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Overview

 Basic MRA techniques


 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

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