role mra in brain tumor batam2011 dr tan.pdf

8/12/2019 ROLE MRA IN BRAIN TUMOR BATAM2011 dr Tan.pdf

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THE ROLE OF MRA

IN BRAIN TUMOR

TAN SIAUW KOANST BORROMEUS HOSPITAL


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OVERVIEW

INTRODUCTION

TECHNIQUES OF MRA

3 CASES OF MENINGIOMA

2 CASES OF HEMANGIOBLASTOMA

CONCLUSION


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MRA : INTRODUCTION

NONINVASIVE TOOL forVISUALIZING BLOOD VESSELS.

ANATOMY

FUNCTIONALDIRECTION & VELOCITY

S C R E E N I N G &EVALUATION

!SIGNIFICANT CAROTIDSTENOSIS.

!ANEURYSM!AVM


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MRA in BRAIN TUMOR

not done very often these days.important test for meningiomas and

hemangioblastoma.

Which blood vessels are supplying the tumor?.

Is the tumor attached to any major bloodvessels in the brain?

Potential occlusion of a dural sinus adjacent to

the tumor.

the pattern of collateral venous drainage

around such an occlusion.


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MRA : TECHNIQUES

WITHOUT CONTRAST

Time!of!flight

Phase contrast

Black blood techniquesWITH CONTRAST

Contrast enhanced

Time-resolved of imaging

contrast kinetics (TRICKS)

!maximize signaldifferences between

flowing and stationarytissues to provide

morphologic and

physiologic information

T1 shortening rather

than flow, detect slow

flow, reduce signal

loss, temporal

resolution


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TOF MR ANGIOGRAPHY

COMBINATION OF FLOW

RELATED ENHANCEMENT ANDSATURATION

Flow-related

enhancement :flow of fully-magnetized blood into the

imaging plane.

Spoiled Gradient Echo

(SPGR): short TR, moderateto high flip angles -> heavily

T1W to saturate spins in

the excited slab.


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DATA ACQUISITION AND

RECONSTRUCTION2D TOF

3D TOF

3D MOTSA(MULTIPLE

OVERLAPPING

THIN SLABS

ACQUISITION)

SOURCE IMAGES

3D MIP ( MAXIMALINTENSITY

PROJECTION )3D SURFACE

RENDERING

3D VOLUME

RENDERING

MPVR (multi projectionvolume reconstruction


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Sequential 2D TOF

techniquecraniocaudad

direction

superiorly

placed

tracking

saturationpulse


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Multiple overlapping DTOF slab techniqueadvantages of bothsequential 2DFT and3DFT

axially orientedpartitions maximizeflow-relatedenhancement

craniocaudad direction

to avoid saturationsuperior saturationsuppresses venoussignal.


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2D vs 3D TOF


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CONTRAST ENHANCED

(CE) MRAhigh concentration of a TI shortening

agent

test injection or automatic triggering

minimally invasive

additional cost

reduction of flow dependence

reduction in patient motion artifactvenous visualization


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CONTRAST ENHANCE & 3D TOF

MR ANGIOGRAPHY


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Man 42 yo

Clinical information:Olfactory groove meningioma.

Visus OS: 0,

Hemiparese sinistra.

Please identify the feeder artery of

Olfactory groove meningioma .

A ethmoidalis ant? A ethmoidalis

post? Other artery?.Plan for total removal with

craniotomy.


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OLFACTORY

MENINGIOMA


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3D TOF & CONTRAST

ENHANCED MRA


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3DTOF 3D MIP


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CE MRA, 3D VR % MIP


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3D TOF MIP MPR

CE MRA MIP MPR


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Woman 41 yo

Clinical information:cephalgia.

Hemiparese sinistra

Falx meningioma.

Vascular evaluation aroundmeningioma


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MENINGIOMA RIGHT

FRONTO PARIETAL


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FALX MENINGIOMA RIGHT

FRONTO PARIETAL

Feeding artery : arteri meningae media

kanan kiri, kanan lebih dari kiri.

Feeding : arteri pericallosal dan

callosomarginal kanan dan arteri

meningae media kanan


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CE MRA 3D VR MIP MPR


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Woman 39 yo

Clinical information:convexity meningioma.


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LEFT OCC PAR MENGINGIOMA


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LEFT OCC PAR

MENGINGIOMA


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VON HIPPEL LINDAU

SYNDR


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VHL SYRINGOMYELIA


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14th ICSM 6/17/10


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14th ICSM 6/17/10


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SPINAL MRA

SPINAL HEMANGIOBLASTOMA

14th ICSM 6/17/10


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CONCLUSION

Noninvasive Angiograph using MRI2D TOF"3D TOF MOTSA

CONTRAST ENHANCED MRA

TRICKS Time Resolved ImagingContrast Kinetics

not done very often for brain tumours

BUT IMPORTANT: for MENINGIOMA,HEMANGIOBLASTOMA.


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role mra in brain tumor batam2011 dr tan.pdf

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