Atherosclerotic disease distribution in carotid and Vertebrobasilar arteries: Clinical experience in 100 patients undergoing fluoro-triggered 3D Gd-MRA

Purpose: To determine how often three dimension gadolinium-enhanced magnetic resonance angiography (3D Gd-RA) shows disease outside of the standard two-dimensional time of flight magnetic resonance angiography (2D TOF MRA) imaging volume. Materials and Methods: One hundred consecutive patients with know or suspected cerebrovascular disease were examined using fluro-triggered 3D Gd-MRA with a 1.5 Tesla scanner. All vessel segments from the aortic arch to the circle of Willis were independently evaluated for the presence of occlusive disease, ulceration, aneurysm, and anatomic variation by two radiologists blinded to clinical information. Branch vessel and circle of Willis visibility were also assessed. Kappa statistics were calculated to determine interobserver agreement. Results: Interobserver agreement for the degree of stenosis was good to excellent (kappa=0.83-10.). Disagreement was more frequent in the cases of mild stenoses and was less frequent for stenoses greater than or equal to50%. In 38% of the patients, 3D Gd-MRA demonstrated either ulcerated plaques in carotid arteries (N=14) or stenosis greater than or equal to50% in great vessel (N=20) and/or vertebral artery (N=38) origins, none of which can be readily evaluated on standard TOF-MRA. Conclusion: Fluor-triggered 3D Gd-MRA provides a comprehensive evaluation of the carotid arteries including all vessel segments from the aortic arch to the circle of Willis.