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Diagnostic Performance of High-Resolution Vessel Wall Magnetic Resonance Imaging and Digital Subtraction Angiography in Intracranial Vertebral Artery Dissection. Diagnostics (Basel) 2022; 12:diagnostics12020432. [PMID: 35204523 PMCID: PMC8871073 DOI: 10.3390/diagnostics12020432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose: Intracranial vertebral artery dissection (VAD) is being increasingly recognized as a leading cause of Wallenberg syndrome and subarachnoid hemorrhage. Conventional angiography is considered the standard diagnostic modality, but the diagnosis of VAD remains challenging. This study aimed to compare the diagnostic performance of high-resolution vessel wall imaging (HR-VWI) with digital subtraction angiography (DSA) for intracranial VAD. Materials and methods: Twenty-four patients with 27 VADs, who underwent both HR-VWI and DSA within 2 weeks, were consecutively enrolled in the study from March 2016 to September 2020. HR-VWI and DSA were performed to diagnose VAD and to categorize its angiographic features as either definite dissection or suspicious dissection. Features of HR-VWI were used to evaluate direct arterial wall imaging. The reference standard was set from the clinicoradiologic diagnosis. Two independent raters evaluated the angiographic features, dissection signs, and interrater agreement. Each subject was also dichotomized into two groups (suspicious or definite VAD) in each modality, and diagnosis from HR-VWI and DSA was compared with the final diagnosis by consensus. Results: HR-VWI had higher agreement (90.6% vs. 53.1%) with the final diagnosis and better interrater reliability (kappa value (κ) = 0.91; 95% confidence interval (CI) = 0.64–1.00) compared with DSA (κ = 0.58; 95% CI = 0.35–1.00). HR-VWI provided a more detailed identification of dissection signs (77.7% vs. 22.2%) and better reliability (κ = 0.88; 95% CI = 0.58–1.00 vs. κ = 0.75; 95% CI = 0.36–1.00), compared to DSA. HR-VWI was comparable to DSA for the depiction of angiographic features for VAD. Conclusions: HR-VWI may be useful to evaluate VAD, with better diagnostic confidence compared to DSA.
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Cuong NN, Luu VD, Tuan TA, Linh LT, Hung KD, Ngoc VTN, Sharma K, Pham VH, Chu DT. Conventional digital subtractional vs non-invasive MR angiography in the assessment of brain arteriovenous malformation. Clin Neurol Neurosurg 2018; 169:29-33. [PMID: 29604508 DOI: 10.1016/j.clineuro.2018.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/14/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Digital subtractional angiography (DSA) is the standard method for diagnosis, assessment and management of arteriovenous malformation in the brain. Conventional DSA (cDSA) is an invasive imaging modality that is often indicated before interventional treatments (embolization, open surgery, gamma knife). Here, we aimed to compare this technique with a non-invasive MR angiography (MRI DSA) for brain arteriovenous malformation (bAVM). PATIENTS AND METHODS Fourteen patients with ruptured brain AVM underwent embolization treatment pre-operation. Imaging was performed for all patients using MRI (1.5 T). After injecting contrast Gadolinium, dynamic MRI was performed with 40 phases, each phase of a duration of 1.2 s and having 70 images. The MRI results were independently assessed by experienced radiologist blinded to the cDSA. RESULTS The AVM nidus was depicted in all patients using cDSA and MRI DSA; there was an excellent correlation between these techniques in terms of the maximum diameter and Spetzler Martin grading. Of the fourteen patients, the drainage vein was depicted in 13 by both cDSA and MRI DSA showing excellent correlation between the techniques used. CONCLUSION MRI DSA is a non-invasive imaging modality that can give the images in dynamic view. It can be considered as an adjunctive method with cDSA to plan the strategy treatment for bAVM.
