The comparative evaluation of three-dimensional magnetic resonance for carotid artery disease

Conventional angiography is the current standard for the evaluation of carotid artery disease. The excellent resolution of this invasive study is offset by the potential for contrast-related, embolic, and puncture site complications. Three-dimensional magnetic resonance angiography may offer a noninvasive diagnostic alternative. We examined this possibility by performing both conventional angiography and three-dimensional magnetic resonance angiography in 13 patients. Cervical duplex scans were also obtained in these patients. Contiguous transverse cervical magnetic resonance images were acquired in a 1.5 tesla magnet, by use of a posterior neck coil and a gradient echo pulse sequence. These "raw" data were transferred to a real-time workstation where three-dimensional cervical arterial images were reformatted, magnified, and examined from multiple angles. Total study time from patient positioning to image generation was approximately 30 minutes. In all patients, on three-dimensional magnetic resonance angiography the common, external, and internal carotid arteries and distal vertebral arteries were easily discernable and correctly identified as patent, stenotic, or occluded. Three-dimensional magnetic resonance angiography was not accurate in detecting carotid ulcers. The degree of internal carotid artery stenosis measured from the three-dimensional magnetic resonance angiography studies correlated well with the internal carotid artery stenosis measured with conventional angiography (r = 0.866, r2 = 75.1%, p = less than or equal to 0.0001). This recent technologic advance represents significant progress toward achieving the goal of completely noninvasive vascular assessment in this patient population.