Neurological Research A Journal of Progress in Neurosurgery, Neurology and Neurosciences
ISSN: 0161-6412 (Print) 1743-1328 (Online) Journal homepage: http://www.tandfonline.com/loi/yner20
Cerebral magnetic resonance angiography Heinrich P. Mattle & Robert R. Edelman To cite this article: Heinrich P. Mattle & Robert R. Edelman (1992) Cerebral magnetic resonance angiography, Neurological Research, 14:2, 118-121, DOI: 10.1080/01616412.1992.11740027 To link to this article: http://dx.doi.org/10.1080/01616412.1992.11740027
Published online: 23 Jul 2016.
Submit your article to this journal
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yner20 Download by: [Australian Catholic University]
Date: 08 August 2017, At: 07:41
Cerebral magnetic resonance angiography Heinrich P. Mattie and Robert R. Edelman Department of Neurology, University of Bern, Switzerland and Harvard Medical School, Department of Radiology, Beth Israel Hospital, Boston, MA, USA
Magnetic resonance angiography ( MRA) is an accurate non-invasive tool for imaging the cerebral vessels. It provides morphologic information about the cerebral vessels relying on blood flow as the physical basis for generating contrast between stationary tissues and moving spins. 'Selective' MRA gives functional information about the cerebrovascular system such as flow direction, origin of flow, and presence or absence of co/laterals. Arteries and veins can be imaged selectively due to their usually opposite flow directions. Although at a relatively early stage of development, MRA has already become a widely used tool for the study of the cerebrovascular system.
Downloaded by [Australian Catholic University] at 07:41 08 August 2017
Keywords: magnetic resonance; angiography; cerebral blood vessels; thrombosis; stroke
INTRODUC TION
Within just the last few years magnetic resonance (MR) has become a powerful tool for accurate and early diagnosis of cerebral ischaemia and has proved helpful for rational therapy of vascular pathology. Spin-echo (SE) images show the localization and extent of ischaemic areas. Magnetic resonance angiography (MRA) has emerged as an adjun~t to SE imaging and serves as a means for evaluating the cerebral arteries and veins1 . The time-of-flight (TOF) method is widely applied to create MR angiograms. It uses a gradient-ech o (GRE) pulse sequence in conjunction with flow compensatio n (a technique to eliminate flow-related phase shifts that cause signal loss). Flowing blood appears bright (called flow-related enhancement) because fresh spins are constantly flowing into the plane of section, whereas stationary tissues appear dark. The resulting angiograms are referred to as 'white blood' images, as opposed to 'black blood' images which are typically created by spin-echo sequences. Alternatively, MR angiograms can be rendered based on the phase shift produced by flow along a magnetic field gradient, called phase contrast angiography . Presaturatio n techniques are an adjunct to MRA. Presaturatio n pulses can be applied to user-defined regions in order to suppress the signal from blood flowing through these regions. The use of presaturatio n in conjunction with MRA is called selective MRA 2 . CLINICAL RESULTS
'·
Giyen the preliminary nature of clinical studies of MRA to date, any conclusions about its clinical utility and impact on the practice of cerebrovasc ular neurology must be considered preliminary and tentative. Nonetheless , there seem to be several applications where MRA using currently available techniques can be recommend ed.
Correspondence to: Dr H.P. Mattie, MD, Department of Neurology, University of Bern, lnselspital, CH-3010 Bern, Switzerland. Accepted for publication january 1992.
