RSS-Feed abonnieren
DOI: 10.1055/s-2005-836923
© Georg Thieme Verlag Stuttgart · New York
Clinical Applications of 2-D Dynamic Contrast-Enhanced MR Subtraction Angiography in Neurosurgery - Preliminary Results
Neurochirurgische Applikationen der dynamischen kontrastmittelverstärkten MR-SubtraktionsangiographiePublikationsverlauf
Publikationsdatum:
29. November 2005 (online)
![](https://www.thieme-connect.de/media/zblneurochir/200504/lookinside/thumbnails/10.1055-s-2005-836923-1.jpg)
Abstract
Objectives: Advances in MR hardware performance and imaging techniques have enabled us to perform subsecond frame rate contrast enhanced MR angiographies as a clinical routine, resulting in subtraction angiographies with temporal resolutions similar to those obtained by conventional DSA. In this manuscript, we describe the technique of 2-D dynamic contrast-enhanced MR subtraction angiography and its possible applications in neurosurgery. Methods: A T1-weighted gradient-echo sequence with short TR and TE values was performed during the intravenous bolus application of MR contrast media. This sequence had a temporal resolution of up to 0.34 seconds per image and was performed in 28 patients harbouring arteriovenous malformations (n = 12), dural AV fistulas (n = 3), meningiomas (n = 8), glomus tympanicum or jugulare tumours (n = 3), and haemangioperizytomas (n = 2). Arterial digital subtraction angiography (DSA) was performed in all patients and compared to the MRA sequences with respect to differentiation into early, late arterial and venous phases, detectability of normal vessels, detection of the pathology, feeding arteries, capillary blush, early draining veins, and hypervascularisation. Results: In all 28 investigated cases and all pathological entities separation of early and late arterial phases, capillary phases, early and late venous phases was possible. The proximal portions of the major cerebral arteries, the capillary blush and the venous anatomy including the tributaries to the large sinuses could be well defined and correlated well with the gold standard, i. e. DSA. Conclusions: Dynamic contrast enhanced MR angiography will prove helpful in 1) the follow-up of AVMs since early venous drainage can be visualised; 2) the demonstration of dural AVF, which can be recognised as an early filling of a dural sinus during the early arterial phase; and 3) the characterisation of the degree of vascularisation of brain tumours.
Zusammenfassung
Einleitung: Fortschritte der MRT-Technologie, vor allem der MR-Hardware aber auch des Sequenzdesigns, ermöglichen mittlerweile MR-Angiographien (MRA) in einer zeitlichen Auflösung, die der der digitalen Subtraktionsangiographie gleich kommt. Das Ziel dieses Manuskriptes ist es, diese MR-Technik, vor allem aber auch ihre neurochirurgischen Applikationen, zu beschreiben. Material und Methoden: Als MRA-Sequenz wurde eine T1-gewichtete Gradienten-Echo Sequenz mit kurzer TR und TE gewählt, die während der intravenösen Bolusapplikation eines MR-Kontrastmittels kontinuierlich Daten akquirierte. Die zeitliche Auflösung betrug bis zu 0,34 Sekunden/Bild. Untersucht wurden 28 Patienten mit arteriovenösen Malformationen (n = 12), duralen AV-Fisteln (n = 3), Meningeomen (n = 8), Glomustumoren (n = 3) und Hämangioperizytomen (n = 2). Eine arterielle digitale Subtraktionsangiographie (DSA) diente als Goldstandard und wurde mit der MRA verglichen, bezogen auf die Differenzierung der frühen und späten arteriellen und venösen Phase, der Detektierung normaler und pathologischer Gefäße, einer verfrühten venösen Drainage und einer Hypervaskularisation. Ergebnisse: In allen Fällen konnte eine klare Separation der früharteriellen, spätarteriellen, kapillären, früh- und spätvenösen Phase erzielt werden. Die großen hirnversorgenden Gefäße, aber auch der kapilläre „Blush” und die venöse Anatomie waren gut zu erkennen und korrespondierten gut zur DSA. Schlussfolgerung: Die beschriebene MRA-Technik kann vor allem in Nachfolgeuntersuchungen nach Behandlung einer AVM nichtinvasiv Informationen zur Verschlussrate geben. Durale AV-Fisteln können durch eine frühe venöse Drainage erkannt werden, und eine mögliche Hypervaskularisation von Tumoren kann nachgewiesen werden.
