title: Gadolinium-enhanced 3D MRA of the aortic arch vessels in the detection of atherosclerotic cerebrovascular occlusive disease.
abstract: OBJECTIVE
  Our goal was to evaluate non-breath-hold Gd-enhanced 3D MR angiography (MRA) for the detection of atherosclerotic occlusive disease of the aortic arch vessels and to compare image quality with two breath-hold techniques.
  
  
  METHODS
  One hundred sixty consecutive patients with known or clinically suspected atherosclerotic cerebrovascular occlusive disease underwent Gd-enhanced 3D MRA of the aortic arch and great vessels. One hundred twenty-six examinations were performed with the body coil after infusion of 40 ml of Gd-DTPA; 89 of these were performed without breath-holding and 37 were acquired during suspended respiration. Thirty-four examinations were performed in a body phased-array coil with breath-holding, a timing examination, and 20 ml of contrast agent by manual (n = 17) or power (n = 17) injection. Images were evaluated for the presence of blurring and ghosting artifacts and venous enhancement. Of the 27 patients who underwent non-breath-hold MRI and digital subtraction angiography (DSA), two readers blinded to the DSA results retrospectively evaluated the MRA examinations for the presence of occlusive disease of the innominate, carotid, subclavian, and vertebral arteries. DSA correlation was not evaluated for the 71 breath-hold studies.
  
  
  RESULTS
  Sensitivity and specificity for arch vessel occlusive disease with non-breath-hold MRA were 38 and 94% for Reader A and 38 and 95% for Reader B. Breath-holding significantly reduced blurring and ghosting artifacts (p < 0.001) when compared with non-breath-hold imaging, and use of 20 ml of contrast medium, with a timing examination, resulted in significantly less venous enhancement than seen with 40 ml (p < 0.001).
  
  
  CONCLUSIONS
  Non-breath-hold Gd-enhanced 3D MRA is insensitive for detecting arch vessel occlusive disease. Breath-hold imaging, in conjunction with a timing examination and a lower dose of contrast agent, improves image quality, but further studies are needed to assess diagnostic accuracy.
authors.affiliation: Department of Radiology, New York University Medical Center, NY 10017, USA.
authors.forename: G
authors.initials: G
authors.lastname: Krinsky
authors.forename: M
authors.initials: M
authors.lastname: Maya
authors.forename: N
authors.initials: N
authors.lastname: Rofsky
authors.forename: J
authors.initials: J
authors.lastname: Lebowitz
authors.forename: P K
authors.initials: PK
authors.lastname: Nelson
authors.forename: M
authors.initials: M
authors.lastname: Ambrosino
authors.forename: E
authors.initials: E
authors.lastname: Kaminer
authors.forename: J
authors.initials: J
authors.lastname: Earls
authors.forename: L
authors.initials: L
authors.lastname: Masters
authors.forename: G
authors.initials: G
authors.lastname: Giangola
authors.forename: A
authors.initials: A
authors.lastname: Litt
authors.forename: J
authors.initials: J
authors.lastname: Weinreb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015901:Angiography, Digital Subtraction / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA