Carotid and Vertebral Circulation: Clinical Applications

  • Sugoto Mukherjee
  • Max Wintermark


Magnetic resonance angiography (MRA) is a broad term referring to a plethora of techniques, all of which can be used to directly image flow in arteries and veins in the extra- and intracranial circulation. These techniques include 2D and 3D time of flight (TOF), 2D and 3D phase contrast (PC), newer techniques such as 3D TOF with multiple overlapping thin slab acquisition (MOTSA), as well as contrast-enhanced MRA (CEMRA). Although intra- and extracranial MRA is a relatively young technique, many of the above-mentioned techniques are mature enough to be a staple part of routine, clinical MR protocols. Hence, their clinical applications, the technical background and the various pitfalls require familiarity from the neuroradiologists. This chapter summarizes the various established as well as emerging clinical uses of these techniques. Understanding the inherent complementary nature of many of the techniques is essential to maximize the diagnostic information for every individual patient. As the physics and the technical background of these techniques have been discussed elsewhere in this book, we stress on their clinical applications.


Magnetic Resonance Angiography Vertebral Artery Moyamoya Disease Catheter Angiography Fibromuscular Dysplasia 
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  1. 1.
    Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991;325:445–453.Google Scholar
  2. 2.
    MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. European Carotid Surgery Trialists’ Collaborative Group. Lancet. 1991;337:1235–1243.CrossRefGoogle Scholar
  3. 3.
    Heiserman JE, Masaryk TJ, Aygun N. MR angiography: techniques and clinical applications. In: Atlas SW, ed. Magnetic Resonance Imaging of the Brain and Spine. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:841–881.Google Scholar
  4. 4.
    Carotid surgery versus medical therapy in asymptomatic carotid stenosis. The CASANOVA Study Group. Stroke. 1991;22:1229–1235.CrossRefGoogle Scholar
  5. 5.
    De Marco JK, Schonfeld S, Keller I, Bernstein MA. Contrast-enhanced carotid MR angiography with commercially available triggering mechanisms and elliptic centric phase encoding. AJR Am J Roentgenol. 2001;176:221–227.PubMedGoogle Scholar
  6. 6.
    Ahn KJ, You WJ, Lee JH, et al. Re-circulation artefact at the carotid bulb can be differentiated from true stenosis. Br J Radiol. 2004;77:551–556.PubMedCrossRefGoogle Scholar
  7. 7.
    DeMarco JK, Huston J 3rd, Bernstein MA. Evaluation of classic 2D time-of-flight MR angiography in the depiction of severe carotid stenosis. AJR Am J Roentgenol. 2004;183:787–793.PubMedGoogle Scholar
  8. 8.
    Anzalone N, Scomazzoni F, Castellano R, et al. Carotid artery stenosis: intraindividual correlations of 3D time-of-flight MR angiography, contrast-enhanced MR angiography, conventional DSA, and rotational angiography for detection and grading. Radiology. 2005;236:204–213.PubMedCrossRefGoogle Scholar
  9. 9.
    Lim R, Shapiro M, Wang E, et al. 3D time-resolved MR angiography (MRA) of the carotid arteries with time-resolved imaging with stochastic trajectories: comparison with 3D contrast-enhanced bolus-chase MRA and 3D time-of-flight MRA. AJNR Am J Neuroradiol. 2008;29:1847–1854.PubMedCrossRefGoogle Scholar
  10. 10.
    Bernstein MA, Huston J 3rd, Lin C, Gibbs GF, Felmlee JP. High-resolution intracranial and cervical MRA at 3.0 T: technical considerations and initial experience. Magn Reson Med. 2001;46:955–962.PubMedCrossRefGoogle Scholar
  11. 11.
    Debrey SM, Yu H, Lynch JK, et al. Diagnostic accuracy of magnetic resonance angiography for internal carotid artery disease: a systematic review and meta-analysis. Stroke. 2008;39:2237–2248.PubMedCrossRefGoogle Scholar
  12. 12.
    Khan S, Cloud GC, Kerry S, Markus HS. Imaging of vertebral artery stenosis: a systematic review. J Neurol Neurosurg Psychiatry. 2007;78:1218–1225.PubMedCrossRefGoogle Scholar
  13. 13.
    Khan S, Rich P, Clifton A, Markus HS. Noninvasive detection of vertebral artery stenosis: a comparison of contrast-enhanced MR angiography, CT angiography, and ultrasound. Stroke. 2009;40:3499–3503.PubMedCrossRefGoogle Scholar
  14. 14.
    Provenzale JM. MRI and MRA for evaluation of dissection of craniocerebral arteries: lessons from the medical literature. Emerg Radiol. 2009;16:185–193.PubMedCrossRefGoogle Scholar
  15. 15.
    Provenzale JM, Sarikaya B. Comparison of test performance characteristics of MRI, MR angiography, and CT angiography in the diagnosis of carotid and vertebral artery dissection: a review of the medical literature. AJR Am J Roentgenol. 2009;193:1167–1174.PubMedCrossRefGoogle Scholar
  16. 16.
    Osborn AG, Anderson RE. Angiographic spectrum of cervical and intracranial fibromuscular dysplasia. Stroke. 1977;8:617–626.PubMedCrossRefGoogle Scholar
  17. 17.
    Steiger HJ, Turowski B. Fibromuscular dysplasia. N Engl J Med. 2004;351:509–510; author reply 509–510.Google Scholar
  18. 18.
    Virmani R, Carroll TJ, Hung J, Hopkins J, Diniz L, Carr J. Diagnosis of subclavian steal syndrome using dynamic time-resolved magnetic resonance angiography: a technical note. Magn Reson Imaging. 2008;26:287–292.PubMedCrossRefGoogle Scholar
  19. 19.
    Turjman F, Tournut P, Baldy-Porcher C, Laharotte JC, Duquesnel J, Froment JC. Demonstration of subclavian steal by MR angiography. J Comput Assist Tomogr. 1992;16:756–759.PubMedCrossRefGoogle Scholar
  20. 20.
    Laub GA, Kaiser WA. MR angiography with gradient motion refocusing. J Comput Assist Tomogr. 1988;12:377–382.PubMedCrossRefGoogle Scholar
  21. 21.
    Yamada I, Nakagawa T, Matsushima Y, Shibuya H. High-resolution turbo magnetic resonance angiography for diagnosis of moyamoya disease. Stroke. 2001;32:1825–1831.PubMedCrossRefGoogle Scholar
  22. 22.
    Fushimi Y, Miki Y, Kikuta K, et al. Comparison of 3.0- and 1.5-T three-dimensional time-of-flight MR angiography in moyamoya disease: preliminary experience. Radiology. 2006;239:232–237.PubMedCrossRefGoogle Scholar
  23. 23.
    Moritani T, Numaguchi Y, Lemer NB, et al. Sickle cell cerebrovascular disease: usual and unusual findings on MR imaging and MR angiography. Clin Imaging. 2004;28:173–186.PubMedCrossRefGoogle Scholar
  24. 24.
    Tien RD, Wilkins RH. MRA delineation of the vertebral-basilar system in patients with hemifacial spasm and trigeminal neuralgia. AJNR Am J Neuroradiol. 1993;14:34–36.PubMedGoogle Scholar
  25. 25.
    Neves F, Huwart L, Jourdan G, et al. Head and neck paragangliomas: value of contrast-enhanced 3D MR angiography. AJNR Am J Neuroradiol. 2008;29:883–889.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Neuroradiology Division, Department of RadiologyUniversity of VirginiaCharlottesvilleUSA

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