Abstract P587: A Standardized MRA Scanning Protocol Leading to Changes in Stroke Prevention Treatment Plan for Pediatric Sickle Cell Patients

Background and Purpose: Magnetic Resonance Angiography (MRA) is performed on pediatric patients with sickle cell disease (SCD) to classify degree of cerebrovascular stenosis, informing stroke risk and treatment plan for stroke prevention. Flow artifact intrinsic to MRA with technician dependent factors can lead to over-interpretation of stenosis. The primary objective of this study was to document any change in stroke prevention therapy that could be attributed to the implementation of a standardized MRA scanning protocol. Methods: A standardized MRA scanning protocol with an echo time (TE) of <5msec based on the SWiTCH (Stroke With Transfusions Changing to Hydroxyurea) study protocol for patients with SCD was implemented at Montefiore Medical Center, NY (MMC) in May 2016. This project included a retrospective chart review of patients at MMC ≤ 21 years of age with SCD who had one MRA head pre-May 2016 AND one MRA post-May 2016. Of the 81 patients that met inclusion criteria, 29 patients were found to have cerebral vasculopathy on pre-May 2016 imaging and included in the analysis. Level of arterial stenosis on MRA, TE, and treatment plans were documented both pre- and post-May 2016. McNemar analysis was used to determine the significance of change in treatment plans before and after implementation of the standardized MRA scanning protocol. Results: 24/29 (83%) patients were on chronic transfusion therapy for cerebrovascular disease pre-May 2016 whereas 18/29 (62%) required chronic transfusion therapy post May 2016. Notably, 6 patients had a resolution of cerebral vasculopathy leading to discontinuation of chronic transfusion therapy whereas 0 patients required escalation of therapy to chronic transfusions. McNemar analysis showed this difference to be statistically significant (p = 0.042). Conclusion: Implementing a standardized MRA scanning protocol allowed for chronic transfusion therapy, which has potentially significant side effects, to be discontinued in 6 out of 24 patients. Minimizing flow artifact with TE <5msec can improve accurate interpretation of true cerebrovascular disease and ensure appropriate treatment plans are in place for stroke prevention.

Optimalization Image Of Turbo Spin Echo (TSE) With Pre Saturation And Gradient Moment Nulling (GMN) To Reduce Flow Artifact On MRI Cervical

ABSTRACTThe research of Optimization Image of Turbo Spin Echo (TSE) with Pre saturation and Gradient Moment Nulling (GMN) to reduce flow artifact on MRI Cervical has been done. The purpose of this research is to know the effect of pre saturation and gradient moment nulling (GMN) on cervical MRI and determine optimal image to reduce flow artifact. This research used four treatment variations that were without pre saturation and without flow compensation (GMN), with pre saturation, with flow compensation (GMN), and with both pre saturation and flow compensation (GMN) on sequence T2-weighting TSE sagital on cervical MRI. The quantitative analysis done by using Region of Interest (ROI) on MRI image then analyzed signal to Noise Ratio (SNR) and Contrast to Noise Ratio (CNR). The best effect and image quality obtained by pre saturation and flow compensation (GMN) treatment with SNR value on tissue was 328,7 at vertebra cervical, 278,6 at spinal cord, 366,6 at discus, 596,3 at CSF. While CNR tissue value was 78,6 at vertebra cervical, 257,6 at spinal cord, 274,8 at discus, and336,3 at CSF followed by the decrease of flow artifact in the amount of 160,4. Conclusion shows that the image with both pre saturation and flow compensation (GMN) treatment on T2 TSE sagital can reduce flow artifact signal on the spinal cord tissue. Keywords : Pre saturation, flow compensation, gradient moment nulling (GMN), MRI Cervical.