FSD-bSSFP非增强MRA下肢动脉病变诊断的初步探讨

目的探讨以血流敏感散相(flow-sensitive dephasing,FSD)为准备脉冲的平衡稳态自由进动序列(bSSFP)在下肢动脉病变中的诊断价值。资料与方法 42例糖尿病患者采用FSD-bSSFP序列非增强磁共振血管造影(NC-MRA)和对比增强磁共振血管造影(CE-MRA)行小腿部动脉扫描,将血管分为胫前动脉、胫后动脉和腓动脉3个节段。以CE-MRA作为参照标准,评价FSD-bSSFP上各血管的狭窄程度(分为0～4级),计算FSD-bSSFP各级血管狭窄程度的敏感性、特异性、阳性预测值、阴性预测值和诊断准确性。运用配对χ2检验分析两种检查方法诊断血管显著性狭窄(≥50%和闭塞)有无统计学差异,并采用Cohen’s kappa检验进行一致性分析。分析FSD-bSSFP在下肢动脉病变的应用价值。结果 42例中41例成功进行了FSD-bSSFP检查,获取243个动脉节段。FSD-bSS-FP对下肢动脉狭窄各级的(0～4级)敏感性分别为97.87%、98.13%、96.86%、94.93%、92.31%;特异性分别为95.10%、93.98%、94.23%、92.31%、84.77%;阳性预测值分别为96...     

颈动脉超声和DSA对颅外段颈动脉狭窄诊断的对比研究

目的:比较彩色多普勒超声(CDFI)和血管造影(DSA)对颅外段颈动脉狭窄的诊断价值。方法:对112例怀疑颈动脉狭窄的患者行颈动脉CDFI检查,然后再行DSA检查,对比两者的检查结果并进行分析。结果:以DSA检查结果为金标准,CDFI对颈动脉狭窄诊断的敏感性87.28%,特异性65.63%,准确性86.16%,阳性预测值87.28%,阴性预测值82.35%。结论:CDFI对颅外段颈动脉狭窄的敏感性高,可重复,无创伤,且对狭窄的原因能做出判断,适合于人群的筛选检查。DSA检查作为诊断颈动脉狭窄的金标准,可以起确诊作用。而二者结合可以全方位地了解狭窄的颈动脉,为临床制定合理的治疗方案提供依据。     

彩色多普勒与CTA在颈动脉血管支架置入术中的对比研究

目的：探讨双功能彩色多普勒（CDFI）和多层螺旋CT血管成像（MSCTA）在颈动脉狭窄血管内支架置入术中的应用价值。方法：回顾性分析行颈动脉支架置入的36例患者治疗前后的CDFI及MSCTA的影像资料,以DSA为标准,比较CDFI和MSCTA两种方法对颈部血管狭窄程度判断及粥样硬化斑块密度分析的符合率;比较这两种方法在颈动脉狭窄血管内支架置入术中的应用价值。结果：CDFI及MSCTA诊断颈动脉狭窄的敏感度分别为90.9%和92.8%,特异度分别为95.6%和95.7%,诊断符合率分别为92.4%和93.8%,阴性预测值分别为82.7%和86.5%,阳性预测值分别为97.8%和97.8%。MSCTA检出粥样动脉硬化斑块分型与CDFI的符合率为86.9%。结论：在颈动脉狭窄血管内支架置入术影像学检查中,CDFI可作为颈动脉病变筛查、术后疗效评价及随访的首选检查方法,MSCTA显示高位分叉的颈内动脉、颈内动脉入颅段及血管走向变异更有优势,两者结合可提高诊断符合率。     

超声诊断颈动脉狭窄的临床应用价值分析

目的探讨血管超声诊断颈动脉狭窄的临床应用价值。方法对84例缺血性脑血管病患者分别采用血管超声和经导管造影诊断患者的动脉狭窄情况,比较两种方法的诊断效果。结果血管超声对颈总动脉、颈总动脉分叉处、颈内动脉等部位的斑块检出率明显高于血管造影,且差异具有统计学意义。血管超声与血管造影对颈动脉狭窄程度评估分级对比无明显差异(P0.05)。以血管造影为金标准,血管超声诊断总动脉狭窄的敏感性、特异性及准确性分别为97.01%、100%、97.62%;而对重度狭窄的诊断敏感性为93.33%,特异性为100%,准确性为97.62%。结论血管超声诊断颈动脉狭窄的敏感性较高,其对颈动脉狭窄程度的判断与DSA具有较高的一致性,可用于颈动脉狭窄的筛选和随访。     

