Contrast-enhanced time-resolved 4D MRA of congenital heart and vessel anomalies: image quality and diagnostic value compared with 3D MRA

Objectives

To evaluate time-resolved interleaved stochastic trajectories (TWIST) contrast-enhanced 4D magnetic resonance angiography (MRA) and compare it with 3D FLASH MRA in patients with congenital heart and vessel anomalies.

Methods

Twenty-six patients with congenital heart and vessel anomalies underwent contrast-enhanced MRA with both 3D FLASH and 4D TWIST MRA. Images were subjectively evaluated regarding total image quality, artefacts, diagnostic value and added diagnostic value of 4D dynamic imaging. Quantitative comparison included signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and vessel sharpness measurements.

Results

Three-dimensional FLASH MRA was judged to be significantly better in terms of image quality (4.0?±?0.6 vs 3.4?±?0.6, P?<?0.05) and artefacts (3.8?±?0.4 vs 3.3?±?0.5, P?<?0.05); no difference in diagnostic value was found (4.2?±?0.4 vs 4.0?±?0.4); important additional functional information was found in 21/26 patients. SNR and CNR were higher in the pulmonary trunk in 4D TWIST, but slightly higher in the systemic arteries in 3D FLASH. No difference in vessel sharpness delineation was found.

Conclusions

Although image quality was inferior compared with 3D FLASH MRA, 4D TWIST MRA yields robust images and added diagnostic value through dynamic acquisition was found. Thus, 4D TWIST MRA is an attractive alternative to 3D FLASH MRA.

Key Points

? New magnetic resonance angiography (MRA) techniques are increasingly introduced for congenital cardiovascular problems. ? Time-resolved angiography with interleaved stochastic trajectories (TWIST) is an example. ? Four-dimensional TWIST MRA provided inferior image quality compared to 3D FLASH MRA but without significant difference in vessel sharpness. ? Four-dimensional TWIST MRA gave added diagnostic value.     

Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF

Purpose

Computed tomography angiography (CTA) and magnetic resonance imaging/angiography (MRI/MRA) are used for the diagnosis of intracranial dural arteriovenous fistulas (DAVFs). The purpose of this study was to compare the diagnostic accuracy of CTA and magnetic resonance imaging/angiography (MRI/MRA) for detection of cortical venous reflux (CVR) in intracranial DAVFs.

Methods

The records of patients with angiography-confirmed intracranial DAVFs who also received CTA and MRI/MRA from January 2008 to July 2016 were reviewed. CTA and MRI/MRA were reviewed for signs of CVR, and the diagnostic accuracy of individual signs was evaluated by receiver operating curve (ROC) analysis.

Results

A total 108 patients were included in this study. CTA signs of CVR included abnormal dilatation, early enhancement, and the presence of a medullary or pial vein. MRI/MRA signs of CVR included abnormal dilatation, early enhancement, flow-related enhancement, flow void, and medullary or pial venous collaterals. The sensitivity of individual CTA signs ranged from 62 to 96%, and specificities from 79 to 94%. The sensitivities of individual MRI/MRA signs ranged from 58 to 83%, and specificities from 77 to 93%. The area under ROC curve (AUC) of CTA and MRI/MRA were 0.91 and 0.87, respectively (P?=?0.04 in direct comparison). In subgroup analysis, CTA had better diagnostic accuracy for higher grade disease (P?=?0.05) and non-aggressive manifestation (P?=?0.04).

Conclusions

Both CTA and MRI/MRA have good diagnostic accuracy for detection of CVR in patients with intracranial DAVFs. There is modest evidence that CTA is better than MRI/MRA.

     

Reflux venous flow in dural sinus and internal jugular vein on 3D time-of-flight MR angiography

Introduction

Reflux venous signal on the brain and neck time-of-flight magnetic resonance angiography (TOF MRA) is thought to be related to a compressed left brachiocephalic vein. This study is aimed to assess the prevalence of venous reflux flow in internal jugular vein (IJV), sigmoid sinus/transverse sinus (SS/TS), and inferior petrosal sinus (IPS) on the brain and neck TOF MRA and its pattern.

