Indications for the use of contrast media in cerebral MR-angiography

Time-of-flight MR-angiography of large volumes is limited by the occurrance of saturation effects, which lead to low signal in both veins and arteries. Alternatively to a number of other MRA-techniques, intravenous application of paramagnetic contrast media in combination with 3D-pulse sequences with or without flow refocussing allows the depiction of slow vessels in large volumes without technical extra expenses. The main intracranial indication is anatomical 3D-imaging of normal and dysplastic cerebral veins with high spatial resolution, and the additional depiction of the venous drainage in AVMs, when unenhanced MRA shows only the arteriel supply and the nidus. In large cerebral aneurysms, bridging veins and venous sinuses, partial thromboses can easily be differentiated from slow flow. Contrast-enhancing tumors can be depicted together with normal or displaced vessels. Improvements of arterial signal due to contrast media with currently used routine MRA techniques are clinically not significant. Signal loss due to spin dephasing in vessels with complex flow is not influences by contrast media. Results of contrast-enhanced MRA are determined by the timing of injection. Since arteries and veins are both imaged with high signal intensity, improvements of postprocessing procedures for secondary vessel segmentation are necessary.