[Contrast-enhanced intracranial 3 D MR angiography (CE-MRA) in assessing arterial stenoses and aneurysms]

Modern cross-sectional imaging in the diagnosis and follow-up of intracranial aneurysms

Digital subtraction angiography (DSA) is still considered the gold standard for most applications in neurovascular imaging. However, with the ongoing development of cross-sectional imaging modalities DSA is increasingly being replaced by less invasive methods. This contribution describes the diagnostic value and the increasing potential of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) in the diagnosis and follow-up of intracranial aneurysms. The main role of CTA is in the diagnosis and therapy planning of ruptured aneurysms; in contrast, MRA plays an increasingly important role in the screening for asymptomatic aneurysms (especially in cases of familial subarachnoid hemorrhage) and in the follow-up after endovascular therapy with coils and/or intracranial stents. Technical issues concerning examination technique are covered here as well as an approach to advanced postprocessing of the image data. Furthermore, a brief outlook on the impact of new developments (MRA with parallel imaging and at 3.0 T) is given.

New partially parallel acquisition technique in cerebral imaging: preliminary findings

In MRI applications where short acquisition time is necessary, the increase of acquisition speed is often at the expense of image resolution and SNR. In such cases, the newly developed parallel acquisition techniques could provide images without mentioned limitations and in reasonably shortened measurement time. A newly designed eight-channel head coil array (i-PAT coil) allowing for parallel acquisition of independently reconstructed images (GRAPPA mode) has been tested for its applicability in neuroradiology. Image homogeneity was tested in standard phantom and healthy volunteers. BOLD signal changes were studied in a group of six volunteers using finger tapping stimulation. Phantom studies revealed an important drop of signal even after the use of a normalization filter in the center of the image and an important increase of artifact power with reduction of measurement time strongly depending on the combination of acceleration parameters. The additional application of a parallel acquisition technique such as GRAPPA decreases measurement time in the range of about 30%, but further reduction is often possible only at the expense of SNR. This technique performs best in conditions in which imaging speed is important, such as CE MRA, but time resolution still does not allow the acquisition of angiograms separating the arterial and venous phase. Significantly larger areas of BOLD activation were found using the i-PAT coil compared to the standard head coil. Being an eight-channel surface coil array, peripheral cortical structures profit from high SNR as high-resolution imaging of small cortical dysplasias and functional activation of cortical areas imaged by BOLD contrast. In BOLD contrast imaging, susceptibility artifacts are reduced, but only if an appropriate combination of acceleration parameters is used.