Contrast-enhanced magnetic resonance angiography of the cervical vessels -Experience with 422 patients

Background and Purpose-Contrast-enhanced magnetic resonance angiography (CE MRA) permits acquisition of high-spatial-resolution, venous-suppressed, 3D MR angiograms of the cervical carotid and vertebral arteries. In this study , an elliptic centric-view ordering with either MR fluoroscopic triggering or test bolus timing was used. The use of CEMRA of the cervical vessels has changed our clinical practice and is replacing conventional angiography fo r the evaluation of most carotid and vertebral artery diseases. Methods-We retrospectively reviewed our experience with the use of CEMRA pe rformed in 422 patients from January through December 1999. Results-CEMRA was performed to evaluate transient ischemic attack and ische mic stroke in 239 patients, asymptomatic carotid bruit in 88 patients, and other neurological symptoms in 95 patients. Carotid endarterectomies were p erformed in 97 patients (103 procedures), and conventional angiography was performed in 12 of these patients. CEMRA was used to evaluate for the prese nce of an arterial dissection in 85 of the 239 patients with transient isch emic attack and ischemic stroke. Of this group, 32 patients had cervical ar terial dissection, and pseudoaneurysm was detected in 11 of these patients. Compared with ultrasonography of the cervical vessels, CEMRA provided addi tional information in 43 of 422 patients and led to changes in the decision as to whether to perform carotid endarterectomy in 5 patients. Conclusions-Use of CEMRA permits noninvasive evaluation of patients suspect ed of having carotid or vertebral disease and avoids the potential complica tions of conventional angiography.