Early Detection of Cerebral Arterial Occlusion on Magnetic Resonance Angiography: Predictive Value of the Baseline NIHSS Score and Impact on Neurological Outcome

ABSTRACT:Objective:Carotid ultrasound (US) is a screening test for patients with transient ischemic attacks (TIAs) or stroke who then undergo Digital Subtraction Angiogram (DSA) or Magnetic Resonance Angiography (MRA). Gold standard DSA is invasive with inherent risks and costs. MRA is an evolving technology. This study compares reliability of MRA and US modes with DSA in determining degree of internal carotid artery stenosis.Methods:A five year retrospective analysis of 140 carotid arteries from patients who had carotid US and DSA, and possibly Magnetic Resonance Angiography was undertaken. Recorded US parameters were peak systolic velocity (PSV), end diastolic velocity (EDV), and ICA/CCA peak systolic velocity ratio. The MRA and DSA parameters used NASCET technique for measuring stenosis. Statistical analysis included ROC curves and Kappa computation.Results:US grading of carotid stenosis can be made more reliable by choosing appropriate parameters. The best combination of sensitivity and specificity for stenosis > 70% in our hospital was seen at PSV > 173cm/s (sensitivity 0.87, specificity 0.8, Positive Predictive Value (PPV) 0.70, Negative Predictive Value (NPV) 0.93, kappa 0.64 and weighted kappa 0.71). MRA kappa was 0.78, (sensitivity 0.75, specificity 1.0, PPV 1.0, NPV 0.85).Conclusions:US parameters should be validated in each centre. At best, US can only approximate the accuracy of DSA, probably due to inherent limitations of this modality. Magnetic Resonance Angiography has a perfect specificity and PPV but this technique needs to be standardized. Simultaneous use of MRA and US for screening increases sensitivity to over 0.9 without compromising specificity in > 70% stenosis.

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The implications of magnetic resonance angiography artifacts caused by different types of intracranial flow diverters

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00753-0 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Batur Halitcan ◽

Sayin Bige ◽

Balci Sinan ◽

Akmangit Ilkay ◽

Daglioglu Ergun ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Predictive Value ◽

Diagnostic Yield ◽

Flow Diverter ◽

Parent Artery ◽

Perfect Agreement ◽

Tof Mra ◽

Flow Diverters

Abstract Background Serial cerebral angiographic imaging is necessary to ensure cerebral aneurysm occlusion after flow diverter placement. Time-of-flight (TOF)-magnetic resonance angiography (MRA) is used for this purpose due to its lack of radiation, contrast media and complications. The comparative diagnostic yield of TOF-MRA for different flow diverters has not been previously analyzed. Purpose To evaluate the diagnostic accuracy of TOF-MRA in cerebral aneurysms treated w divertersith different flow diverters. Materials and Methods Flow-diverted patients whose cerebral follow-up MRA and digital subtraction angiograms (DSA) were obtained within 6 weeks were retrospectively identified. The DSA (as gold standard) and MRA images of these patients were compared by two readers (blinded to both patient data and endovascular procedure data) for residual aneurysms and the status of the parent artery for each type of flow diverter. In a second group of patients, magnetic susceptibility artifacts were manually measured and compared for different FDs. Results Seventy-six patients (85 aneurysms) were included in group one, and 86 patients (95 aneurysms) were included in group 2. TOF-MRA and DSA showed almost perfect agreement for residual aneurysms (κ = 0.88, p < 0.001) (positive predictive value (PPV) = 1.00, specificity = 1.00, negative predictive value (NPV) = 0.89, sensitivity = 0.89). Intermodality agreement (κ = 0.97 vs. κ = 0.74, p < 0.005) and sensitivity (0.97 vs. 0.77, NPV: 0.96 vs. 0.77) were highest with nitinol stents. MRA and DSA showed no agreement for occluded or stenotic parent vessels (κ = 0.13, p = 0.015, specificity = 0.44, NPV = 1.00, sensitivity = 1.00). Specificity was lower in chromium-cobalt based FDs than in nitinol devices (specificity = 0.08 vs. 0.60). Chromium-cobalt stents generated the largest artifacts (p < 0.005). The size of the device-related artifact, in millimeters, increased in respective order, for the Silk, Derivo, Pipeline and Surpass devices. Conclusion Unlike DSA, TOF-MRA is susceptible to dissimilarities between flow diverters. MRA is not well-suited for research studies comparing different flow diverters. Nitinol FDs appear to be advantageous for TOF-MRA follow-up so as not to miss small aneurysm remnants or clinically relevant parent artery stenosis.

