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

Kambiz Nael, A. Meshksar, B. Ellingson, M. Pirastehfar, N. Salamon, P. Finn, D. S. Liebeskind, J. P. Villablanca

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    Abstract

    BACKGROUND AND PURPOSE: 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 contrastenhanced MRA and dynamic susceptibility contrast perfusion, without additional contrast. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

    Original languageEnglish
    Pages (from-to)1078-1084
    Number of pages7
    JournalAmerican Journal of Neuroradiology
    Volume35
    Issue number6
    DOIs
    Publication statusPublished - 1 Jan 2014

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    Nael, K., Meshksar, A., Ellingson, B., Pirastehfar, M., Salamon, N., Finn, P., Liebeskind, D. S., & Villablanca, J. P. (2014). Combined low-dose contrast-enhanced MR angiography and perfusion for acute ischemic stroke at 3T: A more efficient stroke protocol. American Journal of Neuroradiology, 35(6), 1078-1084. https://doi.org/10.3174/ajnr.A3848