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Cerne JW, Pathrose A, Singer AM, Moore JE, Serhal A, Aouad P, Umair M, Ragin A, Allen BD, Avery R, Markl M, Carr JC. MRA of the Supraaortic Vasculature: Comparison of Gadobutrol and Gadoterate Meglumine at 1.5 T. J Magn Reson Imaging 2021; 56:440-449. [PMID: 34953154 DOI: 10.1002/jmri.28044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Gadobutrol (GB) and gadoterate meglumine (GM) are contrast agents used for contrast-enhanced magnetic resonance angiography (CEMRA). Supraaortic vasculature (SAV) CEMRAs are used to evaluate stroke risk and neurologic symptoms. There is a need to compare the SAV CEMRA image quality obtained with GB and GM. PURPOSE To intra-individually compare MRA images obtained with equimolar GB and GM at 1.5 T in the SAV. STUDY TYPE Prospective, crossover. POPULATION Twenty-eight subjects (54 ± 13 years; 17 female). FIELD STRENGTH/SEQUENCE 1.5 T; three-dimensional (3D) gradient recalled echo. ASSESSMENT Quantitative image quality was measured by normalized signal intensity (SIn ) [SIn = SI blood/SD blood] and contrast ratio (CR) [CR = SI blood/SI muscle], determined by an observer (JWC) with 1 year of vascular imaging experience. Three radiologists (AS, PA, and MU) with (5, 5, and 6 years of) vascular imaging experience evaluated image quality by Likert-scale ratings (of image impression, wall conspicuity, and artifact absence). STATISTICAL TESTS SIn and CR were compared with paired t-tests or Wilcoxon signed-rank tests and Bland-Altman plots. Qualitative ratings were compared with Wilcoxon signed-rank test. RESULTS No significant difference in SIn was found between GB and GM. CRs with GB were significantly higher than GM at the right common carotid (6.9 ± 2.5 vs. 4.8 ± 1), left internal carotid (7.3 ± 2 vs. 4.4 ± 1.2), right internal carotid (7.7 ± 2.2 vs. 5 ± 1.1), and left vertebral (6.6 ± 2.2 vs. 4.5 ± 1.1) arteries. Bland-Altman plots showed relatively greater differences between GB and GM at higher CRs and SIn s. GM showed significantly higher artifact than GB (3.56 ± 0.52 vs. 3.36 ± 0.46) and significantly lower overall image quality (10.73 ± 1.45 vs. 11.26 ± 1.58) at the left vertebral artery. DATA CONCLUSION At 1.5 T and equimolar demonstration, GB (0.1 mL/kg, i.e., 0.1 mmol/kg) showed higher CRs in the SAV compared to GM (0.2 mL/kg, i.e., 0.1 mmol/kg) at most vessels. Subjective image quality was not significantly different between the two agents for most vessels. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- John W Cerne
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alyssa M Singer
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jackson E Moore
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, Illinois, USA
| | - Ali Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pascale Aouad
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Muhammad Umair
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ann Ragin
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan Avery
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, Illinois, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Koktzoglou I, Aherne EA, Walker MT, Meyer JR, Edelman RR. Ungated nonenhanced radial quiescent interval slice-selective (QISS) magnetic resonance angiography of the neck: Evaluation of image quality. J Magn Reson Imaging 2019; 50:1798-1807. [PMID: 31077477 DOI: 10.1002/jmri.26781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Standard-of-care time-of-flight (TOF) techniques for nonenhanced magnetic resonance angiography (NEMRA) of the carotid bifurcation and other cervical arteries often provide nondiagnostic image quality due to motion and flow artifacts. PURPOSE To perform an initial evaluation of an ungated radial quiescent-interval slice-selective (QISS) technique for NEMRA of the neck, in comparison with 2D TOF and contrast-enhanced magnetic resonance angiography (CEMRA). STUDY TYPE Retrospective. POPULATION Sixty