Sunghwa Hong, Soyeon Kim, Junghee Yoon,Jihye Choi
Background
Nervous system tumors are common in aging dogs and cats, often requiring precise preoperative imaging for effective surgical or therapeutic planning. Conventional imaging modalities like CTA and DSA offer high-resolution vascular visualization but come with drawbacks such as radiation exposure and contrast agent risks. Time-resolved imaging of contrast kinetics (TRICKS) MRA presents a non-invasive alternative with dynamic imaging capabilities. This study aimed to compare TRICKS MRA and CTA in evaluating vascular structures associated with head and neck tumors in veterinary patients, particularly focusing on their diagnostic value and potential advantages of TRICKS in preoperative planning.
Methods
This retrospective study analyzed 10 veterinary patients (nine dogs and one cat) with confirmed head or neck tumors who underwent both CTA and TRICKS MRA. Imaging was conducted under general anesthesia, with standardized protocols for both modalities. Quantitative assessments of signal intensity (rSI) were conducted for the basilar artery and transverse sinus. Qualitative evaluations included vascular visibility, delineation, connectivity, bone-related artifacts, and overall image quality across 21 major vessels. Tumor-associated vascular assessments evaluated differentiation, intratumoral flow, conspicuity from bone, and identification of feeding and draining vessels.
Results
TRICKS MRA provided comparable or superior visualization of venous structures and tumor-associated vessels compared to CTA. While CTA showed significantly higher arterial rSI and superior visibility for arterial structures, TRICKS excelled in visualizing veins and reducing bone-related artifacts. Both modalities showed equivalent diagnostic performance in identifying tumor-associated feeding and draining vessels. TRICKS also enabled consistent visualization across multiple phases due to its dynamic nature, thereby reducing dependency on exact contrast timing. Overall, CTA had better image quality but was more susceptible to bone artifacts.
Limitations
The study included a small sample size, especially for feline subjects, limiting generalizability. There were potential inconsistencies in contrast timing and imaging parameters due to the retrospective nature of the study. TRICKS had lower spatial resolution compared to CTA, which might impact fine vascular detail visualization. Additionally, the absence of histopathological correlation restricted validation of imaging findings against anatomical truth.
Conclusions
TRICKS MRA demonstrates substantial utility as a complementary imaging modality to CTA for vascular assessment in veterinary neuro-oncology. It is particularly advantageous for evaluating venous structures and tumor-associated vasculature due to its dynamic imaging capability and reduced bone interference. While CTA remains superior in arterial imaging, integrating TRICKS into standard MRI protocols may obviate the need for additional CTA scans, streamlining diagnostic workflows and enhancing preoperative planning.
Maximum Intensity Projection (MIP) reconstruction images from a Computed Tomography Angiography (CTA) scan showing various intra-cranial and extra-cranial vessels in a dog. Some of these vessels exhibited significantly higher vascular visibility and delineation compared to Time-Resolved Imaging of Contrast Kinetics (TRICKS). The identified vessels include the basilar artery, caudal auricular artery, caudal cerebral artery, caudal communicating artery, caudal deep temporal artery, descending palatine artery, infraorbital artery, maxillary artery, middle cerebral artery, rostral cerebellar artery, rostral cerebral artery, dorsal sagittal sinus, superficial temporal vein, temporal sinus, and transverse sinus. (A) Arterial-phase MIP image at the level of the basilar artery. (B) Arterial-phase MIP image displaying arterial vasculature in the dorsal plane. (C) Venous-phase MIP image showing venous structures in the dorsal plane. (D) Sagittal plane MIP image highlighting venous vasculature. (1 rostral cerebral artery, 2 middle cerebral artery, 3 caudal communicating artery, 4 internal carotid artery, 5 caudal cerebral artery, 6 rostral cerebellar artery, 7 infraorbital artery, 8 internal carotid artery, 9 descending palatine artery, 10 maxillary artery, 11 caudal deep temporal artery, 12 caudal auricular artery, 13 basilar artery, 14 dorsal external ophthalmic vein, 15 superficial temporal vein, 16 temporal sinus, 17 transverse sinus, 18 dorsal sagittal sinus, 19 straight sinus, and 20 sigmoid sinus).
How did we do?
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