COMPARATIVE ANALYSIS ANATOMICAL IMAGE INFORMATION BETWEEN 3D

TIME OF FLIGH (TOF) AND 3D PHASE CONTRAST (PC) ON THE EXAMINATION

OF MAGNETIC RESONANCE ANGIOGRAPHY CEREBRAL ARTERY

Ikhlasul Amal1), Farah Hendara Ningrum2), Sigit Wijokongko3)

1)3)
Department of Radiodiagnostic and Radiotherapy Techniques, Poltekkes Kemenkes Semarang, Indonesia
2)
Radiologist RSUP Kariadi
E-mail: amalrr31@gmail.com

ABSTRACT
Background: Magnetic Resonance Angiography (MRA) is ways to depiction blood vessels using MRI. There is
two methods that can be used to MRA, namely 3D time-of-flight (TOF) and 3D phase-contrast (PC). Some of
hospital use both method and the other one just using one method. Using two method to produce the same image
makes the examination time longer. The purpose of this study is to compare anatomical information that produced
by 3D TOF and 3D PC and to know the better methods for Cerebral Artery MRA examination.
Methods: This type of research is a quantitative study with an experimental approach. The sample used was 10
volunteers who performed MRA Artery Cerebral examination using 3D TOF and 3D PC methods. In this study,
the anatomy assessed by radiologist are Internal Carotid Artery, Verterbral Artery, Basilary Artery, Anterior
Cerebral Artery, Posterior Cerebral Artery, Middle Cerebral Artery, Anterior Communicating Artery dan
Poserior Communicating Artery. The results of the assessment of 3 radiologist were tested by Cohen's Kappa to
find out the agreement between respondents, then the Wilcoxon statistical test was conducted to look for differences
and look for mean rank values to find out the best method.
Result: Differences in anatomical information between 3D TOF and 3D PC are found in the anatomy of the
anterior cerebral artery, posterior cerebral artery, Middle Cerebral Artery, and anterior communicating artery
which are supported by the result of Wilcxon test with p-value 0.000. The anatomy can be seen better in 3D TOF
than 3D PC. A better sequence to present Cerebral Artery MRA is 3D TOF, this is reinforced by the Wilcoxon test
results with mean rank results for 3D TOF is 28.23 and 3D PC is 24.00.
Keyword : Magnetic Resonance Angiography, Artery Cerebral, 3D Time-of-Flight, 3D Phase Contrast.
Cerebral artery MRA research with PC and TOF
INTRODUCTION
sequences has been carried out with tittle of
Magnetic Resonance Angiography is imaging differences image quality of brain magnetic
diagnostic technique that could be showed the image resonance angiography phase contrast on
of blood vessels from maximizing signal intensity of hypertension patient on variation of velocity
flowing spin and minimizing signal from stationary. encoding (Irawan, 2018), the differences variation
There are two methods to produce MRA image, the velocity encoding (venc) about information of
methods are Time of Flight (TOF) and Phase magnetic resonance angiography brain artery
Contrast (PC). The mechanism of TOF sequence is anatomy on MRI 1,5 T (Rohmah,2018), and the effect
based of T1 contrast, because TOF is sensitive with of time repetition (TR) and flip angle (FA) on
T1 effect. Phase contrast sequence is using bipolar anatomical information about 3D tof sequences
gradient (positive and negative magnet) and velocity (Alamsyah, 2017).
encoding (VENC). In addition to these sequences, Based on preliminary studies, each hospitals has
other squences that can be used are contrast- a selectin of used sequences for MRA examination.
enhanced (CE)MR (Westbrook, 2019). In the SMC Telogorejo Hospital only using the TOF
According of Mukhrejee (2007) 3D TOF is an sequence, then at Santo Boromeus Hospital is using
important sequence to diagnose stenosis, occlusions, TOF and PC sequences. Base on it, the examination
aneurysm and vascular malformation intra cranial that using both of the sequences, the examination time
artery. 3D TOF is the most relevant sequence for will be longer because there is two sequences that
artery that have thin layer and high speed of blood produce same image of the head blood vessels.
flow. According of Bachtiar (2014), PC sequence is
better than TOF to visualized carotid artery.

