NORMAL VENOUS ANATOMY OF THE BRAIN - DEMONSTRATION WITH GADOPENTETATE DIMEGLUMINE IN ENHANCED 3-D MR ANGIOGRAPHY

This investigation evaluates whether gadopentetate dimeglumine enhancement of three-dimensional (3-D) acquisition MR angiography can generate clinically useful images of the normal venous anatomy of the brain. 3-D MR angiography of normal cerebral arterial anatomy has made rapid progress, although demonstration of detailed venous anatomy with similar techniques has been much less revealing. To overcome the limitation of slow venous flow, IV gadopentetate dimeglumine contrast enhancement was used to alter the relaxation times of blood, thus augmenting the venous signal. Several groups of patients were evaluated: we studied eight patients both with and without contrast enhancement, 20 patients and volunteers with multiple techniques to determine optimal technical parameters, and seven patients in whom enhanced MR studies were compared with standard selective biplane cut-film arterial angiograms. Only the large dural sinuses (such as the transverse sinus) could be seen on unenhanced studies owing to the saturation of slowly flowing venous spins. With contrast enhancement, many of the important small and large cerebral venous structure were routinely seen with reasonable scanning times (7 min). The venous anatomy was well seen for approximately one-half hour after injection and correlated well with angiograms. There are several important limitations to this technique, including a limited field of view, variable visibility of specific veins owing to technical and physiologic factors, confusion of enhancing non-flow-related structures, and lack of detailed physiologic information. Single excitation 3-D MR angiograms are insensitive in the evaluation of cerebral venous structures. Enhancement with gadopentetate dimeglumine affords rapid scanning and excellent visualization of the pertinent venous anatomy. The best image quality was obtained with a sequence of 50/7/30-degrees (TR/TE/flip angle).