Diagnostic accuracy of high-resolution black-blood MRI in the evaluation of intracranial large-vessel arterial occlusions X

A. S. Al-Smadi; R. N. Abdalla; A. H. Elmokadem; A. Shaibani; M. C. Hurley; M. B. Potts; B. S. Jahromi; T. J. Carroll; S. A. Ansari

doi:10.3174/ajnr.A6065

Diagnostic accuracy of high-resolution black-blood MRI in the evaluation of intracranial large-vessel arterial occlusions X

A. S. Al-Smadi, R. N. Abdalla, A. H. Elmokadem, A. Shaibani, M. C. Hurley, M. B. Potts, B. S. Jahromi, T. J. Carroll, S. A. Ansari^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

32 Scopus citations

Abstract

BACKGROUNDANDPURPOSE: 3D high-resolution black-blood MRI orMRvessel wall imaging allows evaluation of the intracranial arterial wall and extraluminal pathology. We investigated the diagnostic accuracy and reliability of black-blood MRI for the intraluminal detection of large-vessel arterial occlusions. MATERIALS AND METHODS: We retrospectively identified patients with intracranial arterial occlusions, confirmed by CTA or DSA, who also underwent 3D black-blood MRI with nonenhanced and contrast-enhanced T1 sampling perfection with application-optimized contrasts by using different flip angle evolution (T1 SPACE) sequences. Black-blood MRI findings were evaluated by 2 independent and blinded neuroradiologists. Large-vessel intracranial arterial segments were graded on a 3-point scale (grades 0-2) for intraluminal baseline T1 hyperintensity and contrast enhancement. Vessel segments were considered positive for arterial occlusion if focal weak (grade 1) or strong (grade 2) T1-hyperintense signal and/or enhancement replaced the normal intraluminal black-blood signal. RESULTS: Thirty-one patients with 38 intracranial arterial occlusions were studied. The median time interval between black-blood MRI and CTA/DSA reference standard studies was 2 days (range, 0-20 days). Interobserver agreement was good for T1 hyperintensity (κ=0.63) and excellent for contrast enhancement (κ = 0.89). High sensitivity (100%) and specificity (99.8%) for intracranial arterial occlusion diagnosis was observed with either intraluminal T1 hyperintensity or contrast-enhancement imaging criteria on black-blood MRI. Strong grade 2 intraluminal enhancement was maintained in-80% of occlusions irrespective of location or chronicity. Relatively increased strong grade 2 intraluminal T1 hyperintensity was noted in chronic/incidental versus acute/subacute occlusions (45.5% versus 12.5%, P = .04). CONCLUSIONS: Black-blood MRI with or without contrast has high diagnostic accuracy and reliability in evaluating intracranial largevessel arterial occlusions with near-equivalency to DSA and CTA.

Original language	English (US)
Pages (from-to)	954-959
Number of pages	6
Journal	American Journal of Neuroradiology
Volume	40
Issue number	6
DOIs	https://doi.org/10.3174/ajnr.A6065
State	Published - Jun 1 2019

Funding

Received January 31, 2019; accepted after revision April 10. From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Neurology (S.A.A.), and Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Radiology (T.J.C.), University of Chicago, Chicago, Illinois; Department of Radiology (R.N.A.), Ain Shams University, Cairo, Egypt; and Department of Radiology (A.H.E.), Mansoura University, Mansoura, Egypt. This work was supported by the following grants: American Heart Association 13GRNT17340018 and 14GRNT20380798 (Principal Investigators: S.A. Ansari and T.J. Carroll); National Institutes of Health/National Heart, Lung, and Blood Institute 1R21HL130969 (Principal Investigator: S.A. Ansari); and National Institutes of Health/ National Heart, Lung, and Blood Institute 1R01NS093908 (Principal Investigator: T.J. Carroll). Please address correspondence to Sameer A. Ansari, MD, PhD, Departments of Radiology, Neurology, and Neurological Surgery, Northwestern University, Fein-berg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611-2927; e-mail: [email protected] Disclosures: Timothy J. Carroll—RELATED: Grant: National Institutes of Health, Comments: National Institutes of Health/National Institute of Neurological Disorders and Stroke 1R01NS093908*; UNRELATED: Grants/Grants Pending: National Institutes of Health.* Sameer A. Ansari—RELATED: Grant: American Heart Association 13GRNT17340018 and 14GRNT20380798 (Principal Investigators: S.A. Ansari and T.J. Carroll); National Institutes of Health/National Heart, Lung, and Blood Institute 1R21HL130969 (Principal Investigator: S.A. Ansari); and National Institutes of Health/ National Institute of Neurological Disorders and Stroke 1R01NS093908 (Principal Investigator: T.J. Carroll).* *Money paid to the institution.

