3.0T MR Imaging
of
the Cranial Arterial Wall
for
the Strategy of Stroke Prevention
Nagasaki Morinoki Neurosurgical Clinic
Hisanobu Koga M.D. Tsuyoshi Oishi M.D.
Carotid artery plaque, Vertebral artery dissection , Intracranial artery stenosis and unruptured
aneurysm
XIX Symposium Neuroradiologicum
The World Congress of Neuroradiology
Bologna, Europe, 4 – 9 October 2010
Equipment
• Philips Achiva 3.0T
– Introduction：July 1. 2007
Root
Cervical disc hernia
Standard Imaging of Carotid artery
R-MPR
L-MPR
US
T1W
TOF-MRA
MIP
VR
T2W
mPROSET T1W
T1W-Black Blood
T2W mPROSET
T2W-Black Blood
Sequence of carotid arterial imaging
TOF-MRA
T1WVISTA
T2WVISTA
mPROSET
T1WBlack Blood
T2WBlack Blood
TR(ms)
20
700
3000
18
1000
2000
TE(ms)
3.5
21
134
4.8/⊿3.9
14
100
NSA(f)
1
2
4
2
2
4
FOV(mm)
160
200
200
200
140
140
Flip angle(°)
20
90
90
8
90
90
Slice
thickness(mm)
1
0.5
0.5
0.5
3
3
Slices
60
100
100
100
9
9
Scan mode
3DFFE
3DTSE
SPIR
3DTSE
SPIR
3DTFE
Pro Set
2DTSE
SPIR
2DTSE
SPIR
Matrix
240
320
304
256
256
256
sliceorientation
transverse
coronal
coronal
coronal
transverse
transverse
Scan time
1’07
5’17
5’03
2’36
5’15
5’06
Reconstruction
MIP,VR
MPR
MPR
MPR
Total scan time : 24m24s
Carotid Artery Case1
L-MPR
６３y Ｍ
Hypertension
TOF-MRA：Heterogenous H.I. covering with LI band
T1W-VISTA T1W-B.B. ：H.I.
T2W-VISTA T2W-B.B. ：I.I.～L.I.
mPROSET ：Heterogenous I.I .with partial non-signal
Intra plaque hemorrhage with smooth fibrous cap
Conservative follow-up
H.I. : High Intensity
L.I. :Low Intensity
I.I. : Iso Intensity
US
T1W
MIP
TOF-MRA
T1W-Black Blood
T2W
mPROS
T2W-Black Blood
Case 2
R-MPR
５４y M
Asymptomatic case
TOF,MIP,VR :Rt-CA 90% Stenosis
T1W-VISTA T1W-B.B. : Homogenous I.I.
T2W-VISTA T2W-B.B. : I.I.with partial H.I.
mPROSET : L.I. with non-signal
Plaque with hemorrhage and calcification
T1W
US
MIP
TOF-MRA
T1W-Black Blood
T2W
mPROSET
T2W-Black Blood
Post-CEA
T1W-Black Blood
T2W-Black Blood
T1W
T2W
Diagnostic Guide
SPIR
T1WI
SPIR
T2WI
mPROSET
H.I.
I.I.
～
L.I.
H.I.
Lipid
Hemorrhage
Lipid
I.I.
～
L.I
Fibrosis
HemorrhCalcificatage
ion
※compare with mandibular gland
I.I.
～
L.I.
