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Time-of-flight angiography: a viable alternative to contrast-enhanced MR angiography and fat-suppressed T1w images for the diagnosis of cervical artery dissection?

  • Magnetic Resonance
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Abstract

Objectives

To compare the use of an unenhanced high-resolution time-of-flight MR angiography sequence (Hr-TOF MRA) with fat-suppressed axial/coronal T1-weighted images and contrast-enhanced angiography (standard MRI) for the diagnosis of cervical artery dissection (cDISS).

Methods

Twenty consecutive patients (9 women, 11 men, aged 24–66 years) with proven cDISS on standard MRI underwent Hr-TOF MRA at 3.0 T using dedicated surface coils. Sensitivity (SE), specificity (SP), positive and negative predictive values (PPV, NPV), Cohen’s kappa (к) and accuracy of Hr-TOF MRA were calculated using the standard protocol as the gold standard. Image quality and diagnostic confidence were assessed on a four-point scale.

Results

Image quality was rated better for standard MRI (P = 0.02), whereas diagnostic confidence did not differ significantly (P = 0.27). There was good agreement between Hr-TOF images and the standard protocol for the presence/absence of cDISS, with к = 0.95 for reader 1 and к = 0.89 for reader 2 (P < 0.001). This resulted in SE, SP, PPV, NPV and accuracy of 97 %, 98 %, 97 %, 98 % and 97 % for reader 1 and 93 %, 96 %, 93 %, 96 % and 95 % for reader 2.

Conclusions

Hr-TOF MRA can be used to diagnose cDISS with excellent agreement compared with the standard protocol. This might be useful in patients with renal insufficiency or if contrast-enhanced MR angiography is of insufficient image quality.

Key Points

• New magnetic resonance angiography sequences are increasingly used for vertebral artery assessment.

• A high-resolution time-of-flight sequence allows the diagnosis of cervical artery dissection.

• This technique allows the diagnosis without intravenous contrast medium.

• It could help in renal insufficiency or when contrast-enhanced MRA fails.

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Abbreviations

cDISS:

cervical artery dissection

CE-MRA:

contrast-enhanced MR angiography

CNR:

contrast-to-noise ratio

DSA:

digital subtraction angiography

fs:

fat-suppressed

Hr-TOF MRA:

high-resolution time-of-flight MR angiography sequence

к:

kappa value

MIP:

reconstruction maximum intensity projection

NPV:

negative predictive value

PET-CT:

combination of positron emission tomography and computed tomography

PPV:

positive predictive value

SE:

sensitivity

SNR:

signal-to-noise ratio

SP:

specificity

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Authors and Affiliations

  1. Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Pettenkoferstr. 8a, 80336, München, Germany

    E. M. Coppenrath, O. Lenz, K. Nikolaou, M. F. Reiser & T. Saam

  2. Department of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, München, Germany

    N. Lummel & J. Linn

  3. Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital Munich, München, Germany

    M. Dichgans

  4. Department of Neurology, Ludwig-Maximilians-University Hospital Munich, München, Germany

    M. Habs & T. Pfefferkorn

Authors
  1. E. M. Coppenrath
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  2. N. Lummel
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  3. J. Linn
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  4. O. Lenz
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  5. M. Habs
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  6. K. Nikolaou
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  7. M. F. Reiser
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  8. M. Dichgans
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  9. T. Pfefferkorn
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  10. T. Saam
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Corresponding author

Correspondence to T. Saam.

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Coppenrath, E.M., Lummel, N., Linn, J. et al. Time-of-flight angiography: a viable alternative to contrast-enhanced MR angiography and fat-suppressed T1w images for the diagnosis of cervical artery dissection?. Eur Radiol 23, 2784–2792 (2013). https://doi.org/10.1007/s00330-013-2891-1

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  • DOI: https://doi.org/10.1007/s00330-013-2891-1

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