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Overview
Basic MRA techniques Drawbacks of conventional MRA techniques Principles of 3D gadolinium-enhanced gadoliniumMR angiography Application of MRA Applications of MRV in idiopathic intracranial hypertension
Why MRA?
NonNon-invasive No Ionizing Radiation Tandem lesions 3-Dimensional No contrast nephrotoxicity Rare Allergic Reactions High Accuracy
MR Angiographic Techniques
Time of Flight MR Angiography Phase Contrast MR Angiography Contrast Enhanced MR
Overview
Basic MRA techniques Drawbacks of conventional MRA techniques Principles of 3D gadolinium-enhanced gadoliniumMR angiography Application of MRA Applications of MRV in idiopathic intracranial hypertension
Why MRA?
NonNon-invasive No Ionizing Radiation Tandem lesions 3-Dimensional No contrast nephrotoxicity Rare Allergic Reactions High Accuracy
MR Angiographic Techniques
Time of Flight MR Angiography Phase Contrast MR Angiography Contrast Enhanced MR
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Attribution Non-Commercial (BY-NC)
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Скачайте в формате PPT, PDF, TXT или читайте онлайн в Scribd
Overview
Basic MRA techniques Drawbacks of conventional MRA techniques Principles of 3D gadolinium-enhanced gadoliniumMR angiography Application of MRA Applications of MRV in idiopathic intracranial hypertension
Why MRA?
NonNon-invasive No Ionizing Radiation Tandem lesions 3-Dimensional No contrast nephrotoxicity Rare Allergic Reactions High Accuracy
MR Angiographic Techniques
Time of Flight MR Angiography Phase Contrast MR Angiography Contrast Enhanced MR
Авторское право:
Attribution Non-Commercial (BY-NC)
Доступные форматы
Скачайте в формате PPT, PDF, TXT или читайте онлайн в Scribd
Drawbacks of conventional MRA techniques Principles of 3D gadolinium-enhanced MR angiography Application of MRA Applications of MRV in idiopathic intracranial hypertension Why MRA? Non-invasive No Ionizing Radiation Tandem lesions 3-Dimensional No contrast nephrotoxicity Rare Allergic Reactions High Accuracy MR Angiographic Techniques
Time of Flight MR Angiography
Phase Contrast MR Angiography Contrast Enhanced MR Angiography 3D TOF angio Lower SNR on low field compromise in TOF
Longer imaging time, lower matrix size and
slightly higher Flip angle ensures adequate visualisation of Circle of Willis and Carotid bifurcation
Circle of Willis- TR/TE 38/9.3 Acq time 6 min
Eff.sl thick-1 mm 256 matrix 3 slabs 16 partitions per slab Flip angle 40
MTC can be additionally incorporated with
increase in TR and scan time for better background suppression 3d flash ce angiography Breathold Coronal Flash 3d Spectral Fat sat not possible on low field Precontrast images to be subtracted from post contrast images before MIP for better background suppression in MIP images. Care Bolus for Time of Flight MRA Flow-compensated, gradient refocussed sequence Stationary tissue is saturated Disadvantages TOF MRA In-plane saturation Turbulence induced signal loss Sensitive to susceptibility artifacts Long acquisition time Phase Contrast MRA Make use of phase shifts as blood flows in the presence of flow-encoding gradients Flow-encoding gradients can be applied in any direction, or in multiple directions Advantage-PC is able to acquire directional flow information Disadvantages of PC MRA Long examination times Motion sensitive- strong flow-encoding gradients make the sequence susceptible to degradation from bulk (cardiac, respiratory, translational motion) Turbulence causes intravoxel phase dispersion and signal loss Contrast enhanced MRA
3D CE-MRA is performed in a manner
analogous to conventional angiography or helical CT Image ‘Blood’ , NOT ‘Blood Flow’ Contrast enhanced MRA Sensitivity to turbulence is dramatically reduced In plane saturation effects are eliminated Extensive field of view at high resolution Short acquisition time Contrast enhanced MRA
Primary issues in dynamic CE MRA are
Detection of contrast arrival Efficient acquisition of appropriate MR data Contrast enhanced MRA Ideally data should be acquired while the arterial MR contrast agent has highest concentration Typical intracranial arteriovenous circulation time is 2.5-6 secs Transit time of contrast agent varies from patient to patient & may depend on cardiac output & presence of vascular pathology Maximizing SNR Field Strength: higher the better Bolus timing perfect Injection duration: ½ scan duration Gd dose: 10-20 ml Sampling efficiency: high Bandwidth: narrow Pulse sequence 3D gradient echo TR: 5-6 msec, short as possible TE: < 3msec Total scan time 10-30 sec range It is critical to time the bolus for maximum arterial [Gd] during acquisition of central k-space data CE-MRA- Bolus timing considerations To determine the time of arrival of contrast ‘Best- Guess’ Technique Test- Bolus technique MR Fluoroscopy ‘Best- Guess’ Technique Imaging delay= (estimated Contrast Travel time)-(imaging Time/2) + (Rise Time) The most difficult aspect is estimating the contrast travel time Test bolus technique Acquires a series of images during the passage of a test bolus, and from these data calculates the contrast arrival time Simple & effective technique No special hardware required MR Fluoroscopy Most advanced technique Uses a series of rapid 2D images to determine contrast arrival Operator views these images and commences the CE MRA volume once the contrast agent arrives Requires special hardware Clinical Applications of MRA Evaluation of Ischemic stroke Carotid dissection
Carotid stenosis
Intracranial stenosis
Moya-moya disease
Anatomical variations
Evaluation of aneurysm MR examination CE MR Venogram Diagnostic angiogram
The pressure gradient across the stenosis was was
21 mm of Hg (30-9), Post Stenting
The pressure gradient reduced to 3 mm (16-13)
following stent placement Conclusion CE MRA provides a safe and cost effective alternative to conventional IADSA Recent advances allow for high resolution breath-hold and multistation imaging with optimal arterial phase contrast bolus timing CE MRV should always be performed in the evaluation of patients with idiopathic intracranial hypertension