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Intracranial magnetic resonance imaging
P M Ruggieri1, T J Masaryk, J S Ross
1Department of Radiology, Cleveland Clinic Foundation, Ohio 44195.
Abstract:
Magnetic resonance angiography (MRA) is currently being incorporated into the routine MR evaluations of patients with suspected cerebrovascular disease. Currently, MRA serves as a useful adjunct to routine parenchymal spin-echo imaging of the head. Intracranial MRA is predominantly used as a screening test for cerebrovascular disease in situations where the clinical suspicion and/or the patient's physical condition does not warrant a conventional arteriogram. Clinical experience to date suggests that MRA can play a significant role in the evaluation of patients with suspected intracranial aneurysms, arteriovenous fistulae, large vessel occlusive disease, and dural sinus occlusion/thrombosis. MRA has not yet reached the point where it can replace conventional catheter angiography. This is most apparent when trying to evaluate 1) larger vessels which are typically difficult to visualize due to higher order motion terms (eg, carotid siphon); 2) the smaller cortical branches with relatively slow flow that would be necessary to see in patients with suspected vasculitis; and 3) any situation in which dynamic information is important such as with mass lesions or vascular malformations. These limitations must be taken into account when deciding on the appropriate imaging study for an individual patient. Large-scale, well-controlled prospective clinical trials will ultimately determine the role intracranial MRA will play in the evaluation of patients with suspected cerebrovascular disease.
Insights
Magnetic resonance angiography (MRA) aids in diagnosing cerebrovascular disease by screening for conditions like aneurysms. However, MRA has limitations and cannot yet replace conventional angiography for all evaluations.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Magnetic resonance angiography (MRA) is increasingly used in routine MR evaluations for suspected cerebrovascular disease.
- MRA serves as a valuable adjunct to standard spin-echo imaging of the head.
Purpose of the Study:
- To assess the current role and limitations of intracranial MRA in diagnosing cerebrovascular conditions.
- To determine MRA's effectiveness as a screening tool compared to conventional arteriography.
Main Methods:
- Clinical experience and evaluation of MRA's utility in detecting specific cerebrovascular pathologies.
- Comparison of MRA capabilities against conventional catheter angiography for various vascular scenarios.
Main Results:
- MRA shows significant potential in evaluating intracranial aneurysms, arteriovenous fistulae, large vessel occlusive disease, and dural sinus thrombosis.
- MRA faces challenges in visualizing larger vessels (e.g., carotid siphon) and small cortical branches, and in assessing dynamic information for mass lesions or vascular malformations.
Conclusions:
- Intracranial MRA is a useful screening tool for specific cerebrovascular diseases but has limitations.
- Further large-scale clinical trials are necessary to fully define the role of MRA in cerebrovascular disease evaluation.