Methods

From the radiology database, 3,475 patients (1,526 men, 1,949 women, age range 19–94, median age 62 years) with brain and neck standard 3D TOF MRA at 3 T and 1.5 T were identified. Rotational maximal intensity projection images of 3D TOF MRA were assessed for the presence of reflux flow in IJV, IPS, and SS/TS.

Results

Fifty-five patients (1.6 %) had reflux flow, all in the left side. It was more prevalent in females (n?=?43/1,949, 2.2 %) than in males (n?=?12/1,526, 0.8 %) (p?=?0.001). The mean age of patients with reflux flow (66 years old) was older than those (60 years old) without reflux flow (p?=?0.001). Three patients had arteriovenous shunt in the left arm for hemodialysis. Of the remaining 52 patients, reflux was seen on IJV in 35 patients (67.3 %). There were more patients with reflux flow seen on SS/TS (n?=?34) than on IPS (n?=?25).

Conclusion

Venous reflux flow on TOF MRA is infrequently observed, and reflux pattern is variable. Because it is exclusively located in the left side, the reflux signal on TOF MRA could be an alarm for an undesirable candidate for a contrast injection on the left side for contrast-enhanced imaging study.     

Triple-TWIST MRA: high spatial and temporal resolution MR angiography of the entire peripheral vascular system using a time-resolved 4D MRA technique

Objectives

Multi-station contrast-enhanced magnetic resonance angiography (MRA) is considered as the imaging investigation of first choice in patients suffering from peripheral arterial occlusive disease. In order to overcome venous overlay and to gain dynamic flow information as provided by digital subtraction angiography (DSA), we developed a triple injection protocol for high-resolution MRA of the entire peripheral vascular system, applying time-resolved (TR) four-dimensional (4D) MRA sequences.

Methods

Ten patients underwent three-station TR-MRA of the pelvis and lower extremities with DSA as reference standard. Both investigations were compared concerning stenosis on a segment-by-segment basis. Furthermore, 28 consecutive patients underwent the same MR-only imaging protocol. All images were evaluated concerning image quality (1 = non-diagnostic, 4 = excellent), venous overlay (from none up to substantial) and time to venous enhancement (very early/early/normal/late).

Results

Three-station TR-MRA proved feasible and was comparable with DSA in 282 vessel segments, with underestimation grade of stenosis in four segments and overestimation in four segments, respectively. In 32/38 patients no venous overlay was noted; in six patients there was mild venous overlay. Image quality was rated excellent or good in most cases.

Conclusions

TR-MRA provides morphological and functional information without any timing issues due to optimal arterial enhancement at high spatial resolution without venous overlay.

Key Points

? Contrast-enhanced MR angiography (MRA) has become widely accepted. ? Time-resolved (TR) MRA provides dynamic arterial flow information without venous overlay. ? TR-MRA and DSA show comparable results for assessment of stenosis. ? TR-MRA provides excellent-good image quality of the peripheral vascular system.     

Evaluation of contrast-enhanced magnetic resonance angiography (MRA) using Gd-DOTA compared with time-of-flight MRA in the diagnosis of clinically significant non-coronary arterial disease

Objectives

This trial assessed diagnostic accuracy of contrast-enhanced magnetic resonance angiography (MRA) with meglumine gadoterate (Gd-DOTA) at 3 Tesla (T) over unenhanced MRA at 3 T in non-coronary arterial diseases by comparing their accuracy with that of the gold standard, x-ray angiography.

Methods

Ninety-two patients with suspected non-coronary arterial disease underwent in fixed sequence unenhanced time-of flight (TOF) MRA, contrast-enhanced MRA using a Gd-DOTA bolus (intravenous bolus 0.1 mmol/kg) and x-ray angiography.

