Review articleContrast-enhanced MR angiography of the intracranial circulation☆
Section snippets
When should one use contrast enhancement for MR angiography?
Flow-dependent acquisition techniques, such as TOF and PC MRA, are in extensive clinical use today. One of the main advantages of non-CE MRA (NCE MRA) procedures is that they are noninvasive and rely only on endogenous mechanisms to provide image contrast between flowing blood and background tissue. These classes have many advantages and disadvantages.
Contrast-enhanced MR angiography
CE MRA is a more invasive class of MRA techniques that requires the intravenous injection of a MR contrast agent. Chelated gadolinium (Gd) ions [30] are commonly used paramagnetic substances that shorten the longitudinal relaxation time (T1) of the blood. Unlike iodinated X-ray agents, commercially available MR contrast agents do not have clinically detectable nephrotoxicity, even at the high doses (>0.1 mmol kg−1) sometimes required for CE MRA [31]. These agents also have a low incidence of
Ischemic stroke
Ischemic stroke results from occlusion of the extra- and intra-cranial arteries and can be broadly classified as thrombotic, embolic, or lacunar. Mohr et al [52] evaluated 694 patients who were hospitalized for stroke and found that 53% had large vessel thrombosis and 31% had cerebral emboli. Thrombotic ischemic infarction is the result of thrombosis of a specific vessel, most frequently caused by atherosclerosis. Embolic ischemic infarctions are often abrupt and catastrophic, with the severity
Summary
NCE MRA can provide the authors with useful diagnostic information in patients suffering from intracranial vascular disease, often leading to improved or altered treatment decisions. Most centers have used 3D TOF for evaluation of stroke—the most common cerebral vascular disease. Because of slow and disturbed flow, conventional 3D TOF MRA tends to overestimate stenotic lesions and occluded arteries and this can confound neurovascular assessment in stroke patients. Post contrast 3D TOF
Acknowledgements
The authors thank the Canada Foundation for Innovation for providing funding for a whole-body 3.0 T MR scanner in many of these studies, they also thank Tae-Sub Chung, MD and Mohammad Sabati, MSc, for their assistance in preparing this article.
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Operational funds were provided by the Alberta Foundation for Health Research, the Alberta Heritage Foundation for Medical Research (AHFMR), the Calgary Health Region through the Partners-in-Health fundraising campaign, the Canadian Institutes for Health Research (CIHR), the Heart and Stroke Foundation of Canada (HSFC), and the University of Calgary. CS is funded by Keimyung University School of Medicine, Daegu, Korea. All authors are also with the Seaman Family MR Research Centre, Foothills Medical Centre, Calgary Health Region, Calgary, Alberta, Canada.