© 1992 Forefront Publishing Group 0161-6412/92/020 118-04 118
Neurological Research, 1992, Volume 14, Suppl
Carotid arteries
Several authors have used MRA in order to image the carotid arteries in the neck and have compared the results to ultrasound and / or contrast arteriograph y3 - 10. Two-dimens ional (20) MR angiography with axial4 •7 or sagittal6 •10 acquisition and three-dimen sional (30) MRA 3•5 •9 , as well as black blood MRA6 •10 , have been tested. MR angiograms of the carotid arteries can be successfully obtained in upwards of 90% of patients, and the study can be finished in less than 30 min. MR angiograms are highly sensitive for carotid disease, but may exaggerate severe stenoses (Figure 1 ). This is primarily due to signal loss caused by turbulent flow-related dephasing and recirculation, the latter causing flowing spins to remain within the imaging volume for a prolonged period where they become saturated. For reasons of comparative cost, MRA cannot routinely replace ultrasonography as a screening technique for carotid disease except when an MR imaging study of the brain is being obtained anyway. In situations where the results of duplex scanning and MR angiography agree, the correlation to contrast angiography has been up to 100%. In these patients MR angiography may eliminate the need for contrast angiography . Vertebral arteries
MR has the potential to image the vertebral arteries in their entire length from the subclavian arteries to the junction with the basilar artery. In our experience a combination of SE imaging and MR angiography has also proved useful in diagnosing dissection of the vertebral arteries. Large-scale clinical studies of MRA in this application have yet to be published. Intracranial arteries Arteries. Using a
30FT TOF MR angiography technique the intracranial arteries such as the middle, anterior, posterior and basilar arteries and their main branches can be imaged reliabli 1•12 . Case reports and small series have demonstrate d the feasibili% of depicting stenoses and occlusions of these vessels 3 - 16.
Cerebral magnetic resonance angiography: H.P. Mattie and R.R. Edelman
Downloaded by [Australian Catholic University] at 07:41 08 August 2017
A stenosis of a cerebral vessel can be suspected when there is sudden narrowing of the lumen. If the stenosis is severe signal downstream will also be reduced as a result of compromised flow. In one series 11 of 13 patients with suspected intracranial arterial occlusions were successfully imaged with both MRA and SE sequences 14. Lack of arterial filling on the MR angiogram could be correlated with areas of infarction on theSE study. In a study correlating MRA, Doppler sonography, and contrast angiography, MRA reliably depicted occlusions of the basilar artery in three patients, and stenoses and occlusions of the middle cerebral artery in 2 patients each 17• Figure 2 gives an example of occipital lobe infarction due to right posterior cerebral artery occlusion.
a
Veins. In 30FT TOF MRA arteries are well seen. Slowly moving spins tend to stay for a long period in the thick imaging volume and become saturated. As a result veins are poorly visualized. In 20FT TOF MR angiography slowly moving spins are less saturated, and flow related enhancement dominates over signal loss18. To produce projection venograms of the head a series of overlapping 20 GRE images are acquired in sagittal, coronal and I or transverse planes with presaturation pulses applied over the neck to eliminate signal from inflowing arterial spins 19. The images are then postprocessed to produce ~rejection images along userdefined viewing angles 0 . Alternative approaches to image the cerebral veins are 30FT TOF MR angiography in conjunctiOJl with contrast agents such as ~adolinium DTPA or phase contrast MR angiography2 - 23 . Using the 20FT TOF MR venography technique the superior sagittal, lateral and straight sinuses, the internal cerebral veins and vein of Galen were visualized reliably and other veins were seen in a high percentage of subjects. Systematic comparison of digital subtraction angiography after intraarterial contrast injection and MR venography in patients showed good correlation between the two techniques18 . MR venography can demonstrate pathological states such as cerebral venous and sinus thrombosis, cerebral venous