Noncontrast magnetic resonance angiography of the hand: Improved arterial conspicuity by multidirectional flow-sensitive dephasing magnetization preparation in 3D balanced steady-state free precession imaging

Purpose: To develop a flow-sensitive dephasing (FSD) preparative scheme to facilitate multidirectional flow-signal suppression in 3-dimensional balanced steady-state free precession imaging and to validate the feasibility of the refined sequence for noncontrast magnetic resonance angiography (NC-MRA) of the hand. Materials and methods: A new FSD preparative scheme was developed that combines 2 conventional FSD modules. Studies using a flow phantom (gadolinium-doped water 15 cm/s) and the hands of 11 healthy volunteers (6 males and 5 females) were performed to compare the proposed FSD scheme with its conventional counterpart with respect to the signal suppression of multidirectional flow. In 9 of the 11 healthy subjects and 2 patients with suspected vasculitis and documented Raynaud phenomenon, respectively, 3-dimensional balanced steady-state free precession imaging coupled with the new FSD scheme was compared with spatial-resolution-matched (0.94 × 0.94 × 0.94 mm) contrast-enhanced magnetic resonance angiography (0.15 mmol/kg gadopentetate dimeglumine) in terms of overall image quality, venous contamination, motion degradation, and arterial conspicuity. Results: The proposed FSD scheme was able to suppress 2-dimensional flow signal in the flow phantom and hands and yielded significantly higher arterial conspicuity scores than the conventional scheme did on NC-MRA at the regions of common digitals and proper digitals. Compared with contrast-enhanced magnetic resonance angiography, the refined NC-MRA technique yielded comparable overall image quality and motion degradation, significantly less venous contamination, and significantly higher arterial conspicuity score at digital arteries. Conclusion: The FSD-based NC-MRA technique is improved in the depiction of multidirectional flow by applying a 2-module FSD preparation, which enhances its potential to serve as an alternative magnetic resonance angiography technique for the assessment of hand vascular abnormalities.