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Affiliation(s)
- Nguyen Ngoc Cuong
- Radiology Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Vu Dang Luu
- Radiology Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Tran Anh Tuan
- Radiology Department, Bach Mai Hospital, Hanoi, Vietnam
| | - Le Tuan Linh
- Radiology Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Kieu Dinh Hung
- Department of Neurosurgery, Hanoi Medical University Hospital, Vietnam
| | | | - Kulbhushan Sharma
- Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Van Huy Pham
- NLP-KD Lab, Faculty of Information Technology, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
| | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam; Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam.
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Park JE, Jung SC, Lee SH, Jeon JY, Lee JY, Kim HS, Choi CG, Kim SJ, Lee DH, Kim SO, Kwon SU, Kang DW, Kim JS. Comparison of 3D magnetic resonance imaging and digital subtraction angiography for intracranial artery stenosis. Eur Radiol 2017; 27:4737-4746. [PMID: 28500366 DOI: 10.1007/s00330-017-4860-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/09/2017] [Accepted: 04/19/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare three-dimensional high-resolution magnetic resonance imaging (3D HR-MRI) and digital subtraction angiography (DSA) for diagnosing and evaluating stenosis in the entire circle of Willis. METHODS The study included 516 intracranial arteries from 43 patients with intracranial artery stenosis (ICAS) who underwent both 3D HR-MRI and DSA within 1 month. Two readers independently diagnosed atherosclerosis, dissection, moyamoya disease and vasculitis, rated their diagnostic confidence for each vessel and measured the luminal diameters. Reference standard was made from clinico-radiologic diagnosis. Diagnostic accuracy, diagnostic confidence, the degree of stenosis and luminal diameter were assessed and compared between both modalities. RESULTS For atherosclerosis, 3D HR-MRI showed better diagnostic accuracy (P = .03-.003), sensitivity (P = .006-.01) and positive predictive value (P ≤ .001-.006) compared to DSA. Overall, the readers were more confident of their diagnosis of ICAS when using 3D HR-MRI (reader 1, P ≤ .001-.007; reader 2, P ≤ .001-.015). 3D HR-MRI showed similar degree of stenosis (P > .05) and higher luminal diameter (P < .05) compared to DSA. CONCLUSIONS 3D HR-MRI might be useful to evaluate atherosclerosis, with better diagnostic confidence and comparable stenosis measurement compared to DSA in the entire circle of Willis. KEY POINTS • 3D HR-MRI showed better diagnostic accuracy for atherosclerosiscompared to DSA • 3D HR-MRI showed better overall diagnostic confidence for stenosiscompared to DSA • 3D HR-MRI and DSA showed similar degree of stenosis.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
| | - Sang Hun Lee
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University, Incheon, Korea
| | - Ji Ye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, 420-767, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Choong-Gon Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Deok Hee Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Dong-Wha Kang
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jong S Kim
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, South Korea
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Ito K, Sasaki M, Kobayashi M, Ogasawara K, Nishihara T, Takahashi T, Natori T, Uwano I, Yamashita F, Kudo K. Noninvasive evaluation of collateral blood flow through circle of Willis in cervical carotid stenosis using selective magnetic resonance angiography. J Stroke Cerebrovasc Dis 2013; 23:1019-23. [PMID: 24103664 DOI: 10.1016/j.jstrokecerebrovasdis.2013.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 08/12/2013] [Accepted: 08/21/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Preoperative assessment of intracranial collateral circulation is helpful in predicting cerebral ischemia during surgical procedures for cervical internal carotid artery (ICA) stenosis. However, magnetic resonance angiography (MRA) and other less-invasive techniques cannot evaluate collateral blood flow because these techniques are nonselective. Hence, by using a newly developed selective MRA technique, we attempted to visualize collaterals via the circle of Willis in patients with ICA stenosis. METHODS Twelve patients who underwent carotid endarterectomy were prospectively examined with a 1.5-T MR scanner. Both selective and nonselective MRA were obtained using a 3-dimensional time-of-flight technique, with or without a cylindrical saturation pulse that suppresses the flow signal from the region of the target ICA. Maximum intensity projection MRA images were generated and compared with digital subtraction angiography (DSA) images. RESULTS In all patients, the distal flow signal of the ipsilateral ICA was completely suppressed on selective MRA compared with nonselective MRA. In addition, collateral blood flow through the anterior and posterior communicating arteries was visualized in 5 and 2 patients, respectively. These findings corresponded well with the DSA imaging. CONCLUSIONS Selective MRA techniques can readily suppress signals from the distal blood flow of the target artery and visualize the presence of collateral flows through the circle of Willis in patients with cervical ICA stenosis.
