GADOLINIUM-ENHANCED 3D MRA OF THE AORTIC-ARCH VESSELS IN THE DETECTION OF ATHEROSCLEROTIC CEREBROVASCULAR OCCLUSIVE DISEASE

Purpose: Our goal was to evaluate non-breath-hold Gd-enhanced 3D MR an giography (MRA) for the detection of atherosclerotic occlusive disease of the aortic arch vessels and to compare image quality with two brea th-hold techniques. Method: One hundred sixty consecutive patients wit h known or clinically suspected atherosclerotic cerebrovascular occlus ive disease underwent Gd-enhanced 3D MRA of the aortic arch and great vessels. One hundred twenty-six examinations were performed with the b ody coil after infusion of 40 ml of Gd-DTPA; 89 of these were performe d without breath-holding and 37 were acquired during suspended respira tion. Thirty-four examinations were performed in a body phased-array c oil with breath-holding, a timing examination, and 20 ml of contrast a gent by manual (n = 17) or power (n = 17) injection. Images were evalu ated for the presence of blurring and ghosting artifacts and venous en hancement. Of the 27 patients who underwent non-breath-hold MRI and di gital subtraction angiography (DSA), two readers blinded to the DSA re sults retrospectively evaluated the MRA examinations for the presence of occlusive disease of the innominate, carotid, subclavian, and verte bral arteries. DSA correlation was not evaluated for the 71 breath-hol d studies. Results: Sensitivity and specificity for arch vessel occlus ive disease with non-breath-hold MRA were 38 and 94% for Reader A and 38 and 95% for Reader B. Breath-holding significantly reduced blurring and ghosting artifacts (p < 0.001) when compared with non-breath-hold imaging, and use of 20 ml of contrast medium, with a timing examinati on, resulted in significantly less venous enhancement than seen with 4 0 ml (p < 0.001). Conclusion: Non-breath-hold Gd-enhanced 3D MRA is in sensitive for detecting arch vessel occlusive disease. Breath-hold ima ging, in conjunction with a timing examination and a lower dose of con trast agent, improves image quality, but further studies are needed to assess diagnostic accuracy.