• Petrice M Cogswell, Jeroen C W Siero, Sarah K Lants, Spencer Waddle, L Taylor Davis, Guillaume Gilbert, Jeroen Hendrikse, and Manus J Donahue.
• Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
• J Magn Reson Imaging. 2018 Oct 1; 48 (4): 1120-1128.

BackgroundFlow suppression techniques have been developed for intracranial (IC) vessel wall imaging (VWI) and optimized using simulations; however, simulation results may not translate in vivo.PurposeTo evaluate experimentally how IC vessel wall and lumen measurements change in identical subjects when evaluated using the most commonly available blood and cerebrospinal fluid (CSF) flow suppression modules and VWI sequences.Study TypeProspective.Population/SubjectsHealthy adults (n = 13; age = 37 ± 15 years) were enrolled.Field Strength/SequenceA 3.0T 3D T1 /proton density (PD)-weighted turbo-spin-echo (TSE) acquisition with post-readout anti-driven equilibrium module, with and without Delay-Alternating-with-Nutation-for-Tailored-Excitation (DANTE) was applied. DANTE flip angle (8-12°) and TSE refocusing angle (sweep = 40-120° or 50-120°) were varied.AssessmentBasilar artery and internal carotid artery (ICA) wall thicknesses, CSF signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and signal ratio (SR) were assessed. Measurements were made by two readers (radiology resident and board-certified neuroradiologist).Statistical TestsA Wilcoxon signed-rank test was applied with corrected two-sided P < 0.05 required for significance (critical P = 0.008, 0.005, and 0.05 for SNR/CNR, SR, and wall thickness, respectively).ResultsA TSE pulse sweep = 40-120° and sweep = 50-120° provided similar (P = 0.55) CSF suppression. Addition of the DANTE preparation reduced CSF SNR from 17.4 to 6.7, thereby providing significant (P < 0.008) improvement in CSF suppression. The DANTE preparation also resulted in a significant (P < 0.008) reduction in vessel wall SNR, but variable vessel wall to CSF CNR improvement (P = 0.87). There was a trend for a difference in blood SNR with vs. without DANTE (P = 0.05). The outer vessel wall diameter and wall thickness values were lower (P < 0.05) with (basilar artery 4.45 mm, 0.81 mm, respectively) vs. without (basilar artery 4.88 mm, 0.97 mm, respectively) DANTE 8°.Data ConclusionIC VWI with TSE sweep = 40-120° and with DANTE flip angle = 8° provides the best CSF suppression and CNR of the approaches evaluated. However, improvements are heterogeneous, likely owing to intersubject vessel pulsatility and CSF flow variations, which can lead to variable flow suppression efficacy in these velocity-dependent modules.Level Of Evidence2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:1120-1128.© 2018 International Society for Magnetic Resonance in Medicine.

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