Magnetic resonance angiography for detection of occlusive neck and proximal vascular diseases

We reviewed magnetic resonance (MR) aortographies of the thoraco-cervical region of 422 patients. Two hundred sixty patients had ischemic cerebrovascular disease, 86 vertigo or dizziness, 22 syncope, 4 ischemic disease of the retina, 3 cervical bruit, and 47 had other intracranial diseases. MR aortography was performed on a 1.5 Tesla MRI using a special head-and-neck coil. Images were obtained using an overlapping multi-slab and three-dimensional time-of-flight technique. Of the 422 patients, 59 underwent conventional angiography, and the findings from their conventional arteriogram were compared with those of MR aortography. As a result, steno-occlusive lesions were found in the carotid system in 21.1% of the patients, in the vertebral system in 18.5%, and in the subclavian and innominate arteries in 2.1%. The diagnoses made based on the MR aortography were in accord with the diagnoses made with conventional arteriography in 49 patients (83.1%). In 8 patients (13.6%), however, the diagnosis based on the MR aortography was found to be overestimated compared with the definitive diagnosis with conventional angiography. In only 2 patients (3.3%), the MR aortography diagnosis was insufficient. Especially, subclavian steal was not diagnosed with the MR aortography, whereas the findings from the MR aortography helped to lead to the diagnosis of this abnormality. In conclusion, we found that MR aortography is a useful tool as a screening test for patients with occlusive extracranial cerebrovascular disease.