title: Nonenhanced hybridized arterial spin labeled magnetic resonance angiography of the extracranial carotid arteries using a fast low angle shot readout at 3 Tesla.
abstract: BACKGROUND
  To evaluate ungated nonenhanced hybridized arterial spin labeling (hASL) magnetic resonance angiography (MRA) of the extracranial carotid arteries using a fast low angle shot (FLASH) readout at 3 Tesla.
  
  
  METHODS
  In this retrospective, institutional review board-approved and HIPAA-compliant study, we evaluated the image quality (4-point scale) of nonenhanced hASL MRA using a FLASH readout with respect to contrast-enhanced MRA (CEMRA) in 37 patients presenting with neurologic symptoms. Two certified neuroradiologists independently evaluated 407 arterial segments (11 per patient) for image quality. The presence of vascular pathology was determined by consensus reading. Gwet's AC1 was used to assess inter-rater agreement in image quality scores, and image quality scores were correlated with age and body mass index. Objective measurements of arterial lumen area and sharpness in the carotid arteries were compared to values obtained with CEMRA. Comparisons were also made with conventional nonenhanced 2D time-of-flight (TOF) MRA.
  
  
  RESULTS
  CEMRA provided the best image quality, while nonenhanced hASL FLASH MRA provided image quality that exceeded 2D TOF at the carotid bifurcation and in the internal and external carotid arteries. All nine vascular abnormalities of the carotid and intracranial arteries detected by CEMRA were depicted with hASL MRA, with no false positives. Inter-rater agreement of image quality scores was highest for CEMRA (AC1 = 0.87), followed by hASL (AC1 = 0.61) and TOF (AC1 = 0.43) (P < 0.001, all comparisons). With respect to CEMRA, agreement in cross-sectional lumen area was significantly better with hASL than TOF in the common carotid artery (intraclass correlation (ICC) = 0.90 versus 0.66; P < 0.05) and at the carotid bifurcation (ICC = 0.87 versus 0.54; P < 0.05). Nonenhanced hASL MRA provided superior arterial sharpness with respect to CEMRA and 2D TOF (P < 0.001).
  
  
  CONCLUSIONS
  Although inferior to CEMRA in terms of image quality and inter-rater agreement, hASL FLASH MRA offers an alternative to 2D TOF for the nonenhanced evaluation of the extracranial carotid arteries at 3 Tesla. Compared with 2D TOF, nonenhanced hASL FLASH MRA provides improved quantification of arterial cross-sectional area, vessel sharpness, inter-rater agreement and image quality.
authors.affiliation: Department of Radiology, NorthShore University HealthSystem, Evanston, USA. ikoktzoglou@gmail.com.|University of Chicago Pritzker School of Medicine, Chicago, USA. ikoktzoglou@gmail.com.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Koktzoglou
authors.affiliation: Department of Radiology, NorthShore University HealthSystem, Evanston, USA.|University of Chicago Pritzker School of Medicine, Chicago, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Walker
authors.affiliation: Department of Radiology, NorthShore University HealthSystem, Evanston, USA.|University of Chicago Pritzker School of Medicine, Chicago, USA.
authors.forename: Joel R
authors.initials: JR
authors.lastname: Meyer
authors.affiliation: Department of Radiology, NorthShore University HealthSystem, Evanston, USA.|Northwestern University Feinberg School of Medicine, Chicago, USA.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Murphy
authors.affiliation: Department of Radiology, NorthShore University HealthSystem, Evanston, USA.|Northwestern University Feinberg School of Medicine, Chicago, USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edelman
mesh_terms: D002339:Carotid Arteries / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000150:complications / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology; D003287:Contrast Media; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013113:Spin Labels
chemical_list: D003287:Contrast Media; D013113:Spin Labels
keywords: Arterial spin labeling; Carotid; Intracranial; Magnetic resonance angiography; Nonenhanced