patients referred for neck MR angiography. FIELD STRENGTH/SEQUENCE Ungated radial QISS at 3T. ASSESSMENT Three radiologists scored image quality of 18 arterial segments using a 4-point scale (1, nondiagnostic; 2, fair; 3, good; 4, excellent), and two radiologists graded proximal internal carotid stenosis using five categories (<50%, 50-69%, 70-99%, occlusion, nondiagnostic). STATISTICAL TESTS Friedman tests with post-hoc Wilcoxon signed-rank tests; unweighted Gwet's AC1 statistic; tests for equality of proportions. RESULTS Ungated radial QISS provided image quality that significantly exceeded 2D TOF (mean scores of 2.7 vs. 2.0, 2.7 vs. 2.2, and 2.9 vs. 2.3; P < 0.001, all comparisons), while CEMRA provided the best image quality (mean scores of 3.6, 3.7, and 3.5 for the three reviewers). Interrater agreement of image quality scores was substantial for CEMRA (AC1 = 0.70, P < 0.001), and moderate for QISS (AC1 = 0.43, P < 0.001) and TOF (AC1 = 0.41, P < 0.001). Compared with TOF, QISS NEMRA provided a significantly higher percentage of diagnostic segments for all three reviewers (91.0% vs. 71.7%, 93.5% vs. 72.9%, 95.5% vs. 85.2%; P < 0.0001) and demonstrated better agreement with CEMRA for grading of proximal internal carotid stenosis (AC1 = 0.94 vs. 0.73 for reviewer 1, P < 0.05; AC1 = 0.89 vs. 0.68 for reviewer 2, P < 0.05). DATA CONCLUSION In this initial study, ungated radial QISS significantly outperformed 2D TOF for the evaluation of the neck arteries, with overall better image quality and more diagnostic arterial segments, and improved agreement with CEMRA for grading stenosis of the proximal internal carotid artery. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1798-1807.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Emily A Aherne
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew T Walker
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Joel R Meyer
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Chen L, Mossa-Basha M, Balu N, Canton G, Sun J, Pimentel K, Hatsukami TS, Hwang JN, Yuan C. Development of a quantitative intracranial vascular features extraction tool on 3D MRA using semiautomated open-curve active contour vessel tracing. Magn Reson Med 2017; 79:3229-3238. [PMID: 29044753 DOI: 10.1002/mrm.26961] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To develop a quantitative intracranial artery measurement technique to extract comprehensive artery features from time-of-flight MR angiography (MRA). METHODS By semiautomatically tracing arteries based on an open-curve active contour model in a graphical user interface, 12 basic morphometric features and 16 basic intensity features for each artery were identified. Arteries were then classified as one of 24 types using prediction from a probability model. Based on the anatomical structures, features were integrated within 34 vascular groups for regional features of vascular trees. Eight 3D MRA acquisitions with intracranial atherosclerosis were assessed to validate this technique. RESULTS Arterial tracings were validated by an experienced neuroradiologist who checked agreement at bifurcation and stenosis locations. This technique achieved 94% sensitivity and 85% positive predictive values (PPV) for bifurcations, and 85% sensitivity and PPV for stenosis. Up to 1,456 features, such as length, volume, and averaged signal intensity for each artery, as well as vascular group in each of the MRA images, could be extracted to comprehensively reflect characteristics, distribution, and connectivity of arteries. Length for the M1 segment of the middle cerebral artery extracted by this technique was compared with reviewer-measured results, and the intraclass correlation coefficient was 0.97. CONCLUSION A semiautomated quantitative method to trace, label, and measure intracranial arteries from 3D-MRA was developed and validated. This technique can be used to facilitate quantitative intracranial vascular research, such as studying cerebrovascular adaptation to aging and disease conditions. Magn Reson Med 79:3229-3238, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Li Chen
