MRI evaluation of peripheral vascular anomalies using time-resolved imaging of contrast kinetics (TRICKS) sequence
We describe the use of time-resolved imaging of contrast kinetics (TRICKS) sequence in the diagnosis of Peripheral Vascular Anomalies. In case of suspected vascular malformations time-resolved MR angiography might add important information for therapeutic decisions and follow-up.
The objective of our study was to assess the usefulness and diagnostic performance of time-resolved imaging of contrast kinetics sequence in the evaluation of peripheral vascular anomalies.
Subjects and methods
Sixty-six patients (23 pediatric, 43 adult; mean age 26) affected by upper or lower limb vascular anomalies and studied using time-resolved imaging of contrast kinetics sequence were prospectively evaluated. All studies were performed on a 1.5-T whole-body MR system. Two independent readers tried to categorized the suspected vascular anomalies in pre-contrast and post-contrast MR sequences and assessed the overall TRICKS image quality. In 11 patients, the diagnostic performance comparability between TRICKS sequence and digital subtraction angiography was evaluated.
On the basis of time-resolved imaging of contrast kinetics, 31 of the vascular anomalies were classified as high-flow vascular malformations, 29 as low-flow vascular lesions and 6 as hemangiomas. There was no significant difference in image quality evaluation and vascular anomaly classification between the two observers. The vascular anomalies characteristics provided by moderate, good or excellent quality TRICKS images were confirmed by digital subtraction angiography.
Time-resolved imaging of contrast kinetics sequence let the radiologist to acquire useful temporal information to correctly evaluate vascular anomalies components, adding more data to those provided by conventional MR sequences, especially in case of arteriovenous malformation. Therefore, both in pediatric and adult population, TRICKS could be used as an additional initial diagnostic tool to rightly classify these lesions and evaluate if a treatment is needed and which.
KeywordsMR angiography Vascular anomalies Arteriovenous malformation TRICKS sequence TR-MRA
Compliance with ethical standards
Conflict of interest
The authors declared no potential conflicts of interests associated with this study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants (or their parental guardian) included in the study.
- 5.Dubois J, Soulez G, Oliva VL, Berthiaume MJ, Lapierre C, Therasse E (2001) Soft-tissue venous malformations in adult patients: imaging and therapeutic issues. Radiographics 21:1519–1531. https://doi.org/10.1148/radiographics.21.6.g01nv031519 CrossRefPubMedGoogle Scholar
- 6.ISSVA Classification of Vascular Anomalies ©2014 International Society for the Study of Vascular Anomalies. Available at http://www.issva.org/classification. Accessed 8 Feb 2017
- 8.Paltiel HJ, Burrows PE, Kozakewich HP, Zurakowski D, Mulliken JB (2000) Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 214:747–754. https://doi.org/10.1148/radiology.214.3.r00mr21747 CrossRefPubMedGoogle Scholar
- 11.Ohgiya Y, Hashimoto T, Gokan T, Watanabe S, Kuroda M, Hirose M, Matsui S, Nobusawa H, Kitanosono T, Munechika H (2005) Dynamic MRI for distinguishing high-flow from low-flow peripheral vascular malformations. AJR Am J Roentgenol 185:1131–1137. https://doi.org/10.2214/AJR.04.1508 CrossRefPubMedGoogle Scholar
- 13.Elster AD (2017) Time-resolved MRA. Questions and answers in MRI web site. http://mri-q.com/tricks-or-twist.html. Accessed 26 March 2017
- 14.Higashihara H, Osuga K, Ueguchi T, Onishi H, Tanaka H, Maeda N, Tomoda K, Tomiyama N (2012) Usefulness of contrast-enhanced three-dimensional MR angiography using time-resolved imaging of contrast kinetics applied to description of extracranial arteriovenous malformations: initial experience. Eur J Radiol 81:1134–1139. https://doi.org/10.1016/j.ejrad.2011.03.040 CrossRefPubMedGoogle Scholar
- 15.Kramer U, Ernemann U, Mangold S, Seeger A, Bretschneider C, Miller S, Claussen CD, Fenchel MC (2012) Diagnostic value of high spatial and temporal resolution time-resolved MR angiography in the workup of peripheral high-flow vascular malformations at 1.5 Tesla. Int J Cardiovasc Imaging 28:823–834. https://doi.org/10.1007/s10554-011-9887-1 CrossRefPubMedGoogle Scholar
- 16.Anzidei M, Cavallo Marincola B, Napoli A, Saba L, Zaccagna F, Lucatelli P, Fanelli F, Bassetti E, Salvatori FM, Catalano C, Passariello R (2011) Low-dose contrast-enhanced time-resolved MR angiography at 3T: diagnostic accuracy for treatment planning and follow-up of vascular malformations. Clin Radiol. 66:1181–1192. https://doi.org/10.1016/j.crad.2011.08.003 CrossRefPubMedGoogle Scholar