Abstract
ObjectivesWe hypothesized that 3D time-of-flight (TOF) and true fast imaging with steady-state precession (true-FISP) fusion imaging could provide more information regarding the arterial vessel wall. The purpose of this study was to compare the accuracy of lesion detection and the diagnostic confidence of VAD between TOF images alone and fused TOF and true-FISP images.MethodsFifty patients were studied: 17 had VAD and 33 had vertebral artery hypoplasia. Fusion images of the vertebral artery were reconstructed using a workstation. A receiver-operating characteristic (ROC) analysis was conducted with a continuous rating scale from 1 to 100 to compare observer performance in VAD detection. Five radiologists participated in the observer performance test, and their performances with TOF images were compared with those using fused images.ResultThe observers found that the mean areas under the best-fit ROC curve for TOF images alone and fused TOF images were 0.66 ± 0.05 and 0.93 ± 0.04, which were significantly different (P < 0.01).ConclusionThe fusion images provided more information regarding the arterial vessel wall. Fused images aided distinction between vertebral artery dissection versus vertebral artery hypoplasia.Key Points• New MR techniques can help to differentiate flowing blood from static blood products.• Fused TOF and true-FISP images differentiate the lumen and the arterial wall, improving diagnostic performance.• Fused images may be superior to time-of-flight MR angiography alone.
Highlights
Vertebral artery dissection is a potential cause of posterior circulation ischemia that requires high-spatial-resolution imaging for the definitive diagnosis [1]
Fused images may be superior to time-of-flight MR angiography alone
The purpose of this study was to compare the accuracy of lesion detection and the diagnostic confidence of vertebral artery dissection between TOF images alone and fused TOF and true-FISP images
Summary
Vertebral artery dissection is a potential cause of posterior circulation ischemia that requires high-spatial-resolution imaging for the definitive diagnosis [1]. Digital subtraction angiography (DSA) remains the gold standard for assessment of the vertebrobasilar arteries, with excellent spatial and temporal resolution [2, 3]. Risks associated with conventional angiography include vascular injury, intracerebral complications, contrast medium nephrotoxicity and exposure to ionizing radiation. Non-invasive diagnostic techniques such as CT angiography (CTA) and magnetic resonance imaging (MRI) with MR angiography (MRA) are typically used. CTA has been shown to have high sensitivity and specificity for the diagnosis of vertebral artery dissection [4]. The accuracy of CT in the evaluation of acute ischaemic lesions in the posterior cranial fossa remains limited [5]
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