多层螺旋CT血管造影在颈部动脉狭窄扩张和支架置入术中的临床应用

目的:探讨多层螺旋CT血管造影(MSCTA)诊断颈部动脉狭窄和粥样硬化斑块及其在血管腔内球囊扩张和支架置入术中的价值。材料和方法:对105例症状性颈部动脉硬化狭窄患者进行MSCTA检查,其中24例于MSCTA检查前后2周内进行了数字减影血管造影(DSA)检查,49例进行了彩色多普勒超声(CFDS)检查。MSCTA扫描横断面轴位图像应用三维重建技术作图像后处理,每段病变动脉的狭窄程度和成分比例由GEAW4.3工作站AVA软件自动测量。其中狭窄程度与DSA相比较,评价MSCTA自动测量血管诊断颈部动脉狭窄的准确性。粥样硬化斑块密度分析与CFDS相比较,评价MSCTA彩色编码技术分析成分比例的准确性。结果:以DSA为金标准,MSCTA影像判断颈部动脉硬化狭窄患者病变动脉≥70%狭窄的敏感性为96.4%,特异性为91.0%,阴性预测率为97.6%,阳性预测率为86.9%,准确性为93.1%。MSCTA检出的粥样硬化斑块图密度分析与CFDS的符合率为80.3%,其中诊断钙化斑块的敏感性为83.3%,特异性为98.2%,准确性为96.7%,阴性预测率为98.2%,阳性预测率为83.3%。结论:MSCTA影像判断颈部动脉硬化狭窄患者病变动脉≥70%狭窄以及诊断钙化斑块有较高的敏感性、特异性和准确性,有助于制订手术方案,选择介入材料及对术中病变部位栓子脱落危险性的评估。     

冠状动脉病变自身因素对CTA评价冠状动脉狭窄准确性的影响

目的 探讨冠状动脉病变自身因素对CTA评估血管狭窄程度准确性的影响. 资料与方法 60例临床拟诊疑为冠状动脉狭窄的患者同期行冠状动脉CT血管造影(CTA)和冠状动脉血管造影检查(CAG).CTA扫描采用64层螺旋CT及回顾性心电门控技术,以CAG结果 为金标准,采用双盲法评价CTA诊断冠状动脉狭窄的准确性,并分析各种冠状动脉病变自身因素对评价狭窄准确性的影响. 结果 CTA诊断冠状动脉轻、中、重度狭窄的敏感性分别为76.47%、77.97%和85.71%,钙化斑块是导致64层螺旋CT评价冠状动脉狭窄假阳性最重要的自身因素(18/28,占64.29%),对于冠状动脉和其分支的狭窄程度的低估占假阴性结果 的66.67%(20/30),壁冠状动脉和心肌桥的漏诊占假阴性结果 的23.33%(7/30). 结论 64层螺旋CT诊断冠状动脉重度狭窄具有较高的准确性,钙化斑块、心肌桥和小血管的狭窄病变本身均影响CTA评价狭窄的准确性,而非钙化斑块和支架/冠状动脉旁路移植术(CABG)后狭窄的诊断准确性较高.     

超声造影与DSA诊断颅外段颈动脉狭窄的对比研究

目的:评价超声造影对颅外段颈动脉狭窄的诊断价值.方法:对16例颅外段颈动脉狭窄患者进行超声造影和DSA检查,分别在所获得的图像上测量颈动脉狭窄的直径狭窄率,并对两组数据进行统计分析.结果:本组超声造影共发现颈动脉血管狭窄39处,37处与DSA分级相符合,假阳性2处,其中颈动脉颅外段狭窄的敏感性、特异性、准确度分别为100%,97.8%～99.0%、97.9%～98.5%(K值=0.928～1).结论:超声造影是对颅外段颈动脉狭窄筛查、术前评估、术后随访的最佳检查方法,能基本替代DSA检查.     

