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Pannell JS, Corey AS, Shih RY, Austin MJ, Chu S, Davis MA, Ducruet AF, Hunt CH, Ivanidze J, Kalnins A, Lacy ME, Lo BM, Setzen G, Shaines MD, Soares BP, Soderlund KA, Thaker AA, Wang LL, Burns J. ACR Appropriateness Criteria® Cerebrovascular Diseases-Stroke and Stroke-Related Conditions. J Am Coll Radiol 2024; 21:S21-S64. [PMID: 38823945 DOI: 10.1016/j.jacr.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Cerebrovascular disease encompasses a vast array of conditions. The imaging recommendations for stroke-related conditions involving noninflammatory steno-occlusive arterial and venous cerebrovascular disease including carotid stenosis, carotid dissection, intracranial large vessel occlusion, and cerebral venous sinus thrombosis are encompassed by this document. Additional imaging recommendations regarding complications of these conditions including intraparenchymal hemorrhage and completed ischemic strokes are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Amanda S Corey
- Panel Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
| | - Robert Y Shih
- Panel Vice Chair, Uniformed Services University, Bethesda, Maryland
| | | | - Sammy Chu
- University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa A Davis
- Yale University School of Medicine, New Haven, Connecticut; Committee on Emergency Radiology-GSER
| | - Andrew F Ducruet
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | - Christopher H Hunt
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | | | | | - Mary E Lacy
- Washington State University, Spokane, Washington; American College of Physicians
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Gavin Setzen
- Albany ENT & Allergy Services, Albany, New York; American Academy of Otolaryngology-Head and Neck Surgery
| | - Matthew D Shaines
- Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York, Primary care physician
| | - Bruno P Soares
- Stanford University School of Medicine, Stanford, California
| | - Karl A Soderlund
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Naval Medical Center Portsmouth, Portsmouth, Virginia
| | | | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Abdalkader M, Miller MI, Klein P, Hui FK, Siracuse JJ, Mian AZ, Sakai O, Nguyen TN, Setty BN. Differential Assessment of Internal Jugular Vein Stenosis in Patients Undergoing CT and MRI with Contrast. Tomography 2024; 10:266-276. [PMID: 38393289 PMCID: PMC10893318 DOI: 10.3390/tomography10020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE Internal Jugular Vein Stenosis (IJVS) is hypothesized to play a role in the pathogenesis of diverse neurological diseases. We sought to evaluate differences in IJVS assessment between CT and MRI in a retrospective patient cohort. METHODS We included consecutive patients who had both MRI of the brain and CT of the head and neck with contrast from 1 June 2021 to 30 June 2022 within the same admission. The degree of IJVS was categorized into five grades (0-IV). RESULTS A total of 35 patients with a total of 70 internal jugular (IJ) veins were included in our analysis. There was fair intermodality agreement in stenosis grades (κ = 0.220, 95% C.I. = [0.029, 0.410]), though categorical stenosis grades were significantly discordant between imaging modalities, with higher grades more frequent in MRI (χ2 = 27.378, p = 0.002). On CT-based imaging, Grade III or IV stenoses were noted in 17/70 (24.2%) IJs, whereas on MRI-based imaging, Grade III or IV stenoses were found in 40/70 (57.1%) IJs. Among veins with Grade I-IV IJVS, MRI stenosis estimates were significantly higher than CT stenosis estimates (77.0%, 95% C.I. [35.9-55.2%] vs. 45.6%, 95% C.I. [35.9-55.2%], p < 0.001). CONCLUSION MRI with contrast overestimates the degree of IJVS compared to CT with contrast. Consideration of this discrepancy should be considered in diagnosis and treatment planning in patients with potential IJVS-related symptoms.