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Affiliation(s)
- Kenji Ito
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan
| | - Makoto Sasaki
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan.
| | | | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | | | | | - Tatsunori Natori
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan
| | - Ikuko Uwano
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan
| | - Fumio Yamashita
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan
| | - Kohsuke Kudo
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan
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Diagnosis of Moyamoya Disease on Magnetic Resonance Imaging: Are Flow Voids in the Basal Ganglia an Essential Criterion for Definitive Diagnosis? J Stroke Cerebrovasc Dis 2013; 22:862-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.07.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/22/2012] [Accepted: 07/11/2012] [Indexed: 11/23/2022] Open
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Assessment of moyamoya disease using multidetector row computed tomography. J Stroke Cerebrovasc Dis 2012; 22:644-9. [PMID: 22365710 DOI: 10.1016/j.jstrokecerebrovasdis.2012.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/12/2011] [Accepted: 01/18/2012] [Indexed: 11/21/2022] Open
Abstract
The recent introduction of multidetector row computed tomography (MDCT) scanners has enabled high-resolution 3-dimensional reconstruction. The purpose of this study was to establish a method to evaluate moyamoya disease using computed tomography angiography (CTA), specifically MDCT. Twenty-four patients (48 sides total) with moyamoya disease diagnosed by magnetic resonance angiography (MRA) were evaluated by means of CTA using MDCT by 3 independent observers, and the resulting 144 sides were analyzed. CTA and MRA were compared in terms of the steno-occlusive changes exhibited in each vessel. CTA and MRA scores were assigned on the basis of the severity of occlusive changes in the internal carotid artery, middle cerebral artery, anterior cerebral artery, and posterior cerebral artery. CTA scores were significantly correlated with MRA scores (P < .0001), and the 2 scores were in complete agreement in 57 sides (39.6%). The mean CTA score was significantly lower than the mean MRA score (P < .0001). Compared with CTA, MRA overestimated occlusion in 115 of the 576 vessels assessed. The mean MRA score was significantly higher in the overestimation group than in the good correlation group (P < .0001). CTA had a significantly higher rate of detection of moyamoya-affected vessels (P = .0001). Our data indicate that CTA using MDCT is a more reliable technique than MRA for diagnosing moyamoya disease. The ability to perform CTA quickly is a significant benefit for patients with moyamoya disease, particularly in pediatric and emergency cases.
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Vakil P, Ansari SA, Hurley MC, Bhat H, Batjer HH, Bendok BR, Eddleman CS, Carroll TJ. Magnetization spoiling in radial FLASH contrast-enhanced MR digital subtraction angiography. J Magn Reson Imaging 2012; 36:249-58. [PMID: 22359391 DOI: 10.1002/jmri.23630] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 01/31/2012] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To increase the in-plane spatial resolution and image update rates of 2D magnetic resonance (MR) digital subtraction angiography (DSA) pulse sequences to 0.57 × 0.57 mm and 6 frames/sec, respectively, for intracranial vascular disease applications by developing a radial FLASH protocol and to characterize a new artifact, not previously described in the literature, which arises in the presence of such pulse sequences. MATERIALS AND METHODS The pulse sequence was optimized and artifacts were characterized using simulation and phantom studies. With Institutional Review Board (IRB) approval, the pulse sequence was used to acquire time-resolved images from healthy human volunteers and patients with x-ray DSA-confirmed intracranial vascular disease. RESULTS Artifacts were shown to derive from inhomogeneous spoiling due to the nature of radial waveforms. Gradient spoiling strategies were proposed to eliminate the observed artifact by balancing gradient moments across TR intervals. The resulting radial 2D MR DSA sequence (2.6 sec temporal footprint, 6 frames/sec with sliding window factor 16, 0.57 × 0.57 mm in-plane) demonstrated small vessel detail and corroborated x-ray DSA findings in intracranial vascular imaging studies. CONCLUSION Appropriate gradient spoiling in radial 2D MR DSA pulse sequences improves intracranial vascular depiction by eliminating circular banding artifacts. The proposed pulse sequence may provide a useful addition to clinically applied 2D MR DSA scans.
