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High-Resolution Breath-Hold Contrast-Enhanced MR Angiography of the Entire Carotid Circulation

James C. Carr1, Jason Ma2, Vibhas Desphande2, Scott Pereles1, Gerhard Laub3 and J. Paul Finn2

1 Department of Radiology, Northwestern University Medical School, 676 St. Clair St., 8th Floor, Chicago, IL 60611.
2 Department of Biomedical Engineering, Northwestern University Medical School, Chicago, IL 60611.
3 Siemens Research and Development, 448 E. Ontario St., Chicago, IL 60611.



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  		Fig. 1. —65-year-old woman with carotid artery disease in whom breath-hold contrast-enhanced MR angiography of carotid circulation was performed. Coronal left anterior oblique maximum-intensity-projection MR image reveals ulcerated plaque causing tight stenosis (white arrow) at origin of left internal carotid artery. Great vessel origins and aortic arch (black arrows) are sharp and clearly visible.

 


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  		Fig. 2A. —58-year-old man with transient ischemic attacks in whom breath-hold contrast-enhanced MR angiography of carotid circulation was carried out. Coronal maximum-intensity-projection MR image reveals weblike, tight stenosis (white arrow) at origin of left internal carotid artery. Origins of great vessels (black arrows) from aortic arch are sharp and well visualized. Left carotid bifurcation and vertebrobasilar system are also clearly visible. Tight stenosis (arrowhead) in distal left vertebral artery is evident. Early filling of right subclavian and brachiocephalic veins (open arrow) does not obscure visualization of structures necessary for diagnosis.

 


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  		Fig. 2B. —58-year-old man with transient ischemic attacks in whom breath-hold contrast-enhanced MR angiography of carotid circulation was carried out. Coronal maximum-intensity-projection MR image in which overlying carotid vessels were manually edited out. Vertebrobasilar system is more clearly visualized. Stenosis (white arrow) in distal left vertebral artery is now more clearly seen.

 


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  		Fig. 3. —57-year-old man with verte-brobasilar ischemia in whom breath-hold contrast-enhanced MR angiography of carotid circulation was performed. Coronal maximum-intensity-projection MR image reveals large aneurysm (white arrow) at origin of basilar artery. Entire carotid circulation from aortic arch to circle of Willis is well visualized. Middle cerebral arteries (open arrows) are clearly visible bilaterally. Both carotid bifurcations (arrowheads) and great vessel origins (black arrows) appear sharp and clearly visualized.

 


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  		Fig. 4. —62-year-old woman with transient ischemic attacks in whom non—breath-hold contrast-enhanced MR angiography of carotid circulation was carried out. Coronal maximum-intensity-projection MR image reveals blurred and indistinct great vessel origins (black arrows). Origin of left internal carotid artery (white arrow) is clearly seen and appears normal.

 


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  		Fig. 5. —Bar graph shows quantitative values for sharpness of aortic arch and great vessel origins are higher for images in breath-hold group than for images in non—breath-hold group. (Higher values denote greater sharpness). No significant difference in vessel sharpness of carotid bifurcations between two groups was noted. Values for sharpness of great vessel origins have been averaged for all three vessels. [UNK] = non—breath-hold, {blacksquare} = breath-hold.

 


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  		Fig. 6. —Bar graph shows qualitative values for sharpness of aortic arch and great vessel origins are consistently higher for images in breath-hold group than for images in non-breath-hold group. (Sharpness was rated on scale 0-5, with 5 = excellent.) No significant difference in vessel sharpness of carotid bifurcations between two groups was noted. Values for sharpness of great vessel origins have been averaged for all three vessels. [UNK] = non—breath-hold, {blacksquare} = breath-hold.

 

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