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PT  - JOURNAL ARTICLE
AU  - Boujan, T.
AU  - Neuberger, U.
AU  - Pfaff, J.
AU  - Nagel, S.
AU  - Herweh, C.
AU  - Bendszus, M.
AU  - Möhlenbruch, M.A.
TI  - Value of Contrast-Enhanced MRA versus Time-of-Flight MRA in Acute Ischemic Stroke MRI
AID  - 10.3174/ajnr.A5771
DP  - 2018 Aug 16
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2018/08/16/ajnr.A5771.short
4100  - http://www.ajnr.org/content/early/2018/08/16/ajnr.A5771.full
AB  - BACKGROUND AND PURPOSE: Vessel imaging in acute ischemic stroke is essential to select patients with large-vessel occlusion for mechanical thrombectomy. Our aim was to compare the diagnostic accuracy of time-of-flight MR angiography and contrast-enhanced MR angiography for identification of vessel occlusion and collateral status in acute ischemic stroke.MATERIALS AND METHODS: One hundred twenty-three patients with stroke with large-vessel occlusion before thrombectomy were included in this retrospective study. Before thrombectomy, 3T MR imaging, including conventional 3D TOF-MRA of the intracranial arteries and contrast-enhanced MRA of intra- and extracranial arteries, was performed. Both techniques were assessed independently by 2 neuroradiologists for location of the occlusion, imaging quality, and collateral status. Findings were compared, with subsequent DSA as the reference standard.RESULTS: Both techniques had good interrater agreement of κ = 0.74 (95% CI, 0.66–0.83) for TOF-MRA and κ = 0.72 (95% CI, 0.63–0.80) for contrast-enhanced MRA. Occlusion localization differed significantly on TOF-MRA compared with DSA (P &amp;lt; .001), while no significant difference was observed between DSA and contrast-enhanced MRA (P = .75). Assessment of collaterals showed very good agreement between contrast-enhanced MRA and DSA (94.9% with P = .25), but only fair agreement between TOF-MRA and DSA (23.2% with P &amp;lt; .001).CONCLUSIONS: Contrast-enhanced MRA offers better diagnostic accuracy than TOF-MRA in acute ischemic stroke. Contrast-enhanced MRA was superior in localizing vessel occlusion within a shorter acquisition time while providing a larger coverage, including extracranial vessels, and a more accurate assessment of collateral status. These results support inclusion of contrast-enhanced MRA in acute stroke MR imaging, perhaps making TOF-MRA superfluous.CE-MRAcontrast-enhanced MRA