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Affiliation(s)
- Mohamad Abdalkader
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
| | - Matthew I. Miller
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA 02139, USA;
| | - Piers Klein
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
| | - Ferdinand K. Hui
- Neuroscience Institute, The Queen’s Medical Center, Honolulu, HI 96813, USA;
- Department of Radiology, University of Hawaii, Honolulu, HI 96813, USA
| | | | - Asim Z. Mian
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
| | - Osamu Sakai
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
| | - Thanh N. Nguyen
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
| | - Bindu N. Setty
- Department of Radiology, Boston Medical, 840 Harrison Ave., Boston, MA 02118, USA (A.Z.M.); (O.S.); (T.N.N.); (B.N.S.)
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Lansberg MG, Wintermark M, Kidwell CS, Albers GW. Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Can intracranial time-of-flight-MR angiography predict extracranial carotid artery stenosis? J Neurol 2021; 269:2743-2749. [PMID: 34750675 PMCID: PMC9021057 DOI: 10.1007/s00415-021-10876-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Extracranial stenosis of the internal carotid artery (ICA) is an important cause of ischemic stroke and transient ischemic attack (TIA). It can be diagnosed using contrast-enhanced CT or MR angiography (MRA) as well as Doppler ultrasound. In this study, we assessed the diagnostic value of intracranial time-of-flight (TOF) MRA to predict extracranial ICA stenosis (ICAS). METHODS We retrospectively analyzed consecutive patients with acute ischemic stroke or TIA and middle- (50-69%) or high-grade (70-99%) unilateral extracranial ICAS according to NASCET criteria assessed by ultrasound between January 2016 and August 2018. The control group consisted of patients without extracranial ICAS. Intraluminal signal intensities (SI) of the intracranial ICA on the side of the extracranial stenosis were compared to the contralesional side on TOF-MRA source images. SI ratios (SIR) of contralesional:lesional side were compared between groups. RESULTS In total, 151 patients were included in the main analysis. Contralesional:lesional SIR in the intracranial C4-segment was significantly higher in patients with ipsilateral extracranial ICA stenosis (n = 51, median 74 years, 57% male) compared to the control group (n = 100, median 68 years, 48% male). Mean SIR was 1.463 vs. 1.035 (p < 0.001) for right-sided stenosis and 1.362 vs. 1.000 (p < 0.001) for left-sided stenosis. Receiver-operating characteristic curve demonstrated a cut-off value of 1.086 for right-sided [sensitivity/specificity 75%/81%; area under the curve (AUC) 0.81] and 1.104 for left-sided stenosis (sensitivity/specificity 70%/84%; AUC 0.80) in C4 as a good predictor for high-grade extracranial ICAS. CONCLUSIONS SIR on TOF-MRA can be a marker of extracranial ICAS.
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Settecase F, Rayz VL. Advanced vascular imaging techniques. HANDBOOK OF CLINICAL NEUROLOGY 2021; 176:81-105. [DOI: 10.1016/b978-0-444-64034-5.00016-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Multiple reader comparison of 2D TOF, 3D TOF, and CEMRA in screening of the carotid bifurcations: Time to reconsider routine contrast use? PLoS One 2020; 15:e0237856. [PMID: 32877415 PMCID: PMC7467222 DOI: 10.1371/journal.pone.0237856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background and purpose MR contrast-enhanced techniques are undergoing increased scrutiny since the FDA applied a warning for gadolinium-based MR contrast agents due to gadolinium deposition within multiple organ systems. While CE-MRA provides excellent image quality, is it required in a screening carotid study? This study compares 2D TOF and 3D TOF MRA vs. CE-MRA in defining carotid stenosis in a large clinical patient population, and with multiple readers with varying experience. Materials and methods 200 consecutive patients had their carotid bifurcations evaluated with 2D TOF, 3D TOF and CE-MRA sequences by 6 board-certified neuroradiologists. Stenosis and quality of examinations were defined for each study. Inter-rater reliability was assessed using two-way random effects intraclass correlation coefficients. Intra-reader reliability was computed via weighted Cohen’s κ. Weighted Cohen’s κ were also computed to assess agreement in stenosis ratings between enhanced images and unenhanced images. Results Agreement between unenhanced and enhanced ratings was substantial with a pooled weighted κ of 0.733 (0.628–0.811). For 5 of the 6 readers, the combination of unenhanced 2D TOF and 3D TOF showed better agreement with contrast-enhanced than either 2D TOF or 3D TOF alone. Intra-reader reliability was substantial. Conclusions The combination of 2D TOF and 3D TOF MRA showed substantial agreement with CE-MRA regarding degree of carotid stenosis in this large outpatient population across multiple readers of varying experience. Given the scrutiny that GBCA are undergoing due to concerns regarding CNS and soft tissue deposition, it seems prudent to reserve CE-MRA for cases which are not satisfactorily answered by the nonenhanced study or other noninvasive examinations.