Results

Eighty-four patients (71 male, 13 female; median age 64.5 years) were included in an intent-to-treat efficacy analysis. Targeted vascular areas were aorto-iliac, calf, carotid, femoral, popliteal and renal. Within-patient accuracy was significantly higher with contrast-enhanced MRA using Gd-DOTA than with unenhanced MRA (p?=?0.0003). There was 84.4?±?17.5% agreement between contrast-enhanced MRA (Gd-DOTA) and x-ray angiography, compared with 76.8?±?20.4% between non-enhanced MRA and x-ray angiography. Sensitivity and specificity were also better with Gd-DOTA compared with non-enhanced MRA at the segment level. Duration of the MRA procedure was 3.5 times shorter with Gd-DOTA compared with non-enhanced MRA. Six patients reported six mild or moderate adverse events. No serious adverse events occurred.

Conclusions

Contrast-enhanced MRA using Gd-DOTA at 3 T was superior to unenhanced TOF MRA in the vascular territories investigated.     

Noncontrast‐enhanced four‐dimensional MR angiography for the evaluation of cerebral arteriovenous malformation: A preliminary trial

Purpose:

To prospectively evaluate noncontrast‐enhanced (NCE), time resolved, four‐dimensional (4D) magnetic resonance angiography (MRA) for assessment of cerebral arteriovenous malformation (AVM), with intraarterial digital subtraction angiography (DSA) performed as the reference standard.

Materials and Methods:

Fifteen patients (ten men, five women; age range 2–59 years, mean 29.4 years) with 15 untreated cerebral AVMs comprised the study population. NCE 4D MRA was performed on a 3.0 T MR scanner. MR images were reviewed by two independent readers and compared with DSA with respect to arterial feeders, nidus size, and venous drainage. Kappa coefficients of concordance were computed to determine the interobserver and intermodality agreements for the depiction of arterial feeders, nidus, and venous drainage between the two techniques.

Results:

Fifteen AVMs detected in DSA were visualized in NCE 4D MRA. Intermodality agreements were excellent for the arterial feeders (K = 0.918, P = 0.000), good for the nidus size (K = 0.692, P = 0.000), and moderate for the venous drainage (K = 0.495, P = 0.001).

Conclusion:

NCE 4D MRA is a promising and potentially valuable method for noninvasive assessment of angioarchitecture and hemodynamics of cerebral AVMs. Further improvement of labeling persistence is desirable in order to enhance the depiction of draining veins for AVMs. J. Magn. Reson. Imaging 2011;. © 2011 Wiley Periodicals, Inc.     

MRI of intracranial vertebral artery dissection: evaluation of intramural haematoma using a black blood, variable-flip-angle 3D turbo spin-echo sequence

Introduction

We investigated the efficacy of three-dimensional black blood T1-weighted imaging (3D-BB-T1WI) using a variable refocusing flip angle turbo spin-echo sequence in the diagnosis of intracranial vertebral artery dissection (VAD).

Methods

Sixteen consecutive patients diagnosed with intracranial VAD underwent magnetic resonance imaging that included 3D time-of-flight-MRA, axial spin-echo T1-weighted images (SE-T1WI) and oblique coronal 3D-BB-T1WI sequences. The visualization, morphology and extent of intramural haematomas were assessed and compared among the sequences. Results obtained by digital subtraction angiography (DSA), 3D-angiography and/or 3D-CT angiography (CTA) were used as standards of reference.

Results

3D-BB-T1WI revealed intramural haematomas in all cases, whereas SE-T1WI and magnetic resonance angiography (MRA) failed to reveal a haematoma in one case and three cases, respectively. The mean visualization grading score for the intramural haematoma was the highest for 3D-BB-T1WI, and there was a statistically significant difference among the sequences (p?<?0.001). At least a portion of the intramural haematoma was distinguishable from the lumen on 3D-BB-T1WI, whereas the haematomas were entirely indistinguishable from intraluminal signals on MRA in two cases (12.5 %) and on SE-T1WI in one case (6.3 %). 3D-BB-T1WI revealed the characteristic crescent shape of the intramural haematoma in 14 cases (87.5 %), whereas SE-T1WI and MRA revealed a crescent shape in only 7 cases (43.8 %) and 8 cases (50 %), respectively. In a consensus reading, 3D-BB-T1WI was considered the most consistent sequence in representing the extent and morphology of the lesion in 14 cases (87.5 %), compared to DSA and CTA.

