Contribution of THRIVE Sequence in Magnetic Resonance Myelography with Intrathecal Gadolinium

Öz

Magnetic Resonance Myelography with Intrathecal Gadolinium (IG-MRM) is an examination method to investigate the etiology of spontaneous intracranial hypotension (SIH). In the examination, the fat supressed 2-dimensional T1-weighted turbo spin echo (2D-T1W TSE) sequence is generally preferred. “T1-weighted high-resolution isotropic volume examination” (THRIVE) sequence is a new generation 3D gradient echo (GRE) imaging technique that offers high resolution fat-suppressed T1 imaging. We aimed to evaluate the diagnostic success of the THRIVE sequence in detecting IG-MRM findings associated with intracranial hypotension by comparing it with the 2D-T1W TSE. Sixteen patients who were diagnosed with SID according to their clinical and radiological findings and underwent IG-MRM between March 2018 and November 2019 were included. 2D-T1A TSE and THRIVE sequences were compared for cerebrospinal fluid (CSF) opacification grade at the cervical, thoracic, and lumbar levels, and counts of epidural CSF collections, dural defects, and meningeal diverticula. CSF opacification grades in THRIVE sequence at cervical and thoracic levels were significantly lower than 2D-T1W TSE (p<0.05). Significantly more dural defects (33-15, p=0.001) and meningeal diverticula (20-4, p=0.027) were detected in the THRIVE sequence than in the 2D-T1W TSE. There was no significant difference between the two examinations in terms of opacification at the lumbar level and the number of epidural CSF collections detected (p>0.05). Small dural defects and meningeal diverticula may be detected more easily using THRIVE sequence in IG-MRM of SIH cases when compared with routine sequences. However, since THRIVE is a gradient echo-based sequence, CSF areas may not be sufficiently opacified, especially at the cervical and thoracic level.

Anahtar Kelimeler

• gadolinium
• mr myelography
• thrive
• intracranial hypotension

İntratekal Gadolinyumlu Manyetik Rezonans Myelografide THRIVE Sekansının Katkısı

Öz

İntratekal Gadolinyumlu Manyetik Rezonans Myelografi (İG-MRM) spontan intrakraniyal hipotansiyonun (SİH) etyolojisini araştırmak için yapılan bir inceleme yöntemidir. İncelemede genellikle yağ baskılı 2 boyutlu T1A turbo spin eko (2B-T1A TSE) sekansı tercih edilmektedir. “T1-weighted high-resolution isotropic volume examination” (THRIVE) sekansı; yüksek çözünürlüklü yağ baskılı T1 görüntüleme imkanı sunan, yeni nesil 3 boyutlu gradient eko (GRE) görüntüleme tekniğidir. Bu çalışmada; THRIVE sekansının intrakraniyal hipotansiyon ile ilişkili İG-MRM bulgularını saptamadaki tanısal başarısını 2B-T1A TSE ile karşılaştırarak değerlendirmeyi amaçladık. Mart 2018 – Kasım 2019 tarihleri arasında klinik ve radyolojik bulgularına göre SİH tanısı konan ve İG-MRM yapılan 16 hasta dahil edildi. 2B-T1A TSE ve THRIVE sekansları; servikal, torakal ve lomber düzeydeki beyin omurilik sıvısı (BOS) opasifikasyon düzeyleri, tekniklerin her birinde saptanan epidural BOS kolleksiyonu, dural defekt ve meningeal divertikül bulgularının sayısı açısından karşılaştırıldı. Servikal ve torakal düzeyde THRIVE sekansındaki BOS opasifikasyon düzeyi 2B-T1A TSE’ye göre anlamlı düzeyde daha düşüktü (p<0,05). THRIVE sekansında 2B-T1A TSE’ye göre anlamlı ölçüde daha çok sayıda dural defekt (33 – 15, p=0,001) ve meningeal divertikül (20 – 4, p=0,027) saptandı. Lomber düzeydeki opasifikasyon ve saptanan epidural BOS kolleksiyon sayısı yönünden her iki tetkik arasında anlamlı farklılık saptanmadı (p>0,05). SİH olgularının İG-MRM’sinde THRIVE sekansının kullanımı ile küçük dural defektler ve meningeal divertiküller rutin sekanslara göre daha kolay saptanabilir. Ancak sekansın gradient eko tabanlı olması nedeni ile özellikle servikal ve torakal düzeyde BOS alanları yeterince opasifiye olmayabilir.

Anahtar Kelimeler

• gadolinyum
• mr myelografi
• thrive
• intrakraniyal hipotansiyon

Kaynakça

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