Question Archive
I thought almost everyone had learned how to do first-pass MRA with proper bolus timing, so why is this now a problem or at least an issue?
Actually, this is a more complicated issue than some 'opinion-leaders' would like us to believe. It is known that not all MR sites routinely perform contrast-enhanced MRA examinations in an optimal manner. Contrast-enhanced MRA is well-established mainly at academic centers which in general are more research-oriented with highly skilled MR scientists as part of the faculty, often collaborating closely with the original equipment manufacturers (OEMs). Furthermore, those radiologists are frequently involved in the actual MRA procedure regarding issues such as imaging parameters and bolus timing in addition to providing significant assistance to the MR technologists from a clinical point of view.
Although the larger teaching hospitals do contribute significantly to the overall advancement of new MRI techniques and procedures, the majority of potential users are the non-academic MR sites. These centers are currently to a large extent avoiding complicated MRI examinations, like MRA of multiple vascular regions because the failure rate is too high – resulting in studies with inferior, non-reproducible and even non-diagnostic quality. Also, for many of these centers, capital investments like hard- and software only adds to the overall operational costs. Consequently, for the largest segment of MR users, blood pool agents will represent a welcomed improvement in terms of robustness and ease-of-use.
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