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11 - Magnetic resonance angiography of the carotid artery

from Luminal imaging techniques

Published online by Cambridge University Press:  03 December 2009

By
Martin J. Graves ,
Jean Marie U-King-Im  and
Jonathan H. Gillard
Edited by
Jonathan Gillard ,
Martin Graves ,
Thomas Hatsukami  and
Chun Yuan
Martin J. Graves
Affiliation:
University of Cambridge, Cambridge CB2 2QQ, UK
Jean Marie U-King-Im
Affiliation:
University of Cambridge, Cambridge CB2 2QQ, UK
Jonathan H. Gillard
Affiliation:
University of Cambridge, Cambridge CB2 2QQ, UK
Jonathan Gillard
Affiliation:
University of Cambridge
Martin Graves
Affiliation:
University of Cambridge
Thomas Hatsukami
Affiliation:
University of Washington
Chun Yuan
Affiliation:
University of Washington
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Summary

Introduction

Magnetic resonance angiography (MRA) has emerged as one of the leading noninvasive modalities used to image the carotid artery. The core of MRA is its ability to portray blood vessels in a projective format similar to the gold standard, conventional digital subtraction angiography (DSA). The potential advantages of MRA over DSA are, however, numerous and compelling: MRA is less expensive, is the modality that patients tend to prefer, does not require iodinated contrast medium, is an outpatient procedure and more significantly, does not incur the 1–2% risks of neurological complications generally associated with intra-arterial catheterization (Willinsky et al., 2003; U-King-Im et al., 2004a, b). Recent advances in MRA technology, resulting from fast gradients and use of contrast agents has allowed substantial improvement in the quality of MRA examinations, leading to increased confidence of both radiologists and clinicians in the modality. Not surprisingly, this has been followed by the widespread use of MRA in the routine clinical work-up of patients with suspected carotid stenosis. This chapter summarizes the current state of carotid MRA. The first sections deal with the technical aspects of the various types of MRA, including time-of-flight (TOF), phase-contrast and contrast-enhanced MRA and highlight promising future developments as well as potential novel contrast agents. The current utility and efficacy of MRA in clinical practice is then discussed from an evidence-based perspective.

Keywords

carotid arterycontrast-enhanced MRAgadolinium-based contrast agentsmagnetic resonance angiographytime-of-flight MRAphase-contrast MRAmultiple overlapping thin slab acquisition
Type
Chapter
Information
Carotid Disease
The Role of Imaging in Diagnosis and Management
 , pp. 140 - 157
Publisher: Cambridge University Press
Print publication year: 2006

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