title: Combined low-dose contrast-enhanced MR angiography and perfusion for acute ischemic stroke at 3T: A more efficient stroke protocol.
abstract: OBJECTIVE
  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 contrast-enhanced 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.
authors: From the Department of Medical Imaging (K.N., A.M.), University of Arizona, Tucson, Arizona kambiz@radiology.arizona.edu.
authors: K
authors: K
authors: Nael
authors: From the Department of Medical Imaging (K.N., A.M.), University of Arizona, Tucson, Arizona.
authors: A
authors: A
authors: Meshksar
authors: Department of Radiological Sciences (B.E., M.P., N.S., P.F., J.P.V.).
authors: B
authors: B
authors: Ellingson
authors: Department of Radiological Sciences (B.E., M.P., N.S., P.F., J.P.V.).
authors: M
authors: M
authors: Pirastehfar
authors: Department of Radiological Sciences (B.E., M.P., N.S., P.F., J.P.V.).
authors: N
authors: N
authors: Salamon
authors: Department of Radiological Sciences (B.E., M.P., N.S., P.F., J.P.V.).
authors: P
authors: P
authors: Finn
authors: Department of Neurology, Stroke Center (D.S.L.), University of California, Los Angeles, Los Angeles, California.
authors: D S
authors: DS
authors: Liebeskind
authors: Department of Radiological Sciences (B.E., M.P., N.S., P.F., J.P.V.).
authors: J P
authors: JP
authors: Villablanca
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002545:Brain Ischemia / Q000150:complications / Q000473:pathology*; D002536:Cerebral Arteries / Q000473:pathology*; D003287:Contrast Media / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005240:Feasibility Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008536:Meglumine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008875:Middle Aged; D015588:Observer Variation; D009942:Organometallic Compounds / Q000008:administration & dosage; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000209:etiology / Q000473:pathology*; D013997:Time Factors
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine