1. TIME RESOLVED ANGIOGRAPHY : CAN IT BE USED AS A VENOUS TRIGGERING TECHNIQUE FOR MAGNETIC RESONNANCE VENOGRAPHY ? FEASABILITY, USEFULLNESS IN CEREBRAL VENOUS PATHOLOGY IMAGING. B Daumas-Duport, R Bourcier, N David, E Auffray-Calvier, A Lintia-Gautier, F Toulgoat, HA Desal CHU de Nantes

2. MRI Venous imaging 2D TOF : –Historical Reference Technique –Non invasive –PITFALLS: –Various saturation / flow phenomena –Low signal on small venous structures / low flow

3. Contrast Enhanced MR venography CEMRV : venous system global visualisation, better spatial resolution 1 Injection protocols: –Fixed Delays 2,3 (20 et 40 ’’) –Carotid Triggering 4 –Torcular Fluoro MR 5 1- Leach et al. Radiographics : (2006) vol. 26 Suppl 1 pp. S19-41 2- Deda et al. Surgical neurology (2005) vol. 64 Suppl 2 pp. S67-71 3- Haroun et al. Surgical and radiologic anatomy : SRA (2007) vol. 29 (4) pp. 323-8 4- Farb et al. Radiology (2003) vol. 226 (1) pp. 203-9 5- Klingebiel et al. Eur J Neurol. 2007;14:139-143.

4. TRATAGEM : TR MRA – CE MRV Association TR MRA and CE MRV : usefull techniques for cerebral venous pathology imaging Delay before venous opacification peak can be used to run a TR MRA TRATAGEM : Time Resolved Angiography Triggered venous Angiography with Gradient-echo Elliptic MR-imaging)

5. Materials & methods MRI Sonata 1,5 T (Siemens) ; 8 channels antenna TR MRA: –IV Bolus Injection (gabobenate, 3 ml/s + 20 ml saline) –FLASH 3D, parallel, –matrix 128 x 256, FOV 220 x 350 –30 sections of 2,5 mm (half a cranium) –TR : 1,5 s /volume CE MRV: –FLASH 3D, (mask followed by subtraction ) –Matrix 229 x 512 x 144 FOV 213 x 310 –SR : 1,5 mm (144 * 1mm, interpolated, 27s)

6. TRATAGEM Time Resolved Angiography Triggered venous Angiography with Gradient-echo Elliptic MR-imaging)

7. CE MRV Signal vs Venous peak 95 consecutives patients –(4 heavy shunts or torcular shunt, 2 torcular thrombosis, 1 short TR MRA, 2 torcular out of TR MRA field) TR MRA 29 ’’ length –Signal measurement (above torcular) CE MRV (launched at 29”) –Signal measurement (above torcular) Time to venous peak (evaluated)

8. SD = 1,98 s SD = 1,35 s TR MRA torcular signal Venous Peak

9. CE MRV Signal vs time to venous peak -4.5 -3 -1.5 0 1.5 3 4.5 6 7.59

11. CE MRV Signal vs time to venous peak -4.5 -3 -1.5 0 1.5 3 4.5 6 7.59

13. TRATAGEM, Feasibility –More than 400 examinations… –TR MRA = Fluoroscopy –MR technicians short learning curve –Short acquisition time.

14. CE MRV CE MRV vs TOF 2D Neuroradiologist 1Neuroradiologist 2Resident 22 examinations (acute or controls of CV phlebitis), TOF 2D vs CE MRV (TRATAGEM) Receiver Operating Characteristic

15. Lateral sinus visualisation –TOF 2D : 68 % –CE MRV : 95 % CE MRV CE MRV vs TOF 2D

16. Other advantages cases report Case n°1

17. Case n° 1: M6, headache, papilar oedema TRATAGEM, cases report

18. Case n°2 TRATAGEM, cases report

19. Case n°2 TRATAGEM, cases report

20. Conclusion TR MRA, CE MRV –Usefull for cerebral venous pathology imaging –Their combination is possible –CE MRV at venous peak –Easy to perform TRATAGEM Time Resolved Angiography Triggered venous Angiography with Gradient-echo Elliptic MR-imaging)