Visualization of the pituitary gland region’s perforating branch artery before transsphenoidal surgery using a high-spatial-resolution three-dimensional fast spin echo sequence
Keiya Hirata1, Osamu Tachibana2, Chihiro Watari1, Tatsunori Kuroda1, Nanako Miyamoto1, Saeko Tomida1, Masaru Takahashi1, Tomokazu Oku1, Shigeo Miyazaki1, Masahiro Kawashima1, Naoko Tsuchiya3, Ichirou Toyota3, Mariko Doai3, and Hisao Tonami3

1Division of radiology, Kanazawa medical university, Uchinada, Japan, 2Department of neurosurgery, Kanazawa medical university, Uchinada, Japan, 3Department of radiology, Kanazawa medical university, Uchinada, Japan

Synopsis

Transsphenoidal surgery is performed in the surgery of the pituitary region. The perforating branch which performs a nutrient of optic nerve and a mamillary body is present in the cistern around the pituitary gland. We can reduce complications of the surgery if we can identify a perforating branch before surgery.We try to visualize the perforating branch as black blood MRA using the high spatial resolution 3D-FSE sequence. We examined the optimal conditions at phantoms and normal volunteers. The optimal condition was a combination of TR2400msec/2shots, and the imaging time was 20 min and 45 s.

Purpose

Transsphenoidal surgery (TSS) is performed to reach the pituitary gland region through the sphenoid sinus. In the cistern around the pituitary gland, many perforating branches branching off from an internal carotid artery are present. Each perforating branch is an important blood vessel that provides nutrients to the optic nerve and a mamillary body. When a perforating branch is damaged during surgery, a visual disturbance may be the result, and thus it is desirable to identify the perforating branches before the surgery is performed. The vascular anatomy of the perforating branch of the pituitary gland region is complicated and the mean diameter of the branch is approx. 0.3 mm1,2, making vessel visualization by the time-of-flight method difficult. In addition, in the steady-state-free-precession sequences such as CISS(Constructive Interference In Steady State) method which are rendered in blood vessels and cerebrospinal fluid (CSF), both of which provide a high signal, it is difficult to identify the perforating branch. Here we attempted to visualize the perforating branch of the pituitary gland region using a high-spatial-resolution SPACE (Sampling Perfection with Application-optimized Contrasts using different flip-angle Evolution) sequence with a high flow-void effect that was the three-dimensional fast spin echo (3D-FSE) method in this examination as non-contrast black blood angiography.

Material and method

We used a 3-Tesla MRI MAGNETOM Trio with a 32-channel head coil (Siemens, Erlangen, Germany). First, we examined the visualization performance using a phantom that we created with saline and nylon thread (dias. 0.17–0.4 mm). We then examined the visualization performance in five healthy adult volunteers. We examined the combination of optimal parameters with TR 1200–2400 msec and 2–6 as the number of shots. The TE was 70 msec, the refocus flip angle was 150°, and the reconstruction voxel size was 0.25 × 0.25 × 0.25 mm. The imaging time for the examination was within 30 min. For the image display we used the minimum-intensity projection (miniIP) method to obtain thick-slab miniIP images. The evaluation of the images was performed visually by five radiological technologists by the one-way ANOVA test.

Results

In the phantom study, the 0.17-mm nylon thread was invisible under the condition of TR1200 msec/2 shots. In the other conditions, it was possible to visualize the nylon threads of all diameters. In the volunteer study, when the TR was 1200 msec, the signals of the brain parenchyma and the CSF were significantly lower than those observed under the other conditions. In the visual assessment of the volunteer images, the score for the TR 2400 msec/2 shot condition was highest, and the optimal imaging time was 20 min and 45 s.

Conclusion

This technique (i.e., SPACE-black blood MRA) renders the low signal as a flow void the perforating branch in the CSF of high signal in T2WI. In the TR 1200 msec/2 shots condition, the signal-to-noise ratios of the brain parenchyma and CSF were both reduced. Perforating branches that are visualized as flow voids are thus buried in the background noise, and we suspect that this is the reason for the decreased visualization performance. We also observed that it was possible to conduct this imaging using the conditions of TR 2400 msec/2 shots. The use of slab-miniIP processing made it possible to identify small objects from the voxel size. Perforating branch visualization MRI using a SPACE sequence can be achieved in a minimally invasive procedure without a contrast agent, and this visualization can be expected to help reduce the complications of TSS.

Acknowledgements

No acknowledgement found.

References

1. Inoue K, Seker A, Osawa S,et al.Microsurgical and endoscopic anatomy of the supratentorial arachnoidal membranes and cisterns.Neurosurgery. 2009 Oct;65(4):644-64; discussion 665.

2.Rhoton, Albert L.Rhoton cranial anatomy and surgical approaches.2007 Aug.Lippincott Williams & Wilkins

Figures

phantom image

a:Direction in which the phase encoding direction and nylon thread are orthogonal

b:Direction in which the slice encoding direction and nylon thread are orthogonal


Clinical image of cystic pituitary tumor

a:axial slab-miniIP

b:sagittal slab-miniIP




Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)
1181