THE ROLE OF MRA IN BRAIN TUMOR

TAN SIAUW KOAN ST BORROMEUS HOSPITAL

OVERVIEW
! " INTRODUCTION ! " TECHNIQUES OF MRA ! " 3 CASES OF MENINGIOMA ! " 2 CASES OF HEMANGIOBLASTOMA ! " CONCLUSION

MRA : INTRODUCTION
! " NONINVASIVE TOOL for

VISUALIZING BLOOD VESSELS.

!" ANATOMY !" FUNCTIONAL

DIRECTION & VELOCITY ! "S C R E E N I N G & EVALUATION

!" SIGNIFICANT

CAROTID

STENOSIS. !" ANEURYSM !" AVM

MRA in BRAIN TUMOR

! " not done very often these days. ! " important test for meningiomas and ! ! ! !

hemangioblastoma. " Which blood vessels are supplying the tumor?. " Is the tumor attached to any major blood vessels in the brain? " Potential occlusion of a dural sinus adjacent to the tumor. " the pattern of collateral venous drainage around such an occlusion.

MRA : TECHNIQUES
WITHOUT CONTRAST
! " Time!of!flight ! " Phase contrast ! " Black blood techniques
!" maximize

signal differences between flowing and stationary tissues to provide morphologic and physiologic information

WITH CONTRAST

T1 shortening rather ! " Contrast enhanced than flow, detect slow ! " Time-resolved of imaging flow, reduce signal contrast kinetics (TRICKS) loss, temporal resolution

TOF MR ANGIOGRAPHY COMBINATION OF FLOW RELATED ENHANCEMENT AND SATURATION

! " Flow-related

enhancement : flow of fullymagnetized blood into the imaging plane. ! " Spoiled Gradient Echo (SPGR): short TR, moderate to high flip angles -> heavily T1W to saturate spins in the excited slab.

DATA ACQUISITION AND RECONSTRUCTION

! " 2D TOF ! " 3D TOF ! " 3D MOTSA
! " SOURCE IMAGES ! " 3D MIP ( MAXIMAL

(MULTIPLE OVERLAPPING THIN SLABS ACQUISITION)

INTENSITY PROJECTION ) ! " 3D SURFACE RENDERING ! " 3D VOLUME RENDERING ! " MPVR (multi projection volume reconstruction

Sequential 2D TOF technique

! " craniocaudad

direction ! " superiorly placed tracking saturation pulse

Multiple overlapping 3D TOF slab technique

! " advantages of both

sequential 2DFT and 3DFT ! " axially oriented partitions maximize flow-related enhancement ! " craniocaudad direction to avoid saturation ! " superior saturation suppresses venous signal.

2D vs 3D TOF

CONTRAST ENHANCED (CE) MRA

! " high concentration of a TI shortening ! ! ! ! ! !

agent " test injection or automatic triggering " minimally invasive " additional cost " reduction of flow dependence " reduction in patient motion artifact " venous visualization

CONTRAST ENHANCE & 3D TOF MR ANGIOGRAPHY

Man 42 yo
! " Clinical information: ! " Olfactory groove meningioma. ! " Visus OS: 0, ! " Hemiparese sinistra. ! " Please identify the feeder artery of

Olfactory groove meningioma . ! " A ethmoidalis ant? A ethmoidalis post? Other artery?. ! " Plan for total removal with craniotomy.

OLFACTORY MENINGIOMA

3D TOF & CONTRAST ENHANCED MRA

3DTOF 3D MIP

CE MRA, 3D VR % MIP

3D TOF MIP MPR

3D TOF MIP MPR

CE MRA MIP MPR

Woman 41 yo
! "Clinical information: ! "cephalgia. ! " Hemiparese sinistra ! " Falx meningioma. ! "Vascular evaluation around

meningioma

MENINGIOMA RIGHT FRONTO PARIETAL

FALX MENINGIOMA RIGHT FRONTO PARIETAL

Feeding artery : arteri meningae media Feeding : arteri pericallosal dan kanan kiri, kanan lebih dari kiri. callosomarginal kanan dan arteri meningae media kanan

CE MRA 3D VR MIP MPR

Woman 39 yo
!" Clinical information: !" convexity meningioma.

LEFT OCC PAR MENGINGIOMA

LEFT OCC PAR MENGINGIOMA

VON HIPPEL LINDAU SYNDR

VHL SYRINGOMYELIA

14th ICSM 6/17/10

14th ICSM 6/17/10

SPINAL MRA SPINAL HEMANGIOBLASTOMA

14th ICSM 6/17/10

CONCLUSION
! " Noninvasive Angiograph using MRI ! " 2D TOF " 3D TOF MOTSA ! " CONTRAST ENHANCED MRA ! " TRICKS Time Resolved Imaging

Contrast Kinetics ! " not done very often for brain tumours BUT IMPORTANT: for MENINGIOMA, HEMANGIOBLASTOMA.