INTRODUCTION
(MRA) Magnetic resonance angiography is a medical imaging technique to visualize blood filled structures, including arteries, veins and the heart chambers. This MRI technique creates soft tissue contrast between blood vessels and surrounding tissues primarily created by flow, rather than displaying the vessel lumen.
MRA
MRA is performed with a short TR to have low signal (due to the longer T1) from the stationary tissue, short scan time to facilitate breath hold imaging, short TE to minimize T2* effects and a bolus injection of a sufficient dose of a gadolinium chelate.
There are bright blood and black blood MRA techniques. With this different MRA techniques both, the blood flow and the condition of the blood vessel walls can be seen. Flow effects in MRI can produce a range of artifacts. MRA takes advantage of these artifacts to create predictable image contrast due to the nature of flow.
In this blood appears black and sequence used is spin echo sequence. In spin echo sequence nuclei that receive both 90and 180 pulses will produce signal .However , flowing blood usually do not receive either 90 or 180pulse .
Slow flow ,clot occlusion will show signal
In this type of imaging blood appears bright . Blood can be made bright by:
TYPES OF MR ANGIOGRAPHY
(TOF) The time of flight angiography is used for the imaging of vessels. Usually the sequence type is a gradient echo sequences with short TR, acquired with slices perpendicular to the direction of blood flow. Uses movement of LM of blood to produce image contrast . Less effective with slow flow because of progressive saturation.
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Takes shorter time than PCMRA Useful for rapid blood flow like extracranial Carotids Less sensitive to turbulance Sensitive to T1 effects hence intravascular contrast media like gadolinium can be given
TOF-MRA
Can be of three types:
2D TOF
Acquisition is slice by slice . 2D TOF is sensitive to slow flow and gives large area of coverage .
3D TOF
Acquisition is from whole volume of the tissue . It gives good resolution . Smaller vessels are better visualized . Is routinely used for evaluating the Circle of Willis.
Combines advantages of 2D( large area of coverage ) and 3D ( high resolution ). In this imaging volume is divided into multiple thin overlapping slabs during acquisition .These slabs are then combined to single volume of data.
Data from TOF MRA is reformatted by technique called MIP ( Maximum intensity projection )to get angiogram .
(PCA) With this method images of the blood flowvelocity (or any other movement of tissue) are produced. The MRI signal contains both amplitude and phase information. The phase information can be used with subtraction of images with and without a velocity encoding gradient. The signal will be directly proportional to the velocity because of the relation between blood flowvelocity and signal intensity.
PC -MRA
Uses movement of TM to produce contrast for the image . Is good for slow flow because there is no saturation.
MRA also can be obtained by injecting intravascular gadolinum . Sequence used is T1 weighting 3D spoiled gradient refocused GRE sequence. (CE MRA) Contrast enhanced MR angiography is based on the T1 values of blood, the surrounding tissue, and paramagnetic contrast agent.
CEMRA
APPLICATION OF MRA
Has become of management of cardiovascular and neurovascular diseases. TOF MRA of carotid arteries and circle of willis are used in imaging the patient with stroke. In cerebral venous thrombosis , PCMRV gives accurate diagnosis. Useful in patient with compromised renal function and those with history of sever allergy to iodinated contrast media.
MRA performed in body and peripheral vessels are usually contrast enhanced
How To Prepare?
During MRA, the area of the body being studied is placed inside an MRI machine. Contrast material is often used during MRA to make blood vessels show up more clearly.
Have any other health conditions, such as kidney problems or sickle cell anemia If you are having blood flow studies, do not use tobacco products and do not eat or drink (including alcohol or caffeinated beverages) for 2 hours before the test. Do not take iron supplements on the day of the test.
Partial or complete blockage of a blood vessel may be seen. Blockage may be caused by a blood clot, the buildup of fat and calcium deposits (plaque), or narrowing (stenosis) of the blood vessel.
A bulge (aneurysm) in the blood vessel wall may be seen. Damage to the wall of a blood vessel may be seen.
REFERENCES
MRI by Stewart C. Bushong
WWW.mrtip.com MRI made easy by Govind B Chavhan