- Department of Electrical Engineering, University of Washington, Seattle, Washington, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Kristi Pimentel
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Jenq-Neng Hwang
- Department of Electrical Engineering, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
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Carotid Artery Stenosis: Comparison of 3D Time-of-Flight MR Angiography and Contrast-Enhanced MR Angiography at 3T. Radiol Res Pract 2014; 2014:508715. [PMID: 24778875 PMCID: PMC3981528 DOI: 10.1155/2014/508715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/04/2013] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of this study was to assess the correlation of 3D time-of-flight MR angiography (TOF MRA) and contrast-enhanced MR angiography (CEMRA) for carotid artery stenosis evaluation at 3T. Material and Methods. Twenty-three patients (5 f, 18 m; mean age 61 y, age range 45–78 y) with internal carotid artery stenosis detected with ultrasonography were examined on a 3.0T MR system. The MR examination included both 3D TOF MRA and CEMRA of the carotid arteries. MR images were evaluated independently by two board-certified radiologists. Stenosis evaluation was based on a five-point scale. Stenosis grades determined by TOF and CEMRA were compared using Spearman's rank correlation coefficient and the Wilcoxon test. Cohen's Kappa was used to evaluate interrater reliability. Results. CEMRA detected stenosis in 24 (52%) of 46 carotids evaluated, while TOF detected stenosis in 27 (59%) of 46 carotids. TOF MRA yielded significantly higher results for stenosis grade in comparison to CEMRA (P = 0.014). Interrater agreement was very good for both TOF MRA (κ = 0.93) and CEMRA (κ = 0.93). Conclusion. At 3T, 3D TOF MRA should not be used as replacement for contrast-enhanced MRA of the carotid arteries, as it results in significantly higher stenosis grades.
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Ferré JC, Raoult H, Breil S, Carsin-Nicol B, Ronzière T, Gauvrit JY. Supra-aortic arteries: three-dimensional time-resolved k-t BLAST contrast-enhanced MRA using a nondedicated body coil at 3 tesla in acute ischemic stroke. J Magn Reson Imaging 2013; 40:1056-63. [PMID: 24222649 DOI: 10.1002/jmri.24466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/14/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess the image quality and diagnostic performance achieved by using supra-aortic 3D-TR-CE-k-t BLAST MRA and a nondedicated body coil as compared with conventional CE-MRA in patients with acute ischemic stroke. MATERIALS AND METHODS In this prospective study, 36 consecutive patients with a suspected acute ischemic stroke underwent both k-t BLAST MRA and conventional CE-MRA. Image quality was assessed using visual and quantitative criteria and the techniques were compared. Both techniques were compared for degree of visual and quantitative measurement of carotid stenosis. RESULTS Delineation of vessel lumen and overall diagnostic confidence were significantly better with CE-MRA, respectively 3.4 ± 0.5 and 3.3 ± 0.6 (mean score ± SD), than with k-t BLAST MRA, respectively 2.8 ± 0.4 and 2.9 ± 0.5 (P < 0.02). SNR and CNR were significantly higher for k-t BLAST MRA, respectively 33.5 ± 19.3 and 27.9 ± 19.3, than for CE-MRA, respectively 25.7 ± 10 and 20.4 ± 8.4 (P < 0.03). Intertechnique agreement was good for carotid stenosis characterization (κ = .763). For the 14 relevant stenosis, stenosis measurements were highly correlated between techniques (0.96; P < 0.0001). The Bland-Altman plot showed a low bias in assessment of the degree of stenosis (mean bias 2.1% ± 7.7). CONCLUSION k-t BLAST MRA using a nondedicated coil offering and dynamic information was a effective diagnostic tool for detection and characterization of carotid stenosis.
