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Extracranial Carotid Artery Disease

E. Mark Haacke¹, Daniel Kido², Karen Tong²

¹The MRI Institute for Biomedical Research, St. Louis, Missouri
²Loma Linda University, Loma Linda, California

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A1.3

DOI:

10.1002/0471142719.mia0103s07

Online Posting Date:

February, 2003

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Abstract

Magnetic Resonance Angiography (MRA) is a noninvasive means for studying the integrity of the vascular system. This unit presents a basic protocol describing an MRA technique for imaging the carotid arteries, time-of-flight MRA, and an Alternate Protocol for contrast-enhanced MRA. A second basic protocol based on high-resolution spin-echo scanning is also described. This protocol can be used to study the vessel wall in more detail. The parameters given here are derived from experience at 1.5 T and may need to be altered slightly depending on the field strength and the equipment manufacturer. In particular, optimal TE may vary with different field strength.

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Unit Introduction
Basic Protocol 1: Imaging the Carotid Arteries by Time-of-Flight MRA
Alternate Protocol: Imaging the Carotid Artery by Contrast-Enhanced Time-of-flight MRA
Basic Protocol 2: Imaging Blood Vessel Walls by Spin-Echo MRA
Commentary
Bibliography
Figures
Tables

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Materials

Alternate Protocol: Imaging the Carotid Artery by Contrast-Enhanced Time-of-flight MRA

Materials

Gadolinium-based MR contrast agent (e.g., Magnevist, Omniscan, or Prohance)
Normal saline (0.9% NaCl), sterile
Power injector

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Figures

Figure A1.3.1

Schematic of the carotid artery and jugular vein. The images resulting from the 3-D TOF scan (sequence 3; Fig. A1.3.2) show dramatically reduced signal from the veins.

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Figure A1.3.2

Transverse and coronal planes of a human neck. (A) A transverse image across the neck without a saturation pulse shows a cross-section of both the carotid artery and the jugular vein (arrows). (B) After a saturation pulse, the signal from the jugular vein is dramatically suppressed. (C, D) Coronally reformatted images obtained from the same 3-D transverse data sets used to obtain the images shown in (A) and (B), respectively. Note that the internal jugular veins (arrows) have vanished in (B) and (D).

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Figure A1.3.3

Images from a contrast-enhanced scan immediately after injection of the contrast agent. Data was acquired coronally so that all vessels could be seen in projection mode. The in-plane resolution is just high enough to show the diseased vessels. (A) A major stenosis is present on the right carotid and some abnormality on the left carotid. (B) A magnified view of the right carotid shows the latter problem more clearly.

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Literature Cited

Literature Cited
	Anderson, C.M., Edelman, R.R., and Tarshi, P.A. (eds.) 1993. Clinical Magnetic Resonance Angiography. Raven Press, New York.
	Haacke, E.M. and Masaryk, T.J. 1989. The salient features of MR angiography. Radiology 173:611-612.
	Haacke, E.M., Brown, R.W., Venkatesan, R., and Thompson, M.R. 1999. Magnetic Resonance Imaging: Physical Principles and Sequence Design. John Wiley & Sons, New York.
	Potchen, J.E., Haacke, E.M., Siebert, J.E., and Gottschalk, A. (eds.) 1992. Magnetic Resonance Angiography. C.V. Mosby, St. Louis.
	Prince, M.R., Chenevert, T.L., Foo, T.K., Londy, F.J., Ward, J.S., and Maki, J.H. 1997. Contract enhanced abdominal MR angiography: Optimization of imaging delay time by automating the detection of contrast material arrival in the aorta. Radiology 203:109-114.
	Raynaud, J.-S., Bridal, S.L., Toussaint, J.-F., Fornès, P., Lebon, V., Berger, G., and Leroy-Willig, A. 1998. Characterization of atherosclerotic plaque components by high resolution quantitative MR and US imaging. J. Magn. Reson. Imaging 8:622-629.
	Shellock, F.G. 2001. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
	Wilman, A.H., Riederer, S.J., Huston, J., 3rd., Wald, J.T., and Debbins, J.P. 1998. Arterial phase carotid and vertebral artery imaging in 3-D contrast-enhanced MR angiography by combining fluoroscopic triggering with an elliptical centric acquisition order. Magn. Reson. Med. 40:24-35.
	Yuan, C., Skinner, M.P., Kaneki, E., Mitsumori, L.M., Hayes, C.E., Raines, E.W., Nelson, J.A., and Ross, R. 1996. Magnetic resonance imaging to study lesions of atherosclerosis in the hyper-lipidemic rabbit aorta. Magn. Reson. Imaging 14:93-102.
Internet Resources
	http://www.mravvh.com
Vascular Visible Human Project, providing an overview of MRA imaging for different parts of the body.
	http://www.mrisafety.com
Covers a number of important patient management issues related to MR imaging, including recommended safety procedures, a list of metallic implants that have been tested for MR compatibility, and a list of other sources on MR safety.
Key References
	Potchen, E.J., Haacke, E.M., Siebert, J.E., and Gottschalk, A. 1993. Magnetic Resonance Angiography: Concepts and Applications. C.V. Mosby, St. Louis.
Contains detailed descriptions of the technical aspects of magnetic resonance angiography, as well as numerous clinical examples.
	Shellock, F.G. 2001. Magnetic Resonance Procedures: Health effects and safety. CRC Press, Fla.
Covers a number of important patient management issues related to MR imaging, including recommended safety procedures, a list of metallic implants that have been tested for MR compatibility, and a list of other sources on MR safety.