Optimising MRI magnetic susceptibility mapping for the study of brain arteriovenous malformations

Abstract

Magnetic resonance imaging (MRI) magnetic susceptibility mapping (SM) enables the calculation of the magnetic susceptibility of biological tissues based on the signal phase of a gradient-recalled echo (GRE) MRI acquisition. Because deoxygenated haemoglobin is paramagnetic, SM can be used to calculate the χ of venous blood which is proportional to venous oxygen saturation (SvO2). In this thesis, I investigated the feasibility of SM for the study of brain arteriovenous malformations (AVMs). AVMs are congenital vascular anomalies characterised by arteriovenous shunting through a network of coiled and tortuous vessels. Because of this anatomy, the venous drainage of an AVM contains high-pressure mixed arterial and venous blood. I investigated whether SM could detect any resulting increased oxygenation in the draining veins. Using numerical simulations and healthy volunteer data, I focussed on optimising the acquisition and processing of GRE phase data to achieve the best possible accuracy and precision for venous SM. I showed that acquiring multi-echo versus single-echo GRE data led to more accurate and precise susceptibility, and that combining the signal from multiple echoes before applying Laplacian-based phase unwrapping or background field removal increased the susceptibility’s accuracy. Based on healthy volunteer and patient data (before and after gamma knife radiosurgery (GKR)) I investigated the feasibility of SM of brain AVMs and the information provided by venous susceptibility on AVM pathophysiology. I showed that an AVM was detectable on a susceptibility map and that the AVM draining pattern had a significantly higher SvO2 compared to healthy veins. Flowing spins in blood cause an additional susceptibility-independent component in the GRE signal phase. Because clinical multi-echo GRE protocols, including the one developed here to study brain AVMs, do not compensate for flow-induced dephasing, I investigated the effect of flow compensation on venous susceptibility and SvO2 measurements and found only a minimal effect