Combined low-dose contrast-enhanced MR angiography and perfusion for acute ischemic stroke at 3T: A more efficient stroke protocol

There is need to improve image acquisition speed for MR imaging in evaluation of patients with acute ischemic stroke. The purpose of this study was to evaluate the feasibility of a 3T MR stroke protocol that combines low-dose contrast-enhanced MRA and dynamic susceptibility contrast perfusion, witho...

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Bibliographic Details
Published in:American journal of neuroradiology : AJNR 2014-06, Vol.35 (6), p.1078-1084
Main Authors: Nael, K, Meshksar, A, Ellingson, B, Pirastehfar, M, Salamon, N, Finn, P, Liebeskind, D S, Villablanca, J P
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Algorithms
Brain
Brain Ischemia - complications
Brain Ischemia - pathology
Cerebral Arteries - pathology
Contrast Media - administration & dosage
Dose-Response Relationship, Drug
Evidence-Based Medicine Level 2
Feasibility Studies
FELLOWS' JOURNAL CLUB
Humans
Image Enhancement - methods
Magnetic Resonance Imaging - methods
Meglumine - administration & dosage
Meglumine - analogs & derivatives
Middle Aged
Observer Variation
Organometallic Compounds - administration & dosage
Radiation Dosage
Radiation Protection - methods
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity
Stroke - etiology
Stroke - pathology
Time Factors
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Summary:There is need to improve image acquisition speed for MR imaging in evaluation of patients with acute ischemic stroke. The purpose of this study was to evaluate the feasibility of a 3T MR stroke protocol that combines low-dose contrast-enhanced MRA and dynamic susceptibility contrast perfusion, without additional contrast. Thirty patients with acute stroke who underwent 3T MR imaging followed by DSA were retrospectively enrolled. TOF-MRA of the neck and brain and 3D contrast-enhanced MRA of the craniocervical arteries were obtained. A total of 0.1 mmol/kg of gadolinium was used for both contrast-enhanced MRA (0.05 mmol/kg) and dynamic susceptibility contrast perfusion (0.05 mmol/kg) (referred to as half-dose). An age-matched control stroke population underwent TOF-MRA and full-dose (0.1 mmol/kg) dynamic susceptibility contrast perfusion. The cervicocranial arteries were divided into 25 segments. Degree of arterial stenosis on contrast-enhanced MRA and TOF-MRA was compared with DSA. Time-to-maximum maps (>6 seconds) were evaluated for image quality and hypoperfusion. Quantitative analysis of arterial input function curves, SNR, and maximum T2* effects were compared between half- and full-dose groups. The intermodality agreements (k) for arterial stenosis were 0.89 for DSA/contrast-enhanced MRA and 0.63 for DSA/TOF-MRA. Detection specificity of >50% arterial stenosis was lower for TOF-MRA (89%) versus contrast-enhanced MRA (97%) as the result of overestimation of 10% (39/410) of segments by TOF-MRA. The DWI-perfusion mismatch was identified in both groups with high interobserver agreement (r = 1). There was no significant difference between full width at half maximum of the arterial input function curves (P = .14) or the SNR values (0.6) between the half-dose and full-dose groups. In patients with acute stroke, combined low-dose contrast-enhanced MRA and dynamic susceptibility contrast perfusion at 3T is feasible and results in significant scan time and contrast dose reductions.
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A3848