Conclusion

3D-BB-T1WI is a promising method to evaluate intramural haematoma in patients with suspected intracranial VAD.     

Nonenhanced ECG-gated time-resolved 4D Steady-state free precession (SSFP) MR angiography (MRA) for assessment of cerebral collateral flow: comparison with digital subtraction angiography (DSA)

Objectives

To evaluate a nonenhanced time-resolved 4D SSFP MRA for dynamic visualization of intracranial collateral blood flow.

Methods

22 patients (59.0?±?11.8 years) with steno-occlusive disease of brain-supplying arteries were included in this study. 4D SSFP MRA of the intracranial arteries was acquired with 15 temporal phases and a temporal resolution of 115 ms using 1.5 T MR. Cerebral DSA served as the reference standard and was available in all patients.

Results

Nonenhanced 4D SSFP MRA allowed for detailed dynamic visualization of blood flow in the circle of Willis and its branches in 21 of 22 (95.5%) patients. Collateral flow was excluded with both 4D SSFP MRA and DSA in 4 patients. In 17 patients, DSA detected anterior collateral flow (n?=?8), posterior collateral flow via the right (n?=?8) and left (n?=?7) posterior communicating artery as well as patent EC-IC bypasses (n?=?8). 29 of 31 collateral flow pathways were visualized by 4D SSFP MRA. As compared to DSA, 4D SSFP MRA showed a high sensitivity (92.3%), specificity (100%), positive predictive value (100%) and negative predictive value (95.2%) for visualization of intracranial collateral flow.

Conclusions

4D SSFP MRA is a promising non-invasive imaging technique for dynamic visualization of intracranial collateral flow.     

Effects of cardiac motion on 3D contrast-enhanced MR angiography of the carotid arteries

Purpose:

To determine the effect of cardiac‐related carotid artery motion on the image quality of 3D contrast‐enhanced MR angiography (CEMRA) in patients presenting with suspected carotid artery disease.

Materials and Methods:

Twenty patients with suspected carotid artery disease underwent cardiac‐gated cinematic steady‐state free precession of the carotid arteries followed by standard 3D CEMRA at 1.5 T. Using postprocessing, computer programs determined the degree of vessel wall dilation and translation across the cardiac cycle from the cinematic exam and related this to vessel wall sharpness in 3D CEMRA, which was determined objectively by computer analysis and subjectively by a panel of expert neuroradiologists.

Results:

In patients, across 40 arteries the average carotid vessel movement due to cardiac pulsation was 0.36 ± 0.17 mm and translation 1.53 ± 0.94 mm. When using computer analysis of sharpness, the mean carotid wall motion had a weak negative correlation with 3D CEMRA vessel sharpness (Pearson's correlation ?0.23, P < 0.01). However, the same trend was not present from the radiological review.

Conclusion:

In standard 3D CEMRA in patients with suspected carotid artery disease, cardiac‐related carotid movement was a statistically significant source of degradation in vessel sharpness, but did not appear to be clinically significant. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.

     

Transarterial Onyx packing of the transverse-sigmoid sinus for dural arteriovenous fistulas

Objective

To report transarterial Onyx packing of the transverse–sigmoid sinus for dural arteriovenous fistulae (DAVFs).

Methods

We retrospectively studied consecutive 5 patients (2 female and 3 male) treated for a transverse–sigmoid sinus DAVF since 2008 in whom transverse sinus packing was attempted with a transarterial approach Onyx embolization. The mean clinical follow-up period was 6.2 months.

Results

Of the five lesions, 2 fistulas were type IIa, 3 were type IIb, according to the Cognard classification. Five Onyx embolizations were all performed via the middle meningeal artery. Cure was obtained in all cases after completion of direct sinus packing. No complications were revealed.

Conclusions

Transarterial Onyx packing of transverse–sigmoid sinus for DAVFs via the meningeal arterial system is a safe therapeutic alternative in selected cases.     