angiomas, compression and displacements of veins and draining vessels from arteriovenous malformations. Arteriovenous malformations (AVM). Size, anatomic location of the nidus, mass effect, and fresh and old haemorrhages are well seen on SE images24•25 • GRE images are helpful to differentiate calcium or haemosiderin containing parts of the nidus from 'flow voids' of vessels. The nidus can also be appreciated well on 30FT TOF MR angiograms26•27 MR angiography does not replace contrast angiography for initial evaluation of an A VM. However, it is useful for assessing nidus patency after treatment. Aneurysms. A combination of SE imaging and MRA should be employed in searching for aneurysms. These techniques can provide information about the size and location and also neck of an aneurysm and whether
b
Figure 1: Patient with transient ischaemic attacks. {a) 30 MRA shows severe stenoses of the internal and external carotid arteries. (b) Corresponding digital subtraction angiogram confirms MRA findings
Neurological Research, 1992, Volume 14, Suppl
119
Downloaded by [Australian Catholic University] at 07:41 08 August 2017
Cerebral magnetic resonance angiography: H.P. Mattie and R.R. Edelman
a b Figure 2: Acute cerebral infarction. (a) T2-weighted SE image shows infarct involving right occipital lobe. (b) Intracranial MRA shows occlusion of the right posterior cerebral artery. Only the left posterior cerebral artery is visible (arrowhead ). Curved arrow = basilar artery
its lumen is perfused or clotted 28 . The sensitivity for detection of aneurysms has been 95% in a small series of 19 patients 29 . Further refinements of MR angiography will likely improve the sensitivity for detecting aneurysms larger than 3 to 4 mm in diameter. To date, MR angiography can be recommended for screening for aneurysms. However, for symptomatic aneurysms contrast angiography is still needed. Collateral flow imaging. Using presaturation pulses over various feeding vessels, collateral flow over the anterior and posterior communicating arteries with stenosis or occlusion of one internal carotid artery has been shown. In addition, flow reversal in the basilar or one vertebral artery with subclavian steal syndrome or situations such as filling of the pericallosal arteries from one side, collateral flow over the ophthalmic arter):', or foetal posterior circulation can be demonstrated2' 30 .
2 3
4
5
6
7
8
9
CONCLUSION MRA is im accurate tool for imaging the major intracranial arteries and veins, although small branch vessels are not reliably evaluated with current technology. Vascular stenoses and occlusions can accurately be depicted and A VMs and aneurysms can be seen. As a completely non-invasive tool MRA provides morphologic information about the cerebrovascular system that is closely related to its haemodynamic s. Selective MRA provides a means to image most arteries and veins of the head selectively and to determine origin, direction of flow, and collateral flow patterns.
10
11
12
13
REFERENCES Wedeen .W), Meuli RA, Edelman RR eta/. Projective imaging of pulsatile flow with magnetic resonance. Science 1985; 230: 946-948
120
Neurological Research, 1992, Volume 14, Suppl
14
15
Mattie HP, Wentz KU. Selective magnetic resonance angiography of the head. Cardiovas lntervent Radio/1992; 15: 65-70 Masaryk Tj, Modic MT, Ruggieri PM et a/. Three-dimensional (volume) gradient echo imaging of the carotid bifurcation: preliminary clinical experience. Radiology 1989; 171: 801-806 Keller Pj, Drayer BP, Fram EK, Williams KD, Dumoulin CL, Souza SP. MR angiography with two-dimensional acquisition and three-dimensional display. Radiology 1989; 173 : 527-532 Bongartz G, Krings W , Vassallo P, Rummeny E, Peters PE. MRI and MR angiography of the carotid artery: validation with DSA. Magnet Reson /mag 1990; 8: (Suppl 1 ), 17 Edelman RR, Mattie HP, Wallner B et a/. Extracranial carotid arteries : evaluation with 'black blood' MR angiography. Radiology 1990; 177: 45-50 Litt AW, Eidelman EM, Pinto RS et a/. A blinded comparison of contrast arteriography, MR angiography, and duplex US in the evaluation of the carotid bifurcation. Radiology 1990; 177: 89 Kido OK, Panzer Rj, Szumowski j et a/. Clinical evaluation of stenosis of the carotid bifurcation with magnetic resonance angiographic techniques. Arch Neuro/1991 ; 48: 484-489 