346 ノート 小児もやもや病における水選択的励起法付加 MRA の有用性について 論文受付 2010 年 4 月 12 日 論文受理 2011 年 1 月 24 日 辻村明日香 小島英之 矢部 仁 Code No. 261 埼玉県立小児医療センター放射線技術部 緒言 MR angiography MRA 1 3D tie of flight MR angiography 3D TOF 2, 3 MIP axiu intensity projection / TE: echo tie 6.9 s opposed phase SPIR spectral presaturation with inversion recovery 2 PROSET: principle of selective excitation technique 4 3D TOF MRA PROSET- MRA Applicability of PROSET-MRA for Evaluating Pediatric Moyaoya Disease Asuka Tsujiura, Hideyuki Kojia, and Hitoshi Yabe Departent of Radiological Technology, Saitaa Children s Medical Center Received April 12, 2010; Revision accepted January 24, 2011; Code No. 261 Suary MR angiography (MRA) for pediatric oyaoya disease is iportant as a non-invasive exaination to diagnose blood flow in the brain. Generally, the conventional 3D-TOF MRA is used for oyaoya disease. However, retrobulbar and subcutaneous fat of the head show high intensity signals. We found that using the conventional MRA to diagnose the details of brain blood flow is difficult and that it cannot differentiate oyaoya vessels and fat. It siilarly obscures the ophthalic artery and superficial teporal artery that overlap with fat in the direction of the axiu intensity projection (MIP). Therefore, we devised an MRA technique with fat suppression to diagnose blood flow in oyaoya disease patients: MR angiography with the principle of selective excitation technique (PROSET). The scan tie does not need to be increased. We studied the TOF effect in constant and pulsatile flows and the water selective excitation ethod with the binoinal pulse (PROSET) for the fat suppression effect for oyaoya disease. The results showed that PROSET-MRA achieved better iage results than conventional MRA. The developent of collaterals of the superficial teporal artery and occipital artery in pre- and post-operation oyaoya disease could be clearly visualized and evaluated. The PROSET-MRA ethod is useful for evaluating pre- and post-operation (encephalo-duro-arteriosynangiosis, encephalo-yo-synangiosis) blood flow reconstruction for patients who have oyaoya disease. Key words: oyaoya disease, PROSET, 3D-TOF MRA 339-0077 2100 67 4
MRA 347 Table 1 Iaging paraeters Iaging No. TE (s) TR (s) Tie Coon iaging paraeters Conventional MRA (-) 6.9 24 3 in 51 s PROSET-MRA 1:1 3.9 13 2 in 12 s PROSET-MRA 1:2:1 5.0 16 2 in 35 s PROSET-MRA 1:3:3:1 6.2 18 2 in 57 s FOV: 250 FA: 20 deg Slab thickness: 96 Partition nuber: 120 Slice thickness: 1.6 / -0.8 Matrix 352 176 Fig. 1 Phanto of brain blood vessels (handade). Fig. 2 Illustration of the drop ethod for constant flow. PROSET-MRA PROSET-MRA EDAS: encephalo duro arterio synangiosis EMS: encephalo yo synangiosis 1. 方法 TOF 2 3 1:1 1:2:1 1:3:3:1 PROSET- MRA MRA PROSET-MRA Table 1 1-1 1 MR Intera Achieva 1.5 T Release 2.6 2 Fig. 1 12 4 4 8 3 Fig. 2 0 150 c/s 4 MRI MRI 5. phase contrast 2011 4
348 PC 0 170 c/s. 1-2 EDAS EMS 2009 7 22 2010 3 30 2 20 12 8 10 18 5 13 MRA 3 PROSET-MRA 1-3 TOF TOF TOF 1 TE TE 1.6 s 2.3 s 4.6 s 6.9 s 9.2 s 5 TR 20 s FA 20 24 Partition 30 352 176 30 PC 0 150 c/s Fig. 3 The schea of ROIs for phanto & MIP iage. (a) Phanto of brain blood vessels. (b) MIP iage. MRA 15 C bf: contrast of blood flow 1 TE TOF Fig. 3a C bf V 1 B 6 B 1 B 6 N N 1 N 6 region of interest ROI 3 2 2 V = B - - TOF TE 0 170 c/s PC TE 5 MRA Fig. 3a N N 1-4 PROSET 3D TOF MRA Fig. 4. 2 TE TR: repetition tie FC: flow copensation 67 4
