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Improved detection and characterization of arterial occlusion in acute ischemic stroke using contrast enhanced MRA
Sarah Dhundass1, Julien Savatovsky2, Loïc Duron2
1Department of Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, 25, rue Manin, 75019 Paris, France; Department of Neuroradiology,University Hospital of Martinique, Fort-de-France, Martinique, France.
Background And Purpose:
To compare the accuracy and utility of contrast enhanced magnetic resonance angiography (MRA) (CEMRA) to Time of Flight MRA (TOF MRA) during detection and evaluation of occlusions on patients diagnosed with acute ischemic stroke (AIS).
Methods:
This single-center study was approved by our local institutional research ethics board. From August 2014 to July 2016, 131 consecutive adult patients with confirmed AIS were included. Detection of an arterial occlusion and its characterization were evaluated independently with CEMRA or TOF MRA by two blinded neuroradiologists, then by consensus using all available MR sequences. A Cohen's Kappa coefficient (κ) and intra-class correlation coefficients (ICC) were used to compare the two techniques.
Results:
There was substantial concordance in the detection of arterial occlusion between CEMRA and TOF MRA (κ = 0.75). TOF MRA was more likely to show an arterial occlusion than CEMRA (63 versus 52 patients respectively). There were 13 and 1 false positive arterial occlusion with TOF MRA and CEMRA respectively, and 1 false negative with TOF MRA. There was excellent concordance between the location of arterial occlusions and CEMRA and TOF MRA [κ = 0.89 (0.72-0.97)]. CEMRA was significantly more likely to allow measurement of the thrombus than was TOF MRA [38 (75%) versus 14 (22%)] (P < 0.0001).
Conclusions:
Our study showed that CEMRA imaging detected arterial occlusions better than TOF MRA in AIS patients and more precisely such that thrombus length and location could be known, which improves the patient's management and care.
Insights
Contrast enhanced magnetic resonance angiography (CEMRA) better detects arterial occlusions in acute ischemic stroke (AIS) patients than Time of Flight MRA (TOF MRA). CEMRA also allows for more precise thrombus measurement, improving patient management.
Area of Science:
- Neuroradiology
- Vascular Imaging
- Stroke Imaging
Background:
- Acute ischemic stroke (AIS) diagnosis relies on accurate detection of arterial occlusions.
- Magnetic Resonance Angiography (MRA) techniques, including Time of Flight (TOF MRA) and Contrast Enhanced MRA (CEMRA), are used for evaluation.
- Comparing the diagnostic performance of these MRA techniques is crucial for optimizing patient care.
Purpose of the Study:
- To compare the accuracy and utility of CEMRA versus TOF MRA in detecting and evaluating arterial occlusions in patients with AIS.
- To assess the ability of each MRA technique to characterize occlusions, including thrombus measurement.
- To determine which MRA technique provides superior information for clinical management of AIS.
Main Methods:
- A single-center study included 131 adult patients with confirmed AIS.
- Two blinded neuroradiologists independently evaluated arterial occlusions using CEMRA and TOF MRA.
- Detection and characterization of occlusions were compared using Cohen's Kappa and intra-class correlation coefficients.
Main Results:
- Substantial concordance was found between CEMRA and TOF MRA for occlusion detection (κ=0.75).
- TOF MRA identified more occlusions (63 patients) than CEMRA (52 patients), but with higher false positive rates (13 vs 1).
- CEMRA demonstrated significantly higher utility for thrombus length measurement (75% vs 22%) and excellent concordance in occlusion location (κ=0.89).
Conclusions:
- CEMRA imaging offers superior detection and characterization of arterial occlusions in AIS patients compared to TOF MRA.
- The ability of CEMRA to precisely measure thrombus length and location improves patient management and care decisions.
- CEMRA is a valuable tool for evaluating arterial occlusions in the context of acute ischemic stroke.
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