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Time-Resolved Angiography for Cerebral Venous Pathology

Explore the feasibility and usefulness of Time-Resolved Angiography Triggered venous Angiography with Gradient-echo Elliptic MR-imaging for imaging cerebral venous pathology. Learn about TR.MRA and CE.MRV techniques, their advantages, and comparison in imaging cases.

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Time-Resolved Angiography for Cerebral Venous Pathology

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  1. TIME RESOLVED ANGIOGRAPHY : CAN IT BE USED AS A VENOUS TRIGGERING TECHNIQUEFOR 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

  2. MRI Venous imaging • 2D TOF : • Historical Reference Technique • Non invasive • PITFALLS: • Various saturation / flow phenomena • Low signal on small venous structures / low flow

  3. Contrast Enhanced MR venography • CEMRV : venous system global visualisation, better spatial resolution 1 • Injection protocols: • Fixed Delays2,3 (20 et 40 ’’) • Carotid Triggering4 • Torcular Fluoro MR5 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.

  4. TRATAGEM :TR MRA – CE MRVAssociation • 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)

  5. 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)

  6. TRATAGEM Time Resolved Angiography Triggered venous Angiography with Gradient-echo Elliptic MR-imaging)

  7. 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)

  8. TR MRA torcular signal SD = 1,98 s Venous Peak SD = 1,35 s

  9. CE MRV Signalvs time to venous peak -4.5 -3 -1.5 0 1.5 3 4.5 6 7.5 9

  10. CE MRV Signalvs time to venous peak -4.5 -3 -1.5 0 1.5 3 4.5 6 7.5 9

  11. TRATAGEM, Feasibility • More than 400 examinations… • TR MRA = Fluoroscopy • MR technicians short learning curve • Short acquisition time.

  12. CE MRV vs TOF 2D 22 examinations (acute or controls of CV phlebitis), TOF 2D vs CE MRV (TRATAGEM) Neuroradiologist 1 Neuroradiologist 2 Resident Receiver Operating Characteristic

  13. CE MRV vs TOF 2D • Lateral sinus visualisation • TOF 2D : 68 % • CE MRV : 95 %

  14. Other advantages cases report Case n°1

  15. Case n° 1: M6, headache, papilar oedema TRATAGEM, cases report

  16. TRATAGEM, cases report Case n°2

  17. Case n°2 TRATAGEM, cases report

  18. 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)

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