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Di Gioia G, Scordino D, Campanale CM, Miglionico M, Creta A, Proscia C, Ragni L, Colaiori I, Di Sciascio G. In-Stent Restenosis After Carotid Artery Stenting: From Diagnosis to Treatment. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10312518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Although carotid artery stenting is a safe and effective treatment for preventing ischaemic stroke in significant carotid atherosclerotic disease, it can be complicated by in-stent restenosis (ISR). Factors involved in the ISR process are both mechanical and patient-related, but the most important is the neointimal thickening within stent struts, leading to lumen reduction. Overall incidence of carotid ISR is low and related embolic risk seems to be lower than native disease. Digital subtraction angiography is the gold standard for diagnosis. Nowadays, Doppler ultrasound should be considered the first-line investigation, due to its non-invasiveness and reproducibility. Computed tomography angiography remains useful when Doppler ultrasound is inconclusive. Indication and modality of treatment of ISR are still debated: both surgery (carotid endarterectomy with stent removal in most cases) or interventional procedures such as percutaneous transluminal angioplasty with simple balloon, cutting-balloon, drug-eluting balloon, and stenting, showed safety and efficacy in follow-up. Surgery is currently reserved for selected cases. Carotid ISR is an overall rare complication which can be easily identified at routine follow-up. This paper is a literature review and state-of-the-art assessment of ISR, clinical features, diagnosis, and treatment.
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Affiliation(s)
- Giuseppe Di Gioia
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Domenico Scordino
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Cosimo Marco Campanale
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marco Miglionico
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Antonio Creta
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Claudio Proscia
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Ragni
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Iginio Colaiori
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Germano Di Sciascio
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Rome, Italy
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Time-of-Flight Magnetic Resonance Angiography With Sparse Undersampling and Iterative Reconstruction. Invest Radiol 2016; 51:372-8. [DOI: 10.1097/rli.0000000000000221] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Pizzolato R, Romero JM. Neurosonology and noninvasive imaging of the carotid arteries. HANDBOOK OF CLINICAL NEUROLOGY 2016; 135:165-191. [PMID: 27432665 DOI: 10.1016/b978-0-444-53485-9.00009-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this chapter, we review imaging of the extracranial carotid arteries and the indications for noninvasive carotid artery evaluation, measuring the degree of arterial stenosis and plaque morphology. We also analyze the types of noninvasive imaging, including carotid duplex ultrasound, transcranial Doppler, magnetic resonance angiography, and computer tomography angiography. We look at each of these modalities, briefly discussing techniques, benefits, limitations, and sources of error. Furthermore, we discuss the apparent accuracy and the need for multimodality imaging. Finally, an imaging algorithm for the evaluation of the extracranial carotid arteries is proposed, which is in routine use at our hospital.
