The comparative evaluation of three-dimensional magnetic resonance for carotid artery disease

Abstract

Conventional angiography is the current standard for the evaluation of carotid artery disease. The excellent resolution of this invasive study is offset by the potential for contrast-related, embolic, and puncture site complications. Three-dimensional magnetic resonance angiography may offer a noninvasive diagnostic alternative. We examined this possibility by performing both conventional angiography and three-dimensional magnetic resonance angiography in 13 patients. Cervical duplex scans were also obtained in these patients. Contiguous transverse cervical magnetic resonance images were acquired in a 1.5 tesla magnet, by use of a posterior neck coil and a gradient echo pulse sequence. These "raw" data were transferred to a real-time workstation where three-dimensional cervical arterial images were reformatted, magnified, and examined from multiple angles. Total study time from patient positioning to image generation was approximately 30 minutes. In all patients, on three-dimensional magnetic resonance angiography the common, external, and internal carotid arteries and distal vertebral arteries were easily discernable and correctly identified as patent, stenotic, or occluded. Three-dimensional magnetic resonance angiography was not accurate in detecting carotid ulcers. The degree of internal carotid artery stenosis measured from the three-dimensional magnetic resonance angiography studies correlated well with the internal carotid artery stenosis measured with conventional angiography (r = 0.866, r2 = 75.1%, p = less than or equal to 0.0001). This recent technologic advance represents significant progress toward achieving the goal of completely noninvasive vascular assessment in this patient population.

Use of magnetic resonance angiography to select candidates with recently symptomatic carotid stenosis for surgery: systematic review

“…Results from four studies using three dimensional time of flight techniques were included, 21 29 39 40 together with six sets of results (from five articles 20 24 28 31 33) obtained by using two dimensional time of flight. Q* was 90% (81% to 99%).…”

“…Six articles did not report age range. 25 27 29 34 35 38 Eight articles stated that asymptomatic patients were included, 16 18 27 – 29 31 32 40 and 18 articles gave no information about symptoms. 16 17 19 – 26 28 – 30 33 – 37…”

Comparison of magnetic resonance angiography, duplex ultrasound, and digital subtraction angiography in assessment of extracranial internal carotid artery stenosis.

“…'2 Previous studies comparing magnetic resonance angiography with conventional angiography have often quoted high correlation coefficients as an indication of good agreement. [13][14][15][16] The correlation coefficient measures the strength of a relation between two variables, not the agreement between them, and it is possible to produce high correlation coefficients for data that seem to be in poor agreement. '2 Problems also arise if the data are divided into several groups-for example, mild (0-29%), moderate (30-69%), severe (70-99%), and occluded (100%) categories, with the frequency of assignments to the same category by each method used as a measure of agreement.…”

“…The relation between the caliper index, based on residual lumen and common carotid artery measurements, and the visual impression of stenosis was assessed by linear regression and Pearson's product moment correlation. 15 Caliper (MRA-DSA) 0 9 (-0 3 to 2-2) 7 …”

Three-Dimensional Ultrasound Study of Carotid Arteries Before and After Endarterectomy

“…The 3-D reconstruction technique has been investigated in carotid artery imaging employing various modalities and has demonstrated some encouraging findings. [23][24][25][26] Whether volume-rendered 3-D ultrasound reconstruction could allow better appreciation of the stenotic lesions and accurate assessment of the severity of stenosis of the cervical carotid artery is not known. Neither is the impact of endarterectomy on the volumetric properties of the regional carotid artery fully understood.…”