Supra-aortic low-dose contrast-enhanced time-resolved magnetic resonance (MR) angiography at 3 T: Comparison with time-of-flight MR angiography and high-resolution contrast-enhanced MR angiography

Background Low-dose, time-resolved, contrast-enhanced, magnetic resonance angiography (TR-CEMRA) has been described previously; however, a comparative study between low dose TR-CEMRA and time-of-flight MRA (TOF-MRA) in the diagnosis of supra-aortic arterial stenosis has not yet been published. Purpose To demonstrate the feasibility and effectiveness of low-dose TR-CEMRA compared with TOF-MRA, using high-resolution contrast-enhanced MRA (HR-CEMRA) as the reference standard. Material and Methods This prospective study consisted of 30 consecutive patients. All patients underwent TOF-MRA of the neck and circle of Willis and supra-aortic HR-CEMRA, followed by supra-aortic low-dose TR-CEMRA. Gadoterate meglumine (Gd-DOTA, Dotarem®, Guerbet, Roissy CdG Cedex, France) was injected at a dose of 0.1 mmol/kg for HR-CEMRA, followed by a 0.03 mmol/kg bolus for low-dose TR-CEMRA. Three readers evaluated the assessibility and image quality, and then two readers classified each stenosis into the following categories: normal (0-30%), mild stenosis (31-50%), moderate (51-70%), severe (71-99%), and occlusion. Results TR-CEMRA and HR-CEMRA showed a greater number of assessable arterial segments than TOF-MRA (P < 0.01). For TR-CEMRA, 29 cases showed within or better than the diagnostic range, whereas all 30 cases were in the diagnostic range for TOF-MRA and HR-CEMRA. For evaluation of stenosis in a total of 743 arterial segments, both TR-CEMRA and TOF-MRA results agreed with those of HR-CEMRA in 729 segments (98.1%), with excellent inter-observer agreement of TR-CEMRA; stenosis was overestimated in nine segments (1.2%) and underestimated in five segments (0.7%). For diagnosis of stenosis using 30% as the cut-off value on HR-CEMRA, the sensitivity and specificity were 88.2% and 99.3%, respectively, for the TR-CEMRA procedure, versus 94.1% and 99.6%, respectively, for TOF-MRA. Conclusion Low-dose TR-CEMRA is feasible and effective in the diagnosis of supra-aortic arterial stenosis, and could be more useful option than TOF-MRA.