64层螺旋CT冠状动脉成像与冠状动脉造影的对比研究

目的 评价64层螺旋CT冠状动脉造影对冠状动脉疾病的临床诊断价值.方法 59例临床诊断或可疑冠心病患者行64层螺旋CT冠状动脉成像检查,并以冠状动脉造影结果作为对照,分段评价结果,冠状动脉狭窄≥50%为阳性病变.分析64层螺旋CT冠状动脉血管成像(CTA)诊断冠状动脉狭窄的敏感性、特异性、阳性预测值及阴性预测值.结果 共评价741段冠状动脉,64层螺旋CT冠状动脉血管成像用于诊断冠心病的敏感性、特异性、阳性预测值、阴性预测值分别为58.8%、97.7%、76.9%、94.8%.结论 64层螺旋CT冠状动脉血管成像有较高的诊断准确性,可以作为评价冠状动脉狭窄的一种无创检查方法.     

磁共振B-TFE肾动脉血管造影的临床应用

目的 探讨磁共振三维平衡式快速场梯度回波(B-TFE)非对比剂肾动脉血管造影的临床应用价值.方法 选择21例临床疑似肾动脉狭窄病人,行B-TFE、CE-MRA扫描,13例同时行DSA检查.由2位医师独立对图像进行评分,评价B-TFE及CE-MRA肾动脉图像质量、狭窄程度、肾动脉分支及肾静脉伪影显示;以DSA为金标准,用受试者操作特性(ROC)曲线分析B-TFE肾动脉狭窄的灵敏度、特异性、阳性预测值和阴性预测值.结果 肾动脉分支B-TFE组评分2.3～2.5,CE-MRA组评分2.3～2.8(P=0.043).肾静脉伪影B-TFE组评分3.7～3.9, CE-MRA组评分3.4～3.7 (P=0.033).B-TFE诊断肾动脉狭窄的灵敏度为94.7% 、特异性为87.5% 、阳性预测值为94.7% 、阴性预测值为87.5%, 其ROC 曲线下面积为0.904.结论 B-TFE可以准确诊断肾动脉狭窄.     

血管超声与经导管造影诊断颈动脉狭窄的对比研究

目的:评价血管超声技术诊断颈动脉狭窄的临床应用价值。方法:对41例怀疑有颈动脉狭窄的患者行超声(US)和血管造影(DSA)检查,颈动脉狭窄应用NASCET标准测量并计算狭窄率。结果:82支颈内动脉中DSA诊断为正常血管53支、轻度~中度狭窄(≤69%)11支、重度狭窄(≥70%)10支、闭塞(100%)8支;以阴性(正常)与阳性(狭窄或闭塞)为切分点时,超声诊断的敏感度、特异度、阳性预测值、阴性预测值分别为94.2%、90%、94.2%、90%;以血管狭窄率70%为切分点时,其敏感度、特异度、阳性预测值、阴性预测值分别为86.4%、72.7%、89%、66%。结论:血管超声诊断颈动脉狭窄的敏感度较高,但特异度偏低,血管超声可用于颈动脉狭窄的筛选。但对于血管重度狭窄(≥70%)拟行颈动脉内膜剥脱术或经皮颈动脉成形术的患者,术前应行DSA检查。     

3.0T高分辨率CE-MRA对颈部血管狭窄的诊断价值

目的探讨三维对比增强磁共振血管成像(3D CE-MRA)在颈部动脉血管狭窄诊断中的临床应用价值。方法对23例临床拟诊颈部动脉血管狭窄行数字减影血管造影(DSA)的患者行颈部3D CE-MRA。将两种方法检查结果进行相关性比较。结果 23例患者共230个节段血管,3D CE-MRA显示了227个节段,共诊断出74处(32.6%)狭窄,其中28处轻度狭窄,22处中度狭窄,20处重度狭窄,4处闭塞;DSA共显示了230个节段的血管,共诊断出69处(30.4%)血管狭窄,其中24处轻度狭窄,23处中度狭窄,19处重度狭窄,3处闭塞。与DSA相比,3DCE-MRA对颈部动脉轻度、中度、重度狭窄及动脉闭塞的显示敏感性均为100%,特异性分别为85.71%、90.91%、90%和75%,两种检查方法对颈部动脉狭窄程度的判断有良好的一致性(κ=0.921,P=0.000)。结论 3.0T 3DCE-MRA能够可靠的评价颈部动脉狭窄性病变,基本可以替代DSA检查。     

Doppler ultrasound and contrast-enhanced magnetic resonance angiography in assessing carotid artery stenosis

