Diagnosis of supra-aortic artery stenosis: comparison of magnetic resonance angiography imaging methods with conventional digital subtraction angiography

Hale Aydin, Agildere A. Muhtesem


Background: The aim of this study was to compare conventional digital subtraction angiography (DSA) with the multi-planar reformation (MPR) and maximum intensity projection (MIP) reconstruction of servical magnetic resonance angiography (MRA) in terms of detecting supra-aortic artery stenoses.

Methods: In the study, 21 patients who had underwent 3D MRA and conventional DSA were retrospectively assessed. Axial MPR, coronal MIP reconstruction and contrast enhanced 3D MRA subtraction images of a total of 333 artery segments were independently assessed by 2 separate radiologists. Conventional DSA results were accepted as gold standard results. The overall and individual Kappa values of all methods were calculated.

Results: Results of the conventional DSA analysis indicated total occlusion in 9 (2.7%), severe stenosis in 16 (4.8%), moderate stenosis in 90 (27.1%), mild stenosis in 105 (31.5%) and no stenosis in 113 (33.9%) arteries. While the k values of all methods were high which demonstrated strong relationships with the DSA method; the coronal MIP reconstruction method was found to be superior to other methods. The 3D MRA subtraction method did not yield better results in any of the individual comparisons.

Conclusions: Our results indicate that the coronal MIP reconstruction method has higher correlation with conventional DSA results compared to the other two methods and may be used as an accurate first-line diagnostic method for supra-aortic artery stenoses.


Carotid arter stenosis, Carotid arter occlusion, Maximum intensity projection, Supraaortic magnetic resonance angiography

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Wetzel S, Bongartz G. MR angiography: supra-aortic vessels. European radiology. 1999;9(7):1277-84.

Krings T, Hans F. New developments in MRA: time-resolved MRA. Neuroradiol. 2004;46(2):s214-s22.

Lee YJ, Laub G, Jung SL, Yoo WJ, Kim YJ, Ahn KJ, et al. Low‐dose 3D time‐resolved magnetic resonance angiography (MRA) of the supraaortic arteries: Correlation with high spatial resolution 3D contrast‐enhanced MRA. J Magnetic Resonance Imaging. 2011;33(1):71-6.

Lim R, Shapiro M, Wang E, Law M, Babb J, Rueff L, et al. 3D time-resolved MR angiography (MRA) of the carotid arteries with time-resolved imaging with stochastic trajectories: comparison with 3D contrast-enhanced Bolus-Chase MRA and 3D time-of-flight MRA. Am J Neuroradiol. 2008;29(10):1847-54.

Thiex R, Norbash A, Frerichs K. The safety of dedicated-team catheter-based diagnostic cerebral angiography in the era of advanced noninvasive imaging. Am J Neuroradiol. 2010;31(2):230-4.

Randoux B, Marro Ba, Koskas F, Duyme M, Sahel M, Zouaoui A, et al. Carotid artery stenosis: prospective comparison of CT, three-dimensional gadolinium-enhanced MR, and conventional angiography. Radiology. 2001;220(1):179-85.

Borisch I, Horn M, Butz B, Zorger N, Draganski B, Hoelscher T, et al. Preoperative evaluation of carotid artery stenosis: comparison of contrast-enhanced MR angiography and duplex sonography with digital subtraction angiography. Am J Neuroradiol. 2003;24(6):1117-22.

Friese S, Krapf H, Fetter M, Klose U, Skalej M, Küker W. Ultrasonography and contrast-enhanced MRA in ICA-stenosis: is conventional angiography obsolete? J Neurol. 2001;248(6):506-13.

Leclerc X, Gauvrit J, Nicol L, Pruvo J. Contrast-enhanced MR angiography of the craniocervical vessels: a review. Neuroradiol. 1999;41(12):867-74.

Kim JK, Farb RI, Wright GA. Test bolus examination in the carotid artery at dynamic gadolinium-enhanced MR angiography. Radiology. 1998;206(1):283-9.

Staikov IN, Arnold M, Mattle H, Remonda L, Sturzenegger M, Baumgartner RW, et al. Comparison of the ECST, CC, and NASCET grading methods and ultrasound for assessing carotid stenosis. J Neurology. 2000;247(9):681-6.

Collaborators NASCET. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. New England J Medicine. 1991;325(7):445-53.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. biometrics. 1977:159-74.

Balcı Y, Yıldız A, Özgür A, Yılmaz A, Kara E. Ekstrakraniyal Karotis ve Vertebral Arter Darlıklarında 64 Kesitli BT Anjiyografi ile DSA Bulgularının Karşılaştırılması. 2014.

Bak S, Roh H, Moon W-J, Choi J, An H. Appropriate Minimal Dose of Gadobutrol for 3D Time-Resolved MRA of the Supra-Aortic Arteries: Comparison with Conventional Single-Phase High-Resolution 3D Contrast-Enhanced MRA. Am J Neuroradiol. 2017;38(7):1383-90.

Remonda L, Senn P, Barth A, Arnold M, Lövblad K-O, Schroth G. Contrast-enhanced 3D MR angiography of the carotid artery: comparison with conventional digital subtraction angiography. Am J Neuroradiol. 2002;23(2):213-9.

Weber J, Veith P, Jung B, Ihorst G, Moske-Eick O, Meckel S, et al. MR angiography at 3 Tesla to assess proximal internal carotid artery stenoses: contrast-enhanced or 3D time-of-flight MR angiography? Clin Neuroradiol. 2015;25(1):41-8.

Gökçe E. İnternal Karotid Arter Darlıklarında Time-Resolved Kontrastlı Manyetik Rezonans Anjiyografi ve Dijital Substraksiyon Anjiyografinin Karşılaştırılması. J Contemporary Med. 2017;7(3):208-16.

Choyke PL, Yim P, Marcos H, Ho VB, Mullick R, Summers RM. Hepatic MR angiography: a multiobserver comparison of visualization methods. American J Roentgenology. 2001;176(2):465-70.

Warach S, Baird AE, Dani KA, Wintermark M, Kidwell CS. Magnetic resonance imaging of cerebrovascular diseases. Stroke: Elsevier Inc. 2011.

Anderson CM, Saloner D, Tsuruda JS, Shapeero LG, Lee RE. Artifacts in maximum-intensity-projection display of MR angiograms. AJR Am J Roentgenol. 1990;154(3):623-9.