Article Figures & Data
Figures
- Fig 1.
A 55-year-old woman presented with acute onset aphasia; NIHSS score 20. Full-thickness MIP of the entire supra-aortic arteries (A) and focused oblique reformatted (B, C, and D) thin MIP images from CE-MRA, coronal MIP images from TOF-MRA of the brain (E) and neck (F), and focused oblique views from DSA (G) after left common and ICA injections are demonstrated. Both CE-MRA and DSA demonstrate mild stenosis of the left distal common carotid artery (arrow in D and arrowhead in G), high-grade stenosis of the distal left ICA near the petrous segment (arrow on C and G), and occlusion of the ICA bifurcation with extension into the left M1 (arrow in B and black arrow in G). Because of longer acquisition time, both TOF-MRA of the neck (F) and brain (E) are degraded by motion artifact. The mild stenosis at the left common carotid artery is not clearly seen. In addition, because of distal occlusion and sluggish flow, the entire left high cervical, petrocavernous, and supracliniod ICA segments appear to be occluded.
- Fig 2.
A, 62-year-old man with acute stroke; NIHSS score, 14. MR imaging was performed at 3T, 5 hours after the onset (from cohort group: 0.1 mmol/kg of gadolinium used for dynamic susceptibility contrast perfusion). B, 58-year-old man with acute stroke; NIHSS score, 16. MR imaging was performed at 3T, 3 hours after the onset (from study group: 0.05 mmol/kg gadolinium was used for dynamic susceptibility contrast perfusion). Serial DWI, Tmax, and superimposed DWI-Tmax demonstrate diagnostic image quality in both patients. A large perfusion-diffusion mismatch was identified with high confidence in both patients. The corresponding arterial input function curves are shown. There is approximately 24% lower arterial peak in half dose (6.7) compared with full dose (8.9). There is only small difference between the full width at half maximum of full dose (13) versus half dose (15).
Tables
- Table 1:
Distribution of arterial stenoses detected by TOF-MRA and CE-MRA in comparison with DSA (total arterial segments available for comparison = 410)
Arterial Segment TOF-MRA CE-MRA DSA Stenosis Severity Stenosis Severity Stenosis Severity ≤50% >50, <99% Occlusion ≤50% >50, <99% Occlusion ≤50% >50, <99% Occlusion Common carotid artery 3 2 3 5 1 0 3 0 0 Cervical ICA 2 1 6 4 4 4 7 5 4 Pretrocavernous ICA 2 3 4 1 1 1 0 2 1 Supraclinoid ICA 3 4 6 1 5 3 1 1 3 MCA 3 6 14 1 2 11 2 1 10 Anterior cerebral artery 2 2 2 0 1 0 2 1 0 Cervical vertebral artery 0 0 1 1 0 1 2 0 1 Intradural vertebral artery 3 0 3 1 0 0 0 1 0 Basilar artery 2 1 0 0 0 0 0 0 0 Posterior cerebral artery 0 3 1 0 2 0 2 1 0 Total 20 22 40 14 18 20 19 12 19 - Table 2:
Diagnostic performance and agreement of CE-MRA and TOF-MRA for arterial stenosis and occlusion in comparison with DSA
DSA No Disease Mild Stenosis (≤50%) High Grade (>50%, <99%) Occlusion CE-MRA TOF-MRA CE-MRA TOF-MRA CE-MRA TOF-MRA CE-MRA TOF-MRA No disease 353 324 7 17 0 14 0 5 Mild stenosis (≤50%) 5 4 7 3 7 4 0 8 High grade (>50%, <99%) 0 0 0 0 11 4 1 8 Occlusion 0 0 0 0 0 0 19 19 Note:—n = 410 arterial segments. DSA served as reference standard.
Intermodality agreement for CE-MRA: k = 0.89; 95% CI, 0.84–0.92.
Intermodality agreement for TOF-MRA, k = 0.63; 95% CI, 0.60–0.72.
- Table 3:
Comparative quantitative analysis of DSC perfusion between full dose (0.1 mmol/kg) and half dose (0.05 mmol/kg)
Image Parameter Evaluated Full Dose Half Dose t Test SNR 342 ± 101 330.3 ± 67 0.6 Max T2* signal drop 120 ± 54 81.6 ± 48 0.01 Background noise 2.5 ± 0.6 2.7 ± 0.9 0.4 Peak of AIF 9.1 ± 2.4 7.2 ± 2.0 0.002 FWHM of AIF 16.8 ± 2.6 18.2 ± 2.8 0.14 Note:—Data presented as mean ± standard deviation.
Max indicates maximum.
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