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• 2D TOF :– Historical Reference Technique– Non invasive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. S67-713- Haroun et al. Surgical and radiologic anatomy : SRA (2007) vol. 29 (4) pp. 323-84- Farb et al. Radiology (2003) vol. 226 (1) pp. 203-95- 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)

SD = 1,98 s

SD = 1,35 s

TR MRA torcular signal

Venous Peak

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 CE MRV vs TOF 2D

Neuroradiologist 1 Neuroradiologist 2 Resident

22 examinations (acute or controls of CV phlebitis), TOF 2D vs CE MRV (TRATAGEM)

Receiver Operating Characteristic

• Lateral sinus visualisation– TOF 2D : 68 %– CE MRV : 95 %

CE MRV CE MRV vs TOF 2D

Other advantages cases report

Case n°1

Case n° 1: M6, headache, papilar oedema

TRATAGEM, cases report

Case n°2

TRATAGEM, cases report

Case n°2

TRATAGEM, cases report

Conclusion• TR MRA, CE MRV

– Usefull for cerebral venous pathology imaging – Their combination is possible– CE MRV at venous peak– Easy to perform

TRATAGEMTime Resolved Angiography Triggered venous Angiography with Gradient-echo Elliptic MR-imaging)