ASJC Scopus subject areas

Clinical Neurology
Radiology Nuclear Medicine and imaging

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10.3174/ajnr.A6065

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@article{ae7451e180024803abedfeca16c1ee9c,

title = "Diagnostic accuracy of high-resolution black-blood MRI in the evaluation of intracranial large-vessel arterial occlusions X",

abstract = "BACKGROUNDANDPURPOSE: 3D high-resolution black-blood MRI orMRvessel wall imaging allows evaluation of the intracranial arterial wall and extraluminal pathology. We investigated the diagnostic accuracy and reliability of black-blood MRI for the intraluminal detection of large-vessel arterial occlusions. MATERIALS AND METHODS: We retrospectively identified patients with intracranial arterial occlusions, confirmed by CTA or DSA, who also underwent 3D black-blood MRI with nonenhanced and contrast-enhanced T1 sampling perfection with application-optimized contrasts by using different flip angle evolution (T1 SPACE) sequences. Black-blood MRI findings were evaluated by 2 independent and blinded neuroradiologists. Large-vessel intracranial arterial segments were graded on a 3-point scale (grades 0-2) for intraluminal baseline T1 hyperintensity and contrast enhancement. Vessel segments were considered positive for arterial occlusion if focal weak (grade 1) or strong (grade 2) T1-hyperintense signal and/or enhancement replaced the normal intraluminal black-blood signal. RESULTS: Thirty-one patients with 38 intracranial arterial occlusions were studied. The median time interval between black-blood MRI and CTA/DSA reference standard studies was 2 days (range, 0-20 days). Interobserver agreement was good for T1 hyperintensity (κ=0.63) and excellent for contrast enhancement (κ = 0.89). High sensitivity (100%) and specificity (99.8%) for intracranial arterial occlusion diagnosis was observed with either intraluminal T1 hyperintensity or contrast-enhancement imaging criteria on black-blood MRI. Strong grade 2 intraluminal enhancement was maintained in-80% of occlusions irrespective of location or chronicity. Relatively increased strong grade 2 intraluminal T1 hyperintensity was noted in chronic/incidental versus acute/subacute occlusions (45.5% versus 12.5%, P = .04). CONCLUSIONS: Black-blood MRI with or without contrast has high diagnostic accuracy and reliability in evaluating intracranial largevessel arterial occlusions with near-equivalency to DSA and CTA.",

author = "Al-Smadi, {A. S.} and Abdalla, {R. N.} and Elmokadem, {A. H.} and A. Shaibani and Hurley, {M. C.} and Potts, {M. B.} and Jahromi, {B. S.} and Carroll, {T. J.} and Ansari, {S. A.}",

