High-resolution 3D arteriography of chronic total peripheral occlusions using a T1-W turbo spin-echo sequence with inner-volume imaging

Percutaneous revascularization of peripheral artery chronic total occlusion (CTO) is challenging under X-ray guidance without direct image feedback, due to poor visualization of the obstructed segment and underappreciation of vessel tortuosity. Operators are required to steer interventional devices relatively "blindly," and therefore procedural failure or perforation may occur. Alternatively, MRI may allow complete visualization of both patent and occluded arterial segments. We designed and implemented a 3D high-resolution, T ₁-weighted (T₁-W) turbo spin-echo (TSE) MRI sequence with inner-volume (IV) imaging to enable detailed peripheral artery CTO imaging. Using this sequence, high-resolution volumes of interest (VOIs) around the vessel were achieved within 5-10 min. This imaging approach may be used for rapid pre- and postprocedural evaluations, and as a 3D roadmap that can be overlaid during real-time X-, MR-, or XMR-guided catheterization. Experiments were successfully performed on a carotid CTO model in swine ex vivo, and in peripheral arteries in normal volunteers and patients in vivo. Delineation of the vascular architecture, including contrast differences between the patent and occluded artery segments, and lesion morphology heterogeneity were visualized.