ORGANIZERS: Christopher P. Hess, M.D.,Ph.D. & Daniel M. Mandell, M.D., Ph.D.
Sunday, 23 April 2017
||13:15 - 16:40
||Kevin DeMarco, Christopher Hess
Skill Level: Intermediate
Slack Channel: #e_neuro
Session Number: WE24
This session will prepare the participant to understand the current state of the art in neurovascular MRI, by working from the arterial through the venous side of the circulation in the brain. Techniques to be covered include noncontrast flow-based contrast (MRA, MRV), dynamic gadolinium-enhanced MRA, phase contrast imaging, 4D flow, ASL and BOLD perfusion, and BOLD venography/SWI. The strengths and limitations of each technique will be developed, and the session includes a case-rich series of clinical examples applying the techniques discussed in the section. To conclude, an ARS session in which an MD and a PhD interact together with the audience to respond to challenge cases to test their understanding of the subject material.
Trainees and clinicians desiring a broad-scope view of the field of vascular imaging.
Upon completion of this course, participants should be able to:
-Recognize the strengths and limitations of state-of-the-art vascular imaging techniques in the brain;
-Categorize the most common scenarios in which vascular imaging finds clinical application; and
-Demonstrate practical application of techniques through challenging clinical cases.
|Intracranial Vessel Wall Imaging
|Blood Flow Imaging
MR imaging is the only effective modality for imaging hemodynamic conditions in the intracranial vasculature. The use of these methods for evaluating healthy and diseased vessels will be discussed.
|Cerebrovascular Reserve Imaging - permission withheld
To understand the hemodynamic changes due to a decrease in cerebral perfusion pressure (CPP), and evaluation of cerebrovascular reserve (CVR) capacity in patients with cerebrovascular disease (CVD) is important to determine the risk of future ischemic events and in the selection and planning of the therapeutic interventions. 3 approaches (positron emission tomography, single photon emission computed tomography and MRI) can be used in the evaluation of CVR. We will present the basic concept to measure CVR in patients with CVD combined by nuclear medicine imaging and introduce the possibility of MRI application in measuring CVR.
In acute stroke imaging, the “penumbra” usually refers to brain tissue that is considered to be at risk for infarction. Identification of the penumbra is consistently a focus of active imaging research, particularly in the development of strategies for selecting patients for intravenous thrombolysis and mechanical thrombectomy. Penumbral imaging approaches usually employ perfusion imaging, which provides a variety of complementary measurements of cerebral hemodynamics at the microvascular level. This talk will explore the relationship of penumbral imaging to fundamental principles of cerebrovascular physiology, addressing both currently implemented penumbral imaging techniques, and potential novel applications of perfusion imaging in stroke care.
|Break & Meet the Teachers
With increasing use of high field scanners and high resolution imaging protocols such as susceptibility-weighted imaging that can be used to visualize fine venous structures, understanding of the structure of fine venous anatomy has become important. Deep medullary veins drain into subependymal veins with four convergence zones and show parallel distribution patterns adjacent to the body or inferior horn and a radial pattern in the frontal horn or trigon of the lateral ventricle. Some disorders are related to deep medullary veins.
|Neurovascular Case Review
|Identifying & Characterizing Arteriovenous Shunting Lesions with Arterial Spin Labeling - permission withheld