Key words
dynamic contrast enhanced MR angiography - AV malformation - AV fistula - hypervascularised tumours
Schlüsselwörter
MR-Angiographie - AV-Malformation - AV-Fistel - hypervaskularisierte Tumoren
References
- 1 Aoki S, Yoshikawa T, Hori M, Nanbu A, Kumagai H, Nishiyama Y, Nukui H, Araki T. MR digital subtraction angiography for the assessment of cranial arteriovenous malformations and fistulas. AJR Am J Roentgenol. 2000; 175 451-453
- 2 Barger A V, Block W F, Toropov Y, Grist T M, Mistretta C A. Time-resolved contrast-enhanced imaging with isotropic resolution and broad coverage using an undersampled 3D projection trajectory. Magn Reson Med. 2002; 48 297-305
- 3 Bendszus M, Koltzenburg M, Burger R, Warmuth-Metz M, Hofmann E, Solymosi L. Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study. Lancet. 1999; 354 1594-1597
- 4 Bryant D J, Payne J A, Firmin D N, Longmore D B. Measurement of flow with NMR imaging using a gradient pulse and phase difference technique. J Comput Assist Tomogr. 1984; 8 588-593
- 5 Carroll T J. The emergence of time-resolved contrast-enhanced MR imaging for intracranial angiography. AJNR Am J Neuroradiol. 2002; 23 346-348
- 6 Coley S C, Romanowski C A, Hodgson T J, Griffiths P D. Dural arteriovenous fistulae: noninvasive diagnosis with dynamic MR digital subtraction angiography. AJNR Am J Neuroradiol. 2002; 23 404-407
- 7 Coley S C, Wild J M, Wilkinson I D, Griffiths P D. Neurovascular MRI with dynamic contrast-enhanced subtraction angiography. Neuroradiology. 2003; 45 843-850
- 8 Dammert S, Krings T, Moeller-Hartmann W, Ueffing E, Hans F J, Willmes K, Mull M, Thron A. Detection of intracranial aneurysms with multi slice CT: comparison with conventional angiography. Neuroradiology. 2004; 46 427-434
- 9 Dietrich U, Wanke I, Asgari S, Forsting M, Oppel F. [Dural arteriovenous fistulas with intracranial hemorrhage: diagnostic and therapeutic aspects]. Zentralbl Neurochir. 2003; 64 12-18
- 10 Dumoulin C L, Cline H E, Souza S P, Wagle W A, Walker M F. Three-dimensional time-of-flight magnetic resonance angiography using spin saturation. Magn Reson Med. 1989; 11 35-46
- 11 Golay X, Brown S J, Itoh R, Melhem E R. Time-resolved contrast-enhanced carotid MR angiography using sensitivity encoding (SENSE). AJNR Am J Neuroradiol. 2001; 22 1615-1619
- 12 Gonner F, Heid O, Remonda L, Nicoli G, Baumgartner R W, Godoy N, Schroth G. MR angiography with ultrashort echo time in cerebral aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol. 1998; 19 1324-1328
- 13 Griffiths P D, Hoggard N, Warren D J, Wilkinson I D, Anderson B, Romanowski C A. Brain arteriovenous malformations: assessment with dynamic MR digital subtraction angiography. AJNR Am J Neuroradiol. 2000; 21 1892-1899
- 14 Gullberg G T, Wehrli F W, Shimakawa A, Simons M A. MR vascular imaging with a fast gradient refocusing pulse sequence and reformatted images from transaxial sections. Radiology. 1987; 165 241-246
