FSP Class-8 - MR Vascular Imaging

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flashsmilenet
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296449
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FSP Class-8 - MR Vascular Imaging
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2015-06-10 14:16:09
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FSP Class MR Vascular Imaging
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FSP Class-8 - MR Vascular Imaging
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  1. Carotid Bruit
    • - abnormal sound on the neck through stethoscope
    • - reason for MRA
  2. DVT
    • - Deep vein thrombosis
    • - reason for MRA
  3. SVT
    • - Superficial vein thrombosis     
    • - information of the calf of the leg
    • - reason for MRA
  4. Aneurism
    • - ballooning of the wall of the artery
    • - reason for MRA
  5. Marfan's syndrome
    • - connective tissue disorder 
    • - alter study - CT Calcium Score
    • - reason for MRA
  6. AVM
    • - Anteriovenous Malformation
    • - abnormal connection b/w vein and arteries
    • - reason for MRA
  7. Abnormal sound on the neck through stethoscope
    • Carotid Bruit
    • - reason for MRA
  8. Ballooning of the wall of the artery
    Aneurism
  9. Connective tissue disorder
    • Marfan's syndrome 
    • - alter study - CT Calcium Score
    • - reason for MRA
  10. Abnormal connection b/w vein and arteries.
    • AVM - Anterior Venous Malformation
    • - reason for MRA
  11. Reasons for MRA (list)
    • 1) Carotid Bruit
    • 2) DVT/STV - Deep/Superficial vein thrombosis
    • 3) Aneurism
    • 4) Marfan's syndrome
    • +1) AVM - Anterior Venous Malformation
  12. Reasons for MRA (details)
    • 1) Carotid Bruit - abnormal sound on the neck through stethoscope
    • 2) DVT - Deep vein thrombosis
    •     SVT - Superficial vein thrombosis
    •       - information of the calf of the leg
    • 3) Aneurism - ballooning of the wall of the artery
    • 4) Marfan's syndrome - connective tissue disorder
    •   - alter study - CT Calcium Score
    • +1) AVM - Anterior Venous Malformation - abnormal connection b/w vein and arteries.
  13. MRA advantages:
    • 1) No ionizing radiation
    • 2) Quick time - 20 sec
    • 3) Contrast C+ NOT all the time
    • 4) Accurate surgery (majore)
  14. MRA disadvantages:
    • 1) Very costly
    • 2) Claustrophobia
  15. Laminar blood flow
    free flowing velocity through out (w/o any restriction)
  16. Free flowing velocity through out (w/o any restriction
    Laminar
  17. Blood speedos at the wall of the artery (age)
    Vortex
  18. Different velocity through due to blocks on the artery
    Turbulent
  19. Turbulent blood flow
    different velocity through due to blocks on the artery
  20. Vortex blood flow
    blood speedos at the wall of the artery (age)
  21. Types of blood flow in the body
    • 1) Laminar - free flowing velocity through out (w/o any restriction)
    • 2) Vortex - blood speedos at the wall of the artery (age)
