Optimal MRI Sequence for Identifying Occlusion Location in Acute Stroke: Which Value of Time-Resolved Contrast-Enhanced MRA?

Bras, Anthony Le; Raoult, Hélène; Ferré, J.-C.; Ronzière, Thomas; Gauvrit, Jean‐Yves

doi:10.3174/ajnr.a4264

Cited by 12 publications

(15 citation statements)

References 34 publications

(43 reference statements)

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“…However, DSA is an invasive tool having potential risks. In a recent study of comparison with DSA, CE MRA also proved reliable for identifying occlusion location in acute stroke (14).…”

Section: Discussionmentioning

confidence: 99%

“…Although CE MRA gives angiographic images of lower spatial resolution compared to TOF MRA, it has several advantages that it can rapidly scan the entire head and neck and major intracranial arteries and it is sensitive to slow flow. As CT angiography and DSA, we can more accurately assess occlusion segment when the distal portion of the occlusion site is reconstituted via collateral pathway, which is important for the consideration of IA thrombolysis (13,14). In our MR stroke protocol, we only performed CE MRA for the purpose of rapid IA thrombectomy decision because we thought that CE MRA of the whole head and neck was sufficient to determine the presence of the major vessel occlusion.…”

Section: Discussionmentioning

confidence: 99%

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Susceptibility Vessel Sign for the Detection of Hyperacute MCA Occlusion: Evaluation with Susceptibility-weighted MR Imaging

Lee

Cho

Choi

et al. 2016

Investig Magn Reson Imaging

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Original ArticlePurpose: Susceptibility vessel sign (SVS) on gradient echo image, which is caused by MR signal loss due to arterial thrombosis, has been reported in acute middle cerebral artery (MCA) infarction. However, the reported sensitivity and diagnostic accuracy of SVS have been variable. Susceptibility-weighted imaging (SWI) is a newly developed MR sequence. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the SVS. The purpose of this study was to evaluate the diagnostic values of SWI for the detection of hyperacute MCA occlusion. Materials and Methods: Sixty-nine patients (37 males, 32 females; 46-89 years old [mean, 69.1]) with acute stroke involving the MCA territory underwent MR imaging within 6 hours after the symptom onset. MR examination included T2, FLAIR (fluid-attenuated inversion recovery), DWI, SWI, PWI (perfusion-weighted imaging), contrast-enhanced MR angiography (MRA) and contrast-enhanced T1. Of these patients, 28 patients also underwent digital subtraction angiography (DSA) within 2 hours after MR examination. Presence or absence of SVS on SWI was assessed without knowledge of clinical, DSA and other MR imaging findings. Results: On MRA or DSA, 34 patients (49.3%) showed MCA occlusion. Of these patients, SVS was detected in 30 (88.2%) on SWI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SWI were 88.2%, 97.1%, 96.8%, 89.5% and 92.8%, respectively. Conclusion: SWI was sensitive, specific and accurate for the detection of hyperacute MCA occlusion.

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“…However, DSA is an invasive tool having potential risks. In a recent study of comparison with DSA, CE MRA also proved reliable for identifying occlusion location in acute stroke (14).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Susceptibility Vessel Sign for the Detection of Hyperacute MCA Occlusion: Evaluation with Susceptibility-weighted MR Imaging

Lee

Cho

Choi

et al. 2016

Investig Magn Reson Imaging

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“…The following arteries are thus able to be adequately evaluated: the iliac artery; femoral artery; deep femoral artery; lateral circumflex femoral artery; popliteal artery; descending genicular artery; anterior tibial artery; and peroneal artery. Assessment of these structures is critical, whereas smaller arterial sub-branches encased by tumors can be safely surgically ligated (3).…”

Section: Discussionmentioning

confidence: 99%

“…Lower extremity computed tomography angiography (CTA) is often employed in clinical practice; however, ionizing radiation, poor soft tissue resolution, and suboptimal depiction of venous structures limit the applicability. Traditional non-enhanced magnetic resonance angiography (MRA) such as three-dimensional (3D) time-of-flight (TOF) may misidentify an area of slow blood flow as a site of occlusion (2) and cannot provide direct visualization of thrombus (3). Three-dimensional contrast-enhanced (3D CE-MRA) overcomes artifacts due to differences in flow dynamics and has gradually become the primary modality for assessment of vascular diseases.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of vascular invasion in patients with musculoskeletal tumors of lower extremities: use of time-resolved 3D MR angiography at 3-T