PURPOSE: This study prospectively compares Doppler ultrasound (Doppler US) and contrast-enhanced magnetic resonance angiography (CE-MRA) with digital subtraction angiography (DSA) and endarterectomy findings to determine the accuracy in assessing carotid artery stenosis. MATERIALS AND METHODS: Thirty-two patients underwent carotid endarterectomy, 21 studied with Doppler US, CE-MRA and DSA and 11 with Doppler US and CE-MRA. In 41 carotid arteries, the degree of stenosis was analysed with Doppler US and CE-MRA and compared with DSA by using the Spearman rank correlation coefficient. Nine out of 32 endarterectomies were done using the eversion technique, and it was possible to compare Doppler US, CE-MRA and DSA with the specimen measurement. Twenty-three out of 32 endarterectomies were done using the standard technique, and the presence of ulcers was documented. RESULTS: There was a significant Doppler US/DSA (Rs=0.86; p<0.001) and CE-MRA/DSA (Rs=0.81; p<0.001) correlation for the degree of stenosis. The diagnostic accuracy of the three methods was the same (89%). Ulcers were most frequently seen at CE-MRA, with a diagnostic accuracy of 85%. CONCLUSIONS: These data suggest that endarterectomy on the basis of Doppler US and CE-MRA can be considered appropriate. CEMRA was the best noninvasive imaging modality to detect plaque ulceration.     

三维对比剂增强MR血管成像对颈部动脉病变的诊断价值

目的　分析三维对比剂增强MR血管成像 (3DCE MRA)显示的颈部动脉常见病变 ;与DSA比较 ,明确 3DCE MRA诊断颈部动脉病变的价值。方法　对 741例超声多普勒怀疑颈部动脉疾病的患者进行 3DCE MRA成像 ,并根据其病变表现总结分类。 2 0 6例病人同时行DSA检查 ,将颈部动脉分为颈总、颈内、颈外、锁骨下及椎动脉 5个部位 ,由 2位放射学专家独立评估DSA及 3DCE MRA血管资料。结果　 3 6 7%病例 (2 72 / 741)显示无异常。 63 2 9% (469/ 741)显示颈部动脉有病变 ,共计 82 7段 ,其中动脉粥样斑块占 3 4 2 2 % (2 83段 ) ,动脉狭窄占 3 4 46% (2 85段 ) ,动脉闭塞占 3 3 8% (2 8段 ) ,动脉发育纤细占 14 87% (12 3段 ) ;动脉开口变异占 3 87% (3 2段 ) ,动脉扭曲占 3 63 % (3 0段 ) ,动脉瘤占 0 72 % (6段 ) ,动脉夹层占 1 2 1% (10段 ) ,肿瘤包绕或推压动脉占 1 45% (12段 ) ,术后复查占2 18% (18段 )。对 2 0 6例的 412段血管与DSA比较 ,3DCE MRA在颈总动脉、颈内动脉及椎动脉的阳性检出率差异有显著性意义 (P <0 0 1) ,主要是对动脉粥样斑块 (2 56段与 2 83段 )和动脉狭窄 (2 58段与 2 85段 )存在一定的高估。但对 412段血管整个样本 ,两种方法在同一部位诊断各种血管病变差异无显著性意义 (P >0 0     

对比剂增强的磁共振血管成像技术对比数字减影血管造影在颈部动脉诊断中的应用

目的：回顾性分析透视触发对化剂增强的磁共振血管成像（CE-MRA）技术对颈部血管的应用,与数字减影血管造影（DSA）对比,探讨其敏感性及应用价值。方法收集2011-2012年经MRA检查患者中临床表现有脑供血异常,疑颅内、颈内动脉或椎动脉狭窄、均进行透视触发CE-MRA和DSA检查的病例资料共28例进行分析。结果 CE-MRA检出狭窄部位30处,其中狭窄程度50％以上14处,完全闭塞6处,50％以下10处。 DSA检出狭窄部位28处,其中狭窄程度50％以上8处,完全闭塞4处,50％以下16处。2处MRA疑轻度狭窄,DSA未见异常;2处MRA示完全闭塞（颈内动脉）,而DSA示狭窄率90％以上。结论透视触发CE-MRA简便易行,敏感性与特异性均较高,可以作为可疑颈部及颅内动脉狭窄患者的首选检查方法。     

Efficacy of patient selection strategies for carotid endarterectomy by contrast-enhanced MRA on a 1 T machine and duplex ultrasound in a regional hospital

