Magnetic resonance angiography of the head and neck vessels

Stroke, a major cause of death and disability in the developed world, is usually caused by atherosclerosis, most commonly an arterio-occlusive lesion at the carotid bifurcation. Numerous multicentre trials have demonstrated that carotid endarterectomy can reduce the risk of stroke in these patients. However, because of the morbidity of catheter angiography coupled with the risks of surgery, the benefits outweigh the risks of surgery only for those with >70% carotid artery stenosis. The gold standard method for assessing the degree of stenosis is catheter-directed cerebral digital subtraction angiography; however, this is associated with a small but substantial stroke risk in addition to inherent risks associated with use of ionizing radiation and nephrotoxic contrast agents. The requirement for alternative imaging techniques that do not contribute to morbidity is ideally met by contrast-enhanced magnetic resonance angiography, which eliminates the need for direct catheterization and therefore eliminates stroke risk associated with a patient work-up. Advances in contrast-enhanced magnetic resonance angiography technology have led to a technique that achieves the goals of high spatial and temporal resolution required for stenosis assessment and streamlining of patients along surgical or medical lines. With the advent of a novel contrast agent, gadofosveset trisodium (Vasovist, Bayer Schering Pharma AG, Berlin, Germany), which has a high relaxivity and an extended imaging time, improved diagnosis of carotid artery stenoses with magnetic resonance angiography can be expected. Gadofosveset trisodium facilitates improved first-pass imaging and also delays steady-state imaging with one injection. Although developed for vascular imaging, gadofosveset trisodium may also allow assessment of brain vascularity, blood-brain barrier breakdown and neurodegenerative disease.