RESUMEN
PURPOSE: To evaluate the feasibility and accuracy of a combined magnetic resonance angiography (MRA) - magnetic resonance venography (MRV) protocol using contrast agents with blood pool properties, gadofosveset trisodium and gadobenate dimeglumine, in the evaluation of pulmonary embolus (PE) and deep venous thrombosis (DVT) as compared to the standard clinical reference imaging modalities; computed tomography pulmonary angiography (CTPA) and color-coded Duplex ultrasound (DUS). MATERIALS AND METHODS: This prospective clinical study recruited patients presenting to the emergency department with clinical suspicion for PE and scheduled for a clinically indicated CTPA. We performed both MRA of the chest for the evaluation of PE as well as MRV of the pelvis and thighs to evaluate for DVT using a single contrast injection. MRA-MRV data was compared to the clinical reference standard CTPA and DUS, respectively. RESULTS: A total of 40 patients were recruited. The results on a per-patient basis comparing MRA to CTPA for pulmonary embolus yielded 100% sensitivity and 97% specificity. There was a small subset of patients that underwent clinical DUS to evaluate for DVT, which demonstrated a sensitivity and specificity of 100% for MRV. CONCLUSIONS: This single-center, preliminary study using contrast agents with blood pool properties to perform a relatively rapid combined MRA-MRV exam to image for PE and above knee DVT shows potential as an alternative imaging choice to CTPA. Further large-scale, multicentre studies are warranted.
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Embolia Pulmonar/diagnóstico , Trombosis de la Vena/diagnóstico , Adulto , Angiografía por Tomografía Computarizada/métodos , Medios de Contraste , Estudios de Factibilidad , Femenino , Gadolinio , Humanos , Angiografía por Resonancia Magnética/métodos , Masculino , Meglumina/análogos & derivados , Persona de Mediana Edad , Compuestos Organometálicos , Pelvis , Flebografía/métodos , Estudios Prospectivos , Exposición a la Radiación/prevención & control , Sensibilidad y Especificidad , TóraxRESUMEN
PURPOSE: To compare gadoxetic acid alone and combined gadoxetic acid/gadofosveset trisodium-enhanced liver MRI for detection of metastases and differentiation of metastases from haemangiomas. METHODS: Ninety-one patients underwent gadoxetic acid-enhanced liver MRI before and after additional injection of gadofosveset. First, two readers retrospectively identified metastases on gadoxetic acid alone enhanced delayed hepatobiliary phase T1-weighted images together with all other MR images (dynamic images, T2-weighted images, diffusion-weighted images). Second, readers assessed additional T1-weighted images obtained after administration of gadofosveset trisodium. For both interpretations, readers rated lesion conspicuity and confidence in differentiating metastases from haemangiomas. Results were compared using alternative free-response receiver-operating characteristic (AFROC) and conventional ROC methods. Histology and follow-up served as reference standard. RESULTS: There were 145 metastases and 16 haemangiomas. Both readers detected more metastases using combined gadoxetic acid/gadofosveset (reader 1 = 130; reader 2 = 124) compared to gadoxetic acid alone (reader 1 = 104; reader 2 = 103). Sensitivity of combined gadoxetic acid/gadofosveset (reader 1 = 90 %; reader 2 = 86 %) was higher than that of gadoxetic acid alone (reader 1 = 72 %; reader 2 = 71 %, both P < 0.01). AFROC-AUC was higher for the combined technique (0.92 vs. 0.86, P < 0.001). Sensitivity for correct differentiation of metastases from haemangiomas was higher for the combined technique (reader 1 = 98 %; reader 2 = 99 % vs. reader 1 = 86 %; reader 2 = 91 %, both P < 0.01). ROC-AUC was significantly higher for the combined technique (reader 1 = 1.00; reader 2 = 1.00 vs. reader 1 = 0.87; reader 2 = 0.92, both P < 0.01). CONCLUSION: Combined gadoxetic acid/gadofosveset-enhanced MRI improves detection and characterization of liver metastases compared to gadoxetic acid alone. KEY POINTS: ⢠Combined gadoxetic acid and gadofosveset-enhanced liver MRI significantly improves detection of metastases. ⢠The combined enhancement technique improves the accuracy to differentiate metastases from haemangiomas. ⢠Prospective studies need to determine the clinical impact of the combined technique.
