Abstract
The technology advancement including high performance gradients, parallel imaging, more efficient methods in sampling k-space, intravascular contrast agents, and higher magnetic field strengths, allows to improve time and spatial resolution of contrast-enhanced MRA. Moreover, technical refine-ments contribute to a renaissance of nonenhanced MRA techniques.
Clinical applications of MRA in studying neck vessels benefit of both faster acquisitions and sharpened images. Arterial steno-occlusive disease of supra-aortic vessels may lead to cerebral infarction that is one of the main worldwide problem of public health. Therefore, the principal MRA application concerns the atherosclerosis of carotid bifurcation. In this field, MRA is a competitor of CTA as a confirmatory noninvasive diagnostic test, aiming to replace DSA in the diagnostic workup of patients with carotid stenosis. In this chapter, we discuss the role and limitations of MRA in grading carotid stenosis before revascularization. Indication to surgical or endovascular revascularization could be set with MRA with a low misclassification rate in case of high-grade carotid stenosis while inconclusive data are available for moderate stenosis.
Because of its short acquisition time, neck vessels MRA can be easily implemented in an MRI protocol of patients with cerebrovascular pathology also in the acute phase of the disease. Typical examples are carotid or vertebral dissections as the main cause of juvenile stroke. In these cases, MRA in conjunction with conventional MR images allows a prompt diagnosis avoiding invasive procedures both at the onset and in the follow-up for monitoring recanalization or eventual pseudoaneurismatic dilation.
Since the introduction of dedicated coils coflering the upper thorax, MRA constitutes a robust tool for the panoramic eflaluation of the origin of epiaortic flessel, a flascular district traditionally difficult to be explored noninflasiflely. Stenosis of flertebral origin, subclaflian steal, or thoracic outlet syndrome can now be detected with an objectifle noninflasifle technique.
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Cosottini, M., Pesaresi, I. (2010). Neck Vessels. In: Neri, E., Cosottini, M., Caramella, D. (eds) MR Angiography of the Body. Diagnostic Imaging. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79717-3_7
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DOI: https://doi.org/10.1007/978-3-540-79717-3_7
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