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Affiliation(s)
- Jean-Christophe Ferré
- CHU Rennes, Department of Neuroradiology, University Hospital of Rennes, Rennes, France
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Wuesten O, Morelli JN, Miller MW, Tuzun E, Lenox MW, Fossum TW, Trelles M, Cotes C, Krombach GA, Runge VM. MR angiography of carotid artery aneurysms in a porcine model at 3 Tesla: comparison of two different macrocyclic gadolinium chelates and of dynamic and conventional techniques. J Magn Reson Imaging 2012; 36:1203-12. [PMID: 22826184 DOI: 10.1002/jmri.23757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 06/15/2012] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the differences in image quality of two macrocyclic gadolinium-based contrast agents, gadobutrol and gadoterate meglumine, using time-resolved, contrast-enhanced MR angiography (CE-MRA) in a porcine carotid artery aneurysm model and to compare image quality between dynamic and conventional, single acquisition CE-MRA. MATERIALS AND METHODS Bilateral carotid aneurysms were created surgically in this Institutional Animal Care and Use Committee approved study. Dynamic CE-MRA studies optimized for high temporal resolution were performed at 3 Tesla. Scans using equivalently dosed (on a per mmol basis) gadobutrol and gadoterate meglumine were compared qualitatively and quantitatively in terms of contrast-to-noise ratio (CNR). Higher spatial resolution dynamic and conventional CE-MRA were also compared. RESULTS N = 16 aneurysms were assessed. Qualitative evaluation of dynamic CE-MRA scans demonstrated a preference for gadobutrol over gadoterate meglumine. Significantly higher aneurysm CNR was found with gadobutrol (133 ± 44) versus gadoterate meglumine, the latter at both equivalent and double injection rates (94 ± 35 and 102 ± 38). In a blinded assessment, conventional CE-MRA was preferred qualitatively when compared with dynamic CE-MRA. However, dynamic CE-MRA was generally capable of providing diagnostic image quality. CONCLUSION Gadobutrol is preferred to gadoterate meglumine for high temporal resolution dynamic CE-MRA, a fact with important clinical implications for low dose CE-MRA protocols in patients at risk for nephrogenic systemic fibrosis. Conventional high resolution CE-MRA provides superior image quality when compared with dynamic CE-MRA.
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Affiliation(s)
- Oliver Wuesten
- Department of Radiology, University of Texas Medical Branch (UTMB), 301 University Boulevard, Galveston, Texas, USA.
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Prabhakaran S, Romano JG. Current diagnosis and management of symptomatic intracranial atherosclerotic disease. Curr Opin Neurol 2012; 25:18-26. [PMID: 22143202 PMCID: PMC3286605 DOI: 10.1097/wco.0b013e32834ec16b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Intracranial atherosclerotic disease (IAD) is likely the most common cause of stroke world-wide and is associated with a very high risk of recurrence. It results in cerebral ischemia due to a variety of mechanisms, including artery-to-artery embolism, hemodynamic failure, and occlusion of penetrating arteries. New imaging modalities focused on physiological consequences of IAD have become available and recent treatment trials have been completed. RECENT FINDINGS We review the traditional imaging modalities, emphasizing the advantages and limitations of each method, and discuss the novel physiological approaches that interrogate physiological process to indicate specific mechanisms of ischemia. These allow deeper understanding of the pathophysiological processes that underlie IAD-related ischemia. The key findings of recent therapeutic trials are reviewed, including the landmark randomized studies showing advantage of antiplatelet agents and risk factor modification, and a significant risk of complications with endovascular approaches. SUMMARY Current evidence argues for aggressive medical management and suggests caution with interventional treatments. We propose that mechanistic information will further refine the risk assessment of patients with IAD to offer targeted therapy.
