MRI flow quantification of Head and Neck arteries
Jérémie Bettoni1, Gwenaël Pagé2, Stéphanie Dakpé1, Jean-Marc Constans3, Sylvie Testelin1, Bernard Devauchelle1, and Olivier Balédent2,4

1Maxillo-Faciale surgery, Amiens Hospital, Amiens, France, 2BioFlow Image, University of Picardie Jules Verne, Amiens, France, 3Diagnostic Radiology, Amiens Hospital, Amiens, France, 4Department of Image Processing, Amiens Hospital, Amiens, France

Synopsis

The aim of this study is to create the first physiological database of the blood flow quantification in the external carotid tree in order to help the surgeon in facial reconstruction by free flap. An original protocol association with 32 head coils channel and microscopic coil is created and 2D PC-MRI are performed on arteries from head and neck area. Blood flow average for each artery is 17 mL/min in superior thyroid artery, 6.5 mL/min in lingual artery, 30.5 mL/min in facial artery, 23.5 mL/min in internal maxillary artery, 21.5 mL/min in superficial temporal artery.

Purpose

Anatomical dissection studies show the different head and neck vascular areas1,2. It does not exist hemodynamics data in normal and pathologic in vivo situations. Phase-Contrast MRI (PC-MRI) can provide both blood flow hemodynamics and morphological informations3. The aim of this study is to create the first physiological database of the blood flow quantification in the external carotid tree in order to help the surgeon in facial reconstruction by free flap.

Methods

After optimization and validation of Phase Contrast sequences on a bifurcation phantom (error percentage less than 3%), 30 healthy volunteers (14 women and 16 men) aged 21 to 55 years old are placed inside a MRI scanner, 3T Achieva dStream Philips. Firstly, 32 head coil channels is used to locate right and left external carotid trees, with 3D PC-MRI angiography sequence (Table 1) (Spatial Resolution 0,5mm*0,5mm*1mm, Velocity encoding 30cm/s, Acquisition time 5min33sec). We applied 2D CINE PC-MRI sequence (Spatial Resolution 0,5mm*0,5mm*3mm, Velocity encoding 25-45cm/s, Cine frame in each cardiac cycle 16, Acquisition time 2min30sec) perpendicular to the internal maxillary and the superficial temporal arteries. Secondly, 47 diameter microscopy coil is used in both sides of the neck to locate the origine thyroid, lingual and facial tree. After a 3D PC-MRI sequence (Spatial Resolution 0,6mm*0,6mm*1,2mm, Velocity encoding 30cm/s, Acquisition time 3min36sec), we applied 2D CINE PC-MRI sequence (Spatial Resolution 0,15mm*0,15mm*2mm, Velocity encoding 25-45cm/s, Cine frame in each cardiac cycle 16, Acquisition time 2min30sec) perpendicular to the facial, lingual and superior thyroid arteries (Figure 1). Finally, post-processing of PC-MRI images by a homemade software is performed to reconstruct blood flow of each artery along the cardiac cycle (Figure 2).

Results

98% of interest arteries were identified which represents 285 arteries of an average diameter of the order of 2mm.

The median of the blood flow average for each artery is (Figure 3):

• 17 mL/min in superior thyroid artery

• 16,5 mL/min in lingual artery

• 30,5 mL/min in facial artery

• 23,5 mL/min in internal maxillary artery

• 21,5 mL/min in superficial temporal artery

Discussion

Anatomic constraint of this area needs to associate 32 coils and microscopic coil to assess with a good accuracy blood flow of head and neck arteries.

In the same time, with this procedure we show the feasibility of MRI flow quantification in small vessels from head and neck area and we create the first hemodynamics database of external carotid three by MRI.

Conclusion

In conclusion, normal blood flow quantification data in face and neck arteries can be used as reference to help the surgeon to choose the recipient vessels in microsurgery reconstruction and to understand different vascular pathologies, such as osteoradionecrosis or veinous arterial malformation.

Acknowledgements

Acknowledgements to Danielle Lembach, Sophie Potier and Caroline Fournez for their participations in MRI quantification. "Région Picardie", "Gueules Cassées" and "ANR" for their financial supports. "Institut Faire Faces" for its collaboration.

References

1.Taylor, G. I., & Palmer, J. H. (1992). Angiosome theory. British journal of plastic surgery, 45(4), 327-328.

2. Houseman, N. D., Taylor, G. I., & Pan, W. R. (2000). The angiosomes of the head and neck: anatomic study and clinical applications. Plastic and reconstructive surgery, 105(7), 2287-2313.

3. Pelc, N. J., Sommer, F. G., Li, K. C., Brosnan, T. J., Herfkens, R. J., & Enzmann, D. R. (1994). Quantitative magnetic resonance flow imaging. Magnetic resonance quarterly, 10(3), 125-147.

Figures

Figure1.

(a). (b). 2D PC-MRI placed on the angiography sequence

Yellow lines, 2D PC-MRI performed with the 32 head coils channels.

1 : Internal Maxillary Artery

2 : Superficial Temporal Artery Red lines,

2D PC-MRI sequences performed with the microscopy coil.

3 : Facial Artery

4 : Superior Thyroid Artery

5 : Lingual Artery


Figure 2.

Measured flow illustration of a facial artery with the Flow© software

(a) 2D PC-MRI placed on the sagittal angiography sequences for a facial artery

(b) 2D PC-MRI phase image of the facial artery.

(c) Flow Software processing with dynamic segmentation and facial artery graphics


Figure 3.

Results of medians blood flow averages measurements on the collateral branches of the external carotid artery in « healthy volunteers group »


Table 1. Sequences parameters used in our study



Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)
2596