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Costello J, Alexander MD, McNally JS, Hecht EM, Porambo ME, Lau VC, DeMarco JK. MR Angiography Series: Neurovascular MR Angiography. Radiographics 2021; 41:E204-E205. [PMID: 34723690 PMCID: PMC8574061 DOI: 10.1148/rg.2021210180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
Abstract
Neurovascular MR angiography (MRA) is an evolving imaging technique and is crucial for the workup of numerous neurologic disorders. While CT angiography (CTA) provides a more rapid imaging assessment, in select patients it can impart a small risk of contrast material-induced nephrotoxicity or radiation-associated cancers. In addition, MRA offers some advantages over CTA for neurovascular evaluation, including higher temporal resolution and the capability for vessel wall imaging. This module is the third in a series created on behalf of the Society for Magnetic Resonance Angiography (SMRA), a group of researchers and clinicians who are passionate about the benefits of MRA but understand its challenges. The full digital presentation is available online. Work of the U.S. Government published under an exclusive license with the RSNA.
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Affiliation(s)
- Justin Costello
- From the Department of Neuroradiology, Walter Reed National Military
Medical Center and Uniformed Services University of Health Sciences, 8901
Rockville Pike, Bethesda, MD 20889 (J.C., M.E.P., V.C.L., J.K.D.); Department of
Neuroradiology, University of Utah, Salt Lake City, Utah (M.D.A., J.S.M.); and
Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.)
| | - Matthew D. Alexander
- From the Department of Neuroradiology, Walter Reed National Military
Medical Center and Uniformed Services University of Health Sciences, 8901
Rockville Pike, Bethesda, MD 20889 (J.C., M.E.P., V.C.L., J.K.D.); Department of
Neuroradiology, University of Utah, Salt Lake City, Utah (M.D.A., J.S.M.); and
Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.)
| | - J Scott McNally
- From the Department of Neuroradiology, Walter Reed National Military
Medical Center and Uniformed Services University of Health Sciences, 8901
Rockville Pike, Bethesda, MD 20889 (J.C., M.E.P., V.C.L., J.K.D.); Department of
Neuroradiology, University of Utah, Salt Lake City, Utah (M.D.A., J.S.M.); and
Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.)
| | - Elizabeth M. Hecht
- From the Department of Neuroradiology, Walter Reed National Military
Medical Center and Uniformed Services University of Health Sciences, 8901
Rockville Pike, Bethesda, MD 20889 (J.C., M.E.P., V.C.L., J.K.D.); Department of
Neuroradiology, University of Utah, Salt Lake City, Utah (M.D.A., J.S.M.); and
Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.)
| | - Michael E. Porambo
- From the Department of Neuroradiology, Walter Reed National Military
Medical Center and Uniformed Services University of Health Sciences, 8901
Rockville Pike, Bethesda, MD 20889 (J.C., M.E.P., V.C.L., J.K.D.); Department of
Neuroradiology, University of Utah, Salt Lake City, Utah (M.D.A., J.S.M.); and
Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.)
| | - Victor C. Lau
- From the Department of Neuroradiology, Walter Reed National Military
Medical Center and Uniformed Services University of Health Sciences, 8901
Rockville Pike, Bethesda, MD 20889 (J.C., M.E.P., V.C.L., J.K.D.); Department of
Neuroradiology, University of Utah, Salt Lake City, Utah (M.D.A., J.S.M.); and
Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.)
| | - J Kevin DeMarco
- From the Department of Neuroradiology, Walter Reed National Military
Medical Center and Uniformed Services University of Health Sciences, 8901
Rockville Pike, Bethesda, MD 20889 (J.C., M.E.P., V.C.L., J.K.D.); Department of
Neuroradiology, University of Utah, Salt Lake City, Utah (M.D.A., J.S.M.); and
Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.)
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Murumkar V, Jabeen S, Peer S, Ramalingaiah AH, Saini J. Ruptured vertebrobasilar junction aneurysm unmasking subclavian steal syndrome. Surg Neurol Int 2020; 11:419. [PMID: 33365182 PMCID: PMC7749953 DOI: 10.25259/sni_561_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022] Open
Abstract
Background Subclavian steal occurs due to stenosis or occlusion of the subclavian artery or innominate artery proximal to the origin of the vertebral artery. Often asymptomatic, the condition may be unmasked due to symptoms of vertebrobasilar insufficiency triggered by strenuous physical exercise involving the affected upper limb. The association of vertebrobasilar junction (VBJ) aneurysms with subclavian steal syndrome has been rarely reported. Hereby, we present a case of VBJ aneurysm associated with subclavian steal treated successfully with endovascular coiling. Case Description A 65-year-old female presented in the emergency department with acute severe headache and vomiting with no focal neurological deficits. Non-contrast computed tomography of the brain showed modified Fischer Grade 3 subarachnoid hemorrhage. Subsequent digital subtraction angiogram (DSA) showed VBJ aneurysm directed inferiorly with the left subclavian artery occlusion. There was retrograde filling of the left vertebral artery on right vertebral injection, confirming the diagnosis of subclavian steal. Balloon assisted coiling of the VBJ aneurysm was performed while gaining access through the stenotic left vertebral artery ostium which provided a more favorable hemodynamic stability to the coil mass. Conclusion Subclavian steal exerting undue hemodynamic stress on vertebrobasilar circulation can be an etiological factor for the development of the flow-related aneurysms. Access to the VBJ aneurysms may be feasible through the stenosed vertebral artery if angioplasty is performed before the coiling of the aneurysm.
