Optimized phase contrast MRV technique outperforms timeof-flight in the diagnosis of cerebral venous thrombosis

Transcription

1 Optimized phase contrast MRV technique outperforms timeof-flight in the diagnosis of cerebral venous thrombosis Poster No.: C-3377 Congress: ECR 2010 Type: Topic: Authors: Keywords: DOI: Scientific Exhibit Neuro M. M. A. Y. Chu, J. C. Rios, P. S. Pawha, L. N. Tanenbaum; New York, NY/US MRV, Time of flight (TOF), Phase contrast /ecr2010/C-3377 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 6

2 Purpose To compare and contrast 2D time-of-flight (TOF) versus optimized 3D phase contrast (PC) magnetic resonance venography (MRV) in patients referred for suspected cerebral venous thrombosis. Methods and Materials Subjects: A retrospective review of 38 examinations in 36 patients between 1/09 and 12/09 was performed evaluating 2D-TOF versus an optimized 3D- PC MRV. Equipment: MR imaging was performed on either a 1.5T or 3T GE scanner. Coronal 2D TOF parameters: TR 30-35, TE 11.5/60, Slice thickeness 2.0, Slice spacing 1.5 mm, FOV 256 x 224, time 5 minutes. Sagittal 3D PC parameters: TR 11-13, TE 5-6/8, Slice thickness 1.2, Slice spacing 0.6 mm, FOV 320 x 256, VENC 35 cm/sec, parallel imaging factor 2, time 6.5 minutes. Post-processing: Full volume rotating MIP and overlapping limited volume maximum intensity projection (OLIVE MIP) images were created in the axial, coronal, and sagittal planes using a slice thickness of 20mm and a slice spacing of 5mm. Evaluation of images: The cases were independently reviewed by two experienced Neuroradiologists asked to rate overall image quality and ability to depict anatomy identify pathology. Saturation effects were rated on a four point scale (best quality, mild saturation effects, potentially interfering with diagnosis, non-diagnostic). Results Overall quality: Radiologists preferred the overall quality of PC to TOF in 92% of studies, and in the remaining cases, the techniques were equivalent. All phase contrast studies were diagnostic and demonstrated no significant degradation and were rated as best quality. In contrast, TOF studies were Page 2 of 6

3 considered best quality in 12 cases (33%) by reviewer 1 and in 16 cases (42%) by reviewer 2. Saturation effects: There was mild saturation effect in 20 cases (53%) (reviewer 1) and in 18 cases (47%) (reviewer 2). In 8 TOF cases, the saturation effects were thought to potentially interfere with accurate interpretation (6 cases by reviewer 1 and 4 cases by reviewer 2 with agreement in 2 cases). No studies were deemed non-diagnostic. Depiction of anatomy and identification of pathology: In the depiction of anatomy and identification of pathology, PC was considered superior in 45% of cases, with the remainder of cases being equal between PC and TOF. Reviewer 1 selected PC at better depicting anatomy/pathology in 24 (63%) cases while reviewer 2 only selected PC as superior in 10 cases (26%). Reviewer 2 rated the majority of studies equal at demonstrating anatomy/pathology in 29 cases (76%) in contrast to Reviewer 1 who rated the techniques as equal in 14 cases (37%). Images for this section: Page 3 of 6

4 Fig. 1: 22 year-old female with history of venous sinus thrombosis (initially diagnosed 3 weeks prior to displayed images). Recanalization of the right transverse sinus is demonstrated on both TOF and PC axial MIPs. Additionally, there is poor visualization of the left transverse sinus on TOF imaging, which raises the possibility of sinus thrombosis. However, the left transverse sinus is patent on PC imaging. This difference is due to inplane flow artifact on TOF, while PC is not susceptible to such artifact. Page 4 of 6

5 Conclusion Optimized 3D-PC was superior to 2D-TOF MRV in depicting anatomy and pathology and resistant to saturation effects. References 1. Liauw L, van Buchem MA, Spilt A, et al. MR angiography of the intracranial venous system. Radiology 2000;214: Ayanzen RH, Bird CR, Keller PJ, et al. Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. AJNR Am J Neuroradiol 2000;21: Du YP, Jin Z, Hu Y, Tanabe J. Multi-echo acquisition of MR angiography and venography of the brain at 3 Tesla. J Magn Reson Imaging Aug;30(2): Connor SE, Jarosz JM. Magnetic resonance imaging of cerebral venous sinus thrombosis. Clin Radiol Jun;57(6): Kirchhof K, Welzel T, Jansen O, Sartor K. More reliable noninvasive visualization of the cerebral veins and dural sinuses: comparison of three MR angiographic techniques. Radiology Sep;224(3): Klingebiel R, Bauknecht HC, Bohner G, Kirsch R, Berger J, Masuhr F. Comparative evaluation of 2D time-of-flight and 3D elliptic centric contrastenhanced MR venography in patients with presumptive cerebral venous and sinus thrombosis. Eur J Neurol Feb;14(2): Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics Oct;26 Suppl 1:S Laub G, Gaa J, Drobnitzky M. Magnetic Resonance Angiography Techniques. ELECTROMEDICA -ERLANGEN. 1998; 66(2): Sun Y, Zheng DY, Ji XM, Weale P, Wu H, Jiang LD, Yang LZ. Diagnostic performance of magnetic resonance venography in the detection of recanalization in patients with chronic cerebral venous sinus thrombus. Chin Med J (Engl) Oct 20;122(20): Reichenbach JR, Barth M, Haacke EM, Klarhöfer M, Kaiser WA, Moser E. High-resolution MR venography at 3.0 Tesla. J Comput Assist Tomogr Nov-Dec;24(6): Pui MH. Cerebral MR venography. Clin Imaging Mar-Apr;28(2):85-9. Page 5 of 6

6 Personal Information Address correspondence to Lawrence Tanenbaum, MD. Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY, lawrence.tanenbaum@mountsinai.org Page 6 of 6