Intracranial vascular lesions: optimization and clinical evaluation of three-dimensional time-of-flight MR angiography.

The clinical value of three-dimensional time-of-flight magnetic resonance (MR) angiography was prospectively evaluated in 26 patients with congenital intracranial vascular lesions; 12 had arteriovenous malformations (AVMs), and 14 had venous angiomas. In the initial phase of the study the entire region of interest was imaged with one large acquisition volume (60-120-mm-thick slab). Later, the angiograms were obtained with adjacent but slightly overlapping, 30-mm-thick slabs, which clearly improved vascular detail. Gadolinium enhancement slightly improved depiction of veins but not of arteries. MR angiograms were compared with available conventional angiograms and MR studies. The topography of the AVM nidus was equally well appreciated on the MR as on the conventional angiograms. However, in six of 12 patients the hyperdynamic afferent arteries were incompletely shown on MR angiograms because of incomplete rephrasing. In three patients, venous drainage was also incompletely visualized. Compared with conventional MR studies, MR angiography offered the same detection rate but better anatomic insight. Thirteen of the 14 venous angiomas were also identified on MR angiograms. Detailed imaging, however, necessitated gadolinium enhancement and thin-slab acquisition.