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Multidirectional Depiction of Internal Carotid Arterial Stenosis: Three-dimensional Time-of-Flight MR Angiography versus Rotational and Conventional Digital Subtraction Angiography¹

¹ From the Departments of Radiology (O.E.H.E., A.F.J.W., P.C.B., W.P.T.M.M.) and Vascular Surgery (B.C.E.) and the Julius Center for Patient Oriented Research (O.E.H.E., Y.v.d.G.), University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands. Received March 1, 1999; revision requested April 26; final revision received October 5; accepted November 10. Address correspondence to O.E.H.E. (e-mail: o.e.h.elgersma@azu.nl).

PURPOSE: To evaluate whether and to what extent greater number of projection images obtained at three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) angiography versus conventional digital subtraction angiography (DSA) causes overestimation of internal carotid arterial (ICA) stenosis.

MATERIALS AND METHODS: DSA (two or three projections), rotational angiography (16 or 32 projections), and 3D TOF MR angiography (12 projections) were performed in 47 stenotic ICAs of 38 symptomatic patients. Two observers independently measured maximum stenosis, and the mean differences among MR angiography, DSA, and rotational angiography were compared.

RESULTS: Three rotational and five MR angiograms were nondiagnostic. Seven MR angiograms of ICA stenoses showed a signal void and were excluded from analysis. On the remaining 32 angiograms, mean differences in maximum stenosis for observers 1 and 2, respectively, were 7% (95% CI: 3%, 12%) and 8% (95% CI: 3%, 13%) at MR angiography versus DSA and 2% (95% CI: -2%, 7%) and -1% (95% CI: -5%, 3%) at MR angiography versus rotational angiography. ICA stenosis was graded significantly higher at MR angiography versus DSA, whereas, it was not overestimated at MR angiography versus rotational angiography. The difference in maximum stenosis at MR angiography versus DSA was significantly different from that of MR angiography versus rotational angiography.

CONCLUSION: Apparent overestimation of ICA stenosis at 3D TOF MR angiography versus conventional DSA may be partly explained by the greater number of projection images available at 3D TOF MR angiography.

Index terms: Angiography, comparative studies, 172.12142, 172.12143, 172.12473 • Carotid arteries, stenosis or obstruction, 172.721, 172.781 • Digital subtraction angiography, 172.12473 • Magnetic resonance (MR), contrast enhancement, 172.12143 • Magnetic resonance (MR), three-dimensional, 172.12142, 172.12143 • Magnetic resonance (MR), time of flight, 172.12142, 172.12143

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