was compared between functionally and mechanically obstructed kidneys. RESULTS. There was excellent correlation between MRR and nuclear renography measure of split renal function ratio (r = 0.87, p < 0.01), with mean difference of less than 10%. There was moderate correlation (r = 0.60, p = 0.01) between eGFRMRR and eGFRMDRD. eGFRMRR underestimated eGFRMDRD, with mean difference of 13.3 mL/min/1.73 m(2). PUR in mechanically obstructed units was significantly lower (0.39 +/- 0.26 vs 2.0 +/- 1.38 min(-1); p < 0.01) compared with functionally obstructed units. PUR discriminated mechanical from functional obstruction with accuracy of 89%. CONCLUSION. In patients with UPJ obstruction, MRR can measure split renal function, estimate eGFRMDRD with moderate correlation, and accurately discriminate mechanical from functional obstruction, thus potentially providing a "one-stop shop" examination.

Gadoxetic acid-enhanced magnetic resonance cholangiopancreatography (MRCP) was performed for evaluation of living donor liver transplantation. T2-weighted MRCP and hepatobiliary-phase postcontrast MRCP showed an aberrant right posterior bile duct, although the precise variant was uncertain. Optimized hepatobiliary-phase MRCP was obtained using 3 sequence modifications: increased flip angle to improve contrast between the biliary tree and surrounding tissues; radial k-space sampling to minimize motion artifact; and free-breathing acquisition to improve signal-to-noise ratio and, in turn, spatial resolution (resolution of 1.28 x 1.28 x 1.5 mm). The optimized sequence demonstrated that the right posterior bile duct drained into the cystic duct, consistent with type 3C biliary variant, thus modifying surgical planning.

PURPOSE: To develop a fast and flexible free-breathing dynamic volumetric MRI technique, iterative Golden-angle RAdial Sparse Parallel MRI (iGRASP), that combines compressed sensing, parallel imaging, and golden-angle radial sampling. METHODS: Radial k-space data are acquired continuously using the golden-angle scheme and sorted into time series by grouping an arbitrary number of consecutive spokes into temporal frames. An iterative reconstruction procedure is then performed on the undersampled time series where joint multicoil sparsity is enforced by applying a total-variation constraint along the temporal dimension. Required coil-sensitivity profiles are obtained from the time-averaged data. RESULTS: iGRASP achieved higher acceleration capability than either parallel imaging or coil-by-coil compressed sensing alone. It enabled dynamic volumetric imaging with high spatial and temporal resolution for various clinical applications, including free-breathing dynamic contrast-enhanced imaging in the abdomen of both adult and pediatric patients, and in the breast and neck of adult patients. CONCLUSION: The high performance and flexibility provided by iGRASP can improve clinical studies that require robustness to motion and simultaneous high spatial and temporal resolution. Magn Reson Med, 2013. (c) 2013 Wiley Periodicals, Inc.

OBJECTIVE: To compare the image quality of contrast-enhanced abdominopelvic 3D fat-suppressed T1-weighted gradient-echo imaging with radial and conventional Cartesian k-space acquisition schemes in paediatric patients. METHODS: Seventy-three consecutive paediatric patients were imaged at 1.5 T with sequential contrast-enhanced T1-weighted Cartesian (VIBE) and radial gradient echo (GRE) acquisition schemes with matching parameters when possible. Cartesian VIBE was acquired as a breath-hold or as free breathing in patients who could not suspend respiration, followed by free-breathing radial GRE in all patients. Two paediatric radiologists blinded to the acquisition schemes evaluated multiple parameters of image quality on a five-point scale, with higher score indicating a more optimal examination. Lesion presence or absence, conspicuity and edge sharpness were also evaluated. Mixed-model analysis of variance was performed to compare radial GRE and Cartesian VIBE. RESULTS: Radial GRE had significantly (all P < 0.001) higher scores for overall image quality, hepatic edge sharpness, hepatic vessel clarity and respiratory motion robustness than Cartesian VIBE. More lesions were detected on radial GRE by both readers than on Cartesian VIBE, with significantly higher scores for lesion conspicuity and edge sharpness (all P < 0.001). CONCLUSION: Radial GRE has better image quality and lesion conspicuity than conventional Cartesian VIBE in paediatric patients undergoing contrast-enhanced abdominopelvic MRI. KEY POINTS: * Numerous techniques are required to provide optimal MR images in paediatric patients. * Radial free-breathing contrast-enhanced acquisition demonstrated excellent image quality. * Image quality and lesion conspicuity were better with radial than Cartesian acquisition. * More lesions were detected on contrast-enhanced radial than on Cartesian acquisition. * Radial GRE can be used for performing abdominopelvic MRI in paediatric patients.