Advanced

AJNR - American Journal of Neuroradiology

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Ishimaru, H. Articles by Uetani, M. Search for Related Content PubMed PubMed Citation Articles by Ishimaru, H. Articles by Uetani, M.

Accuracy of Pre- and Postcontrast 3D Time-of-Flight MR Angiography in Patients with Acute Ischemic Stroke: Correlation with Catheter Angiography

H. Ishimaru^a, M. Ochi^c, M. Morikawa^d, H. Takahata^b, Y. Matsuoka^a, T. Koshiishi^a, T. Fujimoto^a, A. Egawa^a, K. Mitarai^a, T. Murakami^d and M. Uetani^d

^a Department of Radiology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
^b Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Omura, Japan
^c Department of Radiology, Nagasaki-Kita Hospital, Nagasaki, Japan
^d Department of Radiology, Nagasaki University Hospital, Nagasaki, Japan

View larger version (65K): [in this window] [in a new window]   Fig 1. A 51-year-old man with progressive left-sided weakness, dysarthria, and impaired consciousness (patient 4). A, Axial DWI confirms infarction in the centrum semiovale. B, On 3D TOF MR angiogram (anteroposterior [AP] view), occlusion of the C4 segment of the right ICA is suspected. Antegrade filling of the MCA via an anterior communicating artery is identified. C, Relative mean transit time map shows a region of delayed flow in the right hemisphere. D, Depiction of the cavernous portion of the ICA is improved on postcontrast 3D TOF MR angiogram (AP view), which shows severe stenosis at the C2 portion of the ICA. Some contrast enhancement from the cavernous sinus is evident. E, Right internal carotid angiogram immediately after MR imaging examination shows severe stenosis at the C2 portion and delayed flow in the MCA territory, but no antegrade filling into the anterior cerebral artery territory (TIMI grade 1).

View larger version (88K): [in this window] [in a new window]   Fig 2. A 49-year-old man with sudden-onset left-sided paralysis, aphasia, and impaired consciousness (patient 6). A, Axial DWI obtained at the time of MRA confirms infarction of right MCA territory. B, 3D TOF MR angiogram (AP view) shows occlusion of the M1 segment of the right MCA. C, Relative mean transit time map shows a region of delayed flow in the right hemisphere. D, Postcontrast 3D TOF MR angiogram (AP view) shows improved depiction of the distal M1 portion and M2 branches. Some contrast enhancement from the cavernous sinus is evident. E, Right internal carotid angiogram immediately after MR imaging examination shows total occlusion (TIMI grade 0) of the M1 segment of the right MCA. Retrograde opacification of the MCA branches via pial collateral vessels extending from the anterior cerebral artery is noted; however, the vessel just distal to the occlusion is not delineated. F, Right internal carotid angiogram after the first trial of angioplasty by using the 9-mm-long balloon catheter at the occluded portion shows antegrade filling into the distal M1 portion and M2 branches through the residual stenosis. Note that postcontrast MR angiogram (D) precisely demonstrates the extent of the occlusion that is shown on catheter angiography during PTCBA procedures (F).