    • 3) Turbulent - different velocity through due to blocks on the artery
  22. As faster blood flow as...
    ... brighter image
  23. Universal Compensation techniques
    • PRE SAT Pulse
    •   - Presaturation Pulse
    •   - helps evaluate vascular patency
    •   - NOT popular b/c         
    •     a) Limit of #slices 
    •     b) ↥SAR - Spec Abs Rate
    • GRE M0 Nulling
    •   - Gradient Moment Nulling  
    •   - BEST b/c rephase dephasing protons, keeping in imaging process
  24. To help slow blood to be bright on the image we use...
    Compensation techniques
  25. Compensation technique used only in brain
    • MT - Magnetization Transfer   
    • - only in brain b/c white-gray matter and blood
  26. MT
    • MT - Magnetization Transfer   
    • - only in brain b/c white-gray matter and blood
    • - Compensation technique
  27. Collimation to part
    • PRE SAT Pulse - Presaturation Pulse
    •   - helps evaluate vascular patency
    •   - NOT popular b/c    
    •      a) Limit of #slices    
    •      b) ↥SAR - Spec Abs Rate
    •  - Compensation technique
  28. PRE SAT Pulse
    • Presaturation Pulse
    • - collimation to part   
    • - universal
    • - helps evaluate vascular patency
    • - NOT popular b/c    
    •     a) Limit of #slices    
    •     b) ↥SAR - Spec Abs Rate
    • - Compensation technique
  29. Best Compensation technique
    • GRE M0 Nulling - Gradient Moment Nulling  
    • - best b/c rephase dephasing protons, keeping in imaging process  
    • - universal
  30. GRE M0 Nulling
    • - Gradient Moment Nulling  
    • - best b/c rephase dephasing protons, keeping in imaging process  
    • - universal
    • - Compensation technique
  31. Not popular Compensation technique
    • PRE SAT Pulse
    • Presaturation Pulse
    • - collimation to part   
    • - universal   
    • - helps evaluate vascular patency
    • - NOT popular b/c
    •      a) Limit of #slices
    •      b) ↥SAR - Spec Abs Rate
  32. Compensation techniques (details)
    • - to help slow blood to be bright on the image
    • 1) MT - Magnetization Transfer
    •  - transfer of nuclear spin polarization from one population of nuclei to another   
    •  - only in brain b/c white-gray matter and blood
    • 2) PRE SAT Pulse - Presaturation Pulse
    •    - collimation to part  
    •    - universal
    •    - helps evaluate vascular patency
    •    - NOT popular b/c
    •      a) Limit of #slices
    •      b) ↥SAR - Spec Abs Rate
    • 3) GRE M0 Nulling - Gradient Moment Nulling
    •    - best b/c rephase dephasing protons, keeping in imaging process
    •    - universal
  33. MRA for slower blood flow
    • 2DTOF
    • - Slower flow (lower extremities veins, carotid bifurcation, intracranial venous thrombosis, arteriovenous malformation)
    • - Lower scanning time - 5-7 min         
    • - set of fine slices (thickness / spacing)   
    • - ↥FA giving better stationary tissue saturation and an increased vascular signal   
    • ↧SR - Spatial Resolution 
    • - reducing sensitivity to:
    •    a) involuntary motion
    •    b) intravoxel dephasing    
    • - NO Contrast - NEVER
  34. NO Contrast MRA
    2DTOF
  35. 2DTOF
    • - Slower flow (lower extremities veins, carotid bifurcation, intracranial venous thrombosis, arteriovenous malformation)    
    • - Lower scanning time - 5-7 min         
    • - set of fine slices (thickness / spacing)   
    • - ↥FA giving better stationary tissue saturation and an increased vascular signal   
    • ↧SR - Spatial Resolution  
    • - reducing sensitivity to:
    •    a) involuntary motion
    •    b) intravoxel dephasing        
    • - NO Contrast - NEVER
  36. MRA with contrast
    • 3DTOF
    • YES Contrast except COW
    • type of TOF MRA
  37. MOTSA
    • MOTSA - Multiple Overlapping Thin Slab  Acquisition
    • Used in 3DTOF
    • A thick slub (no gap b/w) using MOTSA
    • better resolution b/c thin slice
  38. MRA for faster blood flow
    • 3DTOF
    •  - COW, aorta, carotid art, renal art     
    • - Shorter scanning - 18-36 sec     
    • - A thick slab (no gap b/w)    
    • - dividing 3D acquisition into "slabs" MOTSA    
    • - MOTSA - Multiple Overlapping Thin Slab Acquisition
    • - better resolution b/c thin slice     
    • - YES Contrast except COW
  39. 3DTOF
    •  - Faster flow (COW, aorta, carotid art, renal art)     
    • - Shorter scanning - 18-36 sec     
    • - A thick slab (no gap b/w)    
    • -  dividing 3D acquisition into "slabs" MOTSA    
    • - MOTSA - Multiple Overlapping Thin Slab Acquisition
    • - better resolution b/c thin slice     
    • - YES Contrast except COW