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Affiliation(s)
- Parmede Vakil
- Department of Biomedical Engineering, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Hori M, Aoki S, Oishi H, Nakanishi A, Shimoji K, Kamagata K, Houshito H, Kuwatsuru R, Arai H. Utility of time-resolved three-dimensional magnetic resonance digital subtraction angiography without contrast material for assessment of intracranial dural arterio-venous fistula. Acta Radiol 2011; 52:808-12. [PMID: 21742786 DOI: 10.1258/ar.2011.110128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intracranial dural arteriovenous fistula (DAVF) is an arteriovenous shunting disease of the dura. Magnetic resonance angiography (MRA) is expected to be a safer alternative method in evaluation of DAVF, compared with invasive intra-arterial digital subtraction angiography (IADSA). PURPOSE To evaluate the diagnostic use of time-spatial labeling inversion pulse (Time-SLIP) three-dimensional (3D) magnetic resonance digital subtraction angiography (MRDSA) without contrast material in six patients with DAVF. MATERIAL AND METHODS Images for 3D time-of-flight MRA, which has been a valuable tool for the diagnosis of DAVF but provide little or less hemodynamic information, and Time-SLIP 3D MRDSA, were acquired for each patient. The presence, side, and grade of the disease were evaluated according to IADSA. RESULTS In all patients, the presence and side of the DAVF were correctly identified by both 3D time-of-flight MRA and Time-SLIP 3D MRDSA. Cortical reflux present in a patient with a grade 2b DAVF was not detected by Time-SLIP 3D MRDSA, when compared with IADSA findings. CONCLUSION Time-SLIP 3D MRDSA provides hemodynamic information without contrast material and is a useful complementary tool for diagnosis of DAVF.
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Affiliation(s)
| | | | - Hidenori Oishi
- Department of Neurosurgery, School of Medicine, Juntendo University, Tokyo, Japan
| | | | | | | | | | | | - Hajime Arai
- Department of Neurosurgery, School of Medicine, Juntendo University, Tokyo, Japan
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Parmar H, Ivancevic MK, Dudek N, Gandhi D, Mukherji SK. Dynamic MRA with four-dimensional time-resolved angiography using keyhole at 3 tesla in head and neck vascular lesions. J Neuroophthalmol 2009; 29:119-27. [PMID: 19491635 DOI: 10.1097/wno.0b013e3181a58c20] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Conventional MRA provides inadequate visualization of the dynamic features of blood flow in vascular lesions of the head and neck. Four-dimensional time-resolved angiography using keyhole (4D-TRAK) is a new technique of performing contrast-enhanced MRA. By combining parallel imaging with sensitivity encoding (SENSE) with the keyhole imaging technique and a high field strength (3 T) magnet, we have been able to obtain detailed hemodynamic information similar to that obtained via catheter angiography with digital subtraction (DSA), but without the risks associated with ionizing radiation exposure, iodizing contrast agents, or catheterization itself.
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Affiliation(s)
- Hemant Parmar
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan 48109-0302, USA.
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Hori M, Shiraga N, Watanabe Y, Aoki S, Isono S, Yui M, Ohtomo K, Araki T. Time-resolved three-dimensional magnetic resonance digital subtraction angiography without contrast material in the brain: Initial investigation. J Magn Reson Imaging 2009; 30:214-8. [PMID: 19466714 DOI: 10.1002/jmri.21823] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Masaaki Hori
- Department of Radiology, University of Yamanashi, Chuou, Yamanashi, Japan.