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Affiliation(s)
- Shyam Prabhakaran
- Department of Neurological Sciences, Head, Cerebrovascular Disease & Neurocritical Care, Rush University Medical Center, 1725 W. Harrison St. Suite 1121, Chicago, IL 60612, Tel: 312-563-2518 Fax: 312-563-2206
| | - Jose G. Romano
- Cerebrovascular Division, University of Miami, Miller School of Medicine, 1120 NW 14 St. Suite 1357, Miami FL 33136, Tel: 305-243-2336, Fax: 305-243-7081
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Kumar Dundamadappa S, Cauley K. Vertebral Artery Ostial Stenosis: Prevalence by Digital Subtraction Angiography, MR Angiography, and CT Angiography. J Neuroimaging 2012; 23:360-7. [DOI: 10.1111/j.1552-6569.2011.00692.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Toepker M, Mahabadi A, Heinzle G, Hofmann W, Mathies R, Schuster A, Cejna M. Accuracy of MDCT in the determination of supraaortic artery stenosis using DSA as the reference standard. Eur J Radiol 2011; 80:e351-5. [DOI: 10.1016/j.ejrad.2010.11.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 11/16/2010] [Accepted: 11/18/2010] [Indexed: 11/26/2022]
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Preprocedural imaging strategies in symptomatic carotid artery stenosis. J Vasc Surg 2011; 54:1215-8. [PMID: 21871773 DOI: 10.1016/j.jvs.2011.05.101] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 05/27/2011] [Accepted: 05/28/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND The benefit of carotid endarterectomy (CEA) over best medical therapy was established using intra-arterial angiography (IAA) for patient selection. Its cost, availability, and risk together with the emergence of newer imaging modalities have led to its replacement in the routine assessment of internal carotid artery (ICA) stenosis. The relative performance of these methods should dictate the optimum imaging strategy in symptomatic patients. METHODS A previous meta-analysis (NIHR Health Technology Assessment Programme) was reviewed. Medline and PubMed search was performed for relevant publications since 2006 together with a review of the references in retrieved publications. RESULTS Compared to IAA, the sensitivity and specificity for noninvasive imaging of a ≥70% to 99% ICA stenosis are duplex ultrasound (DUS): 0.89 (0.85-0.92) and 0.84 (0.77-0.89); time-of-flight magnetic resonance angiography (TOF-MRA): 0.88 (0.82-0.92) and 0.84 (0.76-0.97); contrast-enhanced MRA (CE-MRA): 0.94 (0.88-0.97) and 0.93 (0.89-0.96); and computed tomography angiography: 0.77 (0.68-0.84) and 0.95 (0.91-0.97), respectively. A policy of initial DUS followed by confirmatory CE-MRA best matches patient selection by arteriography. Single modality imaging for 50% to 69% ICA stenoses suggests reduced reliability resulting in more inappropriate operations. CONCLUSIONS DUS is the optimum screening tool due to its sensitivity and specificity, availability, and low cost. When CEA appears indicated, confirmatory imaging with CE-MRA is the most reliable and cost-effective method of investigation.
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55:2614-62. [PMID: 20513610 PMCID: PMC3042771 DOI: 10.1016/j.jacc.2009.11.011] [Citation(s) in RCA: 450] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010; 121:2462-508. [PMID: 20479157 PMCID: PMC3034132 DOI: 10.1161/cir.0b013e3181d44a8f] [Citation(s) in RCA: 232] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Schumacher HC, Meyers PM, Higashida RT, Derdeyn CP, Lavine SD, Nesbit GM, Sacks D, Rasmussen P, Wechsler LR. Reporting standards for angioplasty and stent-assisted angioplasty for intracranial atherosclerosis. J Vasc Interv Radiol 2009; 20:S451-73. [PMID: 19560032 DOI: 10.1016/j.jvir.2009.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Revised: 10/27/2008] [Accepted: 11/04/2008] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracranial cerebral atherosclerosis causes ischemic stroke in a significant number of patients. Technological advances over the past 10 years have enabled endovascular treatment of intracranial atherosclerotic stenosis. The number of patients treated with angioplasty or stent-assisted angioplasty for this condition is increasing. Given the lack of universally accepted definitions, the goal of this document is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting clinical and radiological evaluation, technique, and outcome of endovascular treatment using angioplasty or stent-assisted angioplasty for stenotic and occlusive intracranial atherosclerosis. SUMMARY OF REPORT This article was written under the auspices of Joint Writing Group of the Technology Assessment Committee, Society of NeuroInterventional Surgery, Society of Interventional Radiology; Joint Section on Cerebrovascular Neurosurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and the Section of Stroke and Interventional Neurology of the American Academy of Neurology. A computerized search of the National Library of Medicine database of literature (PubMed) from January 1997 to December 2007 was conducted with the goal to identify published endovascular cerebrovascular interventional data in stenotic intracranial atherosclerosis that could be used as benchmarks for quality assessment. We sought to identify those risk adjustment variables that affect the likelihood of success and complications. This document offers the rationale for different clinical and technical considerations that may be important during the design of clinical trials for endovascular treatment of intracranial stenotic and occlusive atherosclerosis. Included in this guidance document are suggestions for uniform reporting standards for such trials. These definitions and standards are primarily intended for research purposes; however, they should also be helpful in clinical practice and applicable to all publications. CONCLUSION In summary, the definitions proposed represent recommendations for constructing useful research data sets. The intent is to facilitate production of scientifically rigorous results capable of reliable comparisons between and among similar studies. In some cases, the definitions contained here are recommended by consensus of a panel of experts in this writing group for consistency in reporting and publication. These definitions should allow different groups to publish results that are directly comparable.
