Evaluation of the Intracranial Dural Sinuses with a 3D Contrast-enhanced MP-RAGE Sequence: Prospective Comparison with 2D-TOF MR Venography and Digital Subtraction Angiography

A–D, The relationship between SNR of flow and concentration of contrast material using four different scan angles between the plastic tube and the slab: 0° (A), 30° (B), 60° (C), and 90° (D). The four curves within one graph represent four different flow velocities. SNR increases as the contrast material concentration increases, but less dramatically after 1 mmol/L concentration

A–D, The relationship between SNR and flow velocity for four different angles: 30° (A), 45° (B), 60° (C), and 90° (D). The five curves within one graph represent five different concentrations of flow of contrast material. SNRs are not greatly affected by fluid velocity if the concentration of flow is greater than 1.0 mmol/L, but SNR does increase significantly with the increase of velocity when flow concentration is low (≤ 0.5 mmol/L)

A and B, ROC curves for the two observers (A and B, respectively) when attempting to detect sinus thrombosis on images obtained with 3D contrast-enhanced MR-RAGE (MP-RAGE: 13.5/7/1, TI = 300, flip angle = 15°), 2D-TOF MR venography (2D-TOF: 25/9/1, flip angle = 30°), T1-weighted imaging (T1WI: 600–700/14–24/1), T2-weighted imaging (T2WI: 3700/96/1), and contrast-enhanced T1-weighted imaging (Gd-T1WI: 600–700/14–24/1). The 3D contrast-enhanced MP-RAGE sequence yielded statistically better detection of sinus thrombosis by both observers as compared with 2D-TOF MR imaging (P < .01), T1-weighted imaging, T2-weighted imaging, and contrast-enhanced T1-weighted imaging (P < .01)

A–E, Hypoplastic left transverse sinus (arrows) in a patient with a posterior fossa meningioma. Although it is difficult to distinguish hypoplasia from occlusion or thrombosis on the source and MIP images (A and B) of 2D-TOF MR venography (25/9/1, flip angle = 30°), the hypoplastic sinus is clearly depicted on the source and MIP images (C and D) of 3D contrast-enhanced MP-RAGE (13.5/7/1, TI = 300, flip angle = 15°), which are nearly identical to the DSA venogram (E). The pacchionian granulations (arrowheads) are also well delineated on 3D contrast-enhanced MP-RAGE images

A–D, Large pacchionian granulation at the top of the straight sinus (arrowheads). Pacchionian granulation is hypointense on reconstructed sagittal and source axial images (A and B) of 3D contrast-enhanced MP-RAGE (13.5/7/1, TI = 300, flip angle = 15°) and hyperintense on T2-weighted image (C) (3700/96/1). DSA image (D) shows filling defect in corresponding region (and could be misdiagnosed as a sinus thrombus)

A–D, Diffuse sinus thrombosis (arrows, arrowheads) in a 37-year-old woman with a history of abruption of placenta and diabetes insipidus. The diagnosis of thrombosis may be possible from the sagittal MIP image of 2D-TOF MR venography (25/9/1, flip angle = 30°) (A) and by the indirect finding of lack of visualization of the affected sinuses. With 3D contrast-enhanced MP-RAGE (13.5/7/1, TI = 300, flip angle = 15°), however, the reconstructed sagittal and source axial images (B and C) show the extent and size of the low signal thrombosis (arrows) as well as the patency of the affected sinuses, which is confirmed on DSA image (D)

A–E, Postoperative sinus thrombosis (arrows) in a 62-year-old man. The coronal source and MIP images of 2D-TOF MR venography (25/9/1, flip angle = 30°) (A and B) show no flow signals in the left transverse and sigmoid sinuses, which may be difficult to differentiate from hypoplasia of the sinuses (see fig 5). The reconstructed coronal and source axial images (C and D) from a 3D contrast-enhanced MP-RAGE sequence (13.5/7/1, TI = 300, flip angle = 15°) clearly show the thrombosis in the left transverse and sigmoid sinuses, which is confirmed on the DSA image (E)