Nonenhanced hybridized arterial spin labeled magnetic resonance angiography of the extracranial carotid arteries using a fast low angle shot readout at 3 TeslaReport as inadecuate




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Journal of Cardiovascular Magnetic Resonance

, 18:18

First Online: 12 April 2016Received: 04 November 2015Accepted: 24 March 2016

Abstract

BackgroundTo evaluate ungated nonenhanced hybridized arterial spin labeling hASL magnetic resonance angiography MRA of the extracranial carotid arteries using a fast low angle shot FLASH readout at 3 Tesla.

MethodsIn this retrospective, institutional review board-approved and HIPAA-compliant study, we evaluated the image quality 4-point scale of nonenhanced hASL MRA using a FLASH readout with respect to contrast-enhanced MRA CEMRA in 37 patients presenting with neurologic symptoms. Two certified neuroradiologists independently evaluated 407 arterial segments 11 per patient for image quality. The presence of vascular pathology was determined by consensus reading. Gwet’s AC1 was used to assess inter-rater agreement in image quality scores, and image quality scores were correlated with age and body mass index. Objective measurements of arterial lumen area and sharpness in the carotid arteries were compared to values obtained with CEMRA. Comparisons were also made with conventional nonenhanced 2D time-of-flight TOF MRA.

ResultsCEMRA provided the best image quality, while nonenhanced hASL FLASH MRA provided image quality that exceeded 2D TOF at the carotid bifurcation and in the internal and external carotid arteries. All nine vascular abnormalities of the carotid and intracranial arteries detected by CEMRA were depicted with hASL MRA, with no false positives. Inter-rater agreement of image quality scores was highest for CEMRA AC1 = 0.87, followed by hASL AC1 = 0.61 and TOF AC1 = 0.43 P < 0.001, all comparisons. With respect to CEMRA, agreement in cross-sectional lumen area was significantly better with hASL than TOF in the common carotid artery intraclass correlation ICC = 0.90 versus 0.66; P < 0.05 and at the carotid bifurcation ICC = 0.87 versus 0.54; P < 0.05. Nonenhanced hASL MRA provided superior arterial sharpness with respect to CEMRA and 2D TOF P < 0.001.

ConclusionAlthough inferior to CEMRA in terms of image quality and inter-rater agreement, hASL FLASH MRA offers an alternative to 2D TOF for the nonenhanced evaluation of the extracranial carotid arteries at 3 Tesla. Compared with 2D TOF, nonenhanced hASL FLASH MRA provides improved quantification of arterial cross-sectional area, vessel sharpness, inter-rater agreement and image quality.

KeywordsMagnetic resonance angiography Carotid Intracranial Arterial spin labeling Nonenhanced AbbreviationsASLArterial spin labeling

bSSFPbalanced steady-state free precession

CIconfidence interval

CCAcommon carotid artery

CEMRAcontrast-enhanced magnetic resonance angiography

CMRcardiovascular magnetic resonance

ECAexternal carotid artery

FLASHfast low-angle shot

hASLhybridized arterial spin labeling

ICAinternal carotid artery

ICCintraclass correlation

MRAmagnetic resonance angiography

QISSquiescent interval slice-selective

RFradiofrequency

TOFtime of flight

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Author: Ioannis Koktzoglou - Matthew T. Walker - Joel R. Meyer - Ian G. Murphy - Robert R. Edelman

Source: https://link.springer.com/article/10.1186/s12968-016-0238-1







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