Dynamic MRA

(TWIST/TREAT)
 In early development major disadvantage
is limitation in temporal resolution with
technology we have right now, it has been
resolved.

While traditional time-of-flight MRA provides excellent spatial resolution, it cannot adequately
visualize smaller blood vessels and provides only indirect flow information about larger arterial
vessels. Three-dimensional phase-contrast MRA evaluation can provide information regarding flow
direction and flow velocity but is highly susceptible to motion artifacts from eye movement,
making it impractical for routine orbit evaluation. December2007
Noninvasive Dynamic Magnetic Resonance Angiography With Time-Resolved Imaging
of Contrast KineticS (TRICKS) in the Evaluation of Orbital Vascular Lesions
Alon Kahana, MD, PhD; Mark J. Lucarelli, MD; Allison M. Grayev, MD; et al
 Strategies to reduce acquisition time per 3D
volume include
the reduction of TR.
A rectangular FOV.
partial Fourier data sampling (k line in the
center image contrast), and parallel
imaging.
Two common acronyms for this approach
TWIST (Time-resolved angiography With
Interleaved Stochastic Trajectories)
TREAT (Time-Resolved Echo-shared
AngiographicTechnique).
 Major advantages of time resolved
MRA protocols include :
A substantial reduction in gadolinium
chelate dose (e.g., a quarter or less of that
required with conventional techniques).
The ability to obtain multiple phases,
enabling demonstration of arterial and
venous flow, directionality of flow, and
visualization of delayed filling.
The lack of a need for a test bolus.
 Critical advantages include :
decreased arteriovenous overlay.
reduction in motion artifacts and the
additional diagnostic information
available from the temporal assessment
of contrast enhancement of the vessels
and tissue perfusion.
Perfusion Imaging
 Perfusion Imaging
Cerebral perfusion imaging is the
visualization of changes or delays in
microvascular blood flow in the brain.
Can be used to facilitate the
evaluation of strokes,tumors, and the
differentiation of radiation necrosis
versus recurrent tumor.
 Exogen tracer contrast bolus
injection
Endogen tracer blood label
continous infusion.
 Exogen tracer
Dynamic imaging (bolus)
Steady state imaging (infusion)

Dynamic imaging takes advantage of

transient changes in the local magnetic
field of the surrounding tissue induced by
a bolus of paramagnetic tracer passing
through the organ capillary network
 Tracer concentration can measure :
Cerebral blood volume
Cerebral blood flow
Mean transit time
Bolus arrival time
 Steady state imaging
Use T1 and T2 or T2*
Assume the tracer nondiffusible
Baseline imaging before contrast
substract with post contrast.
 Disadvantages
Image have low SNR
Patient movement pre and post
accuracy
If the BBB has disrupted spurious
result.
 74.1 c The MTT map
depict time required for
fresh blood to
completely replace that
in volume interest.
Darker area on MTT map
represent tissue having
faster enhancement.
74.1d the rCBV map
calculated base on
changes in the intensity
of pixels over time and
conveys information
regarding tissue blood
volume.
Arterial Spin Labeling
(ASL)
Cari nilai normal crbv mtt dll
 a noninvasive method for the
evaluation of cerebral blood flow-
without the need for intravenous
contrast media injection.
uses magnetically labeled arterial
blood water as an endogenous tracer
for measuring blood flow using
radiofrequency pulses.
 CASL
continuous labeling techniques, an
adiabatic inversion pulse is applied to
the blood upstream of the slice using a
continuous radiofrequency of weak
intensity associated with a gradient
applied in the direction of flow.
 PASL
pulsed labeling techniques, a volume of
blood is labeled upstream of the region of
interest by a short RF pulse. Signal
acquisition is performed after a delay TI (of 1
to 2 sec). The difference image (obtained by
subtracting an image acquired without
labeling), reflects the amount of labeled
blood arriving in the volume of interes
during the delay TI and is proportional to
CBF.
 Limitations of ASL technique :
low SNR (when compared with perfusion
imaging using a gadolinium chelate).
only a single slice is acquired (to cover
an entire anatomic region, scan times
are typically long).
 In clinical application, ASL provides
reproducible and reliable quantitative
CBF measurements for a spectrum of
brain abnormalities, including
neoplastic disease,
ischemia, and arteriovenous
abnormalities.
 CBF maps of
glioblasoma using
dynamic
susceptibility
contrast (a) and
CASL (b).
DIFFUSION MRI
 Basic Principles
Focuses on the micromovements of the extracellular
water molecules