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Bacigaluppi S, Dehdashti AR, Agid R, Krings T, Tymianski M, Mikulis DJ. The contribution of imaging in diagnosis, preoperative assessment, and follow-up of moyamoya disease. Neurosurg Focus 2009; 26:E3. [DOI: 10.3171/2009.01.focus08296] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this review was to evaluate the imaging tools used in diagnosis and perioperative assessment of moyamoya disease, with particular attention to the last decade.
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Affiliation(s)
- Susanna Bacigaluppi
- 1Divisions of Neurosurgery and
- 3Department of Neurosciences and Biomedical Technologies, University of Milan-Bicocca, Milan, Italy
| | | | - Ronit Agid
- 2Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Ontario, Canada; and
| | - Timo Krings
- 2Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Ontario, Canada; and
| | | | - David J. Mikulis
- 2Neuroradiology, University Health Network, Toronto Western Hospital, University of Toronto, Ontario, Canada; and
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KUMASHIRO M, MURASE K, ODA K, FUKUSHIGE M, ITO O, NAGAYAMA M, WATANABE Y. Assessment of Time-Resolved, Dynamic, Contrast-Enhanced MRDSA Using Radial Sliding-Window Reconstruction. Magn Reson Med Sci 2008; 7:1-12. [DOI: 10.2463/mrms.7.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Gauvrit JY, Oppenheim C, Nataf F, Naggara O, Trystram D, Munier T, Fredy D, Pruvo JP, Roux FX, Leclerc X, Meder JF. Three-dimensional dynamic magnetic resonance angiography for the evaluation of radiosurgically treated cerebral arteriovenous malformations. Eur Radiol 2005; 16:583-91. [PMID: 16220210 DOI: 10.1007/s00330-005-0011-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 07/19/2005] [Accepted: 08/18/2005] [Indexed: 11/28/2022]
Abstract
We assessed the value of three-dimensional (3D) dynamic magnetic resonance angiography (MRA) for the follow-up of patients with radiosurgically treated cerebral arteriovenous malformations (AVMs). Fifty-four patients with cerebral AVMs treated by radiosurgery (RS) were monitored using conventional catheter angiography (CCA) and 3D dynamic MRA with sensitivity encoding based on the parallel imaging. Cerebral AVM was qualitatively classified by two radiologists into one of five categories in terms of residual nidus size and persistence of early draining vein (I, >6 cm; II, 3-6 cm; III, <3 cm; IV, isolated early draining vein; V, complete obliteration). 3D MRA findings showed a good agreement with CCA in 40 cases (kappa=0.62). Of 23 nidus detected on CCA, 3D dynamic MRA showed 14 residual nidus. Of 28 occluded nidus on 3D dynamic MRA, 22 nidus were occluded on CCA. The sensitivity and specificity of 3D dynamic MRA for the detection of residual AVM were 81% and 100%. 3D dynamic MRA after RS may therefore be useful in association with MRI and can be repeated as long as opacification of the nidus or early venous drainage persists, one CCA remaining indispensable to affirm the complete occlusion at the end of follow-up.
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Affiliation(s)
- Jean-Yves Gauvrit
- Department of Neuroradiology, EA 2691, Roger Salengro Hospital, rue du Pr. E Laine, 59037, Lille, France.