Masaryk AM, Ross )S, DiCello MC, Modic MT, Paranandi L, Masaryk TJ. 30FT MR angiography of the carotid bifurcation: potential and limitations as a screening examination. Radiology 1991 ; 179: 797- 804 Mattie HP, Kent KC, Edelman RR, Atkinson D), Skillman Jj. Evaluation of the extra cranial carotid arteries: correlation of magnetic resonance angiography, duplex ultrasonography, and conventional angiography. J Vase Surg 1991 ; 13: 838-845 Ruggieri PM, Laub GA, Masaryk T), Modic MT. Intracranial circulation : pulse-sequence considerations in three-dimensional (volume) MR angiography. Radiology 1989; 171: 785-791 Blatter DO, Parker DL, Robison RO. Cerebral MR angiography with multiple overlapping thin slab acquisition. Part I. Quantitative analysis of vessel visibility. Radiology 1991 ; 179: 805-811 Demaerel P, Wilms G, Casteels-van Daele Met a/. Moya-moya. Diagnostic par IRM et angiographie RMN. f Radio/ 1990; 71: 119-123 Masaryk Tj, Laub GA, Modic MT, Ross )S, Haacke EM. Carotid-CNS MR flow imaging. Magnet Reson Med 1990; 14: 308-314 Masaryk Tj, Modic MT, Ross )S eta/. Intracranial circulation:
Downloaded by [Australian Catholic University] at 07:41 08 August 2017
Cerebral magnetic resonance angiography: H.P. Mattie and R.R. Edelman preliminary clinical results with three-dimensional (volume) MR angiography. Radiology 1989; 171: 793-799 16 Wiznitzer M, Ruggieri PM, Masaryk Tj, Ross )5, Modic MT, Bernman B. Diagnosis of cerebrovascular disease in sickle cell anemia by magnetic resonance angiography. j Pediatr 1990; 117: 551-555 17 Rother ), Rautenberg W, Wentz KU, 51iwka U, Hennerici M. Nichtinvasive Diagnostik des intrakraniellen Stromgebietes-eine Korrleation von Magnetresonanz-Angiographie, Dopplersonographie und Angiographie (abstract). U/trascha/1 Klin Prax 1991; 6: 201 18 Mattie HP, Wentz KU, Edelman RR et a/. Cerebral. venography with magnetic resonance. Radiology 1991; 178: 4S3-458 19 Edelman RR, Wentz KU, Mattie HP eta/. Projection arteriography and venography: initial clinical results with MR. Radiology 1989; 172: 351-357 20 Laub G. Displays for MR angiography. Magnet Reson Med 1990; 14: 222-229 21 Creasy jl, Price RR, Presbrey T, Goins D, Partain CL, Kessler RM. Gadolinium-enhanced MR angiography. Radiology 1990; 175: 280-283 22 Chakeres DW, Schmalbrock P, Brogan M, Yuan C, Cohen L. Normal venous anatomy of the brain: demonstration with gadopentetate dimeglumine in enhanced 3-D MR angiography. AJNR 1990; 11: 1107-1118 23 Pernicone jR, Siebert JE, Patchen EJ, Pera A, Dumoulin CL, Souze SP. Three-dimensional phase-contrast MR angiography
in the head and neck: preliminary report. AJNR 1990; 11: 457-466. 24 Smith Hj, Strother CM, Kikuchi Y et a/. MR imaging in the management of supratentorial intracranial AVMs. AJNR 1988; 9: 225-235 25 Needel WM, Maravilla KR. MR flow imaging in vascular malformations using gradient recalled acquisitions. AJNR 1988; 9: 637-642 26 Edelman RR, Wentz KU, Mattie HP et a/. Evaluation of intracerebral arteriovenous malformations using selective magnetic resonance arteriography and venography. Radiology 1989; 173 : 831-837 27 Marchal G, Bosmans, Van Freyenhoven L et a/. Intracranial vascular lesions: optimization and clinical evaluation of three-dimensional time-of-flight MR angiography. Radiology 1990; 175: 443-448 28 Strother CM, Eldevik P, Kickuchi Y, Graves Y, Partington C, Merlis A Thrombus formation and structure and the evolution of mass effect in intracranial aneurysms treated by balloon embolization: emphasis on MR findings. AJNR 1989; 10: 787-796 29 Ross jS, Masaryk Tj, Modic MT, Ruggieri PM, Haacke EM, Selman WR. Intracranial aneurysms: evaluation by MR angiography. AJNR 1990; 11: 449-456 30 Edelman RR, Mattie HP, O ' Reilly GV eta/. Magnetic resonance imaging of flow dynamics in the circle of Willis. Stroke 1990; 21: 56-65
Neurological Research, 1992, Volume 14, Suppl
121
ISSN: 0161-6412 (Print) 1743-1328 (Online) Journal homepage: http://www.tandfonline.com/loi/yner20
Cerebral magnetic resonance angiography Heinrich P. Mattle & Robert R. Edelman To cite this article: Heinrich P. Mattle & Robert R. Edelman (1992) Cerebral magnetic resonance angiography, Neurological Research, 14:2, 118-121, DOI: 10.1080/01616412.1992.11740027 To link to this article: http://dx.doi.org/10.1080/01616412.1992.11740027
Published online: 23 Jul 2016.