  40. TOF - Time of Flight
    • Type of MRA, contains
    • a) 2DTOF     
    •     - Slower flow(lower extremities veins, carotid bifurcation, intracranial venous thrombosis, arteriovenous malformation)
    •     - Lower scanning time - 5-7 min     
    •     - set of fine slices (thickness / spacing)
    •     - ↥FA giving better stationary tissue saturation and an increased vascular signal
    •     - ↧SR - Spatial Resolution
    •     - reducing sensitivity to:
    •        a) involuntary motion  
    •        b) intravoxel dephasing       
    •     - NO Contrast - NEVER
    • b) 3DTOF
    •      - Faster flow (COW, aorta, carotid art, renal art) 
    •      - Shorter scanning - 18-36 sec 
    •      - A thick slab (no gap b/w)
    •      -  dividing 3D acquisition into "slabs" MOTSA
    •      - MOTSA - Multiple Overlapping Thin Slab Acquisition - better resopution b/c thin slice 
    •     - YES Contrast except COW
  41. MRA for slowest blood flow in the body
    Phase Contrast
  42. MRA for Flow Study like CSF flow
    Phase Contrast
  43. MRA in which image is obtained in all directions (plans) of the FOV
    Phase Contrast
  44. NOT popular MRA
    Phase Contrast
  45. MRA using subtraction technique
    Phase Contrast
  46. MRA using VENC
    • Phase Contrast
    • VENC - Velocity Encoding (controlled by tech, matches blood speed - apr 20)
  47. If VENC is wrong
    Aliasing Artifact
  48. Formula of blood flow (speed)
    • Speed Blood (cm/sec) = FV/VA     
    • - FV - Flow Volume     
    • - VA - Vessel Area
  49. Blood Flow - unit of measure
    cm/sec
  50. Phase Contrast
    • Type of MRA
    • - Slowest blood flow in the body  
    • - For Flow Study like CSF flow  
    • - Image is obtained in all directions (plans) of the FOV 
    • - NOT popular  
    • - Subtraction technique   
    • - Use VENC - Velocity Encoding (controlled by tech, matches blood speed - apr 20)
    • - If VENC wrong - Aliasing Artifact
  51. Carotid bifurcation MRA study?
    2DTOF
  52. Intracranial venous thrombosis MRA study
    2DTOF
  53. Arteriovenous malformation (AVM) MRA study
    2DTOF
  54. Types of MRA (details)
    • 1) TOF - Time of Flight
    •    a) 2DTOF
    •      - Slower flow (lower extremities veins, carotid bifurcation, intracranial venous thrombosis, arteriovenous malformation)
    •      - Lower scanning time - 5-7 min         
    •      - set of fine slices (thickness / spacing)
    •      - ↥FA giving better stationary tissue saturation and an increased vascular signal   
    •      - ↧SR - Spatial Resolution 
    •      - reducing sensitivity to:
    •         a) involuntary motion
    •         b) intravoxel dephasing    
    •      - NO Contrast - NEVER
    •    b) 3DTOF
    •      - Faster flow (COW, aorta, carotid art, renal art)     
    •      - Shorter scanning - 18-36 sec     
    •      - A thick slab (no gap b/w)    
    •      -  dividing 3D acquisition into "slabs" MOTSA    
    •      - MOTSA - Multiple Overlapping Thin Slab Acquisition
    •      - better resolution b/c thin slice     
    •      - YES Contrast except COW
    • 2) Phase Contrast
    •    - Slowest flow in the body
    •    - For Flow Study like CSF flow
    •    - Image in all directions
    •    - NOT popular
    •    - Subtraction technique
    •    - Use VENC - Velocity Encoding (controlled by tech, matches blood speed - apr 20)
    •       - If VENC wrong - Aliasing Artifact
  55. MRA
    Artery - small and round - GRE
  56. MRV
    Veins - Large and irregular - GRE
  57. To see different b/w artery and veins used ...
    Placement of Saturation Bland
  58. Saturation Bland (deff)
    To see different b/w artery and veins
  59. Above Heart Vein ⇒ Saturation Bland ...
    inferior
  60. Above Heart Artery ⇒ Saturation Bland ...
    superior
  61. Saturation Bland is superior for ...
    • Above Heart Artery
    • Below Heart Vein
  62. Saturation Bland is inferior for ...
    • Below Heart Artery
    • Above Heart Vein
  63. Below Heart Vein ⇒ Saturation Bland ...
    superior
  64. Below Heart Artery ⇒ Saturation Bland ...
    inferior
  65. MIP
    • - Max Intensity Pixels  
    •  - 1st slice in Saturation Bland
    • - Brightest pixels b/c Entry Slice is more oxiginated   
    • - Used for reconstruction
  66. Saturation Bland (details)
    • To see different b/w artery and veins
    •      Above Heart
    • Artery - Superior Sat Bl
    • Vein - Inferior Sat Bl
    •      Below Heart
    • Artery - Inferior Sat Bl
    • Vein - Superior sat Bl
    • ALL within FOV
    • Total about 150 slices, but
    •    - 1st slice called MIP Recon
    •    - MIP - Max Intensity Pixels (Projection)
