A desirable advancement but not without concern for black blood sequences: vessel wall imaging may not be blindly done

Authors

Subhendra N. Sarkar, CUNY New York City College of TechnologyFollow

Document Type

Article

Publication Date

1-29-2024

Abstract

Time of flight (TOF) gradient echo magnetic resonance angiography (MRA) is a bright lumen method that is supposed to be simpler but is not free of challenges. Post-treatment, tricky geometry, Gd build up and high fields pose challenges and practice variation making some special applications of even the well-developed bright blood method questionable in treated AVMs as discussed in a prior editorial (Sarkar Eur Rad, 2023). In this editorial another, perhaps more important (pseudo-steady state for black blood angiography) is discussed. It has been agreed upon that assessment of vessel wall integrity, particularly plaques and other arterial wall diseases is best done with dark arterial lumen and bright wall visualization. To meet that goal 3D FSE T1-based imaging is possible within clinically tolerable scan times by generating long lasting echoes (pseudo steady state) with sub-millimeter resolution. The 3D FSE T1 approach is relatively recent, more complex than 3D FSE T2 and is less understood. There are many variants also, and the best ones apply excessive demands on hardware and software and drain SNR and CNR of the target pathologies. The lengthening of relaxation times was shown by author (Appl Spectrosc, 1991 and Radiology, 2011) as well as by Alsop (MRM, 1997) and a few others that essentially have built the basis of pseudosteady state MRI getting popular today. In this editorial caution is advised since variability continues in such assessments of carotid plaques and similar vessel wall applications. Hence a blind trust in 3D FSE T1-MRI to achieve black blood angiography with bright wall pathologies could prove to be a pre-matured victory lap.

Comments

This is the author's accepted manuscript of an article originally published in European Radiology, available at https://doi.org/10.1007/s00330-024-10608-8