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Affiliation(s)
- Raffaella Pizzolato
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Javier M Romero
- Department of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Weber J, Veith P, Jung B, Ihorst G, Moske-Eick O, Meckel S, Urbach H, Taschner CA. MR Angiography at 3 Tesla to Assess Proximal Internal Carotid Artery Stenoses: Contrast-Enhanced or 3D Time-of-Flight MR Angiography? Clin Neuroradiol 2014; 25:41-8. [DOI: 10.1007/s00062-013-0279-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/12/2013] [Indexed: 11/30/2022]
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Gupta A, Baradaran H, Kamel H, Mangla A, Pandya A, Fodera V, Dunning A, Sanelli PC. Intraplaque high-intensity signal on 3D time-of-flight MR angiography is strongly associated with symptomatic carotid artery stenosis. AJNR Am J Neuroradiol 2013; 35:557-61. [PMID: 24008170 DOI: 10.3174/ajnr.a3732] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage in carotid artery atherosclerotic plaque has been shown to be a marker of risk, associated with prior and future ischemic events, and has been associated with regions of intraplaque high-intensity signal on 3D-TOF MRA. We assessed the association of intraplaque high-intensity signal determined on 3D-TOF MRA with the incidence of prior ipsilateral stroke or TIA. MATERIALS AND METHODS We assessed intraplaque hemorrhage by evaluating for intraplaque high-intensity signal adapting a recently validated technique on 3D-TOF source images in participants with high-grade (≥ 70%) extracranial carotid stenosis. Logistic regression analyses were used to assess the strength of association between the presence of intraplaque high-intensity signal on routine MRA sequences and prior stroke or TIA. RESULTS Intraplaque high-intensity signal was present in 22 (41.5%) of 53 carotid arteries studied in 51 patients. Ipsilateral ischemic events occurred in 15 (68.1%) of 22 in the intraplaque high-intensity signal-positive group (10 strokes, 5 TIAs) and in 4 (12.9%) of 31 in the intraplaque high-intensity signal-negative group (3 strokes, 1 TIA). Ischemic events occurred within the 6-month period preceding imaging in 18 (94.7%) of 19 cases. The univariate odds ratio of the association of intraplaque high-intensity signal with any prior ischemic event was 14.5 (95% CI, 3.6-57.6), and the multivariate age- and sex-adjusted odds ratio was 14.2 (95% CI, 3.3-60.5). The association remained present across 1.5 T and 3T magnet field strengths. CONCLUSIONS Intraplaque high-intensity signal determined from MRA sequences already in place to measure luminal stenosis is strongly associated with prior ipsilateral ischemic events. Prospective validation of these findings to predict outcome in carotid artery stenosis could provide a valuable and widely accessible stroke risk stratification tool.
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Affiliation(s)
- A Gupta
- From the Departments of Radiology (A.G., H.B., V.F., P.C.S.)
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Blankholm AD, Ginnerup-Pedersen B, Stausbøl-Grøn B, Haislund M, Laustsen S, Ringgaard S. Non-contrast enhanced magnetic resonance angiography techniques in candidates for kidney transplantation: A comparative study. Radiography (Lond) 2013. [DOI: 10.1016/j.radi.2013.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Eller A, Wuest W, Kramer M, May M, Schmid A, Uder M, Lell MM. Carotid CTA: radiation exposure and image quality with the use of attenuation-based, automated kilovolt selection. AJNR Am J Neuroradiol 2013; 35:237-41. [PMID: 23907241 DOI: 10.3174/ajnr.a3659] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE CTA is considered the imaging modality of choice in evaluating the supraaortic vessels in many institutions, but radiation exposure remains a matter of concern. The objective of the study was to evaluate a fully automated, attenuation-based kilovolt selection algorithm in carotid CTA in respect to radiation dose and image quality compared with a standard 120-kV protocol. MATERIALS AND METHODS Ninety-eight patients were included: 53 examinations (patient age, 66 ± 12 years) were performed by use of automated adaption of tube potential (80-140 kV) on the basis of the attenuation profile of the scout scan (study group), and 45 examinations (patient age, 67 ± 11 years) were performed by use of a standard 120-kV protocol (control group). CT dose index volume and dose-length product were recorded from the examination protocol. Image quality was assessed by ROI measurements and calculations of SNR and contrast-to-noise ratio. Subjective image quality was evaluated by 2 observers with the use of a 4-point scale (3, excellent; 0, not diagnostic). RESULTS Subjective image quality was rated as "excellent" or "good" in all examinations (study group, 2.8; control group, 2.8). The algorithm automatically selected 100 kV in 47% and 80 kV in 34%; 120 kV was retained in 19%. An elevation to 140 kV did not occur. Compared with the control group, overall CT dose index volume reduction was 33.7%; overall dose-length product reduction was 31.5%. In the low-kilovolt scans, image noise and mean attenuation of ROIs inside the carotid arteries were significantly higher than in 120-kV scans, resulting in a constant or increased (80-kV group) contrast-to-noise ratio. CONCLUSIONS The attenuation-based, kilovolt selection algorithm enables a dose reduction of >30% in carotid artery CTA while maintaining contrast-to-noise ratio and subjective image quality at adequate levels.
