ISNVD Abstract Book

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MRIPROTOCOLFLOWCHARTWITHOUTCONTRAST BODYOF VENDORMRIACRONYMS TIMEOF TOTAL MRISEQUENCE EXAMINATION Siemens GE Philips AQUISITION TIME SWI GRE SWI SWI1X0.5X2 06:39 T2 T2 T2 T2 02:30 HEAD 3DFGRE, MPRAGE 3DFast 3DTFE MPRAGE 04:03 18:32 SPGR FLAIR FLAIR FLAIR FLAIRSAG 05:20 MovethetablecenterattheNECK TOF TOF TOF 2DTOFMRV 06:57 T2 T2 T2 T2SAG 02:22 NECK FLOWQUANTIFICATION 01:42(x4) 16:07 VIBE LAVAXV THRIVE ATCSFANDTHREENECK LEVELS MovethetablecenterattheMIDSTERNUM TOF TOF TOF 2DTOFMRV(azygous) 10:39 AZYGOUS TOF TOF TOF 2DTOFMRV(azygous 05:12 arch) 17:33 FQ FQ FQ FLOWQUANTIFICATION 01:42 Totalscantimeforhead,neckandazygous:justunder53minutes Totalscantimeforheadandneck:justunder35minutes
Magnetic Resonance Imaging (MRI) Traumatic Brain Injury Protocol The MRI TBI Protocol uses a conventional neuroimaging protocol for MS with additional specialized sequences to study the vasculature in the brain, neck and spine as well as the iron content in the brain. On the vascular side, both anatomic and flow information is collected. A major benefit of using MRI is that it provides the neurologist with what he needs for assessing MS, it provides the interventionalist 3D planning and it provides all parties with critical flow information which may well become a key marker for deciding when or when not to treat a patient. MRI is also operator independent for the most part and the same protocols can be run on most manufacturers’ systems. The data are also easily reproduced when run on the same equipment from site to site. Potential biomarkers for CCSVI and MS can be identified from the data. MRI can also longitudinally track the progress of the disease over time via lesion counts and type, physiologic changes like blood flow and cerebrospinal fluid (CSF) dynamics, and provide a baseline for future scans. The following imaging protocol is presented for a 3-Tesla Siemens Scanner but can be extended to other field strengths and manufacturers. The scans proposed are: 2D time of flight MR venography (TOF MRV), time-resolved contrast enhanced 3D MR angiography and venography (MRAV), 3D volumetric interpolated breath-hold examination (VIBE), phase-contrast flow data at different levels in the neck and thoracic cavity, as well as the conventional T2 weighted imaging (T2WI), T2 fluid attenuated inversion recovery (FLAIR), susceptibility weighted imaging (SWI), and pre and post contrast T1 weighted imaging (T1WI) or magnetization prepared rapid gradient echo (MPRAGE) imaging. Perfusion scanning can also be added into this protocol for a small increment in time (roughly 3 minutes extra). Finally, we add diffusion tensor imaging (DTI) as a measure of microscopic changes in water diffusion. Both fractional anisotropy (FA) and apparent diffusion coefficient (ADC) measures are used from this data. 2D TOF MRV scans are used to detect blood flow in arteries and veins. Using a saturation band, any flow toward the head (arterial flow) will be saturated, and the flow towards the heart (venous flow) will be highlighted in a velocity-dependent manner. From this sequence, veins are well visualized and it can be determined if they are patent, occluded, or stenosed. Since the data are collected with high resolution, vessel cross-section can also be calculated to evaluate the degree of stenosis. 3D CE MRAV can also be used to evaluate vascular abnormalities. The scan uses a T1 reducing contrast agent which passes through all vessels and leads to increased signal for vessels in T1 weighted scans. From the data, 3D anatomical assessments can be done to evaluate vessel patency. Atresias, aplasias, truncular malformations, valve issues, and stenoses can be detected. 3D VIBE pre- and post-contrast can be used to evaluate structural patency of vessels as well as inhomogeneous enhancement of the tissue. It is an alternate approach to the 3D dynamic CE approach just discussed and takes much longer (although still relatively fast). 2D PC-MRI images are used to assess flow dynamics in the head and neck veins and arteries, the azygous vein, and CSF at the C2 cervical level. This information is valuable because it can both corroborate and compliment the information seen in the 2D TOF MRV and 3D CE MRAV. It is not uncommon to visualize the major veins only later to find that many of the veins have compromised blood flow. Susceptibility Weighted Imaging (SWI) is useful because the image contrast is based on the intrinsic susceptibilities of tissues. For example, veins are rich in deoxyhemoglobin which is paramagnetic and provides clear visibility of venous structures. Quantification of iron in the gray matter as well as lesions
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The 2 nd Annual ISNVD Scientific Me
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PRINCIPLE CONSIDERATIONS ON VENOUS
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using several methods. These method
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Page 55 and 56: POSTER ABSTRACTS Monday, February 2
Page 57 and 58: POLITECNICO DI MILANO mlagana@dongn
Page 60 and 61: Background Iron deposition in clini
Page 62 and 63: Short-Term Outcomes After Endovascu
Page 64 and 65: Internal jugular vein valve morphol
Page 66 and 67: The Cerebral Perfusion of Patients
Page 68 and 69: Intravascular Ultrasound for detect
Page 70 and 71: Prevalence of Chronic Cerebrospinal
Page 72 and 73: Azygos compression and effect of re
Page 74 and 75: Iron deposition in pediatric multip
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