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 METHODS
The type of this research is quantitative research
with an experimental approach. The study was
conducted by comparing anatomical image
information from 3D TOF and 3D PC sequences on
Cerebral Artery MRA Examination. The population
and sample of the study were the image of Cerebral
Artery MRA 3D TOF and 3D PC sequences. The
MRI modalities using Siemens Avanto 1,5 T.
Questionnaires data of the anatomical image
information was assessed by 3 radiologist.
Data from respondent’s result are in the form of
ordinal data which is proessed and analyzed with
statistical programs. The data was tested by Cohen’s
Kappa to determine the level of equality of
perceptions among respondents. Furthermore, for
anatomical information, data analysis was performed
with Wilcoxon statistical test. To assess the best
image using the result of Wilcoxon mean rank test
then comparing the value between 3D TOF and 3D
PC.
RESULT
1. Sample Description
Table 1. Description of sample based gender
Gender N (Amount) Percentage (%)
Man 6 60%
Women 4 40%
Sum 10 100%
Based on table 1, the variation of gender on these
sample is showed the man sample was dominated
with the percentage is 60%.
Table 2. Description of sample based on age
Percentage
Age N (Amount)
(%)
20 - 22 7 70%
23 - 25 2 20%
26 - 28 1 10%
Based on the table that know the research was
used 10 volunteer with the percentage of the age is
20-22 70%, 23-25 20% and 26-28 10%.
2. Description of research result
Table 3. Result of Cohen’s Kappa by 3 Respondent.
p-value
Respondent Measure of Information
agreement
R1 - R2 0.806 Good
R1 - R3 0.384 Moderate
R2 - R3 0.430 moderate
The level of agreement between respondent one
and respondent two could be said to be good because
the value of p-value between these respondent is in
the range of kappa coefficient value 0.61-0.80. While
the level of agreement between respondent one with
three and respondent two and three could be said
moderate because the value of p-value between the
respondent is in the kappa coefficient range 0.41-
0.60.
Because the level of agreement between
respondent one and respondent two is good, the writer
is decided to use the data obtained from the second
respondent, taking in to the result of cohen’s kappa
Sequences Sig. Information
3D TOF
0,000 Nothing Difference
3D PC
test of respondent one and two having good level of
agreement, and the second respondent having most
experience assessing MRI image than respondent
one.
Table 4. The result of Wilcoxon Test differences of
image information over all
The Results of differences in anatomical image
information on 3D TOF and 3D PC sequences for
cerebral artery MRA examination as a whole. Based
on table 4 the result of the Wilcoxon test showed p-
value = 0.000 or p<0.005, it was showed that Ho is
rejected and Ha is accepted, these results indicate a
significant difference in anatomical information
between 3D TOF and 3D PC sequences on Cerebal
artery MRA examination.
Based on table 5, it can be seen that there are
differences in anterior cerebral artery, posterior
cerebral artery, middle cerebral artery, and anterior
communicating artery which is it have p-values <
0.05.
Comparison of better anatomical image information
between the 3D TOF and 3D PC sequences on
Cerebral Artery MRA examination was analysed
using mean rank values in table 6. Obtain from the
test from each anatomy was tested.
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Table 5. The results of Wilcoxon test differeces of the
anatomi between 3D TOF and 3D PC
Table 6. The results of mean rank Wilcoxon test in
the anatomy
DISCUSSIONS
The imager results between 3D TOF and 3D PC
have differences which is 3D TOF image on small
artery vessels are still clearly visualized while on the
3D PC are not visualized. The difference ws caused
each sequences has advantages and disadvantages
and different mechanisms in producing of image and
characteristics of artery blood vessels themselves.
One of the characteristics of blood vessels that
influential in imaging MRA is the speed of blood
flow. It is the amount of blood through blood vessels
or groups of blood vessels in one unit of time. If the
amount of blood through the vessels is constant, than
the speed will decrease with increasing surface area
of blood vessels that must be drained of blood. The
flowing fluid in a vessels will experience obstacles,
especially for the near the wall vessels (Guyton,
2007).
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The velocity of blood flow in vessels with a
narrow surface area, more than the velocity in large
surface, this results in some cerebral artery anatomy
on 3D PC sequence not shown (Figure 1), sepecially
on anatomical criteria that have narrow surface, the
3D PC sequence has a velocity encoding (VENC)
setting to controls the strength and duration of the
pulse encoding speed.
Figure 1. Comparison of image results of 3D TOF
and 3D PC (A)3D TOF (B) 3D PC
According to Westbrook (2019), the
recommended VENC value artery imaging is 60-80
cm/s. With the VENC that used in this research is 75
cm/s the results of the 3D PC image on the blood
vessels whose small crossectional area does not
appear or is still visible but not clear. It can happen
because the VENC setting is considered too large, it
made the blood vessels to appear to be smaller and
less visible
The abnormalities on blood vessels such as
contriction and blockages can also affect the MRA
image. The part does not flow through the blood not
produce a signal from the flowing nuclei, in that part
will be considered a stationary nuclei so it will
produce a void/ dark signal.
According to Ferreira (2014), 3D TOF
sequences can be used to produce high resolution
volume image on three directions, it makes the TOF
sequence suitable for describing small vascular
structures. The 3D TOF sequence specifically
produces high spatial resolution which is suitable for
studying small intracranial blood vessels. The 3D
TOF sequence application also includes for stenosis
imaging or extracranial occlusion or intracranial
artery and intracranial aneurysm imaging
Based on the mean rank value in table 6 on each
anatomy criterion that has been tested using
Wilcoxon statistical test, it shows that the 3D TOF
sequence has a higher mean rank than the 3D PC
sequence. The mean value of the overall anatomical
criteria for 3D TOF is 28.24 and for 3D PC is 24.00,
it indicares that the 3D TOF sequence is better than
3D PC.
CONCLUSIONS
The differences in anatomical information
between 3D TOF and 3D PC showed significat
differences between both of the sequences, especially
in the anatomy criteria anterior cerebral artery,
posterior cerebral artery, middle cerebral artery, and
anterior communicating artery. In the 3D TOF
sequence, that anatomy can be seen clearly while on
3D PC can not.
The better sequence between 3D TOF and 3D
PC on cerebral artery MRA examination is 3D TOF
sequence. This reinforced by the Wilcoxon test
results of the mean rank value for 3D TOD is 28.24
and for 3D PC is 24.00.
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