Symptomatic Middle Cerebral Artery Stenosis and Occlusion: Comparison of Three-dimensional Time-of-Flight Magnetic Resonance Angiography with Conventional Angiography

Background and Purpose: 3D pointwise encoding time reduction magnetic resonance angiography (PETRA-MRA) is a promising non-contrast magnetic resonance angiography (MRA) technique for intracranial stenosis assessment but it has not been adequately validated against digital subtraction angiography (DSA) relative to 3D-time-of-flight (3D-TOF) MRA. The aim of this study was to compare PETRA-MRA and 3D-TOF-MRA using DSA as the reference standard for intracranial stenosis assessment before and after angioplasty and stenting in patients with middle cerebral artery (MCA) stenosis.Materials and Methods: Sixty-two patients with MCA stenosis (age 53 ± 12 years, 43 males) underwent MRA and DSA within a week for pre-intervention evaluation and 32 of them had intracranial angioplasty and stenting performed. The MRAs' image quality, flow visualization within the stents, and susceptibility artifact were graded on a 1–4 scale (1 = poor, 4 = excellent) independently by three radiologists. The degree of stenosis was measured by two radiologists independently on DSA and MRAs.Results: There was an excellent inter-observer agreement for stenosis assessment on PETRA-MRA, 3D-TOF-MRA, and DSA (ICCs > 0.90). For pre-intervention evaluation, PETRA-MRA had better image quality than 3D-TOF-MRA (3.87 ± 0.34 vs. 3.38 ± 0.65, P < 0.001), and PETRA-MRA had better agreement with DSA for stenosis measurements compared to 3D-TOF-MRA (r = 0.96 vs. r = 0.85). For post-intervention evaluation, PETRA-MRA had better image quality than 3D-TOF-MRA for in-stent flow visualization and susceptibility artifacts (3.34 ± 0.60 vs. 1.50 ± 0.76, P < 0.001; 3.31 ± 0.64 vs. 1.41 ± 0.61, P < 0.001, respectively), and better agreement with DSA for stenosis measurements than 3D-TOF-MRA (r = 0.90 vs. r = 0.26). 3D-TOF-MRA significantly overestimated the stenosis post-stenting compared to DSA (84.9 ± 19.7 vs. 39.3 ± 13.6%, p < 0.001) while PETRA-MRA didn't (40.6 ± 13.7 vs. 39.3 ± 13.6%, p = 0.18).Conclusions: PETRA-MRA is accurate and reproducible for quantifying MCA stenosis both pre- and post-stenting compared with DSA and performs better than 3D-TOF-MRA.

Download Full-text

Response by Chen et al to Letter Regarding Article, “Magnetic Resonance Imaging of Plaque Morphology, Burden, and Distribution in Patients With Symptomatic Middle Cerebral Artery Stenosis”

Stroke ◽

10.1161/strokeaha.116.014878 ◽

2016 ◽

Vol 47 (11) ◽

Author(s):

Xiang Yan Chen ◽

Nikki Dieleman ◽

Winnie Chiu Wing Chu

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Stenosis ◽

Plaque Morphology ◽

Resonance Imaging ◽

Middle Cerebral Artery Stenosis

Download Full-text

Anatomical Variations of the Proximal Segment of Middle Cerebral Artery and their Clinical Significance: Three Dimensional Magnetic Resonance Angiography study in Egyptians

The Egyptian Journal of Anatomy ◽

10.21608/ejana.2020.18364.1054 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Walaa Sayed ◽

Sherif Arsanyos ◽

Mohamed Shabaan

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Middle Cerebral Artery ◽

Clinical Significance ◽

Cerebral Artery ◽

Three Dimensional ◽

Anatomical Variations ◽

Proximal Segment

Download Full-text

High-Resolution MRI to Evaluate Benefit of Middle Cerebral Artery Stenosis in Secondary Prevention in Patients with Acute Cerebral Infarction

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3586 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1911-1919

Author(s):

Jingwei Wu ◽

Ying Xiao ◽

Chuanzi Li ◽

Zhongshi Nie ◽

Desheng Wang ◽

...

Keyword(s):

Magnetic Resonance ◽

High Resolution ◽

Cerebral Infarction ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Stenosis ◽

Acute Cerebral Infarction ◽

Vascular Stenosis ◽

Middle Cerebral Artery Stenosis ◽

Cerebral Vascular

High-resolution magnetic resonance (HRMRI) combined with magnetic resonance angiography (MRA) was used to analyze the correlation between the degree of infarction and the degree of cerebral vascular stenosis, and these patients are all have the trend to contain acute infarction. All patients were examined by CT cerebral angiography, which was analysed by conventional magnetic resonance imaging (MRI), high-Resolution (HRMRI) imaging, and cerebral vascular (MRA) imaging. The infarct size of each patient with cerebral infarction was calculated. The degree of middle cerebral artery stenosis was evaluated. Moreover, agnosis of acute cerebral infarction in middle cerebral artery region was calculated, and the correlation between acute cerebral infarction in middle cerebral artery region and the degree of cerebral vascular stenosis was analyzed. The specificity, sensitivity, and accuracy of magnetic resonance angiography (MRA) in the diagnosis of acute cerebral infarction in the blood supply area of the middle cerebral artery were 90.48%, 94.87%, and 93.94%. The coincidence rates for the degree of middle cerebral artery stenosis were 90.91% for mild stenosis, 92.31% for moderate stenosis, 93.75% for severe stenosis, and 85.71% for vascular occlusion, respectively. The K value was in good agreement with the results of CTA diagnosis (≥0.75). In conclusion, HRMRI can clearly indicated that the location of lesions with acute cerebral infarction, and MRA can show the degree of vascular stenosis, there is a close relationship between them.

Download Full-text