Contrast-enhanced 3D FISP MR angiography of the aortic arch ostia: Preliminary results

Purpose: The goal of this work was to evaluate three-dimensional (3D) contr ast-enhanced MR angiography (MRA) for the detection of ostial stenoses of t he aortic arch. Method: Sixteen patients with suspected carotid atherosclerotic disease pro spectively underwent digital subtraction angiography of the aortic arch fol lowed by contrast-enhanced MRA using a 3D fast imaging with steady-state pr ecession (FISP) technique (TR = 5 ms, TE = 2 ms,flip angle = 30 degrees). T hree neuroradiologists blindly measured stenoses on the catheter angiograms and MRA. Evaluation included the ostia of the innominate, left carotid, an d left subclavian arteries. Any significant disagree ment on catheter angio graphy was resolved by consensus. The MRA grades of each of the three obser vers were then compared with the consensus grades of the contrast angiogram . Results: Forty-eight vessels were scored, of which five had significant ste noses. MRA demonstrated 100% sensitivity, 89% specificity, 52% positive pre dictive value, and 100% negative predictive value. The Bowker test for symm etry indicated no significant difference between conventional angiography a nd MRA scores (p = 0.32-0.75), and there was good agreement between the thr ee observers (weighted kappa = 0.75-0.86). Conclusion: Contrast-enhanced 3D FISP MRA may be a useful imaging modality for the detection of significant stenoses at the ostia of the major aortic arch branches.