Submit your article to this journal
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=yner20 Download by: [Australian Catholic University]
Date: 08 August 2017, At: 07:41
Cerebral magnetic resonance angiography Heinrich P. Mattie and Robert R. Edelman Department of Neurology, University of Bern, Switzerland and Harvard Medical School, Department of Radiology, Beth Israel Hospital, Boston, MA, USA
Magnetic resonance angiography ( MRA) is an accurate non-invasive tool for imaging the cerebral vessels. It provides morphologic information about the cerebral vessels relying on blood flow as the physical basis for generating contrast between stationary tissues and moving spins. 'Selective' MRA gives functional information about the cerebrovascular system such as flow direction, origin of flow, and presence or absence of co/laterals. Arteries and veins can be imaged selectively due to their usually opposite flow directions. Although at a relatively early stage of development, MRA has already become a widely used tool for the study of the cerebrovascular system.
Downloaded by [Australian Catholic University] at 07:41 08 August 2017
Keywords: magnetic resonance; angiography; cerebral blood vessels; thrombosis; stroke
INTRODUC TION
Within just the last few years magnetic resonance (MR) has become a powerful tool for accurate and early diagnosis of cerebral ischaemia and has proved helpful for rational therapy of vascular pathology. Spin-echo (SE) images show the localization and extent of ischaemic areas. Magnetic resonance angiography (MRA) has emerged as an adjun~t to SE imaging and serves as a means for evaluating the cerebral arteries and veins1 . The time-of-flight (TOF) method is widely applied to create MR angiograms. It uses a gradient-ech o (GRE) pulse sequence in conjunction with flow compensatio n (a technique to eliminate flow-related phase shifts that cause signal loss). Flowing blood appears bright (called flow-related enhancement) because fresh spins are constantly flowing into the plane of section, whereas stationary tissues appear dark. The resulting angiograms are referred to as 'white blood' images, as opposed to 'black blood' images which are typically created by spin-echo sequences. Alternatively, MR angiograms can be rendered based on the phase shift produced by flow along a magnetic field gradient, called phase contrast angiography . Presaturatio n techniques are an adjunct to MRA. Presaturatio n pulses can be applied to user-defined regions in order to suppress the signal from blood flowing through these regions. The use of presaturatio n in conjunction with MRA is called selective MRA 2 . CLINICAL RESULTS
'·
Giyen the preliminary nature of clinical studies of MRA to date, any conclusions about its clinical utility and impact on the practice of cerebrovasc ular neurology must be considered preliminary and tentative. Nonetheless , there seem to be several applications where MRA using currently available techniques can be recommend ed.
Correspondence to: Dr H.P. Mattie, MD, Department of Neurology, University of Bern, lnselspital, CH-3010 Bern, Switzerland. Accepted for publication january 1992.
