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Gd 3D MRA, intracranial pathology, case 3

This 49-year-old female complained of severe facial pain. Neurological examination disclosed sensation problems of the right body including the facial region. Multiple sclerosis was the first clinical diagnosis. MRI performed to rule out this hypothesis in fact demonstrates a huge left meningioma of the cranio-cervical region (image 1). The pre-operative work-up included in this case an angiographic study considering the relationship between the tumor and the adjacent vertebral arteries.

Images 2 - 3
Set of reconstructed images, image 2: sagittal to coronal, image 3: coronal to sagittal.
The first MRA technique chosen in this case is the 3DTOF before any contrast injection. The left vertebral artery (red arrow) is larger compared to the right one (green arrow) (normal variant).
The meningioma is responsible for an lateral external and superior displacement of the left vertebral artery (red arrow). The right vertebral artery is not well seen with this MR angiographic technique and the small caliber of the right vertebral artery may be suspected.

Images 4 - 5 - 6
Gd 3D MRA "arterial bolus" images with multiple reconstructions from coronal to sagittal plan along a foot-head axis. The left large vertebral artery is better seen than on the TOF images. Moreover, the tumor (T) already shows some early enhancement allowing a nice evaluation of the relationship between tumor and adjacent vessels. The right vertebral artery is small but much better seen on this bolus MR angiography compared to the TOF acquisition.

Image 7
Set of reconstructed Gd 3D MRA images from the "venous" set of acquisition. Rapid and homogeneous enhancement of the meningioma is demonstrated thanks to this dynamic approach provided by the MRCET1 technique. Dilatation of the epidural cervical veins due to the presence of the meningioma are here clearly seen (red arrows).

Image 8
Native thin coronal T1Weighted images obtained with the 3DPCA show nicely the tumor extend.

Images 9 - 10 - 11: standard MIP images calculated routinely from the 3DPCA acquisition obtained after the bolus injection of Gadolinium used for the contrast enhance T1 technique. On this MRA, only the vessels are depicted: both vertebral arteries (image 11 - arrows) are here clearly shown as well as their displacement without compression by the meningioma.

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Fig. 1

Gd 3D MRA, intracranial pathology, case 3, Fig. 1
Gd 3D MRA, intracranial pathology, case 3, Fig. 2
Gd 3D MRA, intracranial pathology, case 3, Fig. 3
Gd 3D MRA, intracranial pathology, case 3, Fig. 4
Gd 3D MRA, intracranial pathology, case 3, Fig. 5
Gd 3D MRA, intracranial pathology, case 3, Fig. 6
Gd 3D MRA, intracranial pathology, case 3, Fig. 7
Gd 3D MRA, intracranial pathology, case 3, Fig. 8
Gd 3D MRA, intracranial pathology, case 3, Fig. 9
Gd 3D MRA, intracranial pathology, case 3, Fig. 10
Gd 3D MRA, intracranial pathology, case 3, Fig. 11