Clinical Applications of 2-D Dynamic Contrast-Enhanced MR Subtraction Angiography in Neurosurgery - Preliminary Results

 

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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.

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T. KringsMD 

Department of Neuroradiology · University Hospital of the Technical University Aachen

Pauwelsstraße 30

52057 Aachen

Germany

Phone: +49/2 41/8 08 03 07

Fax: +49/2 41/8 08 24 40

Email: tkrings@izkf.rwth-aachen.de