© 1992 Forefront Publishing Group 0161-6412/92/020 118-04 118
Neurological Research, 1992, Volume 14, Suppl
Carotid arteries
Several authors have used MRA in order to image the carotid arteries in the neck and have compared the results to ultrasound and / or contrast arteriograph y3 - 10. Two-dimens ional (20) MR angiography with axial4 •7 or sagittal6 •10 acquisition and three-dimen sional (30) MRA 3•5 •9 , as well as black blood MRA6 •10 , have been tested. MR angiograms of the carotid arteries can be successfully obtained in upwards of 90% of patients, and the study can be finished in less than 30 min. MR angiograms are highly sensitive for carotid disease, but may exaggerate severe stenoses (Figure 1 ). This is primarily due to signal loss caused by turbulent flow-related dephasing and recirculation, the latter causing flowing spins to remain within the imaging volume for a prolonged period where they become saturated. For reasons of comparative cost, MRA cannot routinely replace ultrasonography as a screening technique for carotid disease except when an MR imaging study of the brain is being obtained anyway. In situations where the results of duplex scanning and MR angiography agree, the correlation to contrast angiography has been up to 100%. In these patients MR angiography may eliminate the need for contrast angiography . Vertebral arteries
MR has the potential to image the vertebral arteries in their entire length from the subclavian arteries to the junction with the basilar artery. In our experience a combination of SE imaging and MR angiography has also proved useful in diagnosing dissection of the vertebral arteries. Large-scale clinical studies of MRA in this application have yet to be published. Intracranial arteries Arteries. Using a
30FT TOF MR angiography technique the intracranial arteries such as the middle, anterior, posterior and basilar arteries and their main branches can be imaged reliabli 1•12 . Case reports and small series have demonstrate d the feasibili% of depicting stenoses and occlusions of these vessels 3 - 16.
Cerebral magnetic resonance angiography: H.P. Mattie and R.R. Edelman
Downloaded by [Australian Catholic University] at 07:41 08 August 2017
A stenosis of a cerebral vessel can be suspected when there is sudden narrowing of the lumen. If the stenosis is severe signal downstream will also be reduced as a result of compromised flow. In one series 11 of 13 patients with suspected intracranial arterial occlusions were successfully imaged with both MRA and SE sequences 14. Lack of arterial filling on the MR angiogram could be correlated with areas of infarction on theSE study. In a study correlating MRA, Doppler sonography, and contrast angiography, MRA reliably depicted occlusions of the basilar artery in three patients, and stenoses and occlusions of the middle cerebral artery in 2 patients each 17• Figure 2 gives an example of occipital lobe infarction due to right posterior cerebral artery occlusion.
a
Veins. In 30FT TOF MRA arteries are well seen. Slowly moving spins tend to stay for a long period in the thick imaging volume and become saturated. As a result veins are poorly visualized. In 20FT TOF MR angiography slowly moving spins are less saturated, and flow related enhancement dominates over signal loss18. To produce projection venograms of the head a series of overlapping 20 GRE images are acquired in sagittal, coronal and I or transverse planes with presaturation pulses applied over the neck to eliminate signal from inflowing arterial spins 19. The images are then postprocessed to produce ~rejection images along userdefined viewing angles 0 . Alternative approaches to image the cerebral veins are 30FT TOF MR angiography in conjunctiOJl with contrast agents such as ~adolinium DTPA or phase contrast MR angiography2 - 23 . Using the 20FT TOF MR venography technique the superior sagittal, lateral and straight sinuses, the internal cerebral veins and vein of Galen were visualized reliably and other veins were seen in a high percentage of subjects. Systematic comparison of digital subtraction angiography after intraarterial contrast injection and MR venography in patients showed