Phase-contrast MR angiography of intracranial dural arteriovenous fistulae

MRI and phase-contrast MR angiography (PC MRA) were obtained in 13 patients with angiographically confirmed intracranial dural arteriovenous fistulae (DAVF). Three- and two-dimensional PC MRA was obtained with low (6–20 cm/s) and high (> 40 cm/s) velocity encoding along the three main body axes. MRI showed focal or diffuse signal abnormalities in the brain parenchyma in six patients, dilated cortical veins in seven, venous pouches in four with type IV DAVF and enlargement of the superior ophthalmic vein in three patients with DAVF of the cavernous sinus. However, it showed none of the fistula sites and did not allow reliable identification of feeding arteries. 3D PC MRA enabled identification of the fistula and enlarged feeding arteries in six cases each. Stenosis or occlusion of the dural sinuses was detected in six of eight cases on 3D PC MRA with low velocity encoding. In six patients with type II DAVF phase reconstruction of 2D PC MRA demonstrated flow reversal in the dural sinuses or superior ophthalmic vein. Received: 14 May 1998 Accepted: 15 December 1998     

Reversibility of cognitive disorder after treatment of dural arteriovenous fistulae

Introduction

Dural arteriovenous fistulae (DAVF) occasionally lead to cognitive disorders whose reversibility after DAVF treatment remains unclear. We studied changes on pre- and post-treatment magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) scans in ten patients with cognitive disorder due to DAVF.

Methods

We studied the symptoms, pre- and post-treatment MRI scans, SPECT findings, and mini-mental state examination (MMSE) and treatment results in ten patients with cognitive disorder due to DAVF. They were divided into two groups; the post-treatment MMSE score exceeded 25 points in group 1 (n?=?6) and was lower than 24 points in group 2 (n?=?4).

Results

In the six group 1 patients, pretreatment diffusion-weighted images (DWI) showed hyperintense areas, and SPECT scans demonstrated the preservation of vasoreactivity after acetazolamide challenge. In the four group 2 patients, pretreatment SPECT demonstrated hypoperfusion areas that coincided with the hyperintense areas seen on DWI; there were areas with marked disturbance in vasoreactivity. The post-treatment MMSE score in groups 1 and 2 improved by 13.7?±?2.4 and 3.8?±?1.0 points, respectively; the difference was significant at p?<?0.01.

Conclusion

In patients with cognitive disorder due to DAVF, the preservation of vasoreactivity on SPECT after acetazolamide challenge indicates that their cognitive disorder may be reversible by DAVF treatment.     

Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension

Objective

To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) and the added benefit of unenhanced proton MR angiography compared with CT pulmonary angiography (CTPA) in patients with chronic thromboembolic disease (CTE).

Methods

A 2?year retrospective study of 53 patients with chronic thromboembolic pulmonary hypertension who underwent CTPA and MRI for suspected pulmonary hypertension and a control group of 36 patients with no CT evidence of pulmonary embolism. The MRI was evaluated for CTE and the combined diagnostic accuracy of ce-MRA and unenhanced proton MRA was determined. CE-MRA generated lung perfusion maps were also assessed.

Results

The overall sensitivity and specificity of CE-MRA in diagnosing proximal and distal CTE were 98% and 94%, respectively. The sensitivity improved from 50% to 88% for central vessel disease when CE-MRA images were analysed with unenhanced proton MRA. The CE-MRA identified more stenoses (29/18), post-stenosis dilatation (23/7) and occlusions (37/29) compared with CTPA. The CE-MRA perfusion images showed a sensitivity of 92% for diagnosing CTE.

Conclusion

CE-MRA has high sensitivity and specificity for diagnosing CTE. The sensitivity of CE-MRA for visualisation of adherent central and lobar thrombus significantly improves with the addition of unenhanced proton MRA which delineates the vessel wall.     

Venous angioarchitectural features of intracranial dural arteriovenous shunt and its relation to the clinical course

Introduction

The aim of this study is to assess the relationship between the venous angioarchitectural features and the clinical course of intracranial dural arteriovenous shunt (DAVS) with cortical venous reflux (CVR).