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Honda M, Kitagawa N, Tsutsumi K, Morikawa M, Nagata I, Kaminogo M. Magnetic resonance angiography evaluation of external carotid artery tributaries in moyamoya disease. ACTA ACUST UNITED AC 2005; 64:325-30. [PMID: 16182003 DOI: 10.1016/j.surneu.2004.12.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Accepted: 12/29/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution magnetic resonance (MR) image has been introduced to diagnose and follow-up moyamoya disease and visualized moyamoya vessels and internal carotid artery stenosis. This study was performed to assess the utility of MR angiography (MRA) for the evaluation of anastomotic channels through the external carotid artery (ECA) in moyamoya disease patients. METHODS Twenty patients with moyamoya disease were reviewed. The cortical anastomosis and superficial temporal artery (STA), middle meningeal artery, and deep temporal artery by MRA were evaluated and were compared with those by digital subtraction angiography if obtained. Fifteen patients (24 hemispheres) underwent bypass surgery, including encephaloduroarteriosynangiosis in 14 hemispheres and STA-middle cerebral artery anastomosis with encephalomyosinangiosis in 10 hemispheres. Five patients did not undergo any surgery. RESULTS MRA could show these vessels and the patency of anastomosis formed by the surgery and also showed naturally formed anastomosis and ECA tributaries in the patients who did not undergo any surgery. CONCLUSION MRA provides useful information for follow-up evaluation on the development of the ECA system in moyamoya disease.
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Affiliation(s)
- Masaru Honda
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan.
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Desal H, Auffray-Calvier E, Toulgoat F, Guillon B, Madoz A, de Kersaint-Gilly A. ARM des vaisseaux cervico-encéphaliques : technique, principales applications cliniques. ACTA ACUST UNITED AC 2005; 86:1117-23. [PMID: 16227907 DOI: 10.1016/s0221-0363(05)81503-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Magnetic resonance angiography (MRA) is a very valuable tool in the routine evaluation of patients with stroke syndrome. It provides powerful noninvasive imaging of the cervical and intracranial vessels allowing the detection and the diagnosis of vascular anomalies. MRA usefully supplements, during the same examination, the analysis by MRI of the cerebral parenchyma. We will describe the indications of the various techniques (MRA with and without injection of contrast media) and show the value, artifacts and limitations of MRA in atherosclerotic stenosis or occlusive disease and in arterial dissections. This noninvasive vascular assessment will depend on the initial therapeutic orientation. Within the framework of the hemorrhagic stroke, we will discuss the role and the interest of dynamic MR angiography in the tracking and control of intracranial aneurysms and also the contribution of this newer sequences with gadolinium injection in the detection of cerebral vascular malformations.
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Affiliation(s)
- H Desal
- Service de Neuroradiologie Diagnostique et Interventionnelle, Unité de Neuro-Vasculaire, Hôpital G. et R. Laënnec, CHU de Nantes, Saint-Herblain, 44093 Nantes Cedex 1
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Houkin K, Nakayama N, Kuroda S, Nonaka T, Shonai T, Yoshimoto T. Novel magnetic resonance angiography stage grading for moyamoya disease. Cerebrovasc Dis 2005; 20:347-54. [PMID: 16131804 DOI: 10.1159/000087935] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 06/17/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Magnetic resonance angiography (MRA) has been acknowledged as a noninvasive diagnostic modality for moyamoya disease. However, in terms of staging of moyamoya disease, conventional angiography is still the gold standard. Therefore, the purpose of this study was to establish MRA grades for moyamoya disease as an alternative to conventional angiography. METHODS Twenty-two patients (44 sides) with moyamoya disease diagnosed by conventional angiography were evaluated by MRA during the past 5 years. MRA scores were assigned based on the severity of occlusive changes of the internal carotid artery, the horizontal portion of the middle cerebral artery, the anterior and the posterior cerebral arteries and the signals of the distal branches of these arteries. Total points ranged from 0 (normal) to 10 (most severe). RESULTS MRA scores (0-10) were significantly consistent with the conventional angiographic staging. Four grades based on this novel MRA scores correlated well with Suzuki's stages, with high sensitivity and specificity. CONCLUSIONS These novel MRA grades can be a reliable alternative to conventional staging. By employing these novel MRA grades, the use of conventional angiography can be avoided for the purpose of evaluation of the stages of moyamoya disease.
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Affiliation(s)
- Kiyohiro Houkin
- Department of Neurosurgery, Sapporo Medical University, Japan.
