Relaxation-Enhanced Angiography Without Contrast and Triggering (REACT) for Fast Imaging of Extracranial Arteries in Acu
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ORIGINAL ARTICLE
Relaxation-Enhanced Angiography Without Contrast and Triggering (REACT) for Fast Imaging of Extracranial Arteries in Acute Ischemic Stroke at 3 T Lenhard Pennig1 · Christoph Kabbasch1 · Ulrike Cornelia Isabel Hoyer1 · Simon Lennartz1,2,3 · David Zopfs1 · Lukas Goertz1,4 · Kai Roman Laukamp1 · Anton Wagner1 · Jan-Peter Grunz5 · Jonas Doerner1 · Thorsten Persigehl1 · Kilian Weiss6 · Jan Borggrefe1,7 Received: 12 May 2020 / Accepted: 2 September 2020 © The Author(s) 2020
Abstract Purpose To evaluate a novel flow-independent 3D isotropic REACT sequence compared with CE-MRA for the imaging of extracranial arteries in acute ischemic stroke (AIS). Methods This was a retrospective study of 35 patients who underwent a stroke protocol at 3 T including REACT (fixed scan time: 2:46 min) and CE-MRA of the extracranial arteries. Three radiologists evaluated scans regarding vessel delineation, signal, and contrast and assessed overall image noise and artifacts using 5-point scales (5: excellent delineation/no artifacts). Apparent signal- and contrast-to-noise ratios (aSNR/aCNR) were measured for the common carotid artery (CCA), internal carotid artery (ICA, C1 segment), and vertebral artery (V2 segment). Two radiologists graded the degree of proximal ICA stenosis. Results Compared to REACT, CE-MRA showed better delineation for the CCA and ICA (C1 and C2 segments) (median 5, range 2–5 vs. 4, range 3–5; P < 0.05). For the ICA (C1 and C2 segments), REACT provided a higher signal (5, range 3–5; P < 0.05/4.5, range 3–5; P > 0.05 vs. 4, range 2–5) and contrast (5, range 3–5 vs. 4, range 2–5; P > 0.05) than CE-MRA. The remaining segments of the blood-supplying vessels showed equal medians. There was no significant difference regarding artifacts, whereas REACT provided significantly lower image noise (4, range 3–5 vs. 4 range 2–5; P < 0.05) with a higher aSNR (P < 0.05) and aCNR (P < 0.05) for all vessels combined. For clinically relevant (≥50%) ICA stenosis, REACT achieved a detection sensitivity of 93.75% and a specificity of 100%. Conclusion Given its fast acquisition, comparable image quality to CE-MRA and high sensitivity and specificity for the detection of ICA stenosis, REACT was proven to be a clinically applicable method to assess extracranial arteries in AIS.
The authors Lenhard Pennig and Christoph Kabbasch contributed equally to the manuscript. Availability of data and material: The datasets generated and/or analyzed during the current study are not publicly available due to data protection but are available from the corresponding author on reasonable request. Code availability: The imaging protocol of applied REACT sequence is available from the corresponding author on reasonable request.
2
Harvard Medical School, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
3
Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Cologne, Germany
4
Center for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine and University Hospital Colog
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