Assessment of CE-MRA for the rapid detection of supra-aortic vascular disease

Background: Contrast-enhanced MR angiography (CE-MRA) using a combined head and neck coil permits non-invasive imaging of the vasculature from the aortic arch through to the Circle of Willis in less than 2 minutes. Objective: To determine the accuracy of CE-MRA for the detection of vascular pathology, in particular vascular stenoses, using digital subtraction angiography (DSA) as the gold standard. Methods: In a prospective study of 81 patients referred for DSA, CE-MRA and DSA studies were performed within 72 hours of each other. CE-MRA was performed on a 1.5 Tesla clinical MRI scanner using a five-channel neurovascular array ( head and neck coil), with dynamic tracking of the IV gadolinium bolus. CE-MRAs and DSA films were read by two interventional neuroradiologists blinded to the clinical presentation of the patient. Results: On DSA, there were 77 vascular stenoses >= 50% identified, 51 extracranial and 26 intracranial. The overall sensitivity of CE-MRA using the neurovascular array for the detection of vascular stenoses >= 50% was 57% ( 95% CI: 46 to 68%) with a specificity of 98% ( 97 to 99%). The sensitivity for the detection of extracranial vascular stenoses >= 50% was 82% ( 72 to 93%) with a specificity of 97% ( 96 to 98%). However, the sensitivity for the detection of intracranial vascular stenoses >= 50% was only 8% ( 0 to 18%), with a specificity of 99% ( 98 to 100%). Conclusions: At this stage Contrast-enhanced MR angiography using a neurovascular coil shows promise as a rapid, specific, and noninvasive screening method for extracranial vascular disease, but not for intracranial vascular disease.