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3.0T spectroscopy in the development of anterior cerebral arteries

Case Study
Prof. Semenova, Natalia, Ph.D. Moscow, Scientific Center for Urgent Pediatric Surgery and Traumatology
Prof. Akhadov, Tolibjon, M.D. Moscow, Scientific Center for Urgent Pediatric Surgery and Traumatology

3.0T brain spectorscopy in the development of anterior celebral arteries

Patient history

A 55-year-old man with frequent headaches without focal neurological symptoms underwent a MR examination on the Achieva 3.0T X-series at the Scientific Center for Urgent Pediatric Surgery and Traumatology.

MR examination

The Achieva 3.0T X-series with the 8-channel SENSE Head coil was used.


Images

 T2 FLAIR
T2 FLAIR

T2 and FLAIR images of the right frontal, temporal and parietal lobes show small foci of increased signal as a result of a chronic ischemic process.


 
 MIP MIP
MIP
MIP

MRA shows a lack of trace of the left anterior cerebral artery above the anterior communicating artery, while the right one is dilated with well-developed collaterals in both hemispheres.


 
 MR Spectroscopy
MR Spectroscopy


The MR spectroscopy data of the anterior cerebral artery were analyzed. For each slice four regions were selected: left and right, with respect to the median line, front - in the central regions of the superior frontal gyrus, and back - in the precentral gyrus on the border of the frontal and parietal lobes. Signal intensities, normalized to the intensity of Cr, were averaged in each region for the four voxels. The most reliable data are related to the slice presented in the figure, where a lesser extent of the CSF / brain border is noted.

Single areas of increased MR signal on T2 and FLAIR images, are quite often detected at high resolution 3.0T MRI in middle-aged or older people, and can not be unambiguously interpreted as an active ischemic process, and especially cannot be used as the basis for therapeutic recommendations. Malformation of the anterior communicating artery, detected in the patient, also can not be used for prediction of the brain's functional status. Multivoxel MR spectroscopy helps us to refine the localization of tissue with a low level of blood flow and helps to determine the severity of ischemic lesions, based on metabolic data.

According to MRS data, the minimum content of NAA, the marker of functionally competent neurons, that is the ratio of the NAA / Cr peaks intensities, is noted in the superior frontal gyrus of the left hemisphere (the rostral group of voxels), and indicates a reduced blood supply in the region. A significantly higher value of NAA / Cr is noted in the front part of right hemisphere. In other areas the values of NAA / Cr are statistically insignificant. The level of choline-containing compounds (ratio of Cho / Cr) is greater in the right regions, compared to the left ones, and is greater in the front.


Diagnosis

Occlusion of Middle Cerebral Artery (M1)


Clinical impact of imaging

Multivoxel three dimensional spectroscopy combined with MR angiography and standard MRI studies on the 3.0T scanners help to diagnose brain tissue condition in transient hypoxia, caused by anatomical features of the cerebral arterial bed.


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May 19, 2011

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Case Study
Achieva 3.0T X-series
Release 2, Release 3
Brain, Neuro
 

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