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Updated: Feb 6, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Value of Contrast-Enhanced MRA versus Time-of-Flight MRA in Acute Ischemic Stroke MRI
T Boujan1, U Neuberger1, J Pfaff1
1From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.).
Background And Purpose:
Vessel imaging in acute ischemic stroke is essential to select patients with large-vessel occlusion for mechanical thrombectomy. Our aim was to compare the diagnostic accuracy of time-of-flight MR angiography and contrast-enhanced MR angiography for identification of vessel occlusion and collateral status in acute ischemic stroke.
Materials And Methods:
One hundred twenty-three patients with stroke with large-vessel occlusion before thrombectomy were included in this retrospective study. Before thrombectomy, 3T MR imaging, including conventional 3D TOF-MRA of the intracranial arteries and contrast-enhanced MRA of intra- and extracranial arteries, was performed. Both techniques were assessed independently by 2 neuroradiologists for location of the occlusion, imaging quality, and collateral status. Findings were compared, with subsequent DSA as the reference standard.
Results:
Both techniques had good interrater agreement of κ = 0.74 (95% CI, 0.66-0.83) for TOF-MRA and κ = 0.72 (95% CI, 0.63-0.80) for contrast-enhanced MRA. Occlusion localization differed significantly on TOF-MRA compared with DSA (P < .001), while no significant difference was observed between DSA and contrast-enhanced MRA (P = .75). Assessment of collaterals showed very good agreement between contrast-enhanced MRA and DSA (94.9% with P = .25), but only fair agreement between TOF-MRA and DSA (23.2% with P < .001).
Conclusions:
Contrast-enhanced MRA offers better diagnostic accuracy than TOF-MRA in acute ischemic stroke. Contrast-enhanced MRA was superior in localizing vessel occlusion within a shorter acquisition time while providing a larger coverage, including extracranial vessels, and a more accurate assessment of collateral status. These results support inclusion of contrast-enhanced MRA in acute stroke MR imaging, perhaps making TOF-MRA superfluous.
Insights
Contrast-enhanced MR angiography is more accurate than time-of-flight MR angiography for identifying large-vessel occlusion and assessing collateral status in acute ischemic stroke patients. This finding supports its use in stroke imaging.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Vessel imaging is crucial for selecting acute ischemic stroke patients for mechanical thrombectomy.
- Accurate identification of large-vessel occlusion and collateral status is essential for treatment decisions.
Purpose of the Study:
- To compare the diagnostic accuracy of time-of-flight MR angiography (TOF-MRA) and contrast-enhanced MR angiography (CE-MRA) in acute ischemic stroke.
- To evaluate the efficacy of these techniques in identifying vessel occlusion and assessing collateral status.
Main Methods:
- Retrospective study of 123 stroke patients with large-vessel occlusion prior to thrombectomy.
- 3T MRI including 3D TOF-MRA and contrast-enhanced MRA performed before thrombectomy.
- Independent assessment of occlusion location, imaging quality, and collateral status by two neuroradiologists, with Digital Subtraction Angiography (DSA) as the reference standard.
Main Results:
- Both TOF-MRA and CE-MRA demonstrated good interrater agreement.
- CE-MRA showed no significant difference compared to DSA for occlusion localization (P = .75), unlike TOF-MRA (P < .001).
- CE-MRA exhibited very good agreement with DSA for collateral assessment (94.9%, P = .25), whereas TOF-MRA showed only fair agreement (23.2%, P < .001).
Conclusions:
- Contrast-enhanced MR angiography offers superior diagnostic accuracy compared to TOF-MRA in acute ischemic stroke.
- CE-MRA is more effective for localizing vessel occlusion, covers a larger area including extracranial vessels, and provides a more accurate collateral assessment.
- The findings advocate for the inclusion of CE-MRA in acute stroke MR imaging protocols, potentially rendering TOF-MRA unnecessary.
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