Clinical Neuro MRA

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Clinical Neuro MRA

• Lawrence N. Tanenbaum, MD FACR
• New Jersey Neuroscience Institute Seton Hall
  University
• Edison Imaging JFK Medical Center
• Edison, New Jersey
• www.drtmasters.com drt_at_drtmasters.com

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Basic clinical Neuro MRA

• Neck
• 1.5 T
• 3DTOF
• 3T
• 3D TOF
• .35 T
• 2D / 3D TOF

1.5 T
.35 T
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3DTOF MRA neck

• TR / min / 20, ramp I-S
• 18 x 12 FOV, f RL
• 224 x 128 1024 ZIP
• 2 mm / 1mm spacing (ZIP)
• 16 kHz, 1 nex
• 20 pps overlap 4, 6 slabs
• 412

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8 channel
3D MOTSA TOF 1.5T
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ICA fenestration
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3DTOF MRA neck3T 4 channel

• TR / min / 20
• 18 / .8 FOV, f RL
• 320 x 192, ZIP 1024
• 2 mm / 1mm spacing (ZIP)
• Ss, ramp I-S
• 31 kHz, 1 nex
• 20 pps overlap 3, 6 slabs
• 540

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3D TOF
3D MOTSA TOF 3T
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SLINKY 3T
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SLINKY 3T
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SLINKY 3T
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SLINKY
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2D TOF 0.35T
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Basic clinical Neuro MRA
1.5 T
3T
0.35 T
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MRA brainaneurysm 1.5T

• vasc TOF SPGR
• 14 / min / 20,16 kHz
• 14 FOV, f AP
• 1 mm / zip 0.5
• 256 x 192
• MOTSA 3 x 32, overlap 3
• ramp IS
• 1 nex, 429

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MRA brainaneurysm 8 ch 1.5T

• vasc TOF SPGR
• 15 / min / 20, 25 kHz
• 18 FOV, f AP
• 1 mm / zip 0.5
• 448 x 192, ASSET x 2
• MOTSA 4 x 32, overlap 3
• ramp IS
• 1 nex, 319

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8 channel MRA brainASSET 319
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MRA brainstroke

• vasc TOF SPGR
• 30 / min / 25, 16 kHz
• 16 FOV, f AP
• 1.6 mm / zip 0.8
• 256 x 160, 512Z
• 50 partitions, 1 slab
• MT, ramp IS
• 1 nex, 349

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MRA brainstroke 8 ch

• vasc TOF SPGR
• 26 / 2.0 / 25, 16 kHz
• 18 FOV, f AP
• 1.6 mm / zip 0.8
• 448 x 192, ASSET x 2
• 50 partitions, 1 slab
• MT, ramp IS
• 1 nex, 208

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MRA
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3D Conventional angiography
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persistent trigeminal artery
256 x 160 512 Z 16 FOV 1.6 / 0.8 26 / 2.4 349
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MRA brain3T- 8 channel

• vasc TOF SPGR
• 14 / 2.3 / 20, 32 kHz
• 18 FOV, f AP
• 1.0 mm / zip 0.5
• 512 x 224, ASSET x 2
• 4 slabs, 32 overlap 3
• ramp IS
• 1 nex, 414

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multislab 3D TOF 512 x 224 414
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ASSET TOF 3T Excite
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1.7 mm aneurysm
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P com A aneurysm
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OLIVE MIP multiplanar volume reformation
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OLIVE MIP

• Overlapping, LImited VolumE MIP
• aka sliding subvolume MIPs, MPVR, etc
• hybrid of MPR and MIP
• tomographic
• reduced overlap
• fast, no threshholding

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OLIVE MIP

• typical technique
• 20 mm slab thickness
• 2 mm incrementation
• sagittal, coronal, axial, oblique
• appropriate small FOV
• 14 cm for head, 24 for renal, etc.

