Transcript Diapositive 1

TIME RESOLVED ANGIOGRAPHY :
CAN IT BE USED AS A
VENOUS TRIGGERING TECHNIQUE
FOR MAGNETIC RESONNANCE VENOGRAPHY ?
FEASABILITY, USEFULLNESS IN CEREBRAL VENOUS PATHOLOGY IMAGING.
B Daumas-Duport, R Bourcier, N David, E Auffray-Calvier,
A Lintia-Gautier, F Toulgoat, HA Desal
CHU de Nantes
MRI Venous imaging
• 2D TOF :
– Historical Reference Technique
– Non invasive
– PITFALLS:
– Various saturation / flow phenomena
– Low signal on small venous structures / low flow
Contrast Enhanced
MR venography
• CEMRV : venous system global visualisation,
better spatial resolution 1
• Injection protocols:
– Fixed Delays2,3 (20 et 40 ’’)
– Carotid Triggering 4
– Torcular Fluoro MR 5
1- Leach et al. Radiographics : (2006) vol. 26 Suppl 1 pp. S19-41
2- Deda et al. Surgical neurology (2005) vol. 64 Suppl 2 pp. S67-71
3- Haroun et al. Surgical and radiologic anatomy : SRA (2007) vol. 29 (4) pp. 323-8
4- Farb et al. Radiology (2003) vol. 226 (1) pp. 203-9
5- Klingebiel et al. Eur J Neurol. 2007;14:139-143.
TRATAGEM :
TR MRA – CE MRV Association
• TR MRA and CE MRV : usefull techniques
for cerebral venous pathology imaging
• Delay before venous opacification peak
can be used to run a TR MRA
TRATAGEM :
Time Resolved Angiography Triggered venous Angiography with Gradient-echo Elliptic MR-imaging)
Materials & methods
• MRI Sonata 1,5 T (Siemens) ; 8 channels antenna
• TR MRA:
–
–
–
–
–
IV Bolus Injection (gabobenate, 3 ml/s + 20 ml saline)
FLASH 3D, parallel,
matrix 128 x 256, FOV 220 x 350
30 sections of 2,5 mm (half a cranium)
TR : 1,5 s /volume
• CE MRV:
– FLASH 3D, (mask followed by subtraction )
– Matrix 229 x 512 x 144 FOV 213 x 310
– SR : 1,5 mm (144 * 1mm, interpolated, 27s)
TRATAGEM
Time Resolved Angiography Triggered venous Angiography with Gradient-echo Elliptic MR-imaging)
CE MRV Signal vs Venous peak
• 95 consecutives patients
– (4 heavy shunts or torcular shunt, 2 torcular thrombosis, 1 short TR MRA, 2 torcular
out of TR MRA field)
• TR MRA 29 ’’ length
– Signal measurement (above torcular)
• CE MRV (launched at 29”)
– Signal measurement (above torcular)
• Time to venous peak (evaluated)
TR MRA torcular signal
SD = 1,98 s
Venous Peak
SD = 1,35 s
CE MRV Signal
vs time to venous peak
-4.5
-3
-1.5
0
1.5
3
4.5
6
7.5
9
CE MRV Signal
vs time to venous peak
-4.5
-3
-1.5
0
1.5
3
4.5
6
7.5
9
TRATAGEM, Feasibility
– More than 400 examinations…
– TR MRA = Fluoroscopy
– MR technicians short learning curve
– Short acquisition time.
CE MRV vs TOF 2D
22 examinations (acute or controls of CV phlebitis),
TOF 2D vs CE MRV (TRATAGEM)
Neuroradiologist 1
Neuroradiologist 2
Receiver Operating Characteristic
Resident
CE MRV vs TOF 2D
• Lateral sinus visualisation
– TOF 2D : 68 %
– CE MRV : 95 %
Other advantages
cases report
Case
n°1
TRATAGEM, cases report
Case n° 1:
M6, headache, papilar oedema
TRATAGEM, cases report
Case
n°2
TRATAGEM, cases report
Case n°2
Conclusion
• TR MRA, CE MRV
– Usefull for cerebral venous pathology imaging
– Their combination is possible
– CE MRV at venous peak
– Easy to perform
TRATAGEM
Time Resolved Angiography Triggered venous Angiography with Gradient-echo Elliptic MR-imaging)