Comparison of Pre- and Postcontrast 3D Time-of-Flight MR Angiography for the Evaluation of Distal Intracranial Branch Occlusions in Acute Ischemic Stroke
Janice J. Yanga,
Michael D. Hilla,c,
William F. Morrisha,c,
Mark E. Hudona,c,
Philip A. Barbera,b,
Andrew M. Demchuka,b,
Robert J. Sevicka,b and
Richard Fraynea,c
a From the Seaman Family MR Research Centre, Foothills Medical Centre, Calgary Health Region (all authors)
b Departments of Clinical Neurosciences (M.D.H., P.A.B., A.M.D., R.J.S., R.F.) University of Calgary
c Department of Radiology (W.F.M., M.E.H., R.J.S., R.F.) University of Calgary
d Calgary Stroke Program (M.D.H., P.A.B., A.M.D.), Calgary, Alberta, Canada
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FIG 1. Acquisition geometry for precontrast (A) and postcontrast (B, C) 3D TOF MR angiography.
A, Two-slab acquisition used to cover the distal extracranial vessels as well as the intracranial circulation (dashed line indicates slab boundary).
B and C, Oblique-axial slabs used to image the intracranial circulation. Slab placement in C was optimal as it excludes the cavernous sinus and thus avoids venous enhancement (dotted line indicates slab position). Effective placement in C can be obtained by projection through only a subset of the sections acquired in B.
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FIG 2. Schematic illustrates labeling of vessel segments and regions report on in this study. ACA indicates anterior cerebral artery region; BA, basilar artery; ICA, internal carotid artery; M1, M1 segment of the MCA; M2, M2 segment of the MCA; P1, P1 segment of the PCA; P2, P2 segment of the PCA; P3, P3 segment of the PCA. For grading purposes, ACA, M2, and P3 were segment regions, and the P1 and P2 segments were scored together and denoted by P1-P2.
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FIG 3. Images in a 78-year-old man with changes in the right anterior circulation.
A, Normal DW image.
B, Relative mean transit time map shows a region of delayed flow in the right hemisphere (arrows), which was consistent with the findings on the pre- and postconrast MR angiograms (D–F).
C, Normal relative cerebral blood volume map.
D, Precontrast 3D TOF MR angiogram suggests a diminished right ICA (thick arrow) and M1 and an occluded right M2 branch (thin arrow).
E and F, Postcontrast 3D TOF MR angiograms show improved depiction of the right ICA and the M1 and M2 MCA. Some contrast enhancement from the cavernous sinus is evident (arrows in E); however, this problem can be removed by changing the position of the slab. Slab positions for images D–F correspond to Fig 1B and C.
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FIG 4. Images in a 75-year-old woman treated with intravenous tPA 2.7 hours after stroke onset. MR imaging commenced 4.1 hours after onset.
A–C, DW image (A) shows diffusion changes (arrow in A) and PW images (B and C) show relative mean-transit time defects (arrow in B) and relative cerebral blood volume defects (arrow in C).
D, Precontrast TOF MR angiogram suggests a diminished left MCA, which is consistent with the DW and PW imaging findings. Also, the right M1 and M2 appear diminished.
E, Postcontrast TOF MR angiogram confirms the left MCA changes, but the right M1 and M2 appear occluded (arrow). Postcontrast findings suggest that the right MCA territory is also at risk.
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FIG 5. Images in a 91-year-old man treated with intravenous tPA at 2.9 hours after stroke onset. MR imaging commenced 5.5 hours after onset.
A, DW image shows an infarct (arrow).
B, Precontrast TOF MR angiogram appears to indicate a diminished left M1 and an occluded left M2 MCA (thick arrow). The ACA (thin arrow) appears occluded.
C, Postcontrast TOF MR angiogram shows the ACA segment is normal (thin arrow), the left M1 is occluded (thick arrow), and the left M2 is diminished.
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