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Gadolinio DTPA/farmacología , Gadolinio/farmacología , Neoplasias Hepáticas/diagnóstico , Imagen por Resonancia Magnética/métodos , Compuestos Organometálicos/farmacología , Medios de Contraste/farmacología , Femenino , Humanos , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Estudios RetrospectivosRESUMEN
BACKGROUND: Improved delineation of vascular structures is a common indication for cardiovascular magnetic resonance (CMR) in children and requires high spatial resolution. Currently, pre-contrast 3D, respiratory navigated, T2-prepared, fat saturated imaging with a bSSFP readout (3D bSSFP) is commonly used; however, these images can be limited by blood pool inhomogeneity and exaggeration of metal artifact. We compared image quality of pediatric vasculature obtained using standard 3D bSSFP to 3D, respiratory navigated, inversion recovery prepared imaging with a gradient echo readout (3D IR GRE) performed after administration of gadofosveset trisodium (GT), a blood pool contrast agent. METHODS: For both sequences, VCG triggering was used with acquisition during a quiescent period of the cardiac cycle. 3D bSSFP imaging was performed pre-contrast, and 3D IR GRE imaging was performed 5 min after GT administration. We devised a vascular imaging quality score (VIQS) with subscores for coronary arteries, pulmonary arteries and veins, blood pool homogeneity, and metal artifact. Scoring was performed on axial reconstructions of isotropic datasets by two independent readers and differences were adjudicated. Signal- and contrast-to-noise (SNR and CNR) calculations were performed on each dataset. RESULTS: Thirty-five patients had both 3D bSSFP and 3D IR GRE imaging performed. 3D IR GRE imaging showed improved overall vascular imaging compared to 3D bSSFP when comparing all-patient VIQS scores (n = 35, median 14 (IQR 11-15), vs 6 (4-10), p < 0.0001), and when analyzing the subset of patients with intrathoracic metal (n = 17, 16 (14-17) vs. 5 (2-9), p < 0.0001). 3D IR GRE showed significantly improved VIQS subscores for imaging the RCA, pulmonary arteries, pulmonary veins, and blood pool homogeneity. In addition, 3D IR GRE imaging showed reduced variability in both all-patient and metal VIQS scores compared to 3D bSSFP (p < 0.05). SNR and CNR were higher with 3D IR GRE in the left ventricle and left atrium, but not the pulmonary arteries. CONCLUSIONS: Respiratory navigated 3D IR GRE imaging after GT administration provides improved vascular CMR in pediatric patients compared to pre-contrast 3D bSSFP imaging, as well as improved imaging in patients with intrathoracic metal. It is an excellent alternative in this challenging patient population when high spatial resolution vascular imaging is needed.
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Medios de Contraste/administración & dosificación , Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Gadolinio/administración & dosificación , Cardiopatías Congénitas/diagnóstico por imagen , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Angiografía por Resonancia Magnética/métodos , Compuestos Organometálicos/administración & dosificación , Arteria Pulmonar/diagnóstico por imagen , Venas Pulmonares/diagnóstico por imagen , Mecánica Respiratoria , Adolescente , Factores de Edad , Artefactos , Niño , Preescolar , Femenino , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Masculino , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Three tesla (3T) coronary magnetic resonance angiography (MRA) may be optimized using gadolinium-based contrast agents (GBCA) such as gadofosveset trisodium. The goal of this study was to evaluate if there is a qualitative or quantitative improvement in the coronary arteries with variation in contrast dose. METHODS: Twenty-eight healthy volunteers were prospectively recruited for coronary MRA at 3T using a steady state injection technique for 3D radial whole-heart image acquisition with retrospective respiratory self-gating (ClinicalTrials.gov identifier: NCT01853592). Nineteen volunteers completed both single- and double-dose imaging instances (0.03 and 0.06 mmol/kg, respectively). Intra-individual comparison of image quality was assessed by measurement of apparent signal/contrast-to-noise ratio (aSNR/aCNR) and subjective evaluation of image quality by 2 independent reviewers. RESULTS: The average duration of coronary MRA acquisition was 7.2 ± 1.2 min. There was significantly higher (60 %, p < 0.001) aSNR of the aorta and right/left ventricle for the double dose compared to single dose injection scheme and aSNR of the coronary arteries increased by 70 % (p < 0.001) for the double dose injection. aCNR increased by +55 % and +60 % in the ventricles and coronary arteries, respectively (p < 0.001). Overall segmental artery visualization for single dose was possible 47 % of the time, which improved to 60 % with double dose (p = 0.019), predominantly driven by improvements in more distal segment visualization (+40 % improvement in mid arterial segments, p = 0.013). CONCLUSIONS: Gadofosveset trisodium dose of 0.06 mmol/kg significantly quantitatively and qualitatively improves the coronary artery image quality compared to 0.03 mmol/kg at 3T for moderate duration (6-8 min) steady state contrast enhanced coronary MRA.