note = "Funding Information: Received January 31, 2019; accepted after revision April 10. From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Neurology (S.A.A.), and Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Radiology (T.J.C.), University of Chicago, Chicago, Illinois; Department of Radiology (R.N.A.), Ain Shams University, Cairo, Egypt; and Department of Radiology (A.H.E.), Mansoura University, Mansoura, Egypt. This work was supported by the following grants: American Heart Association 13GRNT17340018 and 14GRNT20380798 (Principal Investigators: S.A. Ansari and T.J. Carroll); National Institutes of Health/National Heart, Lung, and Blood Institute 1R21HL130969 (Principal Investigator: S.A. Ansari); and National Institutes of Health/ National Heart, Lung, and Blood Institute 1R01NS093908 (Principal Investigator: T.J. Carroll). Please address correspondence to Sameer A. Ansari, MD, PhD, Departments of Radiology, Neurology, and Neurological Surgery, Northwestern University, Fein-berg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611-2927; e-mail: [email protected] Funding Information: Disclosures: Timothy J. Carroll—RELATED: Grant: National Institutes of Health, Comments: National Institutes of Health/National Institute of Neurological Disorders and Stroke 1R01NS093908*; UNRELATED: Grants/Grants Pending: National Institutes of Health.* Sameer A. Ansari—RELATED: Grant: American Heart Association 13GRNT17340018 and 14GRNT20380798 (Principal Investigators: S.A. Ansari and T.J. Carroll); National Institutes of Health/National Heart, Lung, and Blood Institute 1R21HL130969 (Principal Investigator: S.A. Ansari); and National Institutes of Health/ National Institute of Neurological Disorders and Stroke 1R01NS093908 (Principal Investigator: T.J. Carroll).* *Money paid to the institution. Publisher Copyright: {\textcopyright} 2019 American Society of Neuroradiology. All rights reserved.",

year = "2019",

month = jun,

day = "1",

doi = "10.3174/ajnr.A6065",

language = "English (US)",

volume = "40",

pages = "954--959",

journal = "American Journal of Neuroradiology",

issn = "0195-6108",

publisher = "American Society of Neuroradiology",

number = "6",

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TY - JOUR

T1 - Diagnostic accuracy of high-resolution black-blood MRI in the evaluation of intracranial large-vessel arterial occlusions X

AU - Al-Smadi, A. S.

AU - Abdalla, R. N.

AU - Elmokadem, A. H.

AU - Shaibani, A.

AU - Hurley, M. C.

AU - Potts, M. B.

AU - Jahromi, B. S.

AU - Carroll, T. J.

AU - Ansari, S. A.

N1 - Funding Information: Received January 31, 2019; accepted after revision April 10. From the Departments of Radiology (A.S.A.-S., R.N.A., A.H.E., A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Neurology (S.A.A.), and Neurological Surgery (A.S., M.C.H., M.B.P., B.S.J., S.A.A.), Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Radiology (T.J.C.), University of Chicago, Chicago, Illinois; Department of Radiology (R.N.A.), Ain Shams University, Cairo, Egypt; and Department of Radiology (A.H.E.), Mansoura University, Mansoura, Egypt. This work was supported by the following grants: American Heart Association 13GRNT17340018 and 14GRNT20380798 (Principal Investigators: S.A. Ansari and T.J. Carroll); National Institutes of Health/National Heart, Lung, and Blood Institute 1R21HL130969 (Principal Investigator: S.A. Ansari); and National Institutes of Health/ National Heart, Lung, and Blood Institute 1R01NS093908 (Principal Investigator: T.J. Carroll). Please address correspondence to Sameer A. Ansari, MD, PhD, Departments of Radiology, Neurology, and Neurological Surgery, Northwestern University, Fein-berg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611-2927; e-mail: [email protected] Funding Information: Disclosures: Timothy J. Carroll—RELATED: Grant: National Institutes of Health, Comments: National Institutes of Health/National Institute of Neurological Disorders and Stroke 1R01NS093908*; UNRELATED: Grants/Grants Pending: National Institutes of Health.* Sameer A. Ansari—RELATED: Grant: American Heart Association 13GRNT17340018 and 14GRNT20380798 (Principal Investigators: S.A. Ansari and T.J. Carroll); National Institutes of Health/National Heart, Lung, and Blood Institute 1R21HL130969 (Principal Investigator: S.A. Ansari); and National Institutes of Health/ National Institute of Neurological Disorders and Stroke 1R01NS093908 (Principal Investigator: T.J. Carroll).* *Money paid to the institution. Publisher Copyright: © 2019 American Society of Neuroradiology. All rights reserved.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - BACKGROUNDANDPURPOSE: 3D high-resolution black-blood MRI orMRvessel wall imaging allows evaluation of the intracranial arterial wall and extraluminal pathology. We investigated the diagnostic accuracy and reliability of black-blood MRI for the intraluminal detection of large-vessel arterial occlusions. MATERIALS AND METHODS: We retrospectively identified patients with intracranial arterial occlusions, confirmed by CTA or DSA, who also underwent 3D black-blood MRI with nonenhanced and contrast-enhanced T1 sampling perfection with application-optimized contrasts by using different flip angle evolution (T1 SPACE) sequences. Black-blood MRI findings were evaluated by 2 independent and blinded neuroradiologists. Large-vessel intracranial arterial segments were graded on a 3-point scale (grades 0-2) for intraluminal baseline T1 hyperintensity and contrast enhancement. Vessel segments were considered positive for arterial occlusion if focal weak (grade 1) or strong (grade 2) T1-hyperintense signal and/or enhancement replaced the normal intraluminal black-blood signal. RESULTS: Thirty-one patients with 38 intracranial arterial occlusions were studied. The median time interval between black-blood MRI and CTA/DSA reference standard studies was 2 days (range, 0-20 days). Interobserver agreement was good for T1 hyperintensity (κ=0.63) and excellent for contrast enhancement (κ = 0.89). High sensitivity (100%) and specificity (99.8%) for intracranial arterial occlusion diagnosis was observed with either intraluminal T1 hyperintensity or contrast-enhancement imaging criteria on black-blood MRI. Strong grade 2 intraluminal enhancement was maintained in-80% of occlusions irrespective of location or chronicity. Relatively increased strong grade 2 intraluminal T1 hyperintensity was noted in chronic/incidental versus acute/subacute occlusions (45.5% versus 12.5%, P = .04). CONCLUSIONS: Black-blood MRI with or without contrast has high diagnostic accuracy and reliability in evaluating intracranial largevessel arterial occlusions with near-equivalency to DSA and CTA.