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Gauvrit JY, Oppenheim C, Savage J, Nataf F, Reyns N, Pruvo JP, Meder JF, Leclerc X. Applications de l’arm dynamique dans la pathologie vasculaire du système nerveux central. J Neuroradiol 2005; 32:20-5. [PMID: 15798609 DOI: 10.1016/s0150-9861(05)83017-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Conventional catheter angiography (CCA) remains the gold standard for the evaluation of most intracranial vascular malformations. MRA techniques such as Time of Flight, Phase Contrast or 3D contrast-enhanced MRA, provide anatomic evaluation but without hemodynamic information. Recently developed, dynamic MRA is based on dynamic acquisition of images and image subtraction; these two principal characteristics produce images comparable to those obtained by CCA. The purpose of this review is to explain the principles, advantages and drawbacks of this technique in the evaluation of arteriovenous malformations, arteriovenous fistulas, aneurysms and venous thrombosis.
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Affiliation(s)
- J Y Gauvrit
- Service de neuroradiologie, Hôpital Roger Salengro, Boulevard du Professeur Leclercq, 59037 Lille.
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Furuya K, Kawahara N, Morita A, Momose T, Aoki S, Kirino T. Focal hyperperfusion after superficial temporal artery—middle cerebral artery anastomosis in a patient with moyamoya disease. J Neurosurg 2004; 100:128-32. [PMID: 14743925 DOI: 10.3171/jns.2004.100.1.0128] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Superficial temporal artery—middle cerebral artery (STA—MCA) anastomosis is a standard surgical therapeutic option in patients with moyamoya disease. Most patients experience improvement in their clinical symptoms immediately after surgery. The authors report on the case of a 39-year-old man with moyamoya disease who suffered from temporary and frequent neurological deterioration after undergoing a left STA—MCA anastomosis. Hemodilution and hypervolemia therapies did not improve his course. Technetium-99m hexamethylpropyleneamine oxime single-photon emission tomography scans demonstrated focal intense accumulation of the tracer in the frontal operculum on the side of the surgery. Although diffusion-weighted magnetic resonance (MR) imaging demonstrated no abnormalities except for the postoperative change, perfusion-weighted MR images and MR digital subtraction angiography revealed focal hyperperfusion in the left frontal operculum where the cerebral perfusion reserve was severely disturbed preoperatively. This evidence strongly supports the notion that focal hyperperfusion observed after STA—MCA anastomosis could occur in the poor perfusion reserve area preoperatively and could cause temporary neurological deterioration.
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Affiliation(s)
- Kazuhide Furuya
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan.
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Masumoto T, Hayashi N, Mori H, Aoki S, Abe O, Ohtomo K, Abe T, Takahashi T. Development of intraarterial contrast-enhanced 2D MRDSA with a 0.3 tesla open MRI system. Magn Reson Med Sci 2003; 2:97-103. [PMID: 16210826 DOI: 10.2463/mrms.2.97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to develop a new technique for a high temporal resolution two-dimensional MR digital subtraction angiography (2D MRDSA) sequence under intraarterial injection of contrast material to permit the visualization of vascular anatomy and hemodynamics. METHODS 2D MRDSA was imaged on a 0.3T open MR scanner with a T(1)-weighted fast gradient echo sequence. The phantom study examined vials containing gadolinium (Gd) solutions ranging in concentration from 0.5 mmol/L to 100 mmol/L. Repetition time and echo time were fixed at minimal values in order to achieve high temporal resolution, and only the flip angle was changed in 10-degree increments between 10 and 90 degrees. The in vivo study examined a brachial artery of a human volunteer. MRDSA images were acquired continuously during intraarterial injections of Gd solutions ranging in concentration from 0.5 mmol/L to 100 mmol/L. The subtracted images were displayed on the monitor in real time at a frame rate of one frame per second and evaluated to determine the optimal concentration of contrast material. RESULTS In the phantom study, a 10-mmol/L Gd concentration with a flip angle of 50 degrees -90 degrees and a 25-mmol/L Gd concentration with a flip angle of 60 degrees -90 degrees showed high signal-to-noise ratios. In the human brachial artery experiment, the forearm arteries were well visualized when solutions of 5-50 mmol/L Gd concentration were used. The 10- and 25-mmol/L Gd concentrations were considered optimal. The palmar digital arteries were also visualized. Higher Gd concentrations showed a paradoxical signal increase when diluted by blood. CONCLUSION We successfully developed an intraarterial contrast-enhanced 2D MRDSA sequence. With appropriate settings of imaging parameters and Gd concentrations, we obtained acceptable vessel visualization in the human study. The low Gd concentration for optimal visualization permits repeated intraarterial injections. This technique can be a useful tool for investigating the vascular anatomy and hemodynamics required for MR-guided vascular interventions.