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Medios de Contraste/administración & dosificación , Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Gadolinio/administración & dosificación , Angiografía por Resonancia Magnética/métodos , Compuestos Organometálicos/administración & dosificación , Adulto , Medios de Contraste/efectos adversos , Femenino , Gadolinio/efectos adversos , Voluntarios Sanos , Humanos , Interpretación de Imagen Asistida por Computador , Masculino , Compuestos Organometálicos/efectos adversos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Relación Señal-Ruido , Factores de Tiempo , Adulto JovenRESUMEN
The purpose of this study was to compare contrast and image quality of whole-body equilibrium-phase high-spatial-resolution MR angiography using a non-protein-binding unspecific extracellular gadolinium-based contrast medium with that of two contrast media with different protein-binding properties. 45 patients were examined using either 15 mL of gadobutrol (non-protein-binding, n = 15), 32 mL of gadobenate dimeglumine (weakly protein binding, n = 15) or 11 mL gadofosveset trisodium (protein binding, n = 15) followed by equilibrium-phase high-spatial-resolution MR-angiography of four consecutive anatomic regions. The time elapsed between the contrast injection and the beginning of the equilibrium-phase image acquisition in the respective region was measured and was up to 21 min. Signal intensity was measured in two vessels per region and in muscle tissue. Relative contrast (RC) values were calculated. Vessel contrast, artifacts and image quality were rated by two radiologists in consensus on a five-point scale. Compared with gadobutrol, gadofosveset trisodium revealed significantly higher RC values only when acquired later than 15 min after bolus injection. Otherwise, no significant differences between the three contrast media were found regarding vascular contrast and image quality. Equilibrium-phase high-spatial-resolution MR-angiography using a weakly protein-binding or even non-protein-binding contrast medium is equivalent to using a stronger protein-binding contrast medium when image acquisition is within the first 15 min after contrast injection, and allows depiction of the vasculature with high contrast and image quality. The protein-binding contrast medium was superior for imaging only later than 15 min after contrast medium injection.
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Medios de Contraste/administración & dosificación , Gadolinio/administración & dosificación , Aumento de la Imagen/métodos , Angiografía por Resonancia Magnética , Adulto , Anciano , Vasos Sanguíneos/ultraestructura , Medios de Contraste/química , Femenino , Gadolinio/química , Humanos , Masculino , Persona de Mediana Edad , Compuestos Organometálicos/administración & dosificación , Compuestos Organometálicos/químicaRESUMEN
PURPOSE: Demonstration of feasibility and protocol optimization for the combined use of gadofosveset trisodium with gadoxetic acid for delayed T1-weighted liver MRI. METHODS: Eleven healthy volunteers underwent hepatobiliary phase imaging at 3 Tesla (T) using gadoxetic acid. Multiple breathheld T1-weighted three-dimensional spoiled gradient echo sequences were performed at varying flip angles before and after injection of gadofosveset. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured to determine optimal T1-weighting. Examples of three patients with focal liver lesions were acquired. RESULTS: The addition of gadofosveset to the hepatobiliary phase of gadoxetic acid renders vessels isointense to liver tissue at low flip angles due to increased vessel SNR (P < 0.001). The lowest CNR of liver relative to portal vein (CNR = 15; 95% confidence interval [CI]: -14-44) was observed at a 10º flip angle. The highest CNR of liver relative to muscle (CNR = 214; 95% CI: 191-237) was observed at a 20º flip angle. The combined enhancement leads to homogenously enhanced liver tissue and liver vasculature. Cysts were detected in three volunteers and metastases were detected in two patients. In these anecdotal cases the cysts and metastases stood out as conspicuous focal hypointensities on combined gadoxetic acid and gadofosveset enhanced images. CONCLUSION: Combined gadoxetic acid and gadofosveset enhanced liver MRI is feasible, with low flip angles minimizing contrast between vessels and liver. Further clinical studies are needed to confirm that low flip angles provide an optimal combination of sensitivity and specificity for lesion detection in patients.