    •    - Brightest pixels b/c Entry Slice is more oxiginated
    •    - Used for reconstruction
  67. Radial GRE used in ...
    MRCP - Magnetic Resonance Cholangiopancreatography
  68. Angiography requires NPO
    MRCP - Magnetic Resonance Cholangiopancreatography
  69. Angiography that shows gall bladder and ducts
    MRCP - Magnetic Resonance Cholangiopancreatography
  70. Angiography that shows relation to the pancreas
    MRCP - Magnetic Resonance Cholangiopancreatography
  71. MRCP
    • Magnetic Resonance Cholangiopancreatography
    •   - shows gall bladder and ducts
    •   - shows relation to the pancreas
    •   - uses Radial GRE (only MRCP)
    •   - NPO only for MRCP
  72. MRA imaging for Liver
    Multi Phase Imaging
  73. Bolus pulse
    • Used in Multi Phase Imaging
    • Only for Liver
    • First arterial ⇒ 20 sec delay
  74. NON Equilibrium pulse
    • Used in Multi Phase Imaging
    • Only for Liver
    • Second Portal Vein - 60-70 sec delay
  75. Equilibrium pulse
    • Used in Multi Phase Imaging
    • Only for Liver
    • Third washout pulse - contrast gone - 3-5 min delay
  76. Multi Phase Imaging
    • Only for Liver (80% PV / 20% HA) w delay b/w sequences
    •   - scanning 3 times - 2 delays
    • 1) Bolus - arterial ⇒ 20 sec delay
    • 2) NON Equilibrium - Portal Vein - 60-70 sec delay
    • 3) Equilibrium - washout pulse - contrast gone - 3-5 min delay
  77. BI-phasing injection
    • If no power injection we use BI-phasing injection
    •   - small amount (10cc) followed by large amount (30cc)
    •   - inject small amount firs to determine delay setting and do 6 times. Whenever aorta is brighter, it is delay time (3 sec). Inject large amount and delay 3 sec before scan.
  78. Intrathecal Injection
    Any way, but not by mouth
  79. Arthogram
    joint space
  80. Myelogram
    subarachnoid space
  81. Intravenous
    vein
  82. Antecubital vein
    • 9 - best
    • - medial vein
  83. Bacilic vein
    • 7 - good
    • - medial vein
  84. Cephalic vein
    • 11 - worth
    • - lateral vein
  85. Best injection
    • elbow, but can KINK
    • Antecubital vein
  86. Extravasation
    - wrong IV injection (in tissue space)
  87. Worst injection
    • wrist - Extravasation - in tissue space
    • but best for long term
  88. Best side injection
    RT - closes to RT atrium
  89. Elbow injection path
    • Elbow ⇒
    • Brachial vein-12 ⇒
    • Axillary vein-13 ⇒
    • Subclavian vein-15 ⇒
    • Brachiocephalic (innominate) vein-16 ⇒
    • Superior vena cava-14
  90. Butterfly
    • push
    • out of PT
  91. Angiocatheter
    • stays in Pt
    • PSi - 4cc/sec
  92. Injection Time Formula
    • Inj Time = Amt/PSI
    • If 20cc injected in PSI 4cc/sec
    • Inj Time = 20/4 = 5sec
  93. Smart Prep and Injection Time Formula
    • graphic presentation of the amount of contrast per time
    • 30cc in15 sec - you can see on monitor
    • PSI = 30/15 = 2cc/sec
    • Injection Time Formula
    • Inj Time = Amt/PSI
    • If 20cc injected in PSI 2cc/sec
    • Inj Time = 20/2 = 10sec
  94. CINE
    • rapid motion and functioning organs (heart)
    • Used for:
    •   1) Dynamic imaging of the blood vessel
    •   2) Evaluation of aortic dissection (tear in the wall)
    •   3) Evaluate the dynamic flow of CSF in Pts w Hydrocephalus
  95. Scan Time Formula
    • Scan Time in ms (milli second)
    • 2D Scan Time =
    •          TR x NEX x Phase
    • 3D Scan Time =
    •          TR x NEX x Phase x #Slices

    • TR x NEX x Phase x 60,000ms
    • 50  x  1  x  256-192 x 60,000ms 
    •                 smallest #
  96. Waiting period before each R wave is called?
    trigger window
  97. Trigger Window
    Waiting period before each R wave
  98. Waiting period after each R wave is called?
    Trigger delay
  99. Trigger delay
    Waiting period after each R wave

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