Korean J Radiol.  2015 Dec;16(6):1353-1363. 10.3348/kjr.2015.16.6.1353.

Subtraction MR Venography Acquired from Time-Resolved Contrast-Enhanced MR Angiography: Comparison with Phase-Contrast MR Venography and Single-Phase Contrast-Enhanced MR Venography

• Jang J
• Kim BS
• Sung J
• Kim BY
• Choi HS
• Jung SL
• Ahn KJ

• KMID: 2344292
• DOI: http://doi.org/10.3348/kjr.2015.16.6.1353

Abstract

OBJECTIVE
To evaluate the image characteristics of subtraction magnetic resonance venography (SMRV) from time-resolved contrast-enhanced MR angiography (TRMRA) compared with phase-contrast MR venography (PCMRV) and single-phase contrast-enhanced MR venography (CEMRV).
MATERIALS AND METHODS
Twenty-one patients who underwent brain MR venography (MRV) using standard protocols (PCMRV, CEMRV, and TRMRA) were included. SMRV was made by subtracting the arterial phase data from the venous phase data in TRMRA. Co-registration and subtraction of the two volume data was done using commercially available software. Image quality and the degree of arterial contamination of the three MRVs were compared. In the three MRVs, 19 pre-defined venous structures (14 dural sinuses and 5 cerebral veins) were evaluated. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the three MRVs were also compared.
RESULTS
Single-phase contrast-enhanced MR venography showed better image quality (median score 4 in both reviewers) than did the other two MRVs (p < 0.001), whereas SMRV (median score 3 in both reviewers) and PCMRV (median score 3 in both reviewers) had similar image quality (p ≥ 0.951). SMRV (median score 0 in both reviewers) suppressed arterial signal better than did the other MRVs (median score 1 in CEMRV, median score 2 in PCMRV, both reviewers) (p < 0.001). The dural sinus score of SMRV (median and interquartile range [IQR] 48, 43-50 for reviewer 1, 47, 43-49 for reviewer 2) was significantly higher than for PCMRV (median and IQR 31, 25-34 for reviewer 1, 30, 23-32 for reviewer 2) (p < 0.01) and did not differ from that of CEMRV (median and IQR 50, 47-52 for reviewer 1, 49, 45-51 for reviewer 2) (p = 0.146 in reviewer 1 and 0.123 in reviewer 2). The SNR and CNR of SMRV (median and IQR 104.5, 83.1-121.2 and 104.1, 74.9-120.5, respectively) were between those of CEMRV (median and IQR 150.3, 111-182.6 and 148.4, 108-178.2) and PCMRV (median and IQR 59.4, 49.2-74.9 and 53.6, 43.8-69.2).
CONCLUSION
Subtraction magnetic resonance venography is a promising MRV method, with acceptable image quality and good arterial suppression.

Keyword

Time-resolved MR venography; Subtraction; Phase-contrast MR venography; Contrast-enhanced MR venography

MeSH Terms

Adult
Aged
Cerebral Veins/radiography
Cranial Sinuses/radiography
Female
Humans
Magnetic Resonance Angiography/instrumentation/*methods
Male
Middle Aged
Signal-To-Noise Ratio

Figure

• 

  Fig. 1 Representative case for choosing optimal phase for SMRV from TRMRA of 64-year-old female. On time-intensity curve (D) of right common carotid artery (CCA; black curve, white circle in B) and internal jugular vein (IJV; gray curve, black circle in B), signal characteristics of phases A and B were identified. Phase A (A) corresponds to time point of start of venous opacification (thin line), not arterial peak phase (dashed line). Phase B (thick line) had maximum venous structure signal. Phase B (B) shows substantial arterial signal, which is not desirable in MRV images. Acquired SMRV (C) image shows that arterial signal was clearly removed and cavernous and inferior petrosal sinuses were clearly visualized. SMRV = subtraction MR venography, TRMRA = time-resolved contrast-enhanced MR angiography

• 

  Fig. 2 Box plot of reviewer 1's cerebral vein and dural sinus scores of three MRVs. Presented P values were obtained from post hoc test (Wilcoxon signed rank test with Bonferroni correction). CEMRV = single-phase contrast-enhanced MR venography, MRV = MR venography, PCMRV = phase-contrast MR venography, SMRV = subtraction MR venography

• 

  Fig. 3 47-year-old female underwent MRV as part of her preoperative workup for midline meningioma. PCMRV (A), CEMRV (B), and SMRV (C) reveal abrupt obliteration of superior sagittal sinus (arrowheads) and prominent collateral cortical vein (empty arrows). Note unsuppressed signal of internal carotid arteries in PCMRV and CEMRV (asterisks), whereas internal carotid arteries are not seen on SMRV. Internal cerebral veins (arrows) are not visualized on PCMRV. Degree of visualization of straight sinus (double arrows) and vein of Galen are different in three MRV images. CEMRV = single-phase contrast-enhanced MR venography, MRV = MR venography, PCMRV = phase-contrast MR venography, SMRV = subtraction MR venography

• 

  Fig. 4 33-year-old man underwent follow-up MRV after diagnosis and treatment of right transverse sinus thrombosis. Right transverse sinus, sigmoid sinus, jugular bulb and even proximal internal jugular vein are not visualized (dotted circle) on PCMRV (A), and persistent thrombosis or stenosis could be suspected. Note arterial contamination (solid and empty arrowheads) on PCMRV. For this patient, timing of CEMRV (B) was suboptimal, and profound contamination of arterial structures (solid and empty arrowheads) and relatively weaker venous structure signal were observed. However, SMRV (C) enables clear visualization without contamination of arterial structures. Note clear visualization of right transverse and sigmoid sinuses (arrows). In addition, SMRV reveals very prominent paraspinal venous plexus. CEMRV = single-phase contrast-enhanced MR venography, MRV = MR venography, PCMRV = phase-contrast MR venography, SMRV = subtraction MR venography

• 

  Fig. 5 59-year-old female underwent MRV for preoperative workup of left parasagittal meningioma. On PCMRV (A), there is transverse vascular signal (empty arrow) where meningioma is located. Same vascular structure (empty arrow) is seen on CEMRV (B). Vascular structure visualized on two conventional MRV was thought to be draining vein from meningioma. On SMRV (C), this vascular structure is not seen. Instead, enhancing meningioma (asterisk) and tortuous cortical vein (double arrows) in superior aspect of meningioma are noted. TRMRA of arterial phase (D) reveals feeding artery (empty arrow) from middle meningeal artery (solid arrow), which is suspected as draining vein on conventional MRV. Note arterial contamination (solid and empty arrowheads) on PCMRV. CEMRV = single-phase contrast-enhanced MR venography, MRV = MR venography, PCMRV = phase-contrast MR venography, SMRV = subtraction MR venography, TRMRA = time-resolved contrast-enhanced MR angiography

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