AIM: To investigate whether contrast-enhanced magnetic resonance angiography (CE-MRA) and duplex ultrasound (DUS) could replace digital subtraction angiography (DSA) for diagnosing internal carotid artery (ICA) stenosis in regional centres with less specialized technicians and equipment, such as a 1 Tesla MRI machine. MATERIALS AND METHODS: Sixty-six consecutive, symptomatic patients with ICA stenosis, as evidenced using DSA, were included. In the first 34 patients DUS was validated and cut-off criteria were established. Data were analysed by receiver operating characteristic curve and logistic regression. Two observers analysed the DUS and CE-MRA results of 32 patients. Stenoses were categorized in accordance with North American Symptomatic Endarterectomy Trial (NASCET) measurement criteria. RESULTS: Peak systolic velocity (PSV) in the ICA was defined as a better parameter for defining stenosis than end diastolic velocity and the PSV ICA:common carotid artery ratio. The optimal PSV threshold was 230cm/s. Four ICAs were not interpretable on DUS, and one on CE-MRA. Two patients did not undergo CE-MRA. The sensitivities and specificities were calculated: for DUS these were 100% and 68% respectively; for observer 1 on CE-MRA these were 93% and 89%, respectively; for observer 2 these were 92% and 87%, respectively. The sensitivity and specificity for combined DUS/CE-MRA were 100% and 85%, respectively. Seventy-eight percent of CE-MRA and DUS correlated. The weighted Kappa for CE-MRA and DSA were 0.8 and 0.9, respectively. CONCLUSION: DUS and CE-MRA are effective non-invasive methods for selecting patients with ICA stenosis for carotid endarterectomy in non-specialized centres using a 1T machine. The present results suggest that no referrals to more specialized centres for non-invasive diagnostic work-up for carotid artery stenoses will be necessary.     

Time-resolved contrast-enhanced magnetic resonance angiography of the carotid arteries: diagnostic accuracy and inter-observer variability compared with selective catheter angiography

RATIONALE AND OBJECTIVES: To assess the diagnostic accuracy and interobserver variability of contrast-enhanced magnetic resonance angiography (CE-MRA) in a time-resolved technique compared with digital subtraction angiography (x-ray DSA) in patients with suspected stenoses of the internal carotid artery. MATERIALS AND METHODS: A total of 43 patients were enrolled in this prospective study. All patients underwent selective x-ray DSA involving a total of 84 carotid arteries. CE-MRA was performed in a time-resolved technique with a fast gradient-echo sequence on a 1.5 T MR scanner: TR 3.8 milliseconds, TE 1.49 milliseconds. Four consecutive measurements, each a duration of 10 seconds, were performed with omission of measuring bolus transit time. Four independent radiologists scored the degree of stenosis. The interobserver variability was calculated for CE-MRA and x-ray DSA. RESULTS: In the 43 cases, at least one MRA measurement showed arterial contrast without venous degradation. Compared with x-ray DSA the mean sensitivity and specificity for grading stenosis > or = 70% were 98% and 86%, respectively. The interobserver agreement was substantial with no significant difference between CE-MRA (kappa value 0.794) and x-ray DSA (kappa value 0.786). CONCLUSIONS: The short acquisition time of a fast CE-MRA sequence allows a selective visualization of the internal carotid arteries without degradation from venous enhancement. It is a reliable method with a good interobserver agreement.     

3D TRICKS MRA对颈动脉粥样硬化狭窄的诊断价值

目的：探讨3D TRICKS MRA对颈动脉粥样硬化狭窄的诊断价值。方法：对43例临床疑诊颈动脉粥样硬化狭窄的患者行2D TOF MRA和3D TRICKS MRA检查,其中31例同期行DSA检查,以颈总动脉法（CC法）计算狭窄率。结果：颈动脉闭塞2支,重度狭窄10支,中度狭窄31支,轻度狭窄25支,正常18支。2D TOF MRA、3D TRICKS MRA与DSA对照,显示狭窄部位均与DSA所示相符。2D TOF MRA高估狭窄程度6支,3D TRICKS MRA高估狭窄程度1支。以DSA为标准,2D TOF MRA诊断颈动脉狭窄的敏感度、特异度、诊断符合率分别为91.6%,85.7%,90.3%（K=0.737）;3D TRICKS MRA诊断颈动脉狭窄的敏感度、特异度、诊断符合率分别为97.9%,100%,98.4%（K=0.955）。两种方法对诊断颈动脉狭窄的敏感度、特异度和诊断符合率差异均具有统计学意义（P〈0.05）。结论：3D TRICKS MRA与DSA对评估颈动脉粥样硬化狭窄具有极好的一致性（K=0.955）,明显优于2D TOF MRA（K=0.737,P〈0.05）,是对颈动脉粥样硬化狭窄筛查、术前评估、术后随访的最佳检查方法,能基本替代DSA检查。     

