Published Online
on July 22, 2004

A more recent version of this article appeared on September 1, 2004

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Submitted on May 28, 2004
Accepted on June 3, 2004

Comparison of Preperfusion and Postperfusion Magnetic Resonance Angiography in Acute Stroke

Salvador Pedraza MD^*; Yolanda Silva MD; José Mendez MD; Luis Inaraja MD, PhD; Joana Vera MD; Joaquín Serena MD, PhD; and Antoni Dávalos MD, PhD

From the Service of Radiology (S.P., J.M., L.I., J.V.), Unidad de RM-IDI, and the Department of Neurology (Y.S., J.S., A.D.), Hospital Universitari Doctor Josep Trueta, Girona, Spain. Center affiliated with the Universitat Autònoma de Barcelona.

^* To whom correspondence should be addressed. E-mail: spedraza{at}retemail.es.

Background and Purpose--The multimodal magnetic resonance imaging study in acute stroke includes perfusion-weighted imaging (PWI) after administration of contrast and magnetic resonance angiography (MRA). However, MRA may overestimate the degree of vessel obstruction caused by limitations to detect low flow states. Our aim was to determine the usefulness of a new fast imaging protocol combining classical MRA, PWI, and postperfusion MRA to improve the diagnostic management in acute ischemic stroke.

Methods--We studied 31 patients with a middle cerebral artery (MCA) infarction within the first 12 hours from the onset of symptoms. All patients had an MCA stenosis or occlusion. The study protocol included a preperfusion MRA and a postperfusion MRA. Modified thrombolysis in myocardial infarction (TIMI) classification was used to assess the patency of vessels.

Results--In 17 patients (group A, 55%), preperfusion MRA and postperfusion MRA accorded in the estimation of vascular status, whereas in 14 patients (group B, 45%) postperfusion MRA showed a better vascular flow than preperfusion MRA. The improvement in the depiction of flow was from a complete occlusion (TIMI I) to a partial occlusion (TIMI II) in 9 patients and from TIMI II to normal patency (TIMI III) in 5 patients. Thirty-six percent of the patients with suspected internal carotid artery occlusion in the preperfusion MRA showed flow in the intracranial internal carotid artery in the postperfusion MRA.

Conclusions--Postperfusion contrast-enhanced MRA can demonstrate arterial segments with low flow and avoid overestimation of vascular obstruction.

Key words: angiography • contrast media • magnetic resonance • myocardial infarction

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