Value of contrast-enhanced MRA versus time-of-flight MRA in acute ischemic stroke MRI
Background and purpose: Vessel imaging in acute ischemic stroke is essential to select patients with large-vessel occlusion for mechanical thrombectomy. Our aim was to compare the diagnostic accuracy of time-of-flight MR angiography and contrast-enhanced MR angiography for identification of vessel o...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
September 6, 2018
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| In: |
American journal of neuroradiology
Year: 2018, Volume: 39, Issue: 9, Pages: 1710-1716 |
| ISSN: | 1936-959X |
| DOI: | 10.3174/ajnr.A5771 |
| Online Access: | Verlag, Volltext: https://doi.org/10.3174/ajnr.A5771 Verlag, Volltext: http://www.ajnr.org/content/39/9/1710 
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| Author Notes: | T. Boujan, U. Neuberger, J. Pfaff, S. Nagel, C. Herweh, M. Bendszus, and M.A. Möhlenbruch |
| Summary: | Background and purpose: Vessel imaging in acute ischemic stroke is essential to select patients with large-vessel occlusion for mechanical thrombectomy. Our aim was to compare the diagnostic accuracy of time-of-flight MR angiography and contrast-enhanced MR angiography for identification of vessel occlusion and collateral status in acute ischemic stroke. - Materials and methods: One hundred twenty-three patients with stroke with large-vessel occlusion before thrombectomy were included in this retrospective study. Before thrombectomy, 3T MR imaging, including conventional 3D TOF-MRA of the intracranial arteries and contrast-enhanced MRA of intra- and extracranial arteries, was performed. Both techniques were assessed independently by 2 neuroradiologists for location of the occlusion, imaging quality, and collateral status. Findings were compared, with subsequent DSA as the reference standard. - Results: Both techniques had good interrater agreement of κ = 0.74 (95% CI, 0.66–0.83) for TOF-MRA and κ = 0.72 (95% CI, 0.63–0.80) for contrast-enhanced MRA. Occlusion localization differed significantly on TOF-MRA compared with DSA (P < .001), while no significant difference was observed between DSA and contrast-enhanced MRA (P = .75). Assessment of collaterals showed very good agreement between contrast-enhanced MRA and DSA (94.9% with P = .25), but only fair agreement between TOF-MRA and DSA (23.2% with P < .001). - Conclusions: Contrast-enhanced MRA offers better diagnostic accuracy than TOF-MRA in acute ischemic stroke. Contrast-enhanced MRA was superior in localizing vessel occlusion within a shorter acquisition time while providing a larger coverage, including extracranial vessels, and a more accurate assessment of collateral status. These results support inclusion of contrast-enhanced MRA in acute stroke MR imaging, perhaps making TOF-MRA superfluous. |
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| Item Description: | Gesehen am 07.05.2019 |
| Physical Description: | Online Resource |
| ISSN: | 1936-959X |
| DOI: | 10.3174/ajnr.A5771 |