Magnetic resonance angiography minimizes need for arteriography after inadequate carotid duplex ultrasound scanning Martin R Back, MD, G.Aaron Rogers,

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Presentation transcript:

Magnetic resonance angiography minimizes need for arteriography after inadequate carotid duplex ultrasound scanning Martin R Back, MD, G.Aaron Rogers, BS, Jeffrey S Wilson, MD, Brad L Johnson, MD, Murray L Shames, MD, Dennis F Bandyk, MD Journal of Vascular Surgery Volume 38, Issue 3, Pages 422-430 (September 2003) DOI: 10.1016/S0741-5214(03)00794-8

Fig 1 Results of cerebrovascular imaging algorithm, October 1998 to July 2002, for evaluating patients with suspected disease. Resulting intervention (CEA) and required preoperative imaging. CEA, Carotid endarterectomy; MRA, magnetic resonance angiography. Journal of Vascular Surgery 2003 38, 422-430DOI: (10.1016/S0741-5214(03)00794-8)

Fig 2 A, Long (3 cm) internal carotid artery (ICA) plaque, with inability to image past stenosis with duplex scanning (persistent ICA peak systolic velocity (PSV) >125 cm/s). B, Maximum ICA PSV consistent with greater than 75% stenosis. C, Magnetic resonance angiogram shows long stenosis (3 cm by calibration) with short ICA flow gap (arrow). Journal of Vascular Surgery 2003 38, 422-430DOI: (10.1016/S0741-5214(03)00794-8)

Fig 3 A, Blunted, low peak systolic velocity (46 cm/s) right vertebral waveform at duplex scanning. B, Arteriogram exhibits high-grade vertebral origin stenosis (black arrow) and thyrocervical trunk collateral vessels. C, Magnetic resonance angiogram shows right internal carotid artery occlusion (large arrow on left) and patent vertebral artery (short arrows on right), but unresolved vertebral origin region (thin arrow on right). Journal of Vascular Surgery 2003 38, 422-430DOI: (10.1016/S0741-5214(03)00794-8)

Fig 4 A, Right carotid near-occlusion seen on power Doppler scan. Maximum internal carotid artery (ICA) peak systolic velocity is consistent with greater than 50% stenosis. Note small diameter distal ICA lumen. Magnetic resonance angiograms show intracranial ICA flow signal (arrow, B) and faint cervical ICA flow signal (arrows, C), consistent with “trickle” flow. Journal of Vascular Surgery 2003 38, 422-430DOI: (10.1016/S0741-5214(03)00794-8)