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Affiliation(s)
- Tomohiko Masumoto
- Department of Radiology, Faculty of Medicine, University of Tokyo, Japan.
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Fasulakis S, Andronikou S. Comparison of MR angiography and conventional angiography in the investigation of intracranial arteriovenous malformations and aneurysms in children. Pediatr Radiol 2003; 33:378-84. [PMID: 12768254 DOI: 10.1007/s00247-003-0904-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2003] [Accepted: 02/11/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND Magnetic resonance angiography (MRA) is an attractive alternative to conventional catheter angiography (CCA) in children, especially for the detection of intracranial arteriovenous malformations (AVMs) or aneurysms in the out-of-hours setting, because it has fewer risks and complications. OBJECTIVE. To compare MRA with CCA for the detection of intracranial AVMs, aneurysms and arterial anatomy in children. MATERIALS AND METHODS Retrospective blinded review of MRAs and CCAs by two independent paediatric radiologists, in a group of 19 children already diagnosed with AVMs, aneurysms and subarachnoid haemorrhage (SAH) and who had undergone both imaging techniques. RESULTS Abnormalities were identified on MRA in 15 of 19 patients and by CCA in 11 of 19 patients. MRA showed one aneurysm, nine AVMs, three haemorrhages and two indeterminate lesions. CCA showed nine AVMs and two indeterminate lesions. The two modalities showed excellent correlation in the detection of AVMs in nine patients. Vascular supply to the AVMs correlated well in four cases. There was complete disagreement in the determination of vessel supply in one case, and in two cases CCA showed additional vessel supply compared to MRA, while in two further cases MRA showed an additional vessel supply compared to CCA. CCA was superior to MRA in demonstrating arterial anatomy, except with regard to the anterior and posterior communicating arteries where MRA was superior. CONCLUSIONS The high sensitivity of MRA in the detection of AVMs when compared to CCA and the low incidence of aneurysms support the use of MRA as the initial imaging modality when intracranial haemorrhage is diagnosed on CT, especially in the out-of-hours setting.
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Affiliation(s)
- Stephen Fasulakis
- Department of Paediatric Radiology, Royal Children's Hospital, Melbourne, Australia
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Sasaki M, Oikawa H, Yoshioka K, Tamakawa Y, Konno H, Ogawa A. Combining Time-resolved and Single-phase 3D Techniques in Contrast-enhanced Carotid MR Angiography. Magn Reson Med Sci 2002; 1:1-6. [PMID: 16037661 DOI: 10.2463/mrms.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We established an easy-to-use technique for performing contrast-enhanced carotid MR angiography (MRA) with a commercial scanner. Twenty-three patients with suspected carotid or vertebral arterial lesions were prospectively studied. Two techniques were applied in the study. After performing sagittal time-resolved acquisitions, we undertook a coronal single-phase 3D acquisition, in which the injection timing was estimated from the preceding images. In each case, we obtained multidirectional images with sufficient venous suppression. The combined use of time-resolved and single-phase 3D MRA is a feasible technique for obtaining selective arterial images without the use of special applications or hardware.
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Affiliation(s)
- Makoto Sasaki
- Department of Radiology, Iwate Medical University, Morioka, Japan.
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