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Gadolinio DTPA/administración & dosificación , Gadolinio/administración & dosificación , Aumento de la Imagen/métodos , Neoplasias Hepáticas/patología , Hígado/patología , Imagen por Resonancia Magnética/métodos , Compuestos Organometálicos/administración & dosificación , Adulto , Medios de Contraste/administración & dosificación , Combinación de Medicamentos , Sinergismo Farmacológico , Estudios de Factibilidad , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
OBJECTIVES: To intraindividually compare gadoxetate disodium and gadofosveset trisodium regarding vessel contrast, image quality and vessel delineation in dynamic contrast-enhanced liver MRI at 3.0T. METHODS: Twelve patients underwent 3.0T MRI twice (24 examinations) with a single dose of gadoxetate disodium and gadofosveset trisodium, respectively. Signal intensity in abdominal vessels and tissue was determined. Vessel-to-background ratio (VBR) was calculated for each vessel and dynamic phase. All images were evaluated by two radiologists regarding image quality, vessel delineation and anatomic variants or pathologies with digital subtraction angiography as the standard of reference. RESULTS: Gadofosveset trisodium demonstrated a significantly higher VBR compared to gadoxetate disodium (arterial phase: 0.57±0.12 [SD] vs. 0.46±0.19; portal venous phase: 0.51±0.11 vs. 0.37±0.14; equilibrium phase: 0.48±0.10 vs. 0.31±0.13; p≤0.01). Image quality and vessel delineation were rated equal or better for gadofosveset trisodium in all cases. These differences were not significant for most vessel segments. All anatomic variants were correctly identified by both readers for both contrast agents. CONCLUSIONS: Although gadofosveset trisodium provides a significantly higher vessel contrast at 3.0T, gadoxetate disodium is equivalent by qualitative measurements. Thus, gadoxetate-enhanced liver MRI at 3.0T enables reliable assessment of the upper abdominal vasculature with the additional benefit of hepatobiliary imaging.