Methods

With institutional review board approval, 41 patients (M:F?=?24:17; median age, 52 years (range, 1–72 years), median follow-up; 1.5 years; partial treatment, n?=?36) with persistent CVR were included. We evaluated the initial presentation and the incidence of annual morbidity (hemorrhage or new/worsened nonhemorrhagic neurological deficit (NHND)) according to the venous angiographic patterns—isolated venous sinus, occlusion of the draining sinus, direct pial venous drainage, pseudophlebitic pattern, venous ectasia, brisk venous drainage, and length of pial vein reflux—on digital subtraction angiography. Cox regression was performed to identify independent factors for clinical course.

Results

During 111.9 patient-years of follow-up, the overall annual morbidity rate was 11.6 % (mortality; n?=?3, rate; 2.6 %/year). Hemorrhage occurred in five patients (12.2 %, rate; 4.5 %/year) and new/worsened NHND occurred in eight patients (19.5 %, rate; 7.2 %/year). Patients with isolated venous sinus, direct pial venous drainage, and pseudophlebitic pattern were associated with initial aggressive presentation. Venous ectasia was associated with initial hemorrhagic presentation. Brisk venous drainage was associated with initial benign presentation. Patients with isolated venous sinus showed a poor clinical course with a higher annual incidence of hemorrhage or new/worsened NHND (91.2 %/year vs 9.2 %/year; hazard ratio, 6.681; p?=?0.027).

Conclusions

Venous angioarchitectural features may be predictive of the clinical course of DAVSs. DAVS patients with isolated venous sinus may be especially at high risk for future aggressive clinical course.     

In vitro comparison of different carotid artery stents: a pixel-by-pixel analysis using CT angiography and contrast-enhanced MR angiography at 1.5 and 3 T

Introduction  

CT angiography (CTA) and MR angiography (MRA) are increasingly used methods for evaluation of stented vessel segments. The purpose of this study was to compare CTA, contrast-enhanced MRA (CEMRA) at 1.5 T, and CEMRA at 3 T for the visualization of carotid artery stents and to define the best noninvasive imaging technique for each stent.     

Non-ECG-gated unenhanced MRA of the carotids: Optimization and clinical feasibility

Objectives

To optimise and assess the clinical feasibility of a carotid non-ECG-gated unenhanced MRA sequence.

Methods

Sixteen healthy volunteers and 11 patients presenting with internal carotid artery (ICA) disease underwent large field-of-view balanced steady-state free precession (bSSFP) unenhanced MRA at 3T. Sampling schemes acquiring the k-space centre either early (kCE) or late (kCL) in the acquisition window were evaluated. Signal and image quality was scored in comparison to ECG-gated kCE unenhanced MRA and TOF. For patients, computed tomography angiography was used as the reference.

Results

In volunteers, kCE sampling yielded higher image quality than kCL and TOF, with fewer flow artefacts and improved signal homogeneity. kCE unenhanced MRA image quality was higher without ECG-gating. Arterial signal and artery/vein contrast were higher with both bSSFP sampling schemes than with TOF. The kCE sequence allowed correct quantification of ten significant stenoses, and it facilitated the identification of an infrapetrous dysplasia, which was outside of the TOF imaging coverage.

Conclusions

Non-ECG-gated bSSFP carotid imaging offers high-quality images and is a promising sequence for carotid disease diagnosis in a short acquisition time with high spatial resolution and a large field of view.

Key Points

? Non-ECG-gated unenhanced bSSFP MRA offers high-quality imaging of the carotid arteries. ? Sequences using early acquisition of the k-space centre achieve higher image quality. ? Non-ECG-gated unenhanced bSSFP MRA allows quantification of significant carotid stenosis. ? Short MR acquisition times and ungated sequences are helpful in clinical practice. ? High 3D spatial resolution and a large field of view improve diagnostic performance.     

