Contrast-Enhanced MR Angiography of the Carotid and Vertebrobasilar Circulations
Carina W. Yanga,
James C. Carra,
Stephen F. Futterera,
Mark D. Moraschb,
Benson P. Yangc,
Stephanie M. Shorsd and
J. Paul Finne
a Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
b Department of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
c Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
d Department of Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL
e Department of Radiological Sciences, UCLA Medical Center, Los Angeles, CA
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FIG 1. A 72-year-old man with suspected carotid artery disease.
A, CE MRA of the carotid and vertebrobasilar circulations (3D FLASH, TR/TE, 4.36/1.64; flip angle 25°; bandwith, 432 Hz; matrix 136 x 512; field of view, 165 x 330 mm; slab thickness, 70 mm; partitions, 80; and voxel size, 1.33 x 0.64 x 1.15 mm3) shows stenoses in proximal left internal carotid artery (large arrow) and distal left vertebral artery (small arrow).
B, CE MRA MIP image, with carotid vessels edited out, more clearly shows the left vertebral artery stenosis (arrow).
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FIG 2. A 65-year-old woman with headache, blurry vision, and arm weakness.
A, CE MRA MIP image (3D FLASH, TR/TE, 4.36/1.64; flip angle 25°; bandwith, 432 Hz; matrix 136 x 512; field of view, 165 x 330 mm; slab thickness, 70 mm; partitions, 80; and voxel size, 1.33 x 0.64 x 1.15 mm3) of the vertebrobasilar system demonstrates severe stenosis at the origin of right vertebral artery (large arrow). There is a short segmental occlusion of the distal left vertebral artery (small arrow).
B, Selective DSA of right subclavian confirms severe stenosis at the right vertebral origin (arrow).
C, Selective DSA of left vertebral artery confirms the distal occlusion (arrow).
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FIG 3. A 46-year-old man with presyncope and right upper extremity weakness.
A, CE MRA MIP image (3D FLASH, TR/TE, 4.36/1.64; flip angle 25°; bandwith, 432 Hz; matrix 136 x 512; field of view, 165 x 330 mm; slab thickness, 70 mm; partitions, 80; and voxel size, 1.33 x 0.64 x 1.15 mm3) of the vertebrobasilar system shows segmental occlusion of the proximal right vertebral artery (open arrow), as well as diffuse narrowing superior to the occluded segment (small arrows).
B, Selective DSA of the right subclavian confirms occlusion (open arrow) and stenosis (closed arrows) in proximal right vertebral artery.
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FIG 4. A 59-year-old man with carotid and vertebrobasilar disease.
A, CE MRA coronal MIP (3D FLASH, TR/TE, 4.36/1.64; flip angle 25°; bandwith, 432 Hz; matrix 136 x 512; field of view, 165 x 330 mm; slab thickness, 70 mm; partitions, 80; and voxel size of 1.33 x 0.64 x 1.15 mm3) of the carotid system showing high grade stenosis of the proximal left internal carotid artery (large arrow), with moderate stenosis involving the proximal right internal carotid artery (small arrow).
B, CE MRA coronal MIP of the vertebrobasilar system with carotid vessels edited away demonstrates segmental occlusion of the right V1 segment (large arrow) with reconstitution distally and mulitfocal stenoses in V3 and V4 segments (small arrows). There is also a proximal left subclavian stenosis (open arrow).
C, Selective DSA of the right carotid artery confirms stenosis in the proximal right internal carotid (arrow).
D, Aortic arch angiography demonstrates focal stenosis of proximal left subclavian artery (arrow).
E, Delayed image of DSA run confirms multifocal stenotic disease in the right V3 and V4 segments (small arrows), as well as segmental occlusion in the right V1 segment (large arrow).
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