Magnetic Resonance Imaging: Basic Principles
                                             Orhan  Konez, MD                                Türkçe
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Case #8

28-year-old female patient presented with leg pain. Focal pulsatile lesion was noted in the leg and a vascular abnormality was suspected. Magnetic Resonance Angiography (MRA) was performed. The time-of-flight technique was used and Magnetic Resonance Arteriography (MRA) and magnetic Resonance Venography (MRV) images were obtained. What is your diagnosis?

         

Findings / Diagnosis / Discussion:

Arteries and veins can be obtained separately depending on the location of the saturation band placed during the scan.  The arteries on the first image (MRA) and veins in the second image (MRV) appear normal.  An abnormal artery is seen on MRA (same flow direction with the arterial flow). Large caliber vein or veins are seen on MRV.

These MRA and MRV findings are most suggestive of AVM (Arteriovenous Malformation). MRA obtained using the TOF technique is usually not adequate to assess the arteriovenous shunts. For accurate diagnosis, the findings should be confirmed by MRV and clinical data.   

     

If a post-contrast MRA is performed (instead of TOF or in addition to TOF), AVM niduses can be assessed in more detail. The first two images (see above) are first and second phase post-contrast MRA images. The opacification of large draining veins is more prominent on the 2nd image. If a further delayed phase imaging was obtained, dilated veins could be more opacified, therefore, better assessed. This is clearly seen on the conventional arteriography (last image).   

 

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Links:

http://www.konez.com/ufe.htm  -  Fibroid embolization 

http://www.konez.com/laser.htm - Laser ablation of varicose veins

http://www.konez.com/centralcatheters.htm - Central Catheters