Long-term MRA follow-up after coiling of intracranial aneurysms: impact on mood and anxiety

Introduction

Magnetic resonance angiography (MRA) screening for recurrence of a coiled intracranial aneurysm and formation of new aneurysms long-term after coiling may induce anxiety and depression. In coiled patients, we evaluated effects on mood and level of anxiety from long-term follow-up MRA in comparison to general population norms.

Methods

Of 162 patients participating in a long-term (>4.5?years) MRA follow-up after coiling, 120 completed the EQ-5D questionnaire, a visual analog health scale and a self-developed screening related questionnaire at the time of MRA. Three months later, the same questionnaires were completed by 100 of these 120 patients. Results were compared to general population norms adjusted for gender and age.

Results

Any problem with anxiety or depression was reported in 56 of 120 patients (47%; 95%CI38?56%) at baseline and 42 of 100 patients (42%; 95%CI32?52%) at 3?months, equally for screen-positives and -negatives. Compared to the reference population, participants scored 38% (95%CI9?67%) and 27% (95%CI4?50%) more often any problem with anxiety or depression. Three months after screening, 21% (20 of 92) of screen-negatives and 13% (one of eight) of screen-positives reported to be less afraid of subarachnoid hemorrhage (SAH) compared to before screening. One of eight screen-positives reported increased fear of SAH.

Conclusions

Patients with coiled intracranial aneurysms participating in long-term MRA screening reported significantly more often to be anxious or depressed than a reference group. Screening did not significantly increase anxiety or depression temporarily. However, subjectively, patients did report an increase in anxiety caused by screening, which decreased after 3?months.     

Cerebrovascular stenosis in neurofibromatosis type 1 and utility of magnetic resonance angiography: our experience and literature review

Purpose

Neurofibromatosis type 1 (NF1) is a multisystem autosomal dominant disorder that primarily involves the skin and the nervous system. Development of cerebral arterial stenosis is a potentially deadly complication of NF1, which is frequently underestimated. The aim of our paper is to report the frequency of this cerebrovascular disease in a series of patients affected by NF1, using magnetic resonance angiography (MRA). A review of the literature was also performed, focused on the usefulness of MRA in NF1 patients.

Materials and methods

Among 125 patients with NF1 (clinical diagnosis according to the standard National Institutes of Health criteria), 81 (65 %) were studied with brain MRI (magnetic resonance imaging) and MRA using a 1.5 T magnet.

Results

Multiple intracranial arterial stenoses were found in six patients (7.4 %). In our study, MRA proved to be critical, especially for the detection of stenoses in the branches of the Circle of Willis.

Conclusion

Few case series have investigated the incidence of vascular complications of NF1, and most of them have used MRI. We suggest adding MRA to the brain imaging of all these patients, as stenoses of the branches of the Circle of Willis are often undetectable by MRI only.     

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.     

Diagnosis of moyamoya disease using 3-T MRI and MRA: value of cisternal moyamoya vessels

Introduction

The purpose of this study was to propose new magnetic resonance (MR) criteria of diagnosing moyamoya disease (MMD) from cisternal moyamoya vessels (MMVs) on 3-T magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA) and compare the diagnostic accuracy of the existing MR criteria and the proposed MR criteria.

Methods

Participants comprised 20 consecutive patients with MMD (4 males, 16 females) diagnosed clinically using conventional angiography and 20 controls (13 male and 7 female arteriosclerosis patients). In these participants, 3-T MRI/MRA was evaluated by the existing MR criteria, which use MMVs in the basal ganglia, and the proposed MR criteria, which use cisternal MMVs, and then these two criteria were statistically compared by McNemar’s test.

Results

Diagnostic accuracy was 62.5% with the existing MR criteria and 97.5% with the proposed MR criteria. The proposed MR criteria was more sensitive (1.00) than the existing MR criteria (0.45), but less specific (0.95) than the existing MR criteria (1.00).

Conclusion

The proposed MR criteria using cisternal MMVs showed significantly higher diagnostic accuracy than the existing MR criteria. We believe that our proposed MR criteria will be beneficial for diagnosing MMD.