Contrast-Enhanced Carotid MR Angiography with Commercially Available Triggering Mechanisms and Elliptic Centric Phase Encoding
J. Kevin De Marco1,
Steven Schonfeld1,
Irwin Keller1 and
Matt A. Bernstein2
1
Laurie Imaging Center, University Radiology Group, University of Medicine and
Dentistry New Jersey, 141 French St., New Brunswick, NJ 08901.
2
Department of Diagnostic Radiology, Mayo Clinic and Foundation, 200 First St.
S.W., Rochester, MN 55905.
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Fig. 1A. —78-year-old woman with severe carotid stenosis as depicted
equally well with multiple overlapping thin-section acquisition MR
angiography, contrast-enhanced MR angiography, and intraarterial digital
subtraction angiography. Maximum-intensity-projection image from multiple
overlapping thin-section acquisition MR angiogram shows focal severe stenosis
involving left carotid bulb (straight arrow). Turbulent flow disrupts
flow-related enhancement in internal carotid artery just beyond stenosis
(curved arrow).
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Fig. 1B. —78-year-old woman with severe carotid stenosis as depicted
equally well with multiple overlapping thin-section acquisition MR
angiography, contrast-enhanced MR angiography, and intraarterial digital
subtraction angiography. Maximum-intensity-projection image from
contrast-enhanced MR angiogram reveals similar focal severe stenosis
(straight arrow), but with better delineation of internal carotid
artery just beyond stenosis (curved arrow).
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Fig. 1C. —78-year-old woman with severe carotid stenosis as depicted
equally well with multiple overlapping thin-section acquisition MR
angiography, contrast-enhanced MR angiography, and intraarterial digital
subtraction angiography. Intraarterial digital subtraction angiogram confirms
focal severe stenosis caused by densely calcified plaque in carotid bulb
(straight arrow) with bulbous dilatation of internal carotid artery
just beyond stenosis (curved arrow). Both observers believed vessel
margins were sharper on maximum-intensity-projection images from multiple
overlapping thin-section acquisition MR angiogram (A), but
contrast-enhanced MR angiograms (B) looked more like those on
intraarterial digital subtraction angiography (C). Diagnostic
confidence of surgical lesion was high for both MR angiographic
techniques.
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Fig. 2A. —67-year-old woman with ulceration better depicted with
contrast-enhanced MR angiography. Maximum-intensity-projection image from
multiple overlapping thin-section acquisition MR angiogram reveals severe
stenosis. Note faintest suggestion of ulceration (arrow).
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Fig. 2B. —67-year-old woman with ulceration better depicted with
contrast-enhanced MR angiography. Maximum-intensity-projection image from
contrast-enhanced MR angiogram shows focal outpouching compatible with
ulceration (arrow). This ulceration was confirmed at surgery.
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Fig. 3A. —68-year-old man in whom length of severe carotid stenosis was
overestimated with multiple overlapping thin-section acquisition MR
angiography and not with contrast-enhanced MR angiography.
Maximum-intensity-projection image from multiple overlapping thin-section
acquisition MR angiogram suggests severe stenosis of long segment of proximal
internal carotid artery.
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Fig. 3B. —68-year-old man in whom length of severe carotid stenosis was
overestimated with multiple overlapping thin-section acquisition MR
angiography and not with contrast-enhanced MR angiography.
Maximum-intensity-projection image from contrast-enhanced MR angiogram details
focal severe stenosis confirmed at surgery.
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Fig. 4A. —62-year-old woman in whom contrast-enhanced MR angiography
overestimated stenosis compared with multiple overlapping thin-section
acquisition MR angiography. Maximum-intensity-projection image from multiple
overlapping thin-section acquisition MR angiogram reveals high-grade stenosis
(arrow).
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Fig. 4B. —62-year-old woman in whom contrast-enhanced MR angiography
overestimated stenosis compared with multiple overlapping thin-section
acquisition MR angiography. Maximum-intensity-projection image from
contrast-enhanced MR angiogram suggests critical stenosis (arrow).
Sagittally reformatted maximum-intensity-projection image was not as sharp in
this patient, perhaps related to less than optimal gadolinium contrast
enhancement on these magnified images.
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Fig. 5A. —77-year-old woman with focal stenosis involving takeoff of
great vessels as seen on contrast-enhanced MR angiography.
Maximum-intensity-projection image from contrast-enhanced MR angiogram reveals
tandem severe stenosis of left subclavian artery origin and farther distally
at origin of left vertebral artery (arrows). Mild stenosis of origin
of left common carotid artery is also seen. Note high-grade stenosis of left
internal carotid artery at bifurcation and moderate stenosis involving right
carotid bifurcation.
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Fig. 5B. —77-year-old woman with focal stenosis involving takeoff of
great vessels as seen on contrast-enhanced MR angiography. Intraarterial
digital subtraction angiogram of aortic arch and takeoff of great vessels
confirms contrast-enhanced MR angiographic finding (arrows).
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Copyright © 2001 by the American Roentgen Ray Society.