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Affiliation(s)
- H Christian Schumacher
- Saul R. Korey Department of Neurology, Division of Vascular Neurology and Neurocritical Care, Albert Einstein College of Medicine, Bronx, NY, USA
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Schumacher HC, Meyers PM, Higashida RT, Derdeyn CP, Lavine SD, Nesbit GM, Sacks D, Rasmussen P, Wechsler LR. Reporting Standards for Angioplasty and Stent-Assisted Angioplasty for Intracranial Atherosclerosis. Stroke 2009; 40:e348-65. [PMID: 19246710 DOI: 10.1161/strokeaha.108.527580] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Intracranial cerebral atherosclerosis causes ischemic stroke in a significant number of patients. Technological advances over the past 10 years have enabled endovascular treatment of intracranial atherosclerotic stenosis. The number of patients treated with angioplasty or stent-assisted angioplasty for this condition is increasing. Given the lack of universally accepted definitions, the goal of this document is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting clinical and radiological evaluation, technique, and outcome of endovascular treatment using angioplasty or stent-assisted angioplasty for stenotic and occlusive intracranial atherosclerosis.
Summary of Report—
This article was written under the auspices of Joint Writing Group of the Technology Assessment Committee, Society of NeuroInterventional Surgery, Society of Interventional Radiology; Joint Section on Cerebrovascular Neurosurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and the Section of Stroke and Interventional Neurology of the American Academy of Neurology. A computerized search of the National Library of Medicine database of literature (PubMed) from January 1997 to December 2007 was conducted with the goal to identify published endovascular cerebrovascular interventional data in stenotic intracranial atherosclerosis that could be used as benchmarks for quality assessment. We sought to identify those risk adjustment variables that affect the likelihood of success and complications. This document offers the rationale for different clinical and technical considerations that may be important during the design of clinical trials for endovascular treatment of intracranial stenotic and occlusive atherosclerosis. Included in this guidance document are suggestions for uniform reporting standards for such trials. These definitions and standards are primarily intended for research purposes; however, they should also be helpful in clinical practice and applicable to all publications.
Conclusion—
In summary, the definitions proposed represent recommendations for constructing useful research data sets. The intent is to facilitate production of scientifically rigorous results capable of reliable comparisons between and among similar studies. In some cases, the definitions contained here are recommended by consensus of a panel of experts in this writing group for consistency in reporting and publication. These definitions should allow different groups to publish results that are directly comparable.
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Affiliation(s)
- H Christian Schumacher
- Saul R Korey Department of Neurology, Division of Vascular Neurology and Neurocritical Care, Albert Einstein College of Medicine, Bronx, NY, USA
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Abstract
A transient ischemic attack portends significant risk of a stroke. Consequently, the diagnostic evaluation in the emergency department is focused on identifying high-risk causes so that preventive strategies can be implemented. The evaluation consists of a facilitated evaluation of the patient's metabolic, cardiac, and neurovascular systems. At a minimum, the following tests are recommended: fingerstick glucose level, electrolyte levels, CBC count, urinalysis, and coagulation studies; noncontrast computed tomography (CT) of the head; electrocardiography; and continuous telemetry monitoring. Vascular imaging studies, such as carotid ultrasonography, CT angiography, or magnetic resonance angiography, should be performed on an urgent basis and prioritized according to the patient's risk stratification for disease. Consideration should be given for echocardiography if no large vessel abnormality is identified.