Non
Fibrosis
Lipid
Hemorrh- Calcification
age
※compare with blood
SPIR : spectral presaturation with inversion recovery
mPROSET : multiple principle selective excitation technique
Standard Imaging of VA
ＭＩＰ
VISTA
b_FFE (outer wall）
(whole wall)
Sequence of cranial arterial imaging
MRA
B_FFE
T1W_VISTA
T2W_VISTA
TR(ms) /TE(mm)
25 / 3.5
6.9 /2.9
700 / 20
3000 / 134
FOV(mm)
200
150
200
200
Matrix scan
400
272
320
304
Slices
180
30
100
100
Thickness(mm)
0.5
1
0.5
0.5
Fast imaging mode FFE
FFE
TSE
TSE
Slice orientation
Transverse
coronal
coronal
coronal
Flip angle (°)
18
45
90
90
NSA
1
2
2
4
Scan time
4’17
0’52
5’17
5’03
reconstruction
MIP,VR
MPR
MPR
MPR
Total scan time : 15m 29s
Sequence
Carotid artery
T1WI
VISTA
T2WI
VISTA
Intracranial artery
mPROSET
T1WI
VISTA
T2WI
VISTA
B-FFE
TR(ms)
700
3000
18
700
3000
5.8
TE(ms)/⊿TE(ms)
21
134
4.8/⊿3.9
20
133
2.3
NSA(回)
2
4
2
2
4
2
FOV(mm)/RFOV(
%)
200/70
200/75
200/75
150/90
150/90
150/100
Flip angle(°)
90
90
8
90
90
45
Slice
thickness(mm)
0.5
0.5
0.5
0.5
0.5
1
Slices
100
100
100
100
100
30
Scan mode
3DTSE
SPIR
3DTSE
SPIR
3DTFE
Pro Set
3DTSE
SPIR
3DTSE
SPIR
FFE
Matrix
320
304
256
240
288
272
Slice orientation
coronal
coronal
coronal
coronal
coronal
coronal
Scan time
5’17
5’03
2’36
5’17
5’03
0’43
Reconstruction
MPR
MPR
MPR
MPR
MPR
MPR
T1 ＶＩＳＴＡ
DWI
ＶＩＳＴＡ
37y M
DWI : Cerbellar infarction
Rt-VA: Dissection and Thrombus
7month later: clear cavity
Tra
Tra
2009.01.28
2009.08.18
Bilateral VA Aneurysm
• ６１y Ｍ
MIP
VR
b_FFE
Rt-VA
•
No Dissection cacity
Tra
VISTA
b_FFE
Oblique_Cor
Sag
Lt-VA
•
Dissection cavity confirmed
Tra
VISTA
b_FFE
Oblique_Cor
Sag
Golfer headache
• Sever headache after golf swing
4 weeks later
2009.08.20
2009.09.30
Natural Thrombosis of VA An.
58y M
C.C. severe left occipitalgia
Lt-VA aneurysm
1M: partial thrombosis
3M: progressed thrombosis
1Y 5M: complete thrombosis
T2
onset
1M
3M
17 M
BA Stenosis
T1 VISTA
T2 VISTA
Plaque in the wall
Outer wall
BA Stenosis
T1VISTA
Plaque in the inner wall。
T2 VISTA
Outer wall
Rt-MCA Stenosis
V-DWI
①
⑤③
LSA
①
stenosis
Stenosis
④②
②
MIP
Oblique Coronal
•Stenosis: IC Bifurcation［①］,MCA（M１）［③④］
• LSA: Lateral Striate Artery
⑤
LSA
④
stenosis
③
LSA
stenosis
Un-ruptured Lt-ICPC Aneurysm
T1 VISTA
Wall of the anerysm
T1 VISTA
Thin Wall of the Aneurysm
Rt-MCA
Aneurysm
Lt-ICA Aneurysm
P-com
Lt.ICA
An.
T1 VISTA
ＳＡＧ
P-com
ＴＲＡ
Lt.ICA
Wall of the Aneurysm
Aneurysm
Discussion
• It is essential to evaluate the quality of carotid
plaque for the plan of treatment.
• Diagnosis of VA dissection requires quickness and
accuracy. High resolution MRI is more effective
than conventional angiography.
• The image of intracranial arterial wall could be
additional information to prevent stroke.
• The wall image of unruptured aneurysm
contribute to decide the strategy, but the method
has not yet established.
Conclusion
• Routine working of 3.0T MRI without contrast
medium shows clear images of the arterial wall.
• Anatomical and pathological information of the
plaque can be obtained.
• The wall of aneurysm can be imaged and
correspond with operative finding, but not always.
• The images of cervicocephalic arterial wall with
3.0T MRI contribute to prevent stroke.