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Medios de Contraste , Gadolinio DTPA , Gadolinio , Aumento de la Imagen , Hígado/irrigación sanguínea , Imagen por Resonancia Magnética , Compuestos Organometálicos , Anciano , Angiografía de Substracción Digital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Despite the beneficial effects of vascular interventions, these procedures may damage the endothelium leading to increased vascular permeability and remodeling. Re-endothelialization of the vessel wall, with functionally and structurally intact cells, is controlled by endothelial nitric oxide synthase (NOS3) and is crucial for attenuating adverse effects after injury. We investigated the applicability of the albumin-binding MR contrast agent, gadofosveset, to noninvasively monitor focal changes in vascular permeability and remodeling, after injury, in NOS3-knockout (NOS3(-/-)) and wild-type (WT) mice in vivo. METHODS AND RESULTS: WT and NOS3(-/-) mice were imaged at 7, 15, and 30 days after aortic denudation or sham-surgery. T1 mapping (R1=1/T1, s(-1)) and delayed-enhanced MRI were used as measurements of vascular permeability (R1) and remodeling (vessel wall enhancement, mm(2)) after gadofosveset injection, respectively. Denudation resulted in higher vascular permeability and vessel wall enhancement 7 days after injury in both strains compared with sham-operated animals. However, impaired re-endothelialization and increased neovascularization in NOS3(-/-) mice resulted in significantly higher R1 at 15 and 30 days post injury compared with WT mice that showed re-endothelialization and lack of neovascularization (R1 [s(-1)]=15 days: NOS3 (-/-)4.02 [interquartile range, IQR, 3.77-4.41] versus WT2.39 [IQR, 2.35-2.92]; 30 days: NOS3 (-/-)4.23 [IQR, 3.94-4.68] versus WT2.64 [IQR, 2.33-2.80]). Similarly, vessel wall enhancement was higher in NOS3(-/-) but recovered in WT mice (area [mm(2)]=15 days: NOS3 (-/-)5.20 [IQR, 4.68-6.80] versus WT2.13 [IQR, 0.97-3.31]; 30 days: NOS3 (-/-)7.35 [IQR, 5.66-8.61] versus WT1.60 [IQR, 1.40-3.18]). Ex vivo histological studies corroborated the MRI findings. CONCLUSIONS: We demonstrate that increased vascular permeability and remodeling, after injury, can be assessed noninvasively using an albumin-binding MR contrast agent and may be used as surrogate markers for evaluating the healing response of the vessel wall after injury.
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Permeabilidad Capilar , Medios de Contraste , Endotelio Vascular/lesiones , Gadolinio , Angiografía por Resonancia Magnética , Compuestos Organometálicos , Remodelación Vascular , Animales , Permeabilidad Capilar/fisiología , Endotelio Vascular/metabolismo , Humanos , Inmunohistoquímica , Ratones , Ratones Endogámicos , Ratones Noqueados , Modelos Animales , Óxido Nítrico Sintasa de Tipo III , Remodelación Vascular/fisiología , Vasodilatación/fisiologíaRESUMEN
RATIONALE AND OBJECTIVES: To determine if intraprostatic injection of gadofosveset trisodium mixed with human serum albumin (HSA) can identify sentinel lymph nodes (LNs) draining the prostate on magnetic resonance imaging (MRI) in a canine model. MATERIALS AND METHODS: Three male canines weighing between 25.7 and 41.3 kg were anesthetized, placed in a 3-T MRI, and a needle was placed transrectally into one side of the prostate using a commercially available intrarectal needle guide. Gadofosveset trisodium premixed with 10% HSA was then administered at doses ranging from 0.1 to 2.5 mL. T1W MRI was performed immediately after injection, and two readers evaluated images for visualization of LNs draining the prostate. RESULTS: Intraprostatic injection of 0.2 mL gadofosveset trisodium premixed with HSA identified the draining periprostatic LNs in all cases. Delayed images demonstrated upper echelon nodes in the pelvis and the abdomen. Higher volume injections resulted in excessive periprostatic extravasation, whereas lower volume injections resulted in suboptimal visualization of LNs. CONCLUSIONS: We demonstrate that gadofosveset trisodium (premixed with 10% HSA) injected intraprostatically at 0.2 mL visualized LNs draining the prostate. This approach can be readily adapted for clinical applications such as sentinel LN imaging in prostate cancer patients before surgery.