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Affiliation(s)
- Steven R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Debrey SM, Yu H, Lynch JK, Lövblad KO, Wright VL, Janket SJD, Baird AE. Diagnostic Accuracy of Magnetic Resonance Angiography for Internal Carotid Artery Disease. Stroke 2008; 39:2237-48. [DOI: 10.1161/strokeaha.107.509877] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah M. Debrey
- From the Stroke Neuroscience Unit (S.M.D., V.L.W., H.Y., J.K.L., A.E.B.), National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD; and Boston University School of Dental Medicine (S.J.J.), Boston, Mass, USA and HUG Hôpital Cantonal, Geneva, Switzerland
| | - Hua Yu
- From the Stroke Neuroscience Unit (S.M.D., V.L.W., H.Y., J.K.L., A.E.B.), National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD; and Boston University School of Dental Medicine (S.J.J.), Boston, Mass, USA and HUG Hôpital Cantonal, Geneva, Switzerland
| | - John K. Lynch
- From the Stroke Neuroscience Unit (S.M.D., V.L.W., H.Y., J.K.L., A.E.B.), National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD; and Boston University School of Dental Medicine (S.J.J.), Boston, Mass, USA and HUG Hôpital Cantonal, Geneva, Switzerland
| | - Karl-Olof Lövblad
- From the Stroke Neuroscience Unit (S.M.D., V.L.W., H.Y., J.K.L., A.E.B.), National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD; and Boston University School of Dental Medicine (S.J.J.), Boston, Mass, USA and HUG Hôpital Cantonal, Geneva, Switzerland
| | - Violet L. Wright
- From the Stroke Neuroscience Unit (S.M.D., V.L.W., H.Y., J.K.L., A.E.B.), National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD; and Boston University School of Dental Medicine (S.J.J.), Boston, Mass, USA and HUG Hôpital Cantonal, Geneva, Switzerland
| | - Sok-Ja D. Janket
- From the Stroke Neuroscience Unit (S.M.D., V.L.W., H.Y., J.K.L., A.E.B.), National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD; and Boston University School of Dental Medicine (S.J.J.), Boston, Mass, USA and HUG Hôpital Cantonal, Geneva, Switzerland
| | - Alison E. Baird
- From the Stroke Neuroscience Unit (S.M.D., V.L.W., H.Y., J.K.L., A.E.B.), National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD; and Boston University School of Dental Medicine (S.J.J.), Boston, Mass, USA and HUG Hôpital Cantonal, Geneva, Switzerland
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19
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Chapter 50 Imaging intra‐ and extracranial vessels: computed tomography angiography and magnetic resonance angiography. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s0072-9752(08)94050-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Lee J, Beighley P, Ritman E, Smith N. Automatic segmentation of 3D micro-CT coronary vascular images. Med Image Anal 2007; 11:630-47. [PMID: 17827050 DOI: 10.1016/j.media.2007.06.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2006] [Revised: 06/04/2007] [Accepted: 06/20/2007] [Indexed: 11/21/2022]
Abstract
Although there are many algorithms available in the literature aimed at segmentation and model reconstruction of 3D angiographic images, many are focused on characterizing only a part of the vascular network. This study is motivated by the recent emerging prospects of whole-organ simulations in coronary hemodynamics, autoregulation and tissue oxygen delivery for which anatomically accurate vascular meshes of extended scale are highly desirable. The key requirements of a reconstruction technique for this purpose are automation of processing and sub-voxel accuracy. We have designed a vascular reconstruction algorithm which satisfies these two criteria. It combines automatic seeding and tracking of vessels with radius detection based on active contours. The method was first examined through a series of tests on synthetic data, for accuracy in reproduced topology and morphology of the network and was shown to exhibit errors of less than 0.5 voxel for centerline and radius detections, and 3 degrees for initial seed directions. The algorithm was then applied on real-world data of full rat coronary structure acquired using a micro-CT scanner at 20 microm voxel size. For this, a further validation of radius quantification was carried out against a partially rescanned portion of the network at 8 microm voxel size, which estimated less than 10% radius error in vessels larger than 2 voxels in radius.
