Article
Ultra-high resolution 7 Tesla MRI for preoperative depiction of cerebral vascular structures and pathologies
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Authors
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K. Wrede
- Erwin L. Hahn Institute for MRI, University Duisburg-Essen, Essen; Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen
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S. Johst
- Erwin L. Hahn Institute for MRI, University Duisburg-Essen, Essen; Abteilung für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
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E. Sandalcioglu
- Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen
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M. Schlamann
- Abteilung für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
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M. Ladd
- Erwin L. Hahn Institute for MRI, University Duisburg-Essen, Essen; Abteilung für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen
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U. Sure
- Klinik für Neurochirurgie, Universitätsklinikum Essen, Essen
| Published: | April 28, 2011 |
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Outline
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Objective: High-quality pre-operative images are essential for the treatment of intracerebral vascular pathologies. Digital subtraction angiography (DSA) is still the gold standard of the available imaging modalities, but with new ultra-high field MRI scanners, MR angiography (MRA) has the opportunity to become even more competitive. The goal of this study was therefore to evaluate the pre- and intra-operative benefits of ultra-high resolution 3D MRI images for intracerebral vascular pathologies, also in comparison to DSA.
Methods: All patients underwent pre-surgical routine 4 vessel DSA (Allura 3D-RA, Philips, Germany). MR images (MP-RAGE, SWI, 3D FLASH TOF) were acquired with a 7T whole-body system (Magnetom, Siemens, Germany). The clinical whole-brain protocol was optimized in 5 healthy volunteers and performed in 12 patients with cerebral aneurysm (N=8) or arteriovenous malformation (AVM) (N=4). The MeVisLab framework (MEVIS, Germany) was used for post-processing of the volumetric data and 3D visualization with MIPs and volume rendering. The quality of the acquired patient data and 3D visualizations was rated by two experienced neurosurgeons on a three-point scale in comparison to DSA: inferior, equal, superior.
Results: The TOF sequence depicted even very small arteries, which made 3D MIP and volume-rendering images of the complete arterial tree with ultra-high resolution possible. All cerebral aneurysms known from the DSA were clearly depicted with their 3D shape and neighboring structures. All known feeders of the AVMs and the relation of the nidus to the cortical and subcortical structures could be visualized. SWI provided excellent T2* contrast for ultra-high resolution venous segmentation. Especially in the AVM patients, valuable information on the venous drainage could be deduced from the data. The 3D MIP and volume rendering of the MRI data was rated equal to superior in comparison to the 3D DSA data.
Conclusions: The ultra-high resolution TOF MRA and SWI venography show excellent results for depicting the cerebral vascular structures and pathologies such as aneurysms and AVMs. The complete vasculature of the brain is visible in a single 3D dataset, which allows better understanding of the complex vascular structures. Especially for small veins, SWI 3D venography gives more information than DSA. In the future, contrast-enhanced scans (with high temporal resolution) or arterial spin labelling may add additional information regarding the blood flow, which is especially interesting in cerebral AVMs.