Micromovement of extracellular water molecules

three different types of freedom of movement,
free diffusion,
restricted isotropic,
restricted anisotropic
Free Diffusion
the water
molecules displace
freely in all spatial
directions
cerebrospinal
fluid
Restricted isotropic diffusion
the water
molecules
displacement is
restricted, in
whatever spatial
direction
abscess, high cell
density tumors
Restricted anisotropic
diffusion

Certain tissue
allow diffusion that
restricted in certain
spatial directions
nerve fibers
 Sensitivity of these sequences is limited to diffusion in
the direction of the gradients must be repeated by
applying diffusion gradients in at least 3 spatial
directions.

Diffusion magnitude, calculated from the 3 diffusion

images thus obtained, renders the image weighted in
global diffusion (trace image).

Two diffusion sequences with different b-factors used

to quantitatively measure the degree of molecular
mobility, by calculating the apparent diffusion coefficient
(ADC).

ADC is represented in the form of a map, whose values

(in mm2s-1) no longer depend on T2.

An ADC hyposignal thus corresponds to a restriction in

diffusion.
 Vasogenic edema
only begin to occur
suffciently for
detection by MR 8
hour after ictus.
Compering between
DWI and FLAIR. The
lesion poorly
visualize in FLAIR
due to lack
vasogenic edema.
T2-weighted and Diffusion-weighted signal
Diffusion tensor imaging
Diffusion imaging (DW MRI)
 Diffusion Tensor Imaging (DT-MRI)

Fiber tractography is the only method giving an indirect, in-

vivo view of the nerve fiber trajectory.

Can be associated with functional MRI to study the

interconnexions between nerve centers, used to analyze
brain maturation and development (myelinization),

Assist in the preoperative check-up for brain tumors

(corticospinal bundle) or for medullary compression.

Exploring Alzheimers disease, certain psychiatric affections,

inflammatory, tumoral, vascular, traumatic (irreversible
comas) pathologies or drug-resistant epilepsies.
BOLD contrast principle (Blood Oxygenation Level
Dependent).

The neuronal metabolism

blood oxygen supply
Neuronal activity
increase oxygen consumption
increase in local blood flow
(neurovascular coupling).
Exceeds the increase in
oxygen consumption,increase
in oxyhemoglobin compared
to deoxyhemoglobin in the
activated zones MRI as a
weak transient rise in the T2*
weighted signal.
BOLD contrast principle
(Blood Oxygenation Level
Dependent).
DWI & DTI
 DTI

non-invasive method for visualizing

white matter tracts in the brain.
Tractography can now be easily
performed using clinical magnets and
the degree of anisotropy and the
local architecture of white matter
changes can be assessed.
 This technique provides unique
anatomic information by
reconstructing and visualizing chosen
fiber tracts in 3-dimensional (3D)
anatomy of the brain.
 Fiber Tract Anatomy.

A, FA map without directional information.

B, Combined FA and directional map. Color hue indicates direction as
follows: red, left-right; green, anteroposterior; blue, superior-inferior.
This convention applies to all the directional maps in this review.
Brightness is proportional to FA.
 FT showing location of tumor
MRI showing a tumor in relation to surrounding tracts
Case of white matter tracts disruption ,T1- weighted(left) and enhanced T1-weighted
(right) preoperative R image showing the temporal tumor (glioblastoma) C. 3D DTI
reconstruction showing disruption of the tracts in the cerebral volume occupied by
the tumor.
BLOOD OXYGEN LEVEL
DEPENDENT
TERIMA KASIH