Michele Anzidei MD, Presenter: Nothing to Disclose

Alessandro Napoli MD, Abstract Co-Author: Nothing to Disclose

Gaia Cartocci, Abstract Co-Author: Nothing to Disclose

Beatrice Cavallo Marincola MD, Abstract Co-Author: Nothing to Disclose

Fulvio Zaccagna MD, Abstract Co-Author: Nothing to Disclose

Carlo Catalano MD, Abstract Co-Author: Nothing to Disclose

To prospectively evaluate the potential of gadobenate dimeglumine for first-pass (FP) and steady-state (SS) MR Angiography (MRA) of the carotid arteries, compared with computed tomography angiography (CTA) and using digital subtraction angiography (DSA) as reference.

Forty consecutive patients each underwent conventional FP MRA with 15 mL gadobenate dimeglumine using a conventional 3D FLASH sequence (14” acquisition time). Immediately afterwards, SS images were obtained using a high resolution coronal 3D FLASH sequence (240” acquisition time). All patients also underwent CTA and conventional DSA within 8±3 days. Three experienced radiologists assessed FP and SS image quality and calculated sensitivity, specificity, accuracy and predictive values for stenosis grade and length, plaque morphology and tandem lesions using DSA as reference. Detected stenoses were quantified and compared (Spearman rank correlation coefficient, [R(s)]; McNemar test) with DSA and CTA findings. Inter-read variability was assessed using kappa (κ) statistics. The impact of SS acquisitions on diagnostic confidence and patient management was assessed.

MRA FP and SS image quality was excellent in 63 (79%) and 47 (56%) vessels, adequate in 11(14%) and 21 (26%) vessels and poor in 6 (7%) and 12 (15%) vessels, respectively. Area under the curve analysis revealed no significant differences between MRA FP, MRA FP+SS and CTA for the grading of stenoses (p=0.838; accuracy values of 97.4%, 97.45 and 98.7%, respectively). Greater accuracy (p<0.001) was noted for FP+SS images over FP images alone for the assessment of plaque morphology (94.5% for FP+SS images vs. 83.3% for FP). Increased diagnostic confidence was noted for 49 (61.3%) vessels due to additional SS images while an impact on final diagnosis was noted in 8 (10%) cases. Good correlation was noted between SS image quality and impact on final diagnosis (R(s) = 0.7; p<0.0001).

SS imaging of the carotid arteries is feasible with gadobenate dimeglumine. The increased spatial resolution attainable improves evaluation of stenoses and plaque irregularity, yielding comparable diagnostic performance to that of CTA.

SS MRA imaging of the carotid arteries with gadobenate dimeglumine is superior to conventional FP imaging for the evaluation of stenosis and plaque morphology.

Anzidei, M, Napoli, A, Cartocci, G, Cavallo Marincola, B, Zaccagna, F, Catalano, C, Steady State MR Angiography of the Carotid Arteries: Feasibility and Preliminary Clinical Experience with Gadobenate Dimeglumine Compared with CT Angiography and Conventional Angiography.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008993.html