Comparison of pre- and postcontrast 3D time-of-flight MR angiography for the evaluation of distal intracranial branch occlusions in acute ischemic stroke.
Comparison of pre- and postcontrast 3D time-of-flight MR angiography for the evaluation of distal intracranial branch occlusions in acute ischemic stroke.
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发表时间：
2002-04
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通讯作者：
Janice J Yang;M. Hill;W. Morrish;M. Hudon;P. Barber;A. Demchuk;R. Sevick;R. Frayne
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作者：
Janice J Yang;M. Hill;W. Morrish;M. Hudon;P. Barber;A. Demchuk;R. Sevick;R. Frayne
背景和目的三维飞行时间（TOF）MR血管造影术常规用于卒中检查以检测动脉闭塞，但其主要缺点是对血流缓慢或面内血流的血管显示不充分。我们假设对比增强MR血管造影的使用改善了对比增强MR血管造影片上血流减少或缺失的血管的描绘。方法对55例急性脑卒中患者行3DTOF MR血管造影检查。在造影前和造影后血管造影片上评估了480条颅内血管的通畅性。弥散加权（DW）和灌注加权（PW）成像数据也被获得，并与对比前后的MR血管造影结果相关。结果在对比前MR血管造影上发现的50个异常血管段中，对比后MR血管造影导致70%（35个血管段）的血管信号强度改变;这些改变中94%显示了更大程度的血管通畅。静脉和软组织对比增强对所有480条血管中95%的评估没有影响。观察者间可靠性为中等，对比后解释（kappa = 0.48）显示比对比前解释（kappa = 0.41）略有改善。TOF结果与合并的DW和PW成像结果之间具有良好的一致性。结论：与对比前3D TOF MR血管造影相比，对比后3D TOF血管造影改善了对急性缺血血管区域颅内血管通畅性的评估。在一些患者中，通过观察造影前后的图像，可以更好地了解急性缺血性卒中。急性脑卒中的MR评估应包括增强后MR血管造影。
BACKGROUND AND PURPOSE Three-dimensional time-of-flight (TOF) MR angiography is used routinely in stroke workup to detect arterial occlusions, but a major drawback is its inadequate depiction of vessels with slow or in-plane flow. We hypothesized that the use of contrast-enhanced MR angiography improves delineation of vessels with diminished or absent flow on precontrast MR angiograms. METHODS Pre- and postcontrast 3D TOF MR angiograms were acquired in 55 consecutive patients with acute stroke. Patency of 480 intracranial vessels was assessed on both the pre- and postcontrast angiograms. Diffusion-weighted (DW) and perfusion-weighted (PW) imaging data were also obtained and results correlated with those of pre- and postcontrast MR angiography. RESULTS For 50 abnormal vessel segments seen on precontrast MR angiograms, postcontrast MR angiograms resulted in change in the vascular signal intensity in 70% (35 vessel segments); 94% of these changes showed a greater extent of vessel patency. Venous and soft-tissue contrast enhancement had no effect on assessment in 95% of all 480 vessels examined. Interobserver reliability was moderate, with postcontrast interpretation (kappa = 0.48) showing a slight improvement over precontrast interpretation (kappa = 0.41). Good agreement was found between the TOF results and the pooled DW and PW imaging results. CONCLUSIONS Compared with precontrast 3D TOF MR angiograms, postcontrast 3D TOF angiograms improve assessment of intracranial vessel patency in acutely ischemic vascular territories. In some patients, an improved understanding of acute ischemic stroke was obtained by viewing the pre- and postcontrast images. Postcontrast MR angiography should be included in the MR evaluation of acute stroke.