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Arterial Occlusion Sites on Magnetic Resonance Angiography Influence the Efficacy of Intravenous Low-Dose (0·6 mg/kg) Alteplase Therapy for Ischaemic Stroke

International Journal of Stroke ◽

10.1111/j.1747-4949.2009.00347.x ◽

2009 ◽

Vol 4 (6) ◽

pp. 425-431 ◽

Cited By ~ 24

Author(s):

T. Nakashima ◽

K. Toyoda ◽

M. Koga ◽

H. Matsuoka ◽

K. Nagatsuka ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Ischaemic Stroke ◽

Low Dose ◽

Arterial Occlusion

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Accessory Veins and Radial-Cephalic Arteriovenous Fistula Non-Maturation: A Prospective Analysis Using Contrast-Enhanced Magnetic Resonance Angiography

The Journal of Vascular Access ◽

10.1177/112972980700800411 ◽

2007 ◽

Vol 8 (4) ◽

pp. 281-286 ◽

Cited By ~ 14

Author(s):

R.N. Planken ◽

L.E. Duijm ◽

A.G. Kessels ◽

T. Leiner ◽

J.P. Kooman ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Arteriovenous Fistula ◽

Predictive Value ◽

Preoperative Assessment ◽

Cephalic Vein ◽

Salvage Procedure ◽

Venous Stenosis ◽

Contrast Enhanced ◽

Vein Diameter

Purpose To determine if large caliber accessory veins are associated with radial-cephalic arteriovenous fistula (RC-AVF) non-maturation. Methods RC-AVFs were created in 15 consecutive patients (radial artery and cephalic vein diameter >2 mm, in the absence of arterial inflow or venous outflow stenoses or occlusions). Contrast-enhanced magnetic resonance angiography (CE-MRA) was performed preoperatively for the determination of vessel diameters, stenoses and occlusions. The location and caliber of accessory veins was determined. Vascular access (VA) function was monitored and all interventions required to obtain a functioning VA were recorded. Non-maturation was defined as a nonfunctional VA at 2 months after creation. The predictive value of accessory vein caliber for prediction of RC-AVF non-maturation was evaluated using receiver operating characteristic (ROC) analysis. Results Non-maturation occurred in 10 (67%) out of 15 RC-AVFs. Large caliber accessory veins (n=4), venous stenosis (n=3) or both (n=2) were associated with RC-AVF non-maturation. The presence of large caliber accessory veins was the only significant predictor for RC-AVF non-maturation (p=0.01). Preoperatively detected accessory veins with a diameter >70% of the cephalic vein diameter, had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 80, 100, 100 and 91% for prediction of RC-AVF non-maturation on patient level. Accessory vein ligation and dilatation of venous stenosis resulted in an overall salvage success rate of 89% (8/9). Conclusion Large caliber accessory veins are associated with RC-AVF non-maturation. Ligation of large caliber accessory veins is a successful salvage procedure in a substantial group of patients. Furthermore, ligation of these accessory veins during initial RC-AVF creation can potentially reduce non-maturation rates; and therefore, preoperative assessment of accessory veins is recommended.

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A Novel Framework for Early Detection of Hypertension using Magnetic Resonance Angiography

Scientific Reports ◽

10.1038/s41598-019-47368-1 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 4

Author(s):

Heba Kandil ◽

Ahmed Soliman ◽

Mohammed Ghazal ◽

Ali Mahmoud ◽

Ahmed Shalaby ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Early Detection

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Balanced Steady-State Free Precision and Time of Flight Noncontrast Magnetic Resonance Angiography in Peripheral Arterial Disease

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1730845 ◽

2021 ◽

Author(s):

Soumya Susan Regi ◽

Aparna Irodi ◽

Shyamkumar N. Keshava ◽

Sunil Agarwal

Keyword(s):