good correlation between the two techniques18 . MR venography can demonstrate pathological states such as cerebral venous and sinus thrombosis, cerebral venous angiomas, compression and displacements of veins and draining vessels from arteriovenous malformations. Arteriovenous malformations (AVM). Size, anatomic location of the nidus, mass effect, and fresh and old haemorrhages are well seen on SE images24•25 • GRE images are helpful to differentiate calcium or haemosiderin containing parts of the nidus from 'flow voids' of vessels. The nidus can also be appreciated well on 30FT TOF MR angiograms26•27 MR angiography does not replace contrast angiography for initial evaluation of an A VM. However, it is useful for assessing nidus patency after treatment. Aneurysms. A combination of SE imaging and MRA should be employed in searching for aneurysms. These techniques can provide information about the size and location and also neck of an aneurysm and whether
b
Figure 1: Patient with transient ischaemic attacks. {a) 30 MRA shows severe stenoses of the internal and external carotid arteries. (b) Corresponding digital subtraction angiogram confirms MRA findings
Neurological Research, 1992, Volume 14, Suppl
119
Downloaded by [Australian Catholic University] at 07:41 08 August 2017
Cerebral magnetic resonance angiography: H.P. Mattie and R.R. Edelman
a b Figure 2: Acute cerebral infarction. (a) T2-weighted SE image shows infarct involving right occipital lobe. (b) Intracranial MRA shows occlusion of the right posterior cerebral artery. Only the left posterior cerebral artery is visible (arrowhead ). Curved arrow = basilar artery
its lumen is perfused or clotted 28 . The sensitivity for detection of aneurysms has been 95% in a small series of 19 patients 29 . Further refinements of MR angiography will likely improve the sensitivity for detecting aneurysms larger than 3 to 4 mm in diameter. To date, MR angiography can be recommended for screening for aneurysms. However, for symptomatic aneurysms contrast angiography is still needed. Collateral flow imaging. Using presaturation pulses over various feeding vessels, collateral flow over the anterior and posterior communicating arteries with stenosis or occlusion of one internal carotid artery has been shown. In addition, flow reversal in the basilar or one vertebral artery with subclavian steal syndrome or situations such as filling of the pericallosal arteries from one side, collateral flow over the ophthalmic arter):', or foetal posterior circulation can be demonstrated2' 30 .
2 3
4
5
6
7
8
9
CONCLUSION MRA is im accurate tool for imaging the major intracranial arteries and veins, although small branch vessels are not reliably evaluated with current technology. Vascular stenoses and occlusions can accurately be depicted and A VMs and aneurysms can be seen. As a completely non-invasive tool MRA provides morphologic information about the cerebrovascular system that is closely related to its haemodynamic s. Selective MRA provides a means to image most arteries and veins of the head selectively and to determine origin, direction of flow, and collateral flow patterns.
10
11
12
13
REFERENCES Wedeen .W), Meuli RA, Edelman RR eta/. Projective imaging of pulsatile flow with magnetic resonance. Science 1985; 230: 946-948
120
Neurological Research, 1992, Volume 14, Suppl
14
15
Mattie HP, Wentz KU. Selective magnetic resonance angiography of the head. Cardiovas lntervent Radio/1992; 15: 65-70 Masaryk Tj, Modic MT, Ruggieri PM et a/. Three-dimensional (volume) gradient echo imaging of the carotid bifurcation: preliminary clinical experience. Radiology 1989; 171: 801-806 Keller Pj, Drayer BP, Fram EK, Williams KD, Dumoulin CL, Souza SP. MR angiography with two-dimensional acquisition and three-dimensional display. Radiology 1989; 173 : 527-532 Bongartz G, Krings W , Vassallo P, Rummeny E, Peters PE. MRI and MR angiography of the carotid artery: validation with DSA. Magnet Reson /mag 1990; 8: (Suppl 1 ), 17 Edelman RR, Mattie HP, Wallner B et a/. Extracranial carotid arteries : evaluation with 'black blood' MR angiography. Radiology 1990; 177: 45-50 Litt AW, Eidelman EM, Pinto RS et a/. A blinded