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Assessment of CE-MRA for the rapid detection of supra-aortic vascular disease

From the Stroke Neuroscience Unit (V.L. Wright and N. Alberts-Grill, and Drs. Yu and Baird) and Section on Stroke Diagnostics and Therapeutics (Dr. Latour), NINDS, NIH; and Suburban Hospital (Drs. Olan, Dick, and Baird), Bethesda, MD.

Address correspondence and reprint requests to Dr. Alison E. Baird, Stroke Neuroscience Unit, NINDS/NIH, 10 Center Drive, MSC 1294, Room 3N258, Bethesda, MD 20892-1294; e-mail: bairda{at}ninds.nih.gov

Background: Contrast-enhanced MR angiography (CE-MRA) using a combined head and neck coil permits non-invasive imaging of the vasculature from the aortic arch through to the Circle of Willis in less than 2 minutes.

Objective: To determine the accuracy of CE-MRA for the detection of vascular pathology, in particular vascular stenoses, using digital subtraction angiography (DSA) as the gold standard.

Methods: In a prospective study of 81 patients referred for DSA, CE-MRA and DSA studies were performed within 72 hours of each other. CE-MRA was performed on a 1.5 Tesla clinical MRI scanner using a five-channel neurovascular array (head and neck coil), with dynamic tracking of the IV gadolinium bolus. CE-MRAs and DSA films were read by two interventional neuroradiologists blinded to the clinical presentation of the patient.

Results: On DSA, there were 77 vascular stenoses 50% identified, 51 extracranial and 26 intracranial. The overall sensitivity of CE-MRA using the neurovascular array for the detection of vascular stenoses 50% was 57% (95% CI: 46 to 68%) with a specificity of 98% (97 to 99%). The sensitivity for the detection of extracranial vascular stenoses 50% was 82% (72 to 93%) with a specificity of 97% (96 to 98%). However, the sensitivity for the detection of intracranial vascular stenoses 50% was only 8% (0 to 18%), with a specificity of 99% (98 to 100%).

Conclusions: At this stage Contrast-enhanced MR angiography using a neurovascular coil shows promise as a rapid, specific, and noninvasive screening method for extracranial vascular disease, but not for intracranial vascular disease.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 12 issue to find the title link for this article.

Presented at the 5th World Stroke Congress; Vancouver; Canada; June 25, 2004.

Received August 13, 2004. Accepted in final form March 18, 2005.

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