Steady State ◽

Magnetic Resonance ◽

Image Quality ◽

Magnetic Resonance Angiography ◽

Peripheral Arterial Disease ◽

Predictive Value ◽

Weighted Kappa ◽

Arterial Disease ◽

Peripheral Arterial

Abstract Purpose To determine the diagnostic efficacy of balanced steady-state free precession (bSSFP) and time-of-flight (TOF)-based noncontrast magnetic resonance angiography (NC-MRA) in lower limb peripheral arterial disease (PAD). Material and Methods 10 patients with suspected PAD underwent both NC-MRA (bSSFP and 2D TOF) and contrast-enhanced MR angiography (CE-MRA)/CT angiography (CTA). A total of 170 arterial segments (17 segments in each patient) were analyzed on NC-MRA and compared with CE-MRA/CTA for quality of images and for estimating the degree of stenoses. Image quality was graded as 1—poor, 2—fair, 3—good, and 4—excellent. The degree of stenoses was graded as 0—normal, 1— ≤ 50% narrowing, 2— > 50% narrowing, 3—near complete/100% occlusion. Sensitivity, specificity, positive predictive value, and negative predictive value of NC-MRA in identifying significant stenosis, as compared with CE-MRA/CTA, were estimated. Results a) Mean grade of the image quality of NC-MRA was 3.10 and the CE-MRA/CTA was 3.64. b) The agreement in the estimation of the degree of stenosis on NC-MRA as compared with CE-MRA/CTA was substantial in aortoiliac segments (weighted kappa 0.646 [95% CI] [0.361–0.931] [p < 0.001]), almost perfect in femoropopliteal segments (weighted kappa 0.911 [95% CI] [0.79–1.032] [p < 0.001]), and poor in infrapopliteal segments (weighted kappa 0.052 [95% CI] [0.189–0.293] [p < 0.33587]). Conclusion TOF and bSSFP-based NC-MRA was found to be comparable to the CE-MRA/CTA in the evaluation of PAD in lower limbs in the aortoiliac and femoropopliteal regions. NC-MRA was especially helpful in assessing the aortoiliac vessels and femoropopliteal vessels, with the imaging of infrapopliteal arteries being suboptimal.

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TRICKS Magnetic Resonance Angiography at 3-Tesla for Assessing Whole Lower Extremity Vascular Tree in Patients with High-Grade Critical Limb Ischemia: DSA and TASC II Guidelines Correlations

The Scientific World JOURNAL ◽

10.1100/2012/192150 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Sheung-Fat Ko ◽

Jiunn-Jye Sheu ◽

Chen-Chang Lee ◽

Chung-Cheng Huang ◽

Fan-Yen Lee ◽

...

Keyword(s):

Magnetic Resonance ◽

Image Quality ◽

Magnetic Resonance Angiography ◽

Critical Limb Ischemia ◽

Predictive Value ◽

Limb Ischemia ◽

High Grade ◽

Vascular Tree ◽

Point Scale ◽

Significant Stenosis

The entire vascular tree of 58 lower extremities with high-grade critical limb ischemia (CLI) was assessed with three-station time resolved imaging of contrast kinetics (TRICKS) magnetic resonance angiography (T-MRA) and correlated with digital subtraction angiography (DSA) examinations and Trans-Atlantic Inter-Society Consensus II (TASC II) guidelines. Kappa (κ) statistics were utilized to evaluate the agreement of stenosis scores (5-point scale; 0 normal to 4 occlusion) based on T-MRA and DSA. With DSA as the standard, significant stenosis instances (stenosis score ≥2) among vascular segments were compared. Theκ-statistics of image quality (4-point scale; 1 nondiagnostic to 4 excellent) of T-MRA and TASC II classification assessed by a radiologist and a vascular surgeon were also evaluated. Among 870 vascular segments, excellent agreement was observed between T-MRA and DSA (meanκ= 0.883) in revealing stenosis (mean stenosis score, 2.1 ± 1.3 versus 2.0 ± 1.3). T-MRA harbored overall high sensitivity (99.5%), specificity (93.6%), positive predictive value (95.4%), negative predictive value (99.6%), and accuracy (97.7%) in depicting significant stenosis. Excellent interobserver agreement (meanκ= 0.818) of superb image quality (mean score = 3.5–3.6) of T-MRA and outstanding agreement of TASC II classification of aortoiliac and femoral-popliteal lesions (κ= 0.912–0.917) between two raters further verified the clinical feasibility of T-MRA for treatment planning.