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Medios de Contraste/administración & dosificación , Gadolinio/administración & dosificación , Metástasis Linfática/patología , Imagen por Resonancia Magnética/métodos , Compuestos Organometálicos/administración & dosificación , Próstata/patología , Animales , Modelos Animales de Enfermedad , Perros , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Albúmina Sérica/administración & dosificaciónRESUMEN
PURPOSE: To evaluate appropriate injection protocols for gadofosveset at 1.5 and 3 T magnetic resonance imaging (MRI) for semiquantitative myocardial perfusion analysis. MATERIALS AND METHODS: Eighteen young healthy volunteers were subjected to first-pass perfusion cardiac scans at 1.5 and 3 T MRI using three different injection protocols for gadofosveset (0.00375, 0.0075, and 0.0150 mmol/kg bodyweight) and two perfusions. At both field strengths a T1-weighted saturation recovery turboFLASH sequence with parallel imaging was employed. Peak signal-to-noise ratio (SNR), maximum contrast enhancement ratio (CER), peak-baseline difference, and upslope values were assessed. Moreover, sectors with dark banding artifacts were evaluated. RESULTS: Significant differences of the upslope values for first compared to second perfusion could be observed for the medium- and high-dose groups at 1.5 T (P < 0.01), but not at 3 T. Sectors with dark banding artifacts during first perfusion occurred significantly more often at the highest dose of gadofosveset compared to the lowest dose at 1.5 T (P = 0.04) and 3 T (P < 0.01). CONCLUSION: The best injection protocol for semiquantitative perfusion analysis at 1.5 T is 0.00375 mmol/kg, as higher doses lead to lower upslope values during the second perfusion. At 3 T 0.0075 mmol/kg should be used to avoid dark banding artifacts.
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Medios de Contraste/administración & dosificación , Gadolinio/administración & dosificación , Imagen por Resonancia Magnética , Miocardio/patología , Compuestos Organometálicos/administración & dosificación , Imagen de Perfusión , Adulto , Artefactos , Peso Corporal , Relación Dosis-Respuesta a Droga , Voluntarios Sanos , Corazón/efectos de los fármacos , Humanos , Masculino , Relación Señal-RuidoRESUMEN
PURPOSE: To demonstrate the efficacy of contrast enhanced magnetic resonance venography (CEMRV) using gadofosveset trisodium in the comprehensive evaluation of the intracranial and extracranial venous system. MATERIALS AND METHODS: Temporal signal decay, in-plane saturation and flow artifacts were assessed in an institutional review board approved, HIPAA compliant CEMRV study of 99 subjects. In a 39 subject subset, percent diameter narrowing of the internal jugular (IJ), brachiocephalic and azygous veins were coded according to the following ordinal grades for both catheter venography (CV) and CEMRV: grade 0 ≤ 50%, grade 1 >50% and ≤ 75%, grade 2 >75% and <100% and grade 3 = 100% and compared with pressure gradient measurements obtained during CV. RESULTS: There was no significant signal decay, in-plane saturation or flow artifacts identified on CEMRV or hemodynamically significant pressure gradients identified on CV. All brachiocephalic and azygous veins had matched grade 0 narrowing on both modalities. Discrepancy between modalities occurred in the IJ veins at the level of thyroid gland where 15% of IJ veins had CEMRV grade ≥ 1 narrowing compared with 4% for CV or below the thyroid gland where 5% of IJ veins had CEMRV grade ≥ 1 narrowing compared with 20% for CV. There was fair agreement (κ = 0.24) between modalities for grade of narrowing in the combined data set of all coded veins. CONCLUSION: CEMRV using gadofosveset trisodium is accurate in the evaluation of the venous system.
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Gadolinio , Angiografía por Resonancia Magnética/métodos , Compuestos Organometálicos , Venas/anatomía & histología , Adulto , Artefactos , Circulación Cerebrovascular , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/patología , Estudios Prospectivos , Sensibilidad y Especificidad , Venas/patologíaRESUMEN
Hepatic vein stenosis is a rare but serious complication following liver transplantation. Multiple modalities can be utilized to image the hepatic vasculature. Magnetic resonance venography (MRV) provides certain advantages over ultrasound, computed tomography angiography and digital subtraction venography. MRV utilizes the same imaging principles of magnetic resonance angiography in order to image the venous system. Blood pool contrast agents, specifically gadofosveset trisodium, allow for steady state imaging up to 1 h following injection, with improved visualisation of vital venous structures by utilising delayed steady state imaging. Additionally, the inherent physics properties of magnetic resonance imaging also provide excellent soft tissue detail and thus help define the extent of complications that often plague the post-liver transplant patient. This case report describes the use of gadofosveset trisodium in a patient with hepatic venous stenosis following liver transplantation. Initial venography failed to outline the stenoses and thus MRV using a blood pool contrast agent was utilised in order to delineate the anatomy and plan a therapeutic endovascular procedure.