MRA 349 Fig. 4 Illustration of the pulse sequence for PROSET- MRA. Fig. 5 Coparison of conventional MRA and PROSET- MRA (1:1) with the fat suppression effect. T 1 rewinder gradient 3 MRA 2 3 Table 1 PROSET 2 3 4 1-5 1 3 2 Table 1 MRA PROSET-MRA 1:1 MIP Fig. 5 MRA PROSET-MRA 1:1 PROSET-MRA 1:1 PROSET-MRA 1:2:1 PROSET- MRA 1:3:3:1 2 2 5 MIP 3 5 5 1 2 3 4 5 2 PROSET-MRA 1:2:1 1-2 18 Table 1 MRA PROSET-MRA 1:2:1 MRA MIP 3 5 3 C bf C bf = ( V - N ) -( C - N ) x x B - N 2 V x C x B 6 B 1 B 6 N N 1 N 6 MRI signal to noise ratio SNR contrast to noise ratio CNR 6 12 MRA MIP SNR CNR 2 2011 4
350 Fig. 6 Relationship between flow velocity and contrast in constant flow (TOF effect). Fig. 7 Relationship between flow velocity and contrast in pulsatile flow (TOF effect). 2 6 B V 1, 2 V 3, 4 V 5 V 6, 7 V 8, 9 V x C x B C bf Fig. 3b ROI 3 2 2. 結果 2-1 TOF 1 Fig. 6 0 30 c/s 30 100 c/s 100 c/s TE TOF 100 c/s TE TOF 100 c/s TE 2 TOF Fig. 7 0 30 c/s 30 170 c/s TOF 0 170 c/s TE TOF 2-2 1 2 2 PROSET-MRA 1:2:1 PROSET-MRA 1:3:3:1 MIP Fig. 8 PROSET-MRA 1:2:1 Fig. 8 Coparison of conventional MRA and PROSET- MRA (1:2:1, 1:3:3:1) with the fat suppression effect. Table 2 Visual evaluation (fat suppression effect) 1:2:1 1:3:3:1 Right Left Right Left Internal carotid artery 4.3 4.1 4.1 3.9 Vertebral artery 4.4 4.8 4.1 4.8 Superficial teporal artery 4.3 4.3 4.3 4.3 Occipital artery 4.3 4.2 4.0 4.4 Basilar artery 4.8 4.8 Moyaoya vessel 3.3 3.4 Table 2 PROSET-MRA 1:2:1 MRA 2 18 MRA PROSET-MRA 1:2:1 Table 3 4 Table 3 3 PROSET-MRA 1:2:1 67 4
MRA 351 Table 3 Coparison of visual evaluations of conventional MRA and PROSET-MRA (1:2:1) by radiological technologists Conventional PROSET-MRA MRA (1:2:1) Right Left Right Left Internal carotid artery 3.2 3.2 3.4 3.4 Vertebral artery 3.7 3.7 3.7 3.8 Superficial teporal artery 2.6 2.5 4.1 4.2 Occipital artery 2.7 2.7 3.8 3.9 Basilar artery 3.7 3.9 Moyaoya vessel 2.7 3.6 Fig. 9 Contrast of brain blood vessels using conventional MRA. Table 4 Coparison of visual evaluations of conventional MRA and PROSET-MRA (1:2:1) by diagnostic radiologists Conventional PROSET-MRA MRA (1:2:1) Right Left Right Left Internal carotid artery 3.9 3.9 3.8 3.9 Vertebral artery 4.5 4.6 4.6 4.8 Superficial teporal artery 3.1 2.9 4.6 4.3 Occipital artery 3.4 3.6 4.2 4.3 Basilar artery 4.7 4.7 Moyaoya vessel 2.7 2.7 Fig. 10 Contrast of brain blood vessels using PROSET- MRA. MRA Table 4 5 PROSET-MRA 1:2:1 MRA 3 MRA PROSET-MRA 1:2:1 Fig. 9 Fig. 10 PROSET-MRA 1.3 1.4 1.1 1.2 1.2 1.6 1.8 2.2 3. 考察 TOF 30 100 c/s 30 170 c/s TE 1.6 9.2 s C bf 100 c/s TOF 13 3D TOF TR 16 s TOF d 12 V=d/TR 75 c/s FC TOF 100 c/s 3D TOF FC 1 FC FC 2011 4
352 Fig. 11 Coparison of DSA iage and PROSET-MRA (1:2:1) iage for oyaoya disease. 100 c/s FC 18 2 PROSET-MRA 1:2:1 MRA MRA PROSET- MRA 1:2:1 MRA MRA PROSET-MRA 1:2:1 Fig. 11 MRA PROSET-MRA 1:2:1 MIP digital subtraction angiography DSA DSA MRA MIP DSA PROSET-MRA 1:2:1 DSA 4. 結論 2 1:2:1 PROSET-MRA EDAS EMS 謝辞 67 4
MRA 353 参考文献 1 MR Angiography 1992; 8(1): 20-21. 2 tie-of-flight MR angiography 1995; 4(5): 458-464 3 MRI 2 324-326, 261-264, 317-321. 4 MRI Medical view, 2006: 110-113. 5 3DMRA 2002; 58(12): 1599-1608. 6 Yucel EK, Silver MS, Carter AP. MR angiography of noral pelvic arteries: coparison of signal intensity and contrast-to-noise ratio for three different inflow techniques. AJR A J Roentgenol 1994; 163(1): 197-201. 7MR CNR 1989; 8(4): 255-262. 8 Parallel MRI SNR 2008; 64(8): 930-936. 9MRI CNR 2004; 60(11): 1543-1549. 10 MRI 1998; 54(10): 1200-1206. 11 MRI CNR CNR 2008; 64(2): 268-276. 12 3d-MRDSA 2002; 58(12): 1615-1621. 13 MRI 535-561. 図表の説明 Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 MIP ROI PROSET-MRA 1:1 PROSET-MRA 1:2:1 1:3:3:1 MRA PROSET-MRA 1:2:1 PROSET-MRA 1:2:1 DSA Table 1 Table 2 Table 3 MRA PROSET-MRA 1:2:1 Table 4 MRA PROSET-MRA 1:2:1 2011 4