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Three-dimensional time-of-flight MR angiography in the evaluation of cerebral aneurysms
R J Sevick1, J S Tsuruda, P Schmalbrock
1Department of Radiology, University of California, San Francisco 94143-0628.
Abstract:
We review our preliminary experience with the use of three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) angiography (MRA) in the assessment of intra- and extracranial aneurysms. Six patients were examined: Five had intracranial aneurysms and one had a cervical carotid pseudoaneurysm. A 3D rephased gradient recalled echo pulse sequence and maximum intensity projection (MIP) reconstruction algorithm were used. Magnetic resonance angiography, spin echo MR, and conventional angiography were retrospectively reviewed with specific regard to individual vessel visualization, aneurysm depiction, and presence of artifact related to acquisition techniques or MIP reconstruction. All aneurysms were detected on MRA, and anatomical correlation with conventional angiography was excellent. Significant problems included loss of visualization of small vessels, intraluminal signal loss in large vessels, subacute thrombus simulating flow on MIP reconstructions, and limited projections obtainable with MIP techniques. Adequate MRA assessment of aneurysms can be obtained using a combination of T1-weighted spin echo images and 3D TOF MRA. Review of all components of the MRA is required. MRA may be useful in screening asymptomatic patients for intracranial aneurysms as well as in the follow-up of patients treated with balloon occlusion.
Insights
Three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) effectively detects intracranial aneurysms. Combining MRA with spin echo MR provides adequate assessment, aiding screening and follow-up.
Area of Science:
- Medical Imaging
- Neuroradiology
- Vascular Imaging
Background:
- Intracranial aneurysms pose significant health risks.
- Accurate diagnostic imaging is crucial for detection and management.
- Three-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) is a developing technique for vascular assessment.
Purpose of the Study:
- To evaluate the preliminary experience with 3D TOF MRA for assessing intra- and extracranial aneurysms.
- To compare MRA findings with conventional angiography and spin echo MR.
- To identify limitations and benefits of 3D TOF MRA in aneurysm detection.
Main Methods:
- Retrospective review of six patients with aneurysms (five intracranial, one cervical carotid pseudoaneurysm).
- Utilized a 3D rephased gradient recalled echo pulse sequence and maximum intensity projection (MIP) reconstruction.
- Compared MRA with spin echo MR and conventional angiography regarding vessel visualization, aneurysm depiction, and artifacts.
Main Results:
- All aneurysms were successfully detected using MRA.
- Excellent anatomical correlation was observed between MRA and conventional angiography.
- Identified limitations include loss of small vessel visualization, intraluminal signal loss in large vessels, and artifact issues with MIP reconstructions.
Conclusions:
- 3D TOF MRA, combined with T1-weighted spin echo images, offers adequate assessment of aneurysms.
- Comprehensive review of all MRA components is necessary for accurate interpretation.
- MRA shows potential for screening asymptomatic patients and follow-up of treated aneurysms.