Accuracy of 3 T MR angioraphy in vertebral artery stenosis and coincidence with other cerebrovascular stenoses

Introduction

Ostium of vertebral artery (VA) is a common site of pseudostenosis on contrast-enhanced MR angiography (CE-MRA). The purpose of this study was to determine the diagnostic accuracy of CE-MRA at 3 T in the evaluation of ostial stenosis of VA and to find associated coincidental stenoses using logistic regression analysis.

Methods

One hundred and thirty-five VA ostial regions from 72 patients who received CE-MRA of neck vessels, intracranial time of flight (TOF) MRA, and digital subtraction angiography (DSA) were retrospectively reviewed. The sensitivity and specificity of the CE-MRA in detection of ostial stenosis were calculated with reference standard of DSA. Ostial stenosis on MRA was correlated with coincidental lesions in intracranial and cervical arteries by logistic regression analysis.

Results

The sensitivity and specificity of the CE-MRA were 100% and 80.4% for detection of significant stenosis. In case of significant stenoses, CE-MRA showed a tendency of overestimation with a false-positive rate of 52.5%. Logistic regression analysis showed that the stenoses of middle cerebral artery (MCA) on TOF MRA was associated with significant stenoses of VA ostia (OR?=?5.84, 95% confidence intervals 1.41–24.17).

Conclusion

CE-MRA is sensitive in detection of VA ostial stenosis although it has high false-positive rate. True positive ostial stenosis should be considered in cases of coincidental stenoses of MCA on TOF MRA.     

Magnetic resonance angiography with contrast media in the study of carotid arteries

PURPOSE: Purpose of our study was to determine the feasibility and accuracy of contrast enhanced Turbo-MRA (CE-MRA) in the evaluation of patients with carotid artery stenosis, using a dynamic technique with multiple acquisitions. MATERIAL AND METHODS: 37 patients with suspected carotid artery stenosis were studied with a 1.5 T magnet (Siemens Vision Plus) using, with a neck phased array coil, a dynamic tridimensional T1 weighted spoiled GRE (TR/TE/NEX: 3.8/1.4/1; Matrix = 110 x 160; FOV = 163 x 260 mm TA = 10 seconds for each sequence); 4 consecutive sequences were performed during the same breath hold, acquired after i.v. bolus injection with a power injector (Spectris, Medrad) of 15 ml of Gd-DTPA followed by 10 ml of saline solution (flow rate 2 ml/s). The beginning of the sequence coincided with the injection of Gd-DTPA. Images were reconstructed using a standard MIP algorithm, by selecting which of the sequences provided the highest enhancement. In all patients a DSA was also performed. Images were separately evaluated using conventional angiography as the gold standard and assessed for degree of stenosis by using NASCET criteria, and morphology of the plaque. RESULTS: CE-MRA correctly evaluated the degree of stenosis in 71 of the 74 patients, while overestimated the remaining 3 cases correctly evaluated by DSA. In 12 cases ulcerations were adequately demonstrated by one of the radiologist, while 11 on 12 were depicted by the other one. CE MRA allowed to detect tandem lesions of the internal carotid arteries (by both radiologists) in 13 of 74 carotids studied. Stenosis at the origin of the common carotid arteries were correctly detected in 9 cases. Sensitivity, specificity and accuracy were respectively of 98, 97 and 99%. DISCUSSION AND CONCLUSIONS: In order to perform an optimal CE-MRA a dynamic technique must be performed to avoid venous filling. The possibility to use ultrafast imaging allows to selectively image the carotid arteries without jugular filling. The well known tendency to overestimate the degree of stenosis has not been found in this group of patients. CE-MRA is a rapid, reliable method to evaluate patients with suspected carotid artery stenosis. These results allow to consider dynamic CE-MRA as a valid method for direct imaging of the carotid arteries.