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MR Imaging–Guided Vascular Procedures Using CO2 as a Contrast Agent

Frank K. Wacker1, Robbert M. Maes2, Jack A. Jesberger1, Sherif G. Nour1, Jeffrey L. Duerk1 and Jonathan S. Lewin1

1 Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106.
2 Department of Radiology, Gemini-Ziekenhuis, Huisduinerweg 3, 1782 GZ Den Helder, The Netherlands.



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  		Fig. 1. —Graph shows aortic signal-to-noise ratio versus time plot. Three epochs (baseline, CO2 passage, and signal recovery) could be identified.

 


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  		Fig. 2. —Graph shows pooled aortic signal-to-noise–ratio values for each epoch. During CO2 passage, signal-to-noise ratio was significantly less (p < 0.0005) than that of either baseline or recovery.

 


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  		Fig. 3A. —Continuously acquired MR images (TR/TE, 3.03/1.52; flip angle, 40°; 2 images/sec; matrix, 256 x 256; slice thickness, 6 mm) obtained in pig. Coronal oblique two-dimensional (2D) true fast imaging with steady-state free precession (true FISP) image shows abdominal aorta before CO2 injection through catheter located in suprarenal aorta.

 


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  		Fig. 3B. —Continuously acquired MR images (TR/TE, 3.03/1.52; flip angle, 40°; 2 images/sec; matrix, 256 x 256; slice thickness, 6 mm) obtained in pig. Coronal oblique 2D true FISP image shows abdominal aorta during CO2 injection. Image position is identical to that in A; both renal (solid arrow) and splenic (open arrow) arteries can be better appreciated during CO2 injection.

 


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  		Fig. 4B. —MR images (TR/TE, 3.03/1.52; flip angle, 40°; 2 images/sec; matrix, 256 x 256; slice thickness, 5 mm) obtained in pig. Coronal oblique 2D true FISP image obtained after catheter (arrow) insertion into right renal artery shows that position of renal artery changed and image plane had to be adjusted. Compared with A, intraarterial signal intensity is reduced after catheter insertion.

 


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  		Fig. 4A. —MR images (TR/TE, 3.03/1.52; flip angle, 40°; 2 images/sec; matrix, 256 x 256; slice thickness, 5 mm) obtained in pig. Coronal oblique two-dimensional (2D) true fast imaging with steady-state free precession (true FISP) image obtained before catheterization and contrast injection shows aorta, right renal, splenic, and mesenteric arteries.

 


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  		Fig. 4C. —MR images (TR/TE, 3.03/1.52; flip angle, 40°; 2 images/sec; matrix, 256 x 256; slice thickness, 5 mm) obtained in pig. Coronal oblique 2D true FISP image obtained during CO2 injection through catheter located in renal artery shows improved conspicuity of intrarenal arteries and facilitates assessment of vessel patency distal to catheter.

 

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