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Affiliation(s)
- Vivek Murumkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shumyla Jabeen
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sameer Peer
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Rafailidis V, Li X, Chryssogonidis I, Rengier F, Rajiah P, Wieker CM, Kalva S, Ganguli S, Partovi S. Multimodality Imaging and Endovascular Treatment Options of Subclavian Steal Syndrome. Can Assoc Radiol J 2018; 69:493-507. [DOI: 10.1016/j.carj.2018.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/20/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Vasileios Rafailidis
- AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xin Li
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ioannis Chryssogonidis
- AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fabian Rengier
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Prabhakar Rajiah
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Carola M. Wieker
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Sanjeeva Kalva
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Suvranu Ganguli
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sasan Partovi
- Section of Interventional Radiology, Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Tsao TF, Cheng KL, Shen CY, Wu MC, Huang HH, Su CH, Chen FL, Tyan YS, Lin YC. Diagnostic Performance of Combined Contrast-Enhanced Magnetic Resonance Angiography and Phase-Contrast Magnetic Resonance Imaging in Suspected Subclavian Steal Syndrome. Can Assoc Radiol J 2016; 67:190-201. [PMID: 26831732 DOI: 10.1016/j.carj.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/30/2015] [Accepted: 08/01/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The study sought to evaluate the efficacy of magnetic resonance imaging (MRI) in patients with suspected subclavian steal syndrome (SSS) using both contrast-enhanced (CE) MR angiography and phase-contrast (PC) MRI. METHODS Fifteen suspected SSSs from 13 patients were evaluated using CE-MR angiography and PC-MRI. Ten patients also received dynamic CE-MR angiography. RESULTS All MRI examinations were technically successful. By combining CE-MR angiography with PC-MRI, 10 SSSs were diagnosed in 9 patients. The delay enhancement dynamic technique predicted SSS with a sensitivity, specificity, and accuracy of 57.1%, 100%, and 72.7%, respectively. Without the dynamic technique, affected delay-enhanced arteries were poorly visualized and could be mistaken for occluded vessels. Retrograde vertebral flow by PC-MRI was used to predict ipsilateral SSS with a sensitivity, specificity, and accuracy of 100%, 60%, and 86.7%, respectively. There were 2 false positives including 1 patient with a proximal total occlusion of the affected vertebral artery and another with brachiocephalic steal syndrome rather than SSS. This suggested that retrograde vertebral flow does not always indicate SSS. CONCLUSIONS CE-MR angiography combined with PC-MRI is efficacious when evaluating SSS in clinical practice.
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Affiliation(s)
- Teng-Fu Tsao
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan, Republic of China; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Kai-Lun Cheng
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Chao-Yu Shen
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Ming-Chi Wu
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Hsin-Hui Huang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Chun-Hung Su
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China; Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Fong-Lin Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, Republic of China; Division of Pediatric Cardiology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | - Yung-Chang Lin
- Department of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan, Republic of China; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China.
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Krishnam MS, Tomasian A, Lohan DG, Tran L, Finn JP, Ruehm SG. Low-dose, time-resolved, contrast-enhanced 3D MR angiography in cardiac and vascular diseases: correlation to high spatial resolution 3D contrast-enhanced MRA. Clin Radiol 2008; 63:744-55. [PMID: 18555032 DOI: 10.1016/j.crad.2008.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 12/22/2007] [Accepted: 01/03/2008] [Indexed: 11/20/2022]
Abstract
AIM To evaluate the effectiveness of low-dose, contrast-enhanced, time-resolved, three-dimensional (3D) magnetic resonance (MR) angiography (TR-MRA) in the assessment of various cardiac and vascular diseases, and to compare the results with high-resolution contrast-enhanced MRA (CE-MRA). MATERIALS AND METHODS Thirty consecutive patients underwent contrast-enhanced 3D TR-MRA and high spatial resolution 3D CE-MRA for evaluation of cardiac and thoracic vascular diseases at 1.5 T, and neurovascular, abdominal and peripheral vascular diseases at 3T. Gadolinium-based contrast medium was administered at a constant dose of 5 ml for TR-MRA, and 20 ml (lower extremity 30 ml) for CE-MRA. Two readers evaluated image quality using a four-point scale (from 0=excellent to 3=non-diagnostic), artefacts and findings on both datasets. Interobserver variability was tested with kappa coefficient. RESULTS The overall image quality for TR-MRA was in the diagnostic range (median 0, range 0-1; k=0.74). Readers demonstrated important additional dynamic information on TR-MRA in 28 of 30 patients (k=0.84). Confident evaluation of organ perfusion (n=23), arteriovenous malformation/fistula flow patterns (n=7), exclusion of intra-cardiac shunts (n=6), and assessment of stent and conduit patency (n=5) were performed by both readers using TR-MRA. Readers demonstrated fine vascular details with higher confidence in 10 patients on CE-MRA. Using CE-MRA, Reader 1 and 2 depicted anatomical details in 6 and 5 patients, respectively, only on CE-MRA. CONCLUSION Low-dose TR-MRA yields rapid and important functional and anatomical information in patients with cardiac and vascular diseases. Due to limited spatial resolution, TR-MRA is inferior to CE-MRA in demonstrating fine vascular details.
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Affiliation(s)
- M S Krishnam
- Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA 90095-7206, USA.
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