Surgery – Diagnostic testing – Detecting nuclear – electromagnetic – or ultrasonic radiation
Reexamination Certificate
2000-09-18
2003-04-29
Lateef, Marvin M. (Department: 3737)
Surgery
Diagnostic testing
Detecting nuclear, electromagnetic, or ultrasonic radiation
C600S410000, C600S419000, C324S306000, C324S307000, C324S309000
Reexamination Certificate
active
06556856
ABSTRACT:
BACKGROUND OF THE INVENTION
The field of the invention is magnetic resonance angiography (“MRA”), and particularly, studies of the human vasculature using contrast agents which enhance the NMR signals.
Diagnostic studies of the human vasculature have many medical applications. X-ray imaging methods such as digital subtraction angiography (“DSA”) have found wide use in the visualization of the cardiovascular system, including the heart and associated blood vessels. Images showing the circulation of blood in the arteries and veins of the kidneys and the carotid arteries and veins of the neck and head have immense diagnostic utility. Unfortunately, however, these x-ray methods subject the patient to potentially harmful ionizing radiation and often require the use of an invasive catheter to inject a contrast agent into the vasculature to be imaged.
One of the advantages of these x-ray techniques is that image data can be acquired at a high rate (i.e. high temporal resolution) so that a sequence of images may be acquired during injection of the contrast agent. Such “dynamic studies” enable one to select the image in which the bolus of contrast agent is flowing through the vasculature of interest. Earlier images in the sequence may not have sufficient contrast in the suspect vasculature, and later images may become difficult to interpret as the contrast agent reaches veins and diffuses into surrounding tissues. Subtractive methods such as that disclosed in U.S. Pat. No. 4,204,225 entitled “Real-Time Digital X-ray Subtraction Imaging” may be used to significantly enhance the diagnostic usefulness of such images.
Magnetic resonance angiography (MRA) uses the nuclear magnetic resonance (NMR) phenomenon to produce images of the human vasculature. When a substance such as human tissue is subjected to a uniform magnetic field (polarizing field B
0
), the individual magnetic moments of the spins in the tissue attempt to align with this polarizing field, but precess about it in random order at their characteristic Larmor frequency. If the substance, or tissue, is subjected to a magnetic field (excitation field B
1
) which is in the x-y plane and which is near the Larmor frequency, the net aligned moment, M
z
, may be rotated, or “tipped”, into the x-y plane to produce a net transverse magnetic moment M
t
. A signal is emitted by the excited spins, and after the excitation signal B
1
is terminated, this signal may be received and processed to form an image.
When utilizing these signals to produce images, magnetic field gradients (G
x
G
y
and G
z
) are employed. Typically, the region to be imaged is scanned by a sequence of measurement cycles in which these gradients vary according to the particular localization method being used. Each measurement is referred to in the art as a “view” and the number of views determines the resolution of the image. The resulting set of received NMR signals, or views, are digitized and processed to reconstruct the image using one of many well known reconstruction techniques. The total scan time is determined in part by the number of measurement cycles, or views, that are acquired for an image, and therefore, scan time can be reduced at the expense of image resolution by reducing the number of acquired views.
MR angiography (MRA) has been an active area of research. Two basic techniques have been proposed and evaluated. The first class, time-of-flight (TOF) techniques, consists of methods which use the motion of the blood relative to the surrounding tissue as a means for differentiating the NMR signal amplitude. The most common approach is to exploit the differences in signal saturation that exist between flowing blood and stationary tissue. Flowing blood, which is moving through the excited region, is continually refreshed by spins experiencing fewer RF excitation pulses and is, therefore, less saturated. The result is the desired image contrast between the high-signal blood and the low-signal stationary tissues.
MR methods have also been developed that encode motion into the phase of the acquired NMR signal as disclosed in U.S. Pat. No. Re. 32,701. These form the second class of MRA techniques, which are known as phase contrast (PC) methods. Currently, most PC MRA techniques acquire two images, with each image having a different sensitivity to the same spin motion. Angiographic images are then obtained by forming either the phase difference or complex difference between the pair of velocity-encoded images. Phase contrast MRA techniques have been extended so that they are sensitive to velocity components in all three orthogonal directions.
To enhance the diagnostic capability of MRA a contrast agent such as gadolinium can be injected into the patient prior to the MRA scan. As described in U.S. Pat. No. 5,417,213 the trick with this contrast enhanced (CE) MRA method is to acquire the central k-space views at the moment the bolus of contrast agent is flowing through the vasculature of interest. Collection of the central lines of k-space during peak arterial enhancement is key to the success of a CE-MRA exam. If the central lines of k-space are acquired prior to the arrival of contrast, severe image artifacts can limit the diagnostic information in the image. Alternatively, arterial images acquired after the passage of the peak arterial contrast are obscured by the enhancement of veins. In many anatomic regions, such as the carotid or renal arteries, the separation between arterial and venous enhancement can be as short as 6 seconds.
The short separation time between arterial and venous enhancement dictates the use of acquisition sequences of either low spatial resolution or very short repetition times (TR). Short TR acquisition sequences severely limit the signal-to-noise ratio (SNR) of the acquired images relative to those exams in which longer TRs are possible. The rapid acquisitions required by first pass CE-MRA methods thus impose an upper limit on either spatial or temporal resolution. An additional detrimental effect of rapid imaging of the first pass of the bolus of contrast is the spurious modulation of k-space data resulting from the shape of the bolus of contrast. Current CE-MRA exams are of immense clinical utility, but due to the temporal-spatial limitations, they still fall short of x-ray DSA, the current “gold standard”.
Ideally, angiograms should be acquired with techniques which allow longer scan times, after the first pass of the contrast bolus. For example, intravascular contrast agents can provide significant signal enhancement of the blood pool for over one hour. Images acquired after the first pass of the contrast agent in the so called “steady state” portion of the examination have the advantages of providing SNR and resolution increases limited only by patient motion. Even images acquired using currently available extravascular agents, which show only weak decay of plasma T
1
shortening, may be improved by longer acquisitions acquired after the first pass of the bolus. Steady-state images permit excellent vessel delineation, although venous enhancement can severely limit arterial visualization reprojection images.
Clearly, an acquisition method which combines the excellent arterial-venous separation seen in first pass CE-MRA with the high resolution, high SNR images acquired in the steady-state is desirable. One approach is to acquire an angiogram without regard for the venous enhancement, and then remove the venous signal as a post-processing step. These venous removal techniques, which are referred to as vessel “segmentation”, have been attempted by several researchers. Current methods of vessel segmentation, however, have proven to be of limited usefulness partially due to the difficulty in determining which voxels are artery and which are vein based solely on a spatial/geometric analysis of the vessels, or an analysis of their signal intensities.
SUMMARY OF THE INVENTION
The present invention is an improved CE-MRA method in which low spatial resolution NMR data is acquired at a high temporal frame rate during a time resolved phase
Block Walter
Carroll Timothy J.
Du Jiang
Grist Thomas M.
Mazahheri Yousef
Lateef Marvin M.
Lin Jeoyuh
Quarles & Brady LLP
Wisconsin Alumni Research Foundation
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