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Affiliation(s)
- A Eller
- From the Department of Radiology, University Erlangen, Erlangen, Germany
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Non-ECG-gated unenhanced MRA of the carotids: optimization and clinical feasibility. Eur Radiol 2013; 23:3020-8. [PMID: 23783783 DOI: 10.1007/s00330-013-2931-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 05/06/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To optimise and assess the clinical feasibility of a carotid non-ECG-gated unenhanced MRA sequence. METHODS Sixteen healthy volunteers and 11 patients presenting with internal carotid artery (ICA) disease underwent large field-of-view balanced steady-state free precession (bSSFP) unenhanced MRA at 3T. Sampling schemes acquiring the k-space centre either early (kCE) or late (kCL) in the acquisition window were evaluated. Signal and image quality was scored in comparison to ECG-gated kCE unenhanced MRA and TOF. For patients, computed tomography angiography was used as the reference. RESULTS In volunteers, kCE sampling yielded higher image quality than kCL and TOF, with fewer flow artefacts and improved signal homogeneity. kCE unenhanced MRA image quality was higher without ECG-gating. Arterial signal and artery/vein contrast were higher with both bSSFP sampling schemes than with TOF. The kCE sequence allowed correct quantification of ten significant stenoses, and it facilitated the identification of an infrapetrous dysplasia, which was outside of the TOF imaging coverage. CONCLUSIONS Non-ECG-gated bSSFP carotid imaging offers high-quality images and is a promising sequence for carotid disease diagnosis in a short acquisition time with high spatial resolution and a large field of view. KEY POINTS • Non-ECG-gated unenhanced bSSFP MRA offers high-quality imaging of the carotid arteries. • Sequences using early acquisition of the k-space centre achieve higher image quality. • Non-ECG-gated unenhanced bSSFP MRA allows quantification of significant carotid stenosis. • Short MR acquisition times and ungated sequences are helpful in clinical practice. • High 3D spatial resolution and a large field of view improve diagnostic performance.