comparison of contrast arteriography, MR angiography, and duplex US in the evaluation of the carotid bifurcation. Radiology 1990; 177: 89 Kido OK, Panzer Rj, Szumowski j et a/. Clinical evaluation of stenosis of the carotid bifurcation with magnetic resonance angiographic techniques. Arch Neuro/1991 ; 48: 484-489 Masaryk AM, Ross )S, DiCello MC, Modic MT, Paranandi L, Masaryk TJ. 30FT MR angiography of the carotid bifurcation: potential and limitations as a screening examination. Radiology 1991 ; 179: 797- 804 Mattie HP, Kent KC, Edelman RR, Atkinson D), Skillman Jj. Evaluation of the extra cranial carotid arteries: correlation of magnetic resonance angiography, duplex ultrasonography, and conventional angiography. J Vase Surg 1991 ; 13: 838-845 Ruggieri PM, Laub GA, Masaryk T), Modic MT. Intracranial circulation : pulse-sequence considerations in three-dimensional (volume) MR angiography. Radiology 1989; 171: 785-791 Blatter DO, Parker DL, Robison RO. Cerebral MR angiography with multiple overlapping thin slab acquisition. Part I. Quantitative analysis of vessel visibility. Radiology 1991 ; 179: 805-811 Demaerel P, Wilms G, Casteels-van Daele Met a/. Moya-moya. Diagnostic par IRM et angiographie RMN. f Radio/ 1990; 71: 119-123 Masaryk Tj, Laub GA, Modic MT, Ross )S, Haacke EM. Carotid-CNS MR flow imaging. Magnet Reson Med 1990; 14: 308-314 Masaryk Tj, Modic MT, Ross )S eta/. Intracranial circulation:
Downloaded by [Australian Catholic University] at 07:41 08 August 2017
Cerebral magnetic resonance angiography: H.P. Mattie and R.R. Edelman preliminary clinical results with three-dimensional (volume) MR angiography. Radiology 1989; 171: 793-799 16 Wiznitzer M, Ruggieri PM, Masaryk Tj, Ross )5, Modic MT, Bernman B. Diagnosis of cerebrovascular disease in sickle cell anemia by magnetic resonance angiography. j Pediatr 1990; 117: 551-555 17 Rother ), Rautenberg W, Wentz KU, 51iwka U, Hennerici M. Nichtinvasive Diagnostik des intrakraniellen Stromgebietes-eine Korrleation von Magnetresonanz-Angiographie, Dopplersonographie und Angiographie (abstract). U/trascha/1 Klin Prax 1991; 6: 201 18 Mattie HP, Wentz KU, Edelman RR et a/. Cerebral. venography with magnetic resonance. Radiology 1991; 178: 4S3-458 19 Edelman RR, Wentz KU, Mattie HP eta/. Projection arteriography and venography: initial clinical results with MR. Radiology 1989; 172: 351-357 20 Laub G. Displays for MR angiography. Magnet Reson Med 1990; 14: 222-229 21 Creasy jl, Price RR, Presbrey T, Goins D, Partain CL, Kessler RM. Gadolinium-enhanced MR angiography. Radiology 1990; 175: 280-283 22 Chakeres DW, Schmalbrock P, Brogan M, Yuan C, Cohen L. Normal venous anatomy of the brain: demonstration with gadopentetate dimeglumine in enhanced 3-D MR angiography. AJNR 1990; 11: 1107-1118 23 Pernicone jR, Siebert JE, Patchen EJ, Pera A, Dumoulin CL, Souze SP. Three-dimensional phase-contrast MR angiography
in the head and neck: preliminary report. AJNR 1990; 11: 457-466. 24 Smith Hj, Strother CM, Kikuchi Y et a/. MR imaging in the management of supratentorial intracranial AVMs. AJNR 1988; 9: 225-235 25 Needel WM, Maravilla KR. MR flow imaging in vascular malformations using gradient recalled acquisitions. AJNR 1988; 9: 637-642 26 Edelman RR, Wentz KU, Mattie HP et a/. Evaluation of intracerebral arteriovenous malformations using selective magnetic resonance arteriography and venography. Radiology 1989; 173 : 831-837 27 Marchal G, Bosmans, Van Freyenhoven L et a/. Intracranial vascular lesions: optimization and clinical evaluation of three-dimensional time-of-flight MR angiography. Radiology 1990; 175: 443-448 28 Strother CM, Eldevik P, Kickuchi Y, Graves Y, Partington C, Merlis A Thrombus formation and structure and the evolution of mass effect in intracranial aneurysms treated by balloon embolization: emphasis on MR findings. AJNR 1989; 10: 787-796 29 Ross jS, Masaryk Tj, Modic MT, Ruggieri PM, Haacke EM, Selman WR. Intracranial aneurysms: evaluation by MR angiography. AJNR 1990; 11: 449-456 30 Edelman RR, Mattie HP, O ' Reilly GV eta/. Magnetic resonance imaging of flow dynamics in the circle of Willis. Stroke 1990; 21: 56-65
Neurological Research, 1992, Volume 14, Suppl
121
