NetForum uses cookies to ensure that we give you the best experience on our website. If you continue to use the site, we'll assume that you are happy to receive these cookies on the NetForum website. Read about our cookies.
NetForum Community
Learn. Share. Optimize.
Log in | Sign up now | Submit content | Contact

Attention valued NetForum members:

Due to evolving technology needs and global privacy regulations, we have made the hard decision to suspend the NetForum User Community platform on Friday, November 29, 2019.

After this date, the current NetForum can no longer be reached. Please click here for more information about this decision, what happens next and how to stay in touch with us about the future of the community.

Go to similar content

1.5T MRA of the spinal cord arteries - Maastricht UMC

ExamCard
Dr. Backes, Walter Maastricht University Medical Center

Download
Login is required to download ExamCards.

 

ExamCard purpose

The ExamCard was created on Intera 1.5T release 11, but is compatible with higher Intera 1.5T releases and Achieva 1.5T.

 

Due to their small calibers, clinical imaging of spinal cord arteries and veins was until recently only possible using catheter angiography. Recent advances in MR technology have enabled the use of MR angiography for the depiction of these vessels.

 

Requirements

  1. A large craniocaudal FOV is required (~50 cm), because the AKA may originate from any segmental artery of the thoracolumbar spine and its location varies strongly between individual patients.
  2. A high spatial resolution is required for visualization, as spinal cord arteries and veins have submillimeter to millimeter calibers.
  3. The spatial courses of intradural arteries and veins are quite similar. This could lead to misinterpretations. Reliable differentiation requires temporal resolutions in the order of the arteriovenous (AV) transit time of blood in the spinal cord (~10 seconds).

 

This ExamCard proposes to use a dual phase 3D MRA for the depiction of the spinal arteries and veins. This approach has been shown successful for the localization of the AKA at 1.5T field strength. 

ExamCard overview

MRA SPINE
Scan 1Survey
Scan 2Ref SSPC
Scan 3T2W TSE SAG
Scan 4BTFE SAG
Scan 5BTFE TRA
Scan 63D 4 NSA
Scan 73D 1 NSA
Scan 8TIM SAG
Scan 93D 4 DYN

 

For all scans: check that the appropriate coil elements are selected.

The reference scan does not require a breathhold.

Total examination time (including patient preparation): ~ 45 minutes.

ExamCard workflow and planning

T2W TSE SAG This image is used to count the disk level.bTFE TRA Depict Th5-L5.MIP 3D Planning: 
On Sagittal survey: Make sure the dorsal FOV lies just against the fat. 
On bFFE TRA: FOV must encompass entire myelum as well as the dorsal part of the aorta.
T2W TSE SAG
bTFE TRA
MIP 3D
This image is used to count the disk level.
Depict Th5-L5.
Planning: On Sagittal survey: Make sure the dorsal FOV lies just against the fat. On bFFE TRA: FOV must encompass entire myelum as well as the dorsal part of the aorta.

Patient preparation

Position the SENSE Spine coil on the table.

Instruct the patient to lie still.

Post-processing / analysis

(Thin) MIP can be used to visualize the anatomy. Be aware that most images shown in literature and presentations have been created using curved MPR.

 

Results example Open segmental arteries: 
Left: T6 - T11, and L3-L4<br>
Right: T5 - T10, and L3<br>
Collateralization: strong from lumbal area and upper thoracic regions.<br> 
Adamkiewicz artery originates  T8 left.<br><br>
Results example
Open segmental arteries: Left: T6 - T11, and L3-L4
Right: T5 - T10, and L3
Collateralization: strong from lumbal area and upper thoracic regions.
Adamkiewicz artery originates T8 left.

References

  1. Backes WH, Nijenhuis RJ, Mess WH, Wilmink FA, Schurink GW, Jacobs MJ.
    Magnetic resonance angiography of collateral blood supply to spinal cord in thoracic and thoracoabdominal aortic aneurysm patients. J Vasc Surg. 2008 Aug;48(2):261-71.
  2. Backes WH, Nijenhuis RJ.
    Advances in spinal cord MR angiography. AJNR Am J Neuroradiol. 2008 Apr;29(4):619-31.
  3. Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT, Thron A.
    Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2007 Aug;28(7):1249-58.
  4. Jaspers K, Nijenhuis RJ, Backes WH.
    Differentiation of spinal cord arteries and veins by time-resolved MR angiography. J Magn Reson Imaging. 2007 Jul;26(1):31-40.
  5. Krings T, Lasjaunias PL, Hans FJ, Mull M, Nijenhuis RJ, Alvarez H, Backes WH, Reinges MH, Rodesch G, Gilsbach JM, Thron AK.
    Imaging in spinal vascular disease. Neuroimaging Clin N Am. 2007 Feb;17(1):57-72. Review.
  6. Nijenhuis RJ, Jacobs MJ, Jaspers K, Reinders M, van Engelshoven JM, Leiner T, Backes WH.
    Comparison of magnetic resonance with computed tomography angiography for preoperative localization of the Adamkiewicz artery in thoracoabdominal aortic aneurysm patients. J Vasc Surg. 2007 Apr;45(4):677-85.
  7. Nijenhuis RJ, Jacobs MJ, van Engelshoven JM, Backes WH.
    MR angiography of the Adamkiewicz artery and anterior radiculomedullary vein: postmortem validation. AJNR Am J Neuroradiol. 2006 Aug;27(7):1573-5.
  8. Nijenhuis RJ, Mull M, Wilmink JT, Thron AK, Backes WH.
    MR angiography of the great anterior radiculomedullary artery (Adamkiewicz artery) validated by digital subtraction angiography. AJNR Am J Neuroradiol. 2006 Aug;27(7):1565-72.
  9. Nijenhuis RJ, Leiner T, Cornips EM, Wilmink JT, Jacobs MJ, van Engelshoven JM, Backes WH.
    Spinal cord feeding arteries at MR angiography for thoracoscopic spinal surgery: feasibility study and implications for surgical approach. Radiology. 2004 Nov;233(2):541-7.


This content has been made possible by NetForum Community.
Share this on: Share your link in twitter Share your link in facebook Share your link on LinkedIn Print Rate this article: Log in to vote

 
Rating:
Votes:
0
Views:
5846
Added:
Sep 17, 2009

Rate this:
Log in to vote
 

ExamCard
Achieva 1.5T, Intera 1.5T
Release 1, Release 11, Release 12, Release 2
Abdominal MRA, Extracranial MRA, Thoracic MRA, Vascular
 

Clinical News
Best Practices
Case Studies
Publications and Abstracts
White Papers
Web seminars and Presentations
ExamCards
Protocols
Application Tips and FAQ
Training
Try an Application
Business News
Case Studies
White Papers
Web Seminars and Presentations
Utilization Services
Contributing Professionals
Contributing Institutions
Become a Contributor