MRA/MRV CASE REVIEW Carlos Avila R.T.(R)(MR)(CT)
Carlso Avila, RT (R)(MR) No relevant financial relationship reported
MRA/MRV Magnetic resonance angiography: noninvasive examination performed to evaluate arteries with and without contrast. Magnetic resonance venography: noninvasive examination performed to evaluate veins with and without contrast.
Benefits of MRA/MRV No Radiation(CT,Radiography) Cost(Invasive angio) Low risk (non-invasive) Contrast (low volume Gad/Non Contrast) 4D time resolved imaging(unique)
Challenges of MRA/MRV Environment (claustrophobia) Length of time Motion Magnetic field (safety)(signal void) Renal insufficiency(gfr>50)
Keys for optimized imaging of vascular conditions Prescription- Diagnosis Communication- Patient history Determine imaging technique- MRA/MRV Contrast- Timing and type of agent Coil- Transmit device that provides best signal Patient positioning- Comfort to avoid motion
MRA/MRV techniques 3D dynamic (T1 gradient) Contrast 4D multi dynamic (Time resolved) Contrast
3D Dynamics Routinely used for neuro, extremity, and body vascular imaging.
4D Time-resolved Routinely used for neuro, extremity, and body vascular imaging.
4D Time-resolved ANGIO 4D MRA
THORACIC OUTLET SYNDROME Rare condition that occurs when there is compression of vessels and nerves in the area of the clavicle. Occurs when there is an extra cervical rib or because of a tight fibrous band that connects the spinal vertebra to the rib.
T.O.S. imaging Patient is positioned supine and centered towards side of interest. Contrast will be administered based on weight and through opposite arm to avoid venous contamination. Patient will be instructed to hold respiration to avoid breathing motion. Scans will be acquired in neutral position and in military position.
M.R.A. CHEST (T.O.S) NEUTRAL MILITARY
M.R.A. CHEST (T.O.S.) NEUTRAL MILITARY
M.R.A. CHEST (T.O.S.) NEUTRAL MILITARY
M.R.A. CHEST (T.O.S.)
M.R.A. CHEST (T.O.S.) NEUTRAL(NEGATIVE) MILITARY(POSITIVE)
M.R.V. CHEST (T.O.S.) NEUTRAL MILITARY(POSITIVE)
T.O.S treatment options Thrombolytic treatment Anticoagulant medication Surgery
T.O.S treatment options
Pelvic Congestion Syndrome Chronic pelvic pain Varicose veins Pelvic pressure and bulging veins Develops after pregnancy Fullness of leg veins
Pelvic congestion imaging Abd & Pelvis MRA/MRV 3D Dynamic and 4D time resolved(20) Breath hold to eliminate motion Coverage from kidneys to pubis
Pelvic congestion imaging
Pelvic congestion imaging
Pelvic congestion treatment options Medication(reduce pain and size of varicose) Pelvic vein embolization Open or laparoscopic surgery to tie veins
Pelvic congestion treatment options
Pelvic congestion treatment options
Pelvic congestion treatment options
May Thurner Syndrome Left iliac vein compression by right iliac artery Increased risk of DVT Left leg swelling Increased warmth, redness or discoloration of skin Can be life threatening if not treated (P.E.)
May Thurner imaging Abd and Pelvis MRA/MRV Blood pooling contrast Coverage to include IVC and femoral veins. 3D T1 Dynamics with several delays(3) Time resolved imaging can also be used
May Thurner imaging Axial Post Contrast MRA/MRV MRV
May Thurner treatment options Anticoagulation Thrombolytic therapy Angioplasty and stenting
May Thurner treatment options
SVC Syndrome Blockage of Superior Vena Cava Tumor(cancer) Blood clot(pacer wires and dyalisis catheter) Sarcoidosis(masses of inflamed tissue)
SVC Syndrome imaging MRV Dual upper extremity hand injection Diluted contrast(10:1) Time resolved(10-15) Breath hold Delayed post contrast 3D sequence
SVC Syndrome imaging
SVC Syndrome treatment options Tumor(radiation) Swelling(steroids) Clot(stent or thrombolysis)
SVC Syndrome imaging
Conclusion Advancements in medical technology have redefined methods of treatment, making them safer and more specific. Today's non-invasive examinations help reduce the need of costly high risk procedures that were once the only method to properly diagnose vascular disease.