Vascular Imaging of the Central Nervous System: Physical Principles, Clinical Applications, and Emerging Techniques

The first book–length reference to thoroughly describe diagnostic and therapeutic advances in the development of vascular radiology over the last decade

The last ten years has seen vascular imaging of the central nervous system (CNS) evolve from fairly crude, invasive procedures to more advanced imaging methods that are safer, faster, and more precise with computed tomographic (CT) and magnetic resonance (MR) imaging methods playing a special role in these advances.

Vascular Imaging of the Central Nervous System is the first full–length reference text that shows radiologists especially neuroradiologists how to optimize the use of the many techniques available in order to increase the sensitivity and specificity of vascular imaging, thereby improving the diagnosis and treatment of individual patients. Each chapter is formatted carefully and divided into two essential parts: The first part describes the physical principles underlying each imaging technique, along potential associated artifacts and pitfalls; the second part addresses clinical applications and novel applications of each method.

With a strong focus on the clinical application of each modality or technique in CNS radiology, this book provides in–depth chapter coverage of:

Ultrasound Vascular Imaging (UVI)

Computed Tomography Angiography (CTA)

Magnetic Resonance Vascular imaging (MRV)

Digital subtraction angiography (DSA)

Brain perfusion techniques: CT and MRI

Plaque imaging

Intravascular imaging

Pediatric vascular imaging

Along with numerous illustrations and case studies, Vascular Imaging of the Central Nervous System: Physical Principles, Clinical Applications, and Emerging Techniques is an important book for those faced with choosing from the wide range of choices available for clinical practice.

List of Contributors, vii

Preface, ix

Acknowledgments, x

Part One Ultrasound Vascular Imaging (UVI), 1

1 Basic Principles of Ultrasound Sonography, 3
Ana Maria Braz, Jaime Leal Pamplona and Joana N. Ramalho

2 Clinical Applications of Ultrasound Vascular Imaging, 14
Ana Maria Braz, Maria Madalena Patricio, and Joana N.Ramalho

Clinical Vignette #1 Occlusive dissection of theproximal primitive carotid artery with extension to the ICA, 29

3 Novel Applications of Ultrasound Vascular Imaging, 33
Elsa Irene Azevedo and Pedro Miguel Castro

Clinical Vignette #1 Indirect signs of carotiddissection, 60

Clinical Vignette #2 A case of severe perfusion deficitand lack of cerebral vasoreactivity in spite of normal neurologicexamination and cranial CT, 61

Part Two Computed Tomography Angiography (CTA), 67

4 Basic Principles of Computed Tomography Angiography (CTA),69
Margareth Kimura and Mauricio Castillo

Clinical Vignette # 1 Revascularization procedureevaluation by CTA, 81

5 Intracranial Computed Tomography Angiography (CTA), 83
Isabel R. Fragata and Joana N. Ramalho

Clinical Vignette #1 Acute stroke, 105

Clinical Vignette #2 Acute intracerebral hematoma,105

6 Extracranial Computed Tomography Angiography (CTA), 110
Tiago Baptista and João Lopes Reis

Clinical Vignette #1 Carotid stenosis, 118

Part Three Magnetic Resonance Vascular Imaging (MRV),125

7 Basic Principles of Time–of–Flight Magnetic ResonanceAngiography (TOF MRA) and MRV, 127
Hugo Alexandre Ferreira and Joana N. Ramalho

8 Basic Principles of Phase Contrast Magnetic ResonanceAngiography (PC MRA) and MRV, 137
Hugo Alexandre Ferreira and Joana N. Ramalho

9 Time–of–Flight Magnetic Resonance Angiography (TOF MRA) andMRV: Clinical Applications, 146
Mauricio Castillo, Juan Camilo Márquez, and FranciscoJosé Medina

10 Phase Contrast Magnetic Resonance Angiography (PC MRA) andFlow Analysis: Clinical Applications, 161
Pedro Vilela

Clinical Vignette #1 PC MRA, 171

11 Contrast–Enhanced Magnetic Resonance Angiography (MRA):Fundamentals and Clinical Applications, 176
Khurram Javed and Mauricio Castillo

Clinical Vignette #1 Internal carotid artery stenosisquantifi cation, 183

12 Intracranial Magnetic Resonance Angiography (MRA), 1.5 Tversus 3 T: Advantages and Disadvantages, 186
Sara Safder, Benjamin Huang, and Mauricio Castillo

Clinical Vignette #1 Questionable middle cerebral arterystenosis, 192

13 Time–Resolved Techniques, Basic Principles, and ClinicalApplications, 194
Nuno Almeida, David Silva Monteiro, and Daniela Seixas

Clinical Vignette # 1 Occipital arteriovenousmalformation (AVM), 204

Part Four Digital Subtraction Angiography (DSA), 207

14 Digital Subtraction Angiography (DSA): Basic Principles,209
Mauricio Castillo

Clinical Vignette #1 Use of DSA in seizure patient,219

15 Digital Subtraction Angiography (DSA) in Clinical Practice,221
Yueh Z. Lee and Mauricio Castillo

16 Advanced and Future Digital Subtraction Angiography (DSA)Applications, 229
Pedro Vilela

Clinical Vignette #1 Digital subtraction angiography,247

Part Five Brain Perfusion Techniques: Computed Tomography(CT) and Magnetic Resonance Imaging (MRI), 255

17 Computed Tomography (CT) Perfusion: Basic Principles andClinical Applications, 257
Joana N. Ramalho and Isabel R. Fragata

Clinical Vignette # 1 Acute stroke, 272

18 Dynamic Susceptibility Contrast–Enhanced MRI Perfusion: BasicPrinciples and Clinical Applications, 275
Francisco José Medina, Mauricio Castillo, and Juan CamiloMárquez

19 Arterial Spin Labeling (ASL) Perfusion: Basic Concepts,Artifacts, and Clinical Applications, 294
Debora Bertholdo and Mauricio Castillo

Part Six Plaque Imaging, 307

20 Imaging of Carotid Plaque, 309
Sangam G. Kanekar

Clinical Vignette #1 Case examples, 332

Part Seven Intravascular Imaging, 345

21 Basic Concepts and Clinical Applications of IntravascularImaging, 347
Hideki Kitahara, Peter J. Fitzgerald, Paul G. Yock, and YasuhiroHonda

Clinical Vignette #1 Right internal carotid arterystenosis and left internal carotid artery occlusion, 368

Part Eight Pediatric Vascular Imaging, 371

22 Pediatric Vascular Imaging Techniques and ClinicalApplications, 373
Carla R. Conceição, Rita Lopes da Silva and Joana N.Ramalho

Clinical Vignette #1 Use of CT and MRI in a pediatricpatient, 401

Index, 405

Joana Ramalho MD
Department of Neuroradiology, Centro Hospitalar de Lisboa Central Portugal

Mauricio Castillo MD, FACR
Department of Neuroradiology. University of North Carolina at Chapel Hill USA