The diagnostic value of MRI sequences for different type of intracranial capillary malformations

Wang Xinliang & nbsp; Xiaolin Zhou & nbsp;

(First Hospital of Changsha. Hunan.410005)

Objective: To investigate the clinical application of magnetic resonance imaging in different sequence value for intracranial capillary malformation diagnosis. Methods: Magnetic resonance susceptibility sequence (SWI) and gradient echo GRE (FLASH T2WI) and spin-echo sequence SET1WI, T2WI 20 cases of intracranial capillary malformation patients scanned image analysis features and MRI scans of different sequences Compare the number of lesions detected. Results: 20 cases found in SET1WI capillary malformation lesions 7, T2WI found no lesions; GRE & lt; FLASH T2WI & gt; detection of lesions 112, SWI found 188. Conclusion: capillary malformation intracranial lesions, the most sensitive SWI sequence, followed by the FLASH sequence.

Keywords: Magnetic resonance imaging capillary malformations fast low angle shot GRE FLASHT2WI SWI

Diagnostic Value of MRI Different Sequence in Intracerebral Capillary Telangiectasia

  Wang XinLiang  Zhou Xiaolin

Abstract Objective; To investigate the applied value of different MRI sequence in diagnosing intracerebral capillary telangiectasia.Methods: 20 cases with intracerebral capillary telangiectasia under went MR SWI and GRE FLASH and T2WI sequence, SE T1WI and T2WI sequence examination.MRI features intracerebral capillary telangiectasia at different sequence were analysed.Results Of 20 cases,7 capillary telangiectasia lesions were detected with SE T1WI,112 capillary telangiectasia lesions were detected with GRE FLASH and T2WI sequence ，188 capillary telangiectasia lesions were detected with SWI.Conclution:MR SWI sequence is the best of them，.GRE FLASH T2WI sequence is better than SE sequence in showing intracerebral capillary telangiectasia,and can provide some valuable diagnostic informations for clinical treatment.

Key Words: intracerebral capillary telangiectasia MRI FLASH T2WI SWI

 

Capillary malformation known as telangiectasia is a congenital occult intracranial vascular malformations, less clinical symptoms, only a very few have seizures, neurological disorders and treatment of cerebral hemorrhage, head CT is difficult to be detected lesions, MR the number of lesions detected in different sequences are completely different. We from July 2007 to May 2009, where the SE by conventional MR sequences found 20 cases of patients with cerebrovascular disease were SWI, GREFLASH T2WI sequence scan and MR imaging and lesion counts comparative analysis of each sequence, MR to evaluate the sensitivity of each sequence of discovery and diagnostic value of intracranial capillary malformation

1.  terials and Methods

    The group of 20 patients, including 15 males and 5 females, aged 25-80 years, mean age 57.3 years, four cases discovered by CT pontine hemorrhage 15 months underwent MR imaging, three cases of brain hemorrhage a month after the MR examination, 13 cases of multiple lacunar infarctions line MR examination. After the first 20 cases of SE sequences were scanned and re-SWI GRE FLASH T2WI sequence scan. Six cases were enhanced scan, 10 patients underwent MRA imaging, 12 cases in 18 months after hospitalization reviewed again.

Equipment: SIEMENS Avanto magnetion 1.5T superconductive MRI machine

1 Author: 410005 Changsha, Changsha City, the first hospital

About the author: Wang Xinliang (1968-), male, Hunan, master, deputy chief physician. Research interests: the nervous system diagnostic imaging. E-mail: cswxl_2008@126.com

Corresponding author: Xiaolin Zhou (1956-), female, Changsha, Hunan First Hospital Radiology, 410005. E-mail: zxl_0701@sina.com.

2. results

SE sequence after three cases of brain hemorrhage a month later, the patient showed high signal T1WI patchy, T2WI patchy high signal, low signal surrounding ring. 4 cases of pontine hemorrhage 15 months later T1WI patchy low signal, T2WI showed high signal blotchy. The seven cases were seen in the size of the oval low signal cerebellum or pons 4-9mm in T1WI, T2WI patchy in other signals (Figure ①, ②) showed. 13 cases of cerebral infarction T1WI patchy low signal, T2WI patchy high signal.

SWI sequence of 20 cases were seen in multiple round 5-15mm size significantly lower boundary clear signal, 8 patients had lesions see individual connected with the small veins (Figure ③).

GRE FLASH T2WI sequence 5-15mm size class boundaries clear round low signal (Figure ④) 20 patients were seen more hair.

All lesions were seen in the sequence without mass effect. 20 cases were multiple, between brain lesions and lesion signal properly.

20 cases found in the location and number of lesions see table on each sequence.

Capillary malformation type II Schedule 20 cases in various parts of the sequence and the number of display

Figure ①, ②T1WI right parietal see round slightly low signal, T2WI signal change is not obvious.

