[Magnetic resonance angiography with contrast media in the study of carotid arteries]

Purpose of our study was to determine the feasibility and accuracy of contrast enhanced Turbo-MRA (CE-MRA) in the evaluation of patients with carotid artery stenosis, using a dynamic technique with multiple acquisitions. MATERIAL AND METHODS: 37 patients with suspected carotid artery stenosis were studied with a 1.5 T magnet (Siemens Vision Plus) using, with a neck phased array coil, a dynamic tridimensional T1 weighted spoiled GRE (TR/TE/NEX: 3.8/1.4/1; Matrix = 110 x 160; FOV = 163 x 260 mm TA = 10 seconds for each sequence); 4 consecutive sequences were performed during the same breath hold, acquired after i.v. bolus injection with a power injector (Spectris, Medrad) of 15 ml of Gd-DTPA followed by 10 ml of saline solution (flow rate 2 ml/s). The beginning of the sequence coincided with the injection of Gd-DTPA. Images were reconstructed using a standard MIP algorithm, by selecting which of the sequences provided the highest enhancement. In all patients a DSA was also performed. Images were separately evaluated using conventional angiography as the gold standard and assessed for degree of stenosis by using NASCET criteria, and morphology of the plaque. RESULTS: CE-MRA correctly evaluated the degree of stenosis in 71 of the 74 patients, while overestimated the remaining 3 cases correctly evaluated by DSA. In 12 cases ulcerations were adequately demonstrated by one of the radiologist, while 11 on 12 were depicted by the other one. CE MRA allowed to detect tandem lesions of the internal carotid arteries (by both radiologists) in 13 of 74 carotids studied. Stenosis at the origin of the common carotid arteries were correctly detected in 9 cases. Sensitivity, specificity and accuracy were respectively of 98, 97 and 99%. DISCUSSION AND CONCLUSIONS: In order to perform an optimal CE-MRA a dynamic technique must be performed to avoid venous filling. The possibility to use ultrafast imaging allows to selectively image the carotid arteries without jugular filling. The well known tendency to overestimate the degree of stenosis has not been found in this group of patients. CE-MRA is a rapid, reliable method to evaluate patients with suspected carotid artery stenosis. These results allow to consider dynamic CE-MRA as a valid method for direct imaging of the carotid arteries.