- 15 Heiserman J E, Dean B L, Hodak J A, Flom R A, Bird C R, Drayer B P, Fram E K. Neurologic complications of cerebral angiography. AJNR Am J Neuroradiol. 1994; 15 1401-1407
- 16 Hennig J, Scheffler K, Laubenberger J, Strecker R. Time-resolved projection angiography after bolus injection of contrast agent. Magn Reson Med. 1997; 37 341-345
- 17 Isoda H, Takehara Y, Isogai S, Masunaga H, Takeda H, Nozaki A, Sakahara H. MRA of intracranial aneurysm models: a comparison of contrast-enhanced three-dimensional MRA with time-of-flight MRA. J Comput Assist Tomogr. 2000; 24 308-315
- 18 Maki J H, Chenevert T L, Prince M R. Contrast-enhanced MR angiography. Abdom Imaging. 1998; 23 469-484
- 19 Mori H, Aoki S, Okubo T, Hayashi N, Masumoto T, Yoshikawa T, Tago M, Shin M, Kurita H, Abe O, Ohtomo K. Two-dimensional thick-slice MR digital subtraction angiography in the assessment of small to medium-size intracranial arteriovenous malformations. Neuroradiology. 2003; 45 27-33
- 20 Prince M R. Gadolinium-enhanced MR aortography. Radiology. 1994; 191 155-164
- 21 Prince M R. Contrast-enhanced MR angiography: theory and optimization. Magn Reson Imaging Clin N Am. 1998; 6 257-267
- 22 Schuierer G, Huk W J, Laub G. Magnetic resonance angiography of intracranial aneurysms: comparison with intra-arterial digital subtraction angiography. Neuroradiology. 1992; 35 50-54
- 23 Sure U, Butz N, Siegel A M, Mennel H D, Bien S, Bertalanffy H. Treatment-induced neoangiogenesis in cerebral arteriovenous malformations. Clin Neurol Neurosurg. 2001; 103 29-32
- 24 Tsuchiya K, Katase S, Yoshino A, Hachiya J. MR digital subtraction angiography of cerebral arteriovenous malformations. AJNR Am J Neuroradiol. 2000; 21 707-711
- 25 Tsuchiya K, Katase S, Yoshino A, Hachiya J. MR digital subtraction angiography in the diagnosis of meningiomas. Eur J Radiol. 2003; 46 130-138
- 26 Wang Y, Johnston D L, Breen J F, Huston J, Jack C R, Julsrud P R, Kiely M J, King B F, Riederer S L, Ehman R L. Dynamic MR digital subtraction angiography using contrast enhancement, fast data acquisition, and complex subtraction. Magn Reson Med. 1996; 36 551-556
- 27 Warren D J, Hoggard N, Walton L, Radatz M W, Kemeny A A, Forster D M, Wilkinson I D, Griffiths P D. Cerebral arteriovenous malformations: comparison of novel magnetic resonance angiographic techniques and conventional catheter angiography. Neurosurgery. 2001; 48 973-982
- 28 Wetzel S G, Bilecen D, Lyrer P, Bongartz G, Seifritz E, Radue E W, Scheffler K. Cerebral dural arteriovenous fistulas: detection by dynamic MR projection angiography. AJR Am J Roentgenol. 2000; 174 1293-1295
- 29 Wilson G J, Hoogeveen R M, Willinek W A, Muthupillai R, Maki J H. Parallel imaging in MR angiography. Top Magn Reson Imaging. 2004; 15 169-185
T. KringsMD
Department of Neuroradiology · University Hospital of the Technical University Aachen
Pauwelsstraße 30
52057 Aachen
Germany
Telefon: +49/2 41/8 08 03 07
Fax: +49/2 41/8 08 24 40
eMail: tkrings@izkf.rwth-aachen.de