European Radiology

, Volume 27, Issue 5, pp 2119–2128 | Cite as

3D-black-blood 3T-MRI for the diagnosis of thoracic large vessel vasculitis: A feasibility study

  • Karla Maria Treitl
  • Stefan Maurus
  • Nora Narvina Sommer
  • Hendrik Kooijman-Kurfuerst
  • Eva Coppenrath
  • Marcus Treitl
  • Michael Czihal
  • Ulrich Hoffmann
  • Claudia Dechant
  • Hendrik Schulze-Koops
  • Tobias Saam
Magnetic Resonance

Abstract

Objectives

To evaluate the feasibility of T1w-3D black-blood turbo spin echo (TSE) sequence with variable flip angles for the diagnosis of thoracic large vessel vasculitis (LVV).

Methods

Thirty-five patients with LVV, diagnosed according to the current standard of reference, and 35 controls were imaged at 3.0T using 1.2 × 1.3 × 2.0 mm3 fat-suppressed, T1w-3D, modified Volumetric Isotropic TSE Acquisition (mVISTA) pre- and post-contrast. Applying a navigator and peripheral pulse unit triggering (PPU), the total scan time was 10–12 min. Thoracic aorta and subclavian and pulmonary arteries were evaluated for image quality (IQ), flow artefact intensity, diagnostic confidence, concentric wall thickening and contrast enhancement (CWT, CCE) using a 4-point scale.

Results

IQ was good in all examinations (3.25 ± 0.72) and good to excellent in 342 of 408 evaluated segments (83.8 %), while 84.1 % showed no or minor flow artefacts. The interobserver reproducibility for the identification of CCE and CWT was 0.969 and 0.971 (p < 0.001) with an average diagnostic confidence of 3.47 ± 0.64. CCE and CWT were strongly correlated (Cohen’s k = 0.87; P < 0.001) and significantly more frequent in the LVV-group (52.8 % vs. 1.0 %; 59.8 % vs. 2.4 %; P < 0.001).

Conclusions

Navigated fat-suppressed T1w-3D black-blood MRI with PPU-triggering allows diagnosis of thoracic LVV.

Key Points

Cross-sectional imaging is frequently applied in the diagnosis of LVV.

Navigated, PPU-triggered, T1w-3D mVISTA pre- and post contrast takes 10–12 min.

In this prospective, single-centre study, T1w-3D mVISTA accurately depicted large thoracic vessels.

T1w-3D mVISTA visualized CWT/CCW as correlates of mural inflammation in LVV.

T1w-3D mVISTA might be an alternative diagnostic tool without ionizing radiation.

Keywords

Systemic vasculitis Magnetic resonance imaging Giant cell arteritis Takayasu arteritis Aortitis 

Abbreviations

2D

Two-dimensional

3D

Three-dimensional

ACR

American College of Rheumatology

BB

Black blood

CDUS

Colour duplex ultrasound

CCE

Concentric contrast enhancement

CWT

Concentric wall thickening

DCL

Diagnostic confidence level

ETL

Echo train length

FAI

Flow artefact intensity

FDG

[18F]fluorodeoxyglucose

LVV

Large vessel vasculitis

MRI

Magnetic resonance imaging

PET/CT

Positron emission tomography/computed tomography

T1w

T1-weighted

TAB

Temporal artery biopsy

TSE

Turbo spin-echo

mVISTA

Modified Volumetric ISotropic TSE Acquisition

Notes

Acknowledgments

The scientific guarantor of this publication is Prof. Dr. Tobias Saam. The authors of this manuscript declare relationships with the following companies: Dr. Hendrik Kooijman-Kurfuerst is a physicist, who works for Philips Healthcare. He modified the original VISTA sequence and so developed the mVISTA sequence.

The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported at the RSNA Meeting 2014 and at the ISMRM meeting 2015. Pdf-versions of the corresponding power-point presentations are attached as supplemental material. The RSNA-presentation reports about 14 patients and 14 controls of the entire study cohort. The ISMRM-presentation includes the entire study cohort of 70 subjects.

Methodology: prospective, case-control study, performed at one institution.

Supplementary material

330_2016_4525_MOESM1_ESM.pdf (3.4 mb)
ESM 1 (PDF 3449 kb)
330_2016_4525_MOESM2_ESM.pdf (3.7 mb)
ESM 2 (PDF 3832 kb)

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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Karla Maria Treitl
    • 1
    • 2
  • Stefan Maurus
    • 1
  • Nora Narvina Sommer
    • 1
  • Hendrik Kooijman-Kurfuerst
    • 3
  • Eva Coppenrath
    • 1
  • Marcus Treitl
    • 1
  • Michael Czihal
    • 4
  • Ulrich Hoffmann
    • 4
  • Claudia Dechant
    • 5
  • Hendrik Schulze-Koops
    • 5
  • Tobias Saam
    • 1
    • 2
  1. 1.Institute for Clinical Radiology, LMU MunichMunichGermany
  2. 2.German Center for Cardiovascular Disease Research (DZHK e. V.)MunichGermany
  3. 3.Philips HealthcareHamburgGermany
  4. 4.Division of Vascular Medicine, Medical Clinic and Policlinic IVLMU MunichMunichGermany
  5. 5.Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IVLMU MunichMunichGermany

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