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Gadolinium-enhanced MR angiography of the carotid arteries
W S Enochs1, R H Ackerman, J A Kaufman
1Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Abstract:
To assess the efficacy of gadolinium (Gd)-enhanced magnetic resonance angiography (gdMRA) in overcoming signal dropout artifacts on conventional MRA (cMRA), the authors examined 13 patients with suspected neurovascular stenotic/occlusive lesions on MRA pre- and post-gadolinium enhancement. The sample consisted of 18 internal carotid artery (ICA) les ons (16 extracranial, 2 cranial). In 13 of 16 stenotic vessels, gdMRA better characterized the pathoanatomy of moderate to severe stenotic lesions, changing MRA diagnosis in 3 patients. In zero of three vessels with no flow enhancement by cMRA, the lumen remained nonvisualized on gdMRA. For an ICA lesion at the skull base, enhancement of surrounding normal structures limited the usefulness of the technique. The authors conclude that Gd MRA is a fast, accurate, and convenient noninvasive technique for documenting the morphology and severity of carotid stenotic disease, especially extracranially.
Insights
Gadolinium-enhanced MRA (gdMRA) effectively improves visualization of carotid artery stenosis compared to conventional MRA (cMRA). This technique aids in accurately diagnosing and characterizing neurovascular lesions, especially extracranial internal carotid artery disease.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Conventional magnetic resonance angiography (cMRA) can suffer from signal dropout artifacts, potentially obscuring neurovascular lesions.
- Accurate assessment of internal carotid artery (ICA) stenosis is crucial for managing stroke risk.
Purpose of the Study:
- To evaluate the efficacy of gadolinium-enhanced magnetic resonance angiography (gdMRA) in overcoming signal dropout artifacts seen in cMRA.
- To assess gdMRA's utility in characterizing the pathoanatomy and severity of suspected neurovascular stenotic/occlusive lesions.
Main Methods:
- A study involving 13 patients with suspected neurovascular stenotic/occlusive lesions.
- Comparison of MRA scans performed before and after gadolinium enhancement (gdMRA).
- Analysis focused on 18 internal carotid artery (ICA) lesions, including 16 extracranial and 2 cranial.
Main Results:
- gdMRA provided better characterization of moderate to severe stenotic lesions in 13 out of 16 stenotic vessels.
- MRA diagnosis was altered in 3 patients due to gdMRA findings.
- In cases with no initial flow enhancement on cMRA, the lumen remained nonvisualized on gdMRA.
- Enhancement of surrounding structures limited gdMRA's usefulness for a skull base ICA lesion.
Conclusions:
- Gadolinium-enhanced MRA is a fast, accurate, and convenient noninvasive method for assessing carotid stenotic disease.
- gdMRA is particularly effective for documenting the morphology and severity of extracranial carotid artery stenosis.
- gdMRA demonstrates significant advantages over cMRA in overcoming signal dropout artifacts for specific neurovascular evaluations.