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multiplanar volume reformations OLIVE MIP MPVR
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OLIVE MIP
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SAH negative conventional angiogram
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OLIVE MIP
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oa
oa
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ophthalmic artery 3.5 mm aneurysm
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3 wks s/p worst headache ever
right CN III Palsy pupil involved
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CA
CA
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basilar stenosis
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512
128
224
149
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3T 8 channel Excite
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512 x 128 20 FOV 1 mm /0.5 mm 32 pps / overlap 3
ASSET x 2 149
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Contrast augmented MRA

• Neck
• great vessel origins
• problem solving

Dublin 2003
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Neurovascular CAMRAchallenges

• SmartPrep difficult
• tortuous, moving target
• rapid arterial to venous transit
• elliptical-centric PE
• maximum spatial resolution without venous
  interference
• 3 clinical approaches
• high resolution, single phase
• fluoro triggered (timing run)
• rapid, multiphase FAME
• trade coverage, spatial for temporal resolution
• TRICKS
• multiphase, hi resolution

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High resolution CAMRAneuro MRA

• fluoro triggered
• 1.5 cc/sec, 0.05 mmol/kg
• 3-point oblique coronal
• elliptical-centric phase encoding
• min TR, TE 30 FA
• 1.2 / 0.6 mm, 224 x 128 (1024 Z)
• 26 x 16 FOV, 16 KHz BW
• 1 nex, 35-60 seconds

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fluoro triggered high resolution EC MRA
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high resolution CAMRA
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3D MOTSA TOF
3D CAMRA
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46 cm
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8 channel neurovascular coil
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right arch occluded aberrent left
subclavian artery
Volume rendering
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MRA volume rendering
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Multi-phase FAMEneuro MRA

• 4 phases, 6 sec/phase, 30 sec per study
• 5 sec delay, 1.5 cc/sec, 0.05 mmol/kg
• elliptical-centric phase encoding
• min TR, TE 30 FA
• 2.6 / 1.3 mm, 256 x 128 (Z512), 0.5 nex
• 26 x 16 FOV, 62 KHz BW
• subtract initial phase from phases with contrast

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multi-phase FAME
37 sec 5 phases
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multi-phase FAME
problem solving
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multi-phase FAME CAMRA
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Time resolved MRAphysiologic imaging
multi-phase CAMRA FAME

• traditional time resolved MRA techniques trade
  spatial resolution and coverage for temporal
  resolution

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TRICKSTime Resolved Imaging of Contrast Kinetics
D
B
A

• variable rate k-space sampling
• K-space segmented into 4 regions
• center region sampled more frequently

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3D elliptical-centric TRICKS
Sydney 2001
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3D elliptical centric TRICKS 0.1 mmol/kg
Giessen 2001
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3D TOF
EC TRICKS
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512 x 128 ASSET 38 x 2 mm partitions 2 sec
temporal resolution 0.1 mmol/kg
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Contrast augmented MRA

• brain
• ?giant aneurysms
• post op clipping/coil
• min TE, high BW
• AVM, fistula

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AVM
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3D CAMRA
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OLIVE MIP
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OLIVE VR
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CAMRA
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3D catheter angio
CAMRA
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3D Elliptical centric TRICKS
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dural AVF
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proptosis - post trauma
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TRICKS
c-c fistula
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Recent advances

• Broadband reception and processing
• 8 channel coils
• true and interpolated 1024 matrices
• ASSET
• massively parallel
• novel reconstruction techniques
• 3D ECTRICKS
• projection reconstruction

448 x 192 19 FOV 1024 ZIP
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eight channel neurovascular coil
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Recent advances

• Broadband reception and processing
• 8 channel coils
• true and interpolated 1024 matrices
• ASSET
• parallel imaging
• novel reconstruction techniques
• 3D ECTRICKS
• projection reconstruction

NYC 2002
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ASSET
B Stein MD

• parallel imaging (SENSE)
• use of ½ FOV reduces number of phase encoding
  steps
• sensitivity info from PA coils permits unfolding
  of resultant phase wrap
• result is 50 reduction in scan time or doubled
  resolution / coverage

12 sec scan
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FT ECASSET 2 mm / 22 seconds
TwinSpeed
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Recent and future developments

• broadband reception and processing
• higher ASSET factors
• massively parallel
• novel reconstruction techniques
• projection reconstructions

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Parallel imaging 32 channel
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Parallel imaging 32 channel
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High Spatial Resolution MRA
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High Spatial Resolution MRA
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High Temporal Resolution MRA
54 second acquisition
2.8mmx2.8mmx2.8mm true voxel size over
36cmx36cmx36cm 12-fold acceleration
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High Temporal Resolution MRA
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projection reconstruction MRA
U of Wisconsin
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Summary

• TOF routine _at_ all fields
• CAMRA
• origins
• problem solving
• dynamic lesions
• neck
• fluoro triggered single phase EC
• 3D ECTRICKS
• brain
• multiphase 3D EC TRICKS
• ASSET high resolution

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www.drtmasters.com
JFK Medical Center