AB - BACKGROUNDANDPURPOSE: 3D high-resolution black-blood MRI orMRvessel wall imaging allows evaluation of the intracranial arterial wall and extraluminal pathology. We investigated the diagnostic accuracy and reliability of black-blood MRI for the intraluminal detection of large-vessel arterial occlusions. MATERIALS AND METHODS: We retrospectively identified patients with intracranial arterial occlusions, confirmed by CTA or DSA, who also underwent 3D black-blood MRI with nonenhanced and contrast-enhanced T1 sampling perfection with application-optimized contrasts by using different flip angle evolution (T1 SPACE) sequences. Black-blood MRI findings were evaluated by 2 independent and blinded neuroradiologists. Large-vessel intracranial arterial segments were graded on a 3-point scale (grades 0-2) for intraluminal baseline T1 hyperintensity and contrast enhancement. Vessel segments were considered positive for arterial occlusion if focal weak (grade 1) or strong (grade 2) T1-hyperintense signal and/or enhancement replaced the normal intraluminal black-blood signal. RESULTS: Thirty-one patients with 38 intracranial arterial occlusions were studied. The median time interval between black-blood MRI and CTA/DSA reference standard studies was 2 days (range, 0-20 days). Interobserver agreement was good for T1 hyperintensity (κ=0.63) and excellent for contrast enhancement (κ = 0.89). High sensitivity (100%) and specificity (99.8%) for intracranial arterial occlusion diagnosis was observed with either intraluminal T1 hyperintensity or contrast-enhancement imaging criteria on black-blood MRI. Strong grade 2 intraluminal enhancement was maintained in-80% of occlusions irrespective of location or chronicity. Relatively increased strong grade 2 intraluminal T1 hyperintensity was noted in chronic/incidental versus acute/subacute occlusions (45.5% versus 12.5%, P = .04). CONCLUSIONS: Black-blood MRI with or without contrast has high diagnostic accuracy and reliability in evaluating intracranial largevessel arterial occlusions with near-equivalency to DSA and CTA.

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Diagnostic accuracy of high-resolution black-blood MRI in the evaluation of intracranial large-vessel arterial occlusions X

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