Usefulness of three-dimensional fast imaging employing steady-state acquisition MRI of large vessel occlusion for detecting occluded middle cerebral artery and internal carotid artery before acute mechanical thrombectomy

Abstract

Objective: Acute mechanical thrombectomy (AMT) in patients with acute ischemic stroke from large vessel occlusion (LVO) is performed without directly identifying the occluded vessels. In this study, we evaluated whether 1.5 T magnetic resonance imaging (MRI) with 3D-fast imaging employing steady-state acquisition (FIESTA) could visualize the occluded intracranial middle cerebral artery (MCA) and internal carotid artery (ICA) before AMT.Methods: This retrospective study included 21 consecutive patients who underwent time-of-flight magnetic resonance angiography (TOF MRA) and 3D-FIESTA MRI immediately before AMT. The patients also underwent TOF MRA after AMT and achieved TICI 2b or 3 by AMT at our hospital between February 2018 and April 2019. When LVO in the anterior circulation was detected by TOF MRA, 3D-FIESTA MRI was additionally performed. Then, the occluded intracranial MCA and ICA, including their branches, were constructed on the workstation with volume rendering. The obtained images were fused with the TOF MRA images to create combined 3D images.Results: The length and top-to-bottom distance of the affected M1 segment (calculated by the ipsilateral-to-contralateral ratio) were 1.29 and 1.17, respectively, on 3D-FIESTA MRI before AMT and 1.34 and 1.24, respectively, on TOF MRA after AMT. We assessed the number of M2 segments branching from the affected M1/M2 junction and visualized the affected anterior temporal artery. The 3D-FIESTA MRI before AMT and TOF MRA after AMT were consistent in all patients, except for two who moved vigorously during imaging.Conclusions: Images acquired by 1.5T 3D-FIESTA MRI can visualize to predict the existing path of the occluded MCA and ICA before AMT in patients with LVO of the anterior circulation.

3D T2-Weighted Sampling Perfection with Application-Optimized Contrasts Using Different Flip Angle Evolutions (SPACE) and 3D Time-of-Flight (TOF) MR Angiography Fusion Imaging for Occluded Intracranial Arteries

“…The fusion image using T2-SPACE presented herein is simple to generate, requiring imaging and reconstruction times of approximately 2.5 min and 5 min, respectively. The scanning time was slightly longer than that reported by Sato et al 5) However, the total scanning time with the addition of evaluating MRA is less than 5 min, which is comparable to their report. 5) A manual is in place at our medical center so that the technician on duty can produce images even at night and/or without optimal support from their clinical team.…”

“…The MCA can be followed by imaging the retrograde blood flow using cone-beam computed tomography 3) and 3D fast imaging. 4 , 5) Basi-parallel anatomical scanning, which uses heavy T2-weighted images, is a well-known technique for visualizing the arterial outer diameter within vertebral artery dissection; however, this technique is limited as it only provides two-dimensional description. 14) To the best of our knowledge, few comprehensive studies to date have predicted the course of an occluded vessel or discussed the most appropriate method for supporting the MT procedure.…”

“…We used the T2-SPACE imaging method within 3T MRI as provided by Siemens; however, it is entirely possible that similar fast spin-echo imaging methods provided by other companies could produce comparable images. 4 , 5) …”

“… 2) To the best of our knowledge, only few studies of visualization of the occluded vessels prior to MT have been reported. 3 – 5) Therefore, most interventionalists perform MT blindly. This may lead to hemorrhagic complications and incomplete recanalization.…”

Effective Mechanical Thrombectomy for Posterior Circulation Ischemia Using Magnetic Resonance Imaging-based Arterial Structures

“…8) A few studies of mechanical thrombectomy have em-ployed magnetic resonance imaging (MRI) to detect occluded vessels in the anterior circulation, and we have demonstrated the efficacy of three-dimensional turbo spinecho (3D-TSE) sequences using T1WI and T2WI to evaluate both thrombus configuration and arterial anatomy at the middle cerebral artery bifurcations. [9][10][11] In this study, we applied 3D-TSE T2WI to examine the vascular structure of the posterior circulation, including a comparison of vessel diameters between the posterior communicating artery (PCoA) and the P1 segment of the posterior cerebral artery (PCA). Our findings indicate the utility of 3D-TSE T2WI for identifying the mechanism of posterior circulation cerebral ischemia and achieving a safe and efficient mechanical thrombectomy.…”