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3-dimensional time-resolved contrast-enhanced magnetic resonance angiography for evaluation late after the Mustard operation for transposition

Cardiology in the Young ◽

10.1017/s1047951109990692 ◽

2009 ◽

Vol 20 (1) ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Bengt Johansson ◽

Sonya V. Babu-Narayan ◽

Philip J. Kilner ◽

Timothy M. Cannell ◽

Raad H. Mohiaddin

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Predictive Value ◽

Imaging Method ◽

Venous Flow ◽

Time Resolved ◽

3 Dimensional ◽

Cardiovascular Magnetic Resonance Protocol ◽

Contrast Enhanced

AbstractPurposeCardiovascular magnetic resonance assessment of adults late after an atrial redirection operation for transposition is demanding and time consuming. We hypothesised that the relatively fast and standardised 3-dimensional time-resolved contrast-enhanced magnetic resonance angiography, or dynamic angiography, would be valuable in the periodic follow-up of these patients.MethodsWe investigated prospectively 36 adults with transposition using dynamic angiography, comparing our results against a comprehensive but non-contrast cardiovascular magnetic resonance protocol. We acquired 6 dynamic angiographic datasets after injection of contrast. The primary aim was to detect significant obstruction of the pathways for venous flow.ResultsIn 4 patients (11%), we found evidence of moderate-to-severe, and thus clinically important, obstruction of systemic venous channels on standard cardiovascular magnetic resonance. All these patients were correctly identified by dynamic angiography. In 4 additional patients, we found mild and haemodynamically insignificant obstructions in the systemic venous channels. Of the 8 (22%) patients with any obstruction, 6 were detected by angiography. There were no false positives reported, giving sensitivity of 75% and specificity of 100%, a positive predictive value of 100%, and negative predictive value of 93%. In 1 patient, there was a moderate obstruction of the pulmonary venous compartment which was not readily seen by dynamic angiography.Conclusions3-dimensional dynamic angiography is a useful method for detecting anatomically moderate-to-severe, but not mild, obstructions in the systemic venous channels following Mustard repair for transposition. This technique can be used as a single imaging method and/or as complimentary to standard two dimensional cardiovascular magnetic resonance techniques for detection of clinically important obstructions in the systemic venous channels.

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PREDICTION OF CEREBRAL HYPERPERFUSION AFTER CAROTID ENDARTERECTOMY USING MIDDLE CEREBRAL ARTERY SIGNAL INTENSITY IN PREOPERATIVE SINGLE-SLAB 3-DIMENSIONAL TIME-OF-FLIGHT MAGNETIC RESONANCE ANGIOGRAPHY

Neurosurgery ◽

10.1227/01.neu.0000345941.99443.99 ◽

2009 ◽

Vol 64 (6) ◽

pp. 1065-1072 ◽

Cited By ~ 24

Author(s):

Hiroki Kuroda ◽

Kuniaki Ogasawara ◽

Ryonoshin Hirooka ◽

Masakazu Kobayashi ◽

Shunro Fujiwara ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Middle Cerebral Artery ◽

Predictive Value ◽

Signal Intensity ◽

3 Dimensional ◽

Cerebral Hyperperfusion ◽

Patients At Risk

Abstract OBJECTIVE Cerebral hyperperfusion after carotid endarterectomy (CEA) occurs in patients with preoperative impairments in cerebral hemodynamics. Signal intensity of the middle cerebral artery (MCA) on single-slab 3-dimensional time-of-flight magnetic resonance angiography (MRA) can assess hemodynamic impairment in the cerebral hemisphere. The purpose of the present study was to determine whether the signal intensity of the MCA on preoperative MRA could identify patients at risk for cerebral hyperperfusion after CEA. METHODS The signal intensity of the MCA ipsilateral to CEA on preoperative MRA was graded according to the ability to visualize the MCA in 81 patients with ipsilateral internal carotid artery stenosis (≥70%). Cerebral blood flow was also quantified using single-photon emission computed tomography before and immediately after CEA and on the third postoperative day. RESULTS Cerebral hyperperfusion immediately after CEA (cerebral blood flow increase ≥100% compared with preoperative values) was observed in 10 patients. Multivariate analysis revealed that only reduced signal intensity of the MCA was significantly associated with the development of postoperative cerebral hyperperfusion (95% confidence interval, 1.015–1.401; P = 0.0319). When the reduced signal intensity of the MCA on MRA was defined as an impairment in cerebral hemodynamics, MRA grading resulted in 100% sensitivity and 63% specificity, with a 28% positive predictive value and a 100% negative predictive value for the development of post-CEA hyperperfusion. Hyperperfusion syndrome developed on the fourth and sixth postoperative days in 2 of the 10 patients who exhibited hyperperfusion immediately after CEA. CONCLUSION Signal intensity of the MCA, as assessed by this simple MRA method, may identify patients at risk for post-CEA cerebral hyperperfusion.

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