③ SWI sequence diagram shows multiple sizes of round, clear boundary apparent low signal.

Figure ④ GRE FLASH T2WI sequence boundaries clearly visible round low signal-prone.

Figure ⑤ T1WI enhanced scan showed a lesion with mild heterogeneous enhancement I no enhancement.

3 Discussion

Intracranial capillary malformation is a congenital malformation of intracranial vessels. It was a pile of twisted capillary dilation, diameter up to about 50-150μm, thin capillary walls, only a layer of endometrial cells, the lack of elastic fibers and smooth muscle and fibrous tissue layer, and occasionally showed collagenous thickening of the capillary wall no artery, may have single or multiple tortuous expansion of the draining veins, like creeping line between expansion of the capillaries of normal brain tissue. General lesions were located in the cerebellum and pons, we can see the brain [1]. The majority of patients with asymptomatic, because very few vessels rupture was caused attention, conventional CT and MRI sequences can only display hematoma, dilated capillaries deformity is difficult to find, angiography is often no positive findings. In the past that intracranial capillary malformation of intracranial vascular malformations in a rare type, and pons single main,Now, with the development of MRI, it has more knowledge [2]. The group of 20 cases of multiple lesions of the brain are based. Only seven cases seen in the round low signal T1WI, T2WI showed such signals on the SE sequence. Due to increased susceptibility GREFLASH T2WI sequences, and can be seen in multiple sizes 5-15mm round about low signal 20 cases, clear boundaries, no mass effect. SWI sequence is also part of the new gradient echo sequence, optimized TR / TE, the use of a significant phase contrast enhanced noise ratio of the image, and therefore more sensitive to the local magnetic field inhomogeneity, and the application of the minimum intensity projection SWI, all all lesions to be displayed, all showed significant loss of signal, so 20 cases of lesions on SWI sequence found more than GREFLASH T2WI sequences showed a clear advantage for SWI capillary malformation diagnosis.

In addition to using SE sequence acquisition echo readout gradient field is switched to read out the echo, but also need to use the 180 ° pulse gathered to remove the main magnetic field inhomogeneity caused by proton loss phase, so the proton due to local magnetic field inhomogeneity caused by loss phase corrected well [3], so the magnetic field inhomogeneity insensitive, capillary malformation in SE sequence difficult to detect. In GREFLASH T2WI echo sequence, there is no conventional SE sequences involved in phase 180 ° pulse reunited echo generation relies switched gradient fields, proton magnetic field inhomogeneity can not remove the main cause of loss of phase, so the local magnetic field inhomogeneity comparison of the sensitivity of [3]. Capillary malformation due to dilated capillaries containing the blood, and the blood flow is slow, containing more deoxygenated hemoglobin, which is paramagnetic molecules, between the surrounding normal brain tissue and the formation of a local gradient field, Resulting in a partial loss of phase, T2 relaxation time was significantly shorter, so the GRE FLASH T2WI can be detected more lesions. The new sequence is a sequence derived from the GRE SWI out, it is also the use of higher levels of expansion of the capillary blood deoxyhemoglobin, blood T2 * shortening noise and increased phase change vessels and surrounding structures, resulting in the local magnetic field is not uniform, loss of spin phase [4]. SWI sequence but also three-dimensional acquisition, significantly improved spatial resolution, choose thin sweep surface, significantly reduces the effect of background noise field T2 *, conducted a full flow compensation in all directions, to remove the influence of small arteries, but also through Select the appropriate time to produce the maximum echo signal cancellation intravascular combined phase information to adjust the final image contrast, and better reflect differences in susceptibility between organizations, but also shorten TR SWI time image acquisition speed, improve stability state, better signal to noise ratio of the image, so SWI for capillary malformation is more sensitive detection of lesions show more clearer.

In short, SWI sequence detection for capillary malformation lesions than GRE FLASH T2WI sequence is more sensitive, has important clinical value for stroke prevention.

[References]

1. allowed back in, Rosai and Ackerman. Surgical Pathology. Peking University Medical Press 2006,2473.

2. gold, Yang Fung Kam, Lijun Qiu and other diagnostic value of susceptibility weighted imaging of the brain telangiectasia of China Medical Imaging Technology 2008 24 (7): 1008-1010.

3. Yangzheng Han, Feng Feng, Wang Xiao Ying and other MRI techniques Guide People's Medical Publishing House 2007: 324-327.

4.  Yuri Yoshida,MD,Satoshi Terae,MD,PhD.Kohsuke Kudo,MD,PhD,et al.Capillary Telangiectasia of the Brain stem Diagonosed by susceptibility-weighted imaging,J Comput Assist Tomgr.2006;30980-982