Evaluation of brain and head and neck tumors with 4D contrast-enhanced MR angiography at 3T

Abstract

Background and purpose: Systematic assessment of brain and head and neck tumors with 4D-CE-MRA at 3T has not been investigated. The purpose of this study was to test the hypothesis that 4D-CE-MRA at 3T can replace DSA in the identification of feeding arteries and tumor stain to plan interventional procedures in hypervascular brain and head and neck tumors.

Materials and methods: Fifteen consecutive patients with brain and head and neck tumors underwent 4D-CE-MRA at 3T and DSA. 4D-CE-MRA combined randomly segmented central k-space ordering, keyhole imaging, SENSE, and half-Fourier imaging. We obtained 30 dynamic scans every 1.9 seconds at an acquired spatial resolution of 0.9 × 0.9 × 1.5 mm; the matrix was 256 × 256. Two independent observers inspected the 4D-CE-MRA images for the main arterial feeders and tumor stain. Interobserver and intermodality agreement was assessed by κ statistics.

Results: For 4D-CE-MRA, the interobserver agreement was fair with respect to the main arterial feeders and very good for the degree of tumor stain (κ = 0.28 and 0.87, respectively). Intermodality agreement was moderate for the main arterial feeders (κ = 0.45) and good for the tumor stain (κ = 0.74).

Conclusions: Although 4D-CE-MRA may be useful for evaluating tumor stain in hypervascular brain and head and neck tumors, it is not able to replace DSA in planning interventional procedures.

Fig 1.

A 44-year-old man with juvenile angiofibroma. A, Axial contrast-enhanced T1-weighted MR image shows an enhanced mass in the left nasopharyngeal space (arrow). B, Anteroposterior (upper) and lateral (lower) DSA projections from the left common carotid artery during the early arterial (left), late arterial (middle), and venous (right) phase. DSA shows a tumor stain (arrowheads) at the early-arterial-to-venous phase; supply is from branches of the left internal maxillary artery (arrow). C, Anteroposterior (upper) and lateral (lower) projections of maximum-intensity 4D-CE-MRA images (2.9/1.4, 20° flip angle). Tumor stain (arrowheads) is seen from the early arterial phase (left); it is apparent in the late arterial (middle) and venous phases (right). The tumor is mainly supplied by branches from the left internal maxillary artery (arrow). Both readers judged that the internal maxillary artery was the main arterial feeder and that the tumor stain was grade 2.

Fig 2.

A 54-year-old man with cerebellar hemangioblastoma. A, Contrast-enhanced MR image shows a ring-enhanced mass in the left cerebellar hemisphere (arrow). B, Lateral DSA projections from the left vertebral (left, middle) and the external carotid (right) artery at the early arterial (left, right) and venous (middle) phases. DSA shows a tumor mainly supplied by branches from the posterior meningeal artery (white arrow). The other feeders were the posterior inferior cerebellar (small white arrow) and occipital (black arrow) arteries. Tumor stain is seen at the early arterial and venous phases (arrowheads). C, Lateral projections of maximum-intensity 4D-CE-MRA images (2.9/1.4, 20° flip angle). Tumor stain (arrowheads) is seen from the early arterial (left) to the venous phase (right). Both readers judged that the occipital artery (arrow) was the main arterial feeder and that the tumor stain was grade 2.