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Human Peripheral Arteries: Feasibility of Transvenous Intravascular MR Imaging of the Arterial Wall¹

¹ From the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Blalock 545, 600 N Wolfe St, Baltimore, MD 21287. Received February 20, 2004; revision requested April 29; revision received July 22; accepted August 19. Address correspondence to L.V.H. (e-mail: lhofmann@jhmi.edu).

View larger version (143K): [in a new window]   Figure 1. Patient 2. Transverse double inversion-recovery fast spin-echo T2-weighted MR image (1600/50) of left common iliac artery and vein in 63-year-old black man shows signal intensity measurement of arterial wall with transvenous MR imaging at four consistent locations, similar to points on the face of a clock, and demonstrates diffuse arterial wall thickening. To determine locations, a line was drawn to connect the following three points: a point at the guidewire (arrowhead), a point on the arterial wall closest (12) to the guidewire, and a point on the arterial wall farthest (6) from the guidewire. A second line was drawn perpendicular to the first line; the two points where it intersected the arterial wall are labeled 3 and 9. Signal intensity and standard deviations were measured at each numbered location.

View larger version (138K): [in a new window]   Figure 2a. Patient 4. Transverse MR images of right common iliac artery with guidewire (black arrowhead) in right common iliac vein in 56-year-old white man. The guidewire is the only receiver coil used in transvenous MR images. Changes in lumen (white arrow) were observed on each image. (a) Precontrast transvenous fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) shows diffuse thickening of arterial wall (black arrow) and only minimal decrease in lumen diameter. (b) Transvenous double inversion-recovery fast spin-echo T2-weighted MR image (1600/50) demonstrates a focal plaque on anterior wall with low-signal- intensity core (white arrowhead, also in c) and thin fibrous cap (black arrow, also in c). With this pulse sequence, the lumen was more narrowed than was observed on precontrast T1-weighted MR image in a. (c) Postcontrast transvenous fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) demonstrates circumferential wall enhancement. A focal plaque on the anterior wall with low-signal-intensity core and thin enhancing fibrous cap were seen. Moderate narrowing of lumen is similar to that on T2-weighted image in b. (d) Summation image of all three images obtained with surface coil and same imaging parameters was acquired at same time as c. Common iliac arterial wall was not well visualized, and a faint outline of the arterial lumen was observed. Circumferential wall enhancement of common iliac vein was observed.

View larger version (141K): [in a new window]   Figure 2b. Patient 4. Transverse MR images of right common iliac artery with guidewire (black arrowhead) in right common iliac vein in 56-year-old white man. The guidewire is the only receiver coil used in transvenous MR images. Changes in lumen (white arrow) were observed on each image. (a) Precontrast transvenous fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) shows diffuse thickening of arterial wall (black arrow) and only minimal decrease in lumen diameter. (b) Transvenous double inversion-recovery fast spin-echo T2-weighted MR image (1600/50) demonstrates a focal plaque on anterior wall with low-signal- intensity core (white arrowhead, also in c) and thin fibrous cap (black arrow, also in c). With this pulse sequence, the lumen was more narrowed than was observed on precontrast T1-weighted MR image in a. (c) Postcontrast transvenous fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) demonstrates circumferential wall enhancement. A focal plaque on the anterior wall with low-signal-intensity core and thin enhancing fibrous cap were seen. Moderate narrowing of lumen is similar to that on T2-weighted image in b. (d) Summation image of all three images obtained with surface coil and same imaging parameters was acquired at same time as c. Common iliac arterial wall was not well visualized, and a faint outline of the arterial lumen was observed. Circumferential wall enhancement of common iliac vein was observed.

View larger version (112K): [in a new window]   Figure 2c. Patient 4. Transverse MR images of right common iliac artery with guidewire (black arrowhead) in right common iliac vein in 56-year-old white man. The guidewire is the only receiver coil used in transvenous MR images. Changes in lumen (white arrow) were observed on each image. (a) Precontrast transvenous fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) shows diffuse thickening of arterial wall (black arrow) and only minimal decrease in lumen diameter. (b) Transvenous double inversion-recovery fast spin-echo T2-weighted MR image (1600/50) demonstrates a focal plaque on anterior wall with low-signal- intensity core (white arrowhead, also in c) and thin fibrous cap (black arrow, also in c). With this pulse sequence, the lumen was more narrowed than was observed on precontrast T1-weighted MR image in a. (c) Postcontrast transvenous fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) demonstrates circumferential wall enhancement. A focal plaque on the anterior wall with low-signal-intensity core and thin enhancing fibrous cap were seen. Moderate narrowing of lumen is similar to that on T2-weighted image in b. (d) Summation image of all three images obtained with surface coil and same imaging parameters was acquired at same time as c. Common iliac arterial wall was not well visualized, and a faint outline of the arterial lumen was observed. Circumferential wall enhancement of common iliac vein was observed.