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Coppenrath EM, Lummel N, Linn J, Lenz O, Habs M, Nikolaou K, Reiser MF, Dichgans M, Pfefferkorn T, Saam T. Time-of-flight angiography: a viable alternative to contrast-enhanced MR angiography and fat-suppressed T1w images for the diagnosis of cervical artery dissection? Eur Radiol 2013; 23:2784-92. [DOI: 10.1007/s00330-013-2891-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 03/29/2013] [Accepted: 04/03/2013] [Indexed: 11/29/2022]
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Pizzolato R, Hirsch JA, Romero JM. Imaging challenges of carotid artery in-stent restenosis. J Neurointerv Surg 2013; 6:32-41. [DOI: 10.1136/neurintsurg-2012-010618] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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MANSO-DÍAZ G, GARCÍA-REAL MI, CASTELEYN C, SAN-ROMÁN F, TAEYMANS O. Time-of-flight magnetic resonance angiography (TOF-MRA) of the normal equine head. Equine Vet J 2012; 45:187-92. [DOI: 10.1111/j.2042-3306.2012.00621.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lummel N, Boeckh-Behrens T, Lutz J, Burke M, Linn J. Evaluation of the supraaortic arteries using non-contrast-enhanced Velocity MR angiography "Inhance". Neuroradiology 2012; 54:1215-9. [PMID: 22569954 DOI: 10.1007/s00234-012-1038-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 04/04/2012] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The aim of this study was to compare the recently developed phase contrast-based Inhance 3D Velocity magnetic resonance angiography technique (Inhance) to the contrast-enhanced standard method (CE-MRA) in the evaluation of the supraaortic arteries. METHODS Inhance and CE-MRA were performed in ten consecutive patients with a suspected pathology of the supraaortic arteries on a 3-T MR scanner. Two neuroradiologists evaluated in consensus both sequences regarding the visualisation of the supraaortic arteries and their segments on a five-point score. Diagnostic certainty regarding the overall presence of a vascular pathology was rated on the same five-point score. RESULTS On CE-MRA as well as on Inhance, a vascular pathology of the supraaortic arteries was detected in seven patients. There was no statistically significant difference in the overall diagnostic certainty regarding the presence or absence of pathologic findings for CE-MRA compared to Inhance. Furthermore, no statistically significant difference was found with regard to visualisation of the distal cervical and intracranial arterial segments, while CE-MRA was superior to Inhance in the visualisation of the origins of the cervical vessels from the aortic arch. CONCLUSION Non-contrast Inhance proved useful in the evaluation of the supraaortic arteries with limited assessment of the proximal supraaortic branches. Hence, this technique features a valuable alternative to CE-MRA in the visualisation of the supraaortic arteries, particularly in patients with renal insufficiency.
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Affiliation(s)
- Nina Lummel
- Department of Neuroradiology, University of Munich, Marchioninistrasse 15, Munich, Germany.
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Suinesiaputra A, de Koning PJH, Zudilova-Seinstra E, Reiber JHC, van der Geest RJ. Automated quantification of carotid artery stenosis on contrast-enhanced MRA data using a deformable vascular tube model. Int J Cardiovasc Imaging 2011; 28:1513-24. [PMID: 22160666 PMCID: PMC3463799 DOI: 10.1007/s10554-011-9988-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 11/24/2011] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to develop and validate a method for automated segmentation of the carotid artery lumen from volumetric MR Angiographic (MRA) images using a deformable tubular 3D Non-Uniform Rational B-Splines (NURBS) model. A flexible 3D tubular NURBS model was designed to delineate the carotid arterial lumen. User interaction was allowed to guide the model by placement of forbidden areas. Contrast-enhanced MRA (CE-MRA) from 21 patients with carotid atherosclerotic disease were included in this study. The validation was performed against expert drawn contours on multi-planar reformatted image slices perpendicular to the artery. Excellent linear correlations were found on cross-sectional area measurement (r = 0.98, P < 0.05) and on luminal diameter (r = 0.98, P < 0.05). Strong match in terms of the Dice similarity indices were achieved: 0.95 ± 0.02 (common carotid artery), 0.90 ± 0.07 (internal carotid artery), 0.87 ± 0.07 (external carotid artery), 0.88 ± 0.09 (carotid bifurcation) and 0.75 ± 0.20 (stenosed segments). Slight overestimation of stenosis grading by the automated method was observed. The mean differences was 7.20% (SD = 21.00%) and 5.2% (SD = 21.96%) when validated against two observers. Reproducibility in stenosis grade calculation by the automated method was high; the mean difference between two repeated analyses was 1.9 ± 7.3%. In conclusion, the automated method shows high potential for clinical application in the analysis of CE-MRA of carotid arteries.