Jin

et al. 2017

Acta Radiol

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Background Time-resolved angiography with stochastic trajectories (TWIST) sequence makes considerable progress in temporal and spatial resolution, which presents high potential in evaluation of vascular diseases. Purpose To assess magnetic resonance imaging (MRI) using TWIST MR angiography (MRA) sequence in the assessment of vascular invasion for bone and soft-tissue tumors in comparison to computed tomography angiography (CTA) as the reference standard. Material and Methods Thirty-three patients with lower extremity musculoskeletal tumors were imaged with conventional MR and TWIST MRA. CTA was performed 48 h later. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the femoral artery were calculated. Vascular invasion as determined by MRA and CTA was separately analyzed. Vascular invasion by MRA and CTA were analyzed with kappa coefficients to determine agreement between the imaging methods. Results Seven cases of bone and 26 cases of soft tissue tumors were examined. SNR and CNR of the femoral artery were excellent for TWIST MRA (mean ± SD values of 317 ± 80 and 276 ± 76, respectively). Based on the TWIST sequence, the vessels were free of tumor in 16 cases. Vascular displacement was found in 11 cases and vascular stenosis in six cases. The MRA findings conflicted with CTA findings in only one case. The kappa value was 0.953 ( P < 0.01). In five cases, vascular malformations were found with TWIST MRA but not CTA. Conclusion TWIST MRA enables accurate delineation of anatomical structures and tumor arterial involvement, providing reliable preoperative imaging information with respect to lower extremity musculoskeletal tumors.

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“…In magnetic resonance imaging (MRI), several acquisition techniques are being used to gather sufficient spatial and temporal information about the cerebral vasculature for a complete diagnosis of the vessel architecture and its hemodynamics [4,5]. Spatial and temporal information are concluded from different sequences which impedes a correct diagnosis of a variety of diseases, especially when the arteries are altered as in vascular malformations or stroke [6][7][8]. Furthermore, MRA is an attractive tool for follow-up imaging after interventions to spare patients further exposition of X-rays [9,10].…”

Section: Introductionmentioning

confidence: 99%

Time-Resolved High-Resolution Angiography Combining Arterial Spin Labeling and Time-of-Flight Imaging

2020

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A strategy to combine two non-contrast-enhanced magnetic resonance angiography techniques is presented. It is based on arterial spin-labeled magnetic resonance imaging to visualize the arterial system at different time points to obtain information about hemodynamic properties in conjunction with a high-resolution time-of-flight angiography acquisition. The temporal information obtained by arterial spin labeling (ASL) is combined with the highly spatial resolved time-of-flight image to obtain information about blood flow. Extracting the information of ASL and time-of-flight-imaging leads to images with high spatial resolution which also give information about the temporal course of blood through the intracerebral vasculature. Furthermore, owing to the properties of ASL, visible venous flow in the time-of-flight images can be suppressed. The behavior of vascular filling (i.e. signal changes in the ASL) is investigated and used for further interpretation of the data. Furthermore, the ASL data were down-sampled to find a minimally needed spatial resolution to combine both image types. Up to 1.6 mm isotropic resolution still showed satisfying results rated by two independent readers. In conclusion, a combination of these two different vascular imaging modalities allows to obtain highly spatial and time-resolved images.

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Optimal MRI Sequence for Identifying Occlusion Location in Acute Stroke: Which Value of Time-Resolved Contrast-Enhanced MRA?

Cited by 12 publications

References 34 publications

Susceptibility Vessel Sign for the Detection of Hyperacute MCA Occlusion: Evaluation with Susceptibility-weighted MR Imaging

Susceptibility Vessel Sign for the Detection of Hyperacute MCA Occlusion: Evaluation with Susceptibility-weighted MR Imaging

Evaluation of vascular invasion in patients with musculoskeletal tumors of lower extremities: use of time-resolved 3D MR angiography at 3-T

Time-Resolved High-Resolution Angiography Combining Arterial Spin Labeling and Time-of-Flight Imaging

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