In the setting of acute ischemic stroke, imaging of the extracranial arteries is necessary to detect atherosclerosis and potentially associated comorbidities such as carotid artery stenosis and large vessel occlusion or dissections [1,2]. Contrast-enhanced magnetic resonance angiography (CE-MRA) represents the standard of care in stroke MRI; however, several risks and limitations have to be considered, e.g. nephrogenic systemic fibrosis, allergic reactions, and uncertain long-time effects of gadolinium deposition in the brain [3-5]. Additionally, image quality of CE-MRA may be hampered due to mistiming of acquisition...
Methods and materials
This retrospective, IRB-approved single-center study included 35 patients (mean age 60.31±21 years, 17 females; May to July 2019) receiving a standard MRI stroke protocol (Philips Ingenia 3T, Philips Healthcare) in clinical routine. The protocol included both, flow-independent 3D isotropic REACT (Compressed SENSE factor 4 for acceleration of image acquisition; fixed scan time: 02:46 minutes) and high-resolution 3D CE-MRA (Compressed SENSE factor 6) of the extracranial arteries. Three blinded radiologists independently scored 630 arterial segments (aortic arch/adjacent branches, bilateral common carotid artery (CCA), internal carotid artery...
In comparison to REACT, CE-MRA provided better delineation for the CCA and ICA (C1- and C2-segment) (each median 5 [min 2 - max 5] vs. 4 [3-5]; P0.05)) than CE-MRA. The remaining segments of the blood supplying vessels of the brain showed equal medians. For these arteries, no segment achieved a lower minimum score in REACT compared to CE-MRA. There was no statistical difference regarding artifacts whereas REACT yielded a significantly lower image noise (median 4 [3-5] vs. 4 [2-5], P
Given its short acquisition and reconstruction times as well as to high-resolution CE-MRA comparable image quality and omission of triggering, Compressed SENSE accelerated flow-independent isotropic 3D REACT proves to be a clinically applicable method for imaging of the extracranial arteries in acute ischemic stroke without gadolinium contrast and associated restrictions.We will evaluate its performance in assessing carotid artery disease in a larger cohort.
Personal information and conflict of interest
D. Zopfs; Cologne/DE - nothing to disclose C. Hoyer; Cologne/DE - nothing to disclose L. Pennig; Cologne/DE - nothing to disclose S. Lennartz; Cologne/DE - nothing to disclose A. Wagner; Cologne/DE - nothing to disclose K. Weiss; Cologne/DE - Employee at Philips Healthcare C. Kabbasch; Cologne/DE - nothing to disclose J. Borggrefe; Cologne/DE - Speaker at Philips Healthcare
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Phan T, Huston J, Bernstein MA, et al. Contrast-enhanced magnetic resonance angiography of the cervical vessels: Experience with 422 patients. Stroke. 2001;32:2282-2286.
Perazella MA. Advanced kidney disease, gadolinium and nephrogenic systemic fibrosis: The perfect storm. Curr. Opin. Nephrol. Hypertens. 2009;18:519-525.
Jung J-W, Kang H-R, Kim M-H, et al. Immediate Hypersensitivity Reaction...