View larger version (162K): [in a new window]   Figure 2d. Patient 4. Transverse MR images of right common iliac artery with guidewire (black arrowhead) in right common iliac vein in 56-year-old white man. The guidewire is the only receiver coil used in transvenous MR images. Changes in lumen (white arrow) were observed on each image. (a) Precontrast transvenous fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) shows diffuse thickening of arterial wall (black arrow) and only minimal decrease in lumen diameter. (b) Transvenous double inversion-recovery fast spin-echo T2-weighted MR image (1600/50) demonstrates a focal plaque on anterior wall with low-signal- intensity core (white arrowhead, also in c) and thin fibrous cap (black arrow, also in c). With this pulse sequence, the lumen was more narrowed than was observed on precontrast T1-weighted MR image in a. (c) Postcontrast transvenous fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) demonstrates circumferential wall enhancement. A focal plaque on the anterior wall with low-signal-intensity core and thin enhancing fibrous cap were seen. Moderate narrowing of lumen is similar to that on T2-weighted image in b. (d) Summation image of all three images obtained with surface coil and same imaging parameters was acquired at same time as c. Common iliac arterial wall was not well visualized, and a faint outline of the arterial lumen was observed. Circumferential wall enhancement of common iliac vein was observed.

View larger version (123K): [in a new window]   Figure 3a. Patient 6. Right renal artery in-stent restenosis in 79-year-old white woman. (a) Posteroanterior spot radiograph of guidewire (thick arrow) placed through a reversed-curve catheter (arrowhead) is within left renal vein. Platinum stent (thin arrow) is in the left renal artery. (b) Posteroanterior selective digital angiogram of left renal artery shows narrowing (arrowheads) of vessel lumen within stent. (c) Precontrast transvenous transverse fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) of right renal artery (thick white arrow) demonstrates narrowing of vessel lumen from neointima (small arrowhead). Stent struts (thin white arrow) produce minimal susceptibility artifact. Guidewire (large arrowhead) is in left renal vein (black arrow). (d) Transverse transvenous double inversion-recovery fast spin-echo T2-weighted MR image (1600/50) of right renal artery depicts arterial wall (thick white arrow) and neointima (small arrowhead). Stent struts (thin white arrow) are not easily observed. Guidewire (large arrowhead) is within left renal vein (black arrow).

View larger version (127K): [in a new window]   Figure 3b. Patient 6. Right renal artery in-stent restenosis in 79-year-old white woman. (a) Posteroanterior spot radiograph of guidewire (thick arrow) placed through a reversed-curve catheter (arrowhead) is within left renal vein. Platinum stent (thin arrow) is in the left renal artery. (b) Posteroanterior selective digital angiogram of left renal artery shows narrowing (arrowheads) of vessel lumen within stent. (c) Precontrast transvenous transverse fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) of right renal artery (thick white arrow) demonstrates narrowing of vessel lumen from neointima (small arrowhead). Stent struts (thin white arrow) produce minimal susceptibility artifact. Guidewire (large arrowhead) is in left renal vein (black arrow). (d) Transverse transvenous double inversion-recovery fast spin-echo T2-weighted MR image (1600/50) of right renal artery depicts arterial wall (thick white arrow) and neointima (small arrowhead). Stent struts (thin white arrow) are not easily observed. Guidewire (large arrowhead) is within left renal vein (black arrow).

View larger version (142K): [in a new window]   Figure 3c. Patient 6. Right renal artery in-stent restenosis in 79-year-old white woman. (a) Posteroanterior spot radiograph of guidewire (thick arrow) placed through a reversed-curve catheter (arrowhead) is within left renal vein. Platinum stent (thin arrow) is in the left renal artery. (b) Posteroanterior selective digital angiogram of left renal artery shows narrowing (arrowheads) of vessel lumen within stent. (c) Precontrast transvenous transverse fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) of right renal artery (thick white arrow) demonstrates narrowing of vessel lumen from neointima (small arrowhead). Stent struts (thin white arrow) produce minimal susceptibility artifact. Guidewire (large arrowhead) is in left renal vein (black arrow). (d) Transverse transvenous double inversion-recovery fast spin-echo T2-weighted MR image (1600/50) of right renal artery depicts arterial wall (thick white arrow) and neointima (small arrowhead). Stent struts (thin white arrow) are not easily observed. Guidewire (large arrowhead) is within left renal vein (black arrow).

View larger version (122K): [in a new window]   Figure 3d. Patient 6. Right renal artery in-stent restenosis in 79-year-old white woman. (a) Posteroanterior spot radiograph of guidewire (thick arrow) placed through a reversed-curve catheter (arrowhead) is within left renal vein. Platinum stent (thin arrow) is in the left renal artery. (b) Posteroanterior selective digital angiogram of left renal artery shows narrowing (arrowheads) of vessel lumen within stent. (c) Precontrast transvenous transverse fat-saturated double inversion-recovery fast spin-echo T1-weighted MR image (800/12) of right renal artery (thick white arrow) demonstrates narrowing of vessel lumen from neointima (small arrowhead). Stent struts (thin white arrow) produce minimal susceptibility artifact. Guidewire (large arrowhead) is in left renal vein (black arrow). (d) Transverse transvenous double inversion-recovery fast spin-echo T2-weighted MR image (1600/50) of right renal artery depicts arterial wall (thick white arrow) and neointima (small arrowhead). Stent struts (thin white arrow) are not easily observed. Guidewire (large arrowhead) is within left renal vein (black arrow).