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Affiliation(s)
- Jack Lee
- Bioengineering Institute, Faculty of Engineering, The University of Auckland, Private Bag 92019, Auckland, New Zealand.
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21
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Pineau S, Vidal V, Monnet O, Varoquaux A, Le Corroller T, Gaubert JY, Jacquier A, Bartoli JM, Moulin G. Indagini radiologiche preoperatorie in chirurgia vascolare. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1283-0801(07)70071-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, Powers WJ, DeCarli C, Merino JG, Kalaria RN, Vinters HV, Holtzman DM, Rosenberg GA, Wallin A, Dichgans M, Marler JR, Leblanc GG. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke 2006; 37:2220-41. [PMID: 16917086 DOI: 10.1161/01.str.0000237236.88823.47] [Citation(s) in RCA: 1090] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE One in 3 individuals will experience a stroke, dementia or both. Moreover, twice as many individuals will have cognitive impairment short of dementia as either stroke or dementia. The commonly used stroke scales do not measure cognition, while dementia criteria focus on the late stages of cognitive impairment, and are heavily biased toward the diagnosis of Alzheimer disease. No commonly agreed standards exist for identifying and describing individuals with cognitive impairment, particularly in the early stages, and especially with cognitive impairment related to vascular factors, or vascular cognitive impairment. METHODS The National Institute for Neurological Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN) convened researchers in clinical diagnosis, epidemiology, neuropsychology, brain imaging, neuropathology, experimental models, biomarkers, genetics, and clinical trials to recommend minimum, common, clinical and research standards for the description and study of vascular cognitive impairment. RESULTS The results of these discussions are reported herein. CONCLUSIONS The development of common standards represents a first step in a process of use, validation and refinement. Using the same standards will help identify individuals in the early stages of cognitive impairment, will make studies comparable, and by integrating knowledge, will accelerate the pace of progress.
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Affiliation(s)
- Vladimir Hachinski
- London Health Sciences Centre, University Campus, London, Ontario, Canada
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Graves MJ, U-King-Im J, Howarth S, Gillard JH. Ultrafast magnetic resonance imaging protocols in stroke. Expert Rev Neurother 2006; 6:921-30. [PMID: 16784414 DOI: 10.1586/14737175.6.6.921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Stroke is the third leading cause of death and morbidity in the Western world. Ever since the publication of the major randomized trials showing the benefit of thrombolysis in early acute stroke, there has been growing impetus for the diagnosis of acute stroke to become a medical emergency. Currently, computed tomography (CT) remains the diagnostic method of choice in the assessment of acute strokes. It is practical, rapid, and widely available and, as used in these trials, can robustly exclude acute hemorrhage before potential thrombolysis. Although magnetic resonance imaging (MRI) has a number of advantages over unenhanced CT, the practicalities of performing MRI in the acute setting have hampered its widespread use. There are several reasons why speed of imaging is paramount in acute strokes. Firstly, such patients are often unwell and agitated and, as such, require close monitoring. Moreover, because of the short window within which intravenous thrombolysis can be given, time-consuming imaging studies decrease the therapeutic options available and likelihood of successful intervention. This review summarizes the latest developments in ultrafast imaging protocols that have the potential to improve practical feasibility, and thus propel MRI back to the forefront of acute stroke imaging.
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Affiliation(s)
- Martin J Graves
- University of Cambridge Hospitals NHS Foundation Trust, Departments of Radiology and Medical Physics, Hills Road, Cambridge, CB2 2QQ, UK.
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