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Affiliation(s)
- Avan Suinesiaputra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Abstract
The goal of stroke imaging is to appropriately select patients for different types of therapeutic management in order to optimize outcome and minimize potential complications. To accomplish this, the radiologist has to evaluate each case and tailor an imaging protocol to fit the patient's needs and best answer the clinical question. This review outlines the routinely used, current neuroimaging techniques and their role in the evaluation of the acute stroke patient. The ability of computed tomography and magnetic resonance imaging to adequately evaluate the infarcted brain parenchyma, the cerebral vasculature, and the ischemic, but potentially viable tissue, often referred to as the "ischemic penumbra," is compared The authors outline an imaging algorithm that has been employed at their institution, and briefly review endovascular therapies that can be used in specific patients for stroke treatment.
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Affiliation(s)
- Mara M Kunst
- Section of Neuroradiology, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
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Warach S, Baird AE, Dani KA, Wintermark M, Kidwell CS. Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Use of magnetic resonance imaging to predict outcome after stroke: a review of experimental and clinical evidence. J Cereb Blood Flow Metab 2010; 30:703-17. [PMID: 20087362 PMCID: PMC2949172 DOI: 10.1038/jcbfm.2010.5] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite promising results in preclinical stroke research, translation of experimental data into clinical therapy has been difficult. One reason is the heterogeneity of the disease with outcomes ranging from complete recovery to continued decline. A successful treatment in one situation may be ineffective, or even harmful, in another. To overcome this, treatment must be tailored according to the individual based on identification of the risk of damage and estimation of potential recovery. Neuroimaging, particularly magnetic resonance imaging (MRI), could be the tool for a rapid comprehensive assessment in acute stroke with the potential to guide treatment decisions for a better clinical outcome. This review describes current MRI techniques used to characterize stroke in a preclinical research setting, as well as in the clinic. Furthermore, we will discuss current developments and the future potential of neuroimaging for stroke outcome prediction.
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Chang HH, Duckwiler GR, Valentine DJ, Chu WC. Computer-assisted extraction of intracranial aneurysms on 3D rotational angiograms for computational fluid dynamics modeling. Med Phys 2010; 36:5612-21. [PMID: 20095274 DOI: 10.1118/1.3260841] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Three-dimensional rotational angiography (3DRA) is an evolving imaging procedure from traditional digital subtraction angiography and is gaining much interest for detecting intracranial aneurysms. Computational fluid dynamics (CFD) modeling plays an important role in understanding the biomechanical properties and in facilitating the prediction of aneurysm rupture. A successful computational study relies on an accurate description of the vascular geometry that is obtained from volumetric images. METHODS The authors propose a new aneurysm segmentation algorithm to facilitate the study of CFD. This software combines a region-growing segmentation method with the 3D extension of a deformable contour based on a charged fluid model. A charged fluid model essentially consists of a set of charged elements that are governed by the nature of electrostatics. The approach requires no prior knowledge of anatomic structures and automatically segments the vasculature after the end-user selects a vessel section in a plane image. RESULTS Experimental results on 15 cases indicate that aneurysm structures were effectively segmented and in good agreement with manual delineation outcomes. In comparison with the existing methods, the algorithm provided a much higher overlap index with respect to the ground truth. Furthermore, the outcomes of the proposed approach achieved a clean representation of vascular structures that is advantageous for hemodynamics analyses. CONCLUSIONS A new aneurysm segmentation framework in an attempt to automatically segment vascular structures in 3DRA image volumes has been developed. The proposed algorithm demonstrated promising performance and unique characteristics to adequately segment aneurysms in 3DRA image volumes for further study in computational fluid dynamics.
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Affiliation(s)
- Herng-Hua Chang
- Institute of Biomedical Engineering, National Yang-Ming University, 155 Linong Street, Section 2, Beitou, Taipei 112, Taiwan
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