A review of the clinical significance of lumbar puncture in the diagnostic approach of Aneurysmal Subarachnoid Hemorrhage (SAH): A case report of CT-Negative and Lumbar Puncture–Positive SAH

@#Headaches are a common presentation in the emergency department (ED). Even though not all are potentially serious, some such as subarachnoid hemorrhage (SAH) can be more dangerous than others. SAH is a medical emergency with an almost 50% mortality rate. It is crucial not to miss the diagnosis of SAH, as a missed or delayed diagnosis can be severely detrimental. It classically presents as thunderclap headache, a severe, sudden-onset headache. There are various approaches in diagnosing or excluding SAH, which is classically done by performing a computed tomography (CT) scan followed by a lumbar puncture (LP). But with the improved sensitivity of more modern diagnostic tools, more physicians are in support of changing this classical teaching. The aim of this case report is to review the advantages and disadvantages of LP in diagnosing SAH, along with other diagnostic tools commonly used.

Magnetization Transfer Contrast Angiography for Organized Thrombosed Intracranial Aneurysm in TOF MR Angiography: a Case Report

A 66-year-old woman was referred for treatment of incidental detection of two intracranial aneurysms. Time-of-flight MR angiography (TOF MRA) revealed two aneurysms at the M1 segment of the right middle cerebral artery, and clinoid segment of left internal carotid artery, respectively. On digital subtraction angiography, there was a saccular aneurysm on the left internal carotid artery, but the other aneurysm was not detected on the right middle cerebral artery. Based on comprehensive review of imaging findings, organized thrombosed aneurysm was judged as the most likely diagnosis. In the presented report, magnetization transfer (MT) pulse to TOF MRA was used, to differentiate aneurysm-mimicking lesion on TOF MRA. We report that MT technique could be effective in differentiating true aneurysm, from possible T1 high signal artifact on TOF MRA.

Associations between Morphological Characteristics of Intracranial Arteries and Atherosclerosis Risk Factors in Subjects with Less Than 50% Intracranial Arterial Stenosis

PURPOSE: To assess associations between morphological characteristics of intracranial arteries in time-of-flight MR angiography (TOF-MRA) and atherosclerotic risk factors. MATERIALS AND METHODS: From January 2014 to October 2015, a total of 129 patients (65 men and 64 women) without intracranial arterial stenosis > 50% were included in this study. All MRIs were performed using a 3T machine with 3D TOF-MRA sequences. We evaluated irregularity, tortuosity, and dilatation of intracranial arteries in maximal intensity projection (MIP) of TOF-MRA. Subjects' risk factors for atherosclerosis including history of hypertension and diabetes were collected by reviewing their medical records. Associations between morphological characteristics and each known atherosclerosis risk factor were examined using univariate regression analysis. Multivariate regression models were built to determine combined association between those risk factors and morphologic changes of intracranial arteries. RESULTS: In multivariate analysis, hypertension (coefficient [95% CI]: 0.162 [0.036, 0.289], P = 0.012) and absence of diabetes (coefficient [95% CI]: −0.159 [−0.296, −0.023], P = 0.022) were associated with large diameter of intracranial arteries. Males (coefficient [95% CI]: 0.11 [−0.006, 0.23], P = 0.062) and higher age (coefficient [95% CI]: 0.003 [−0.001, 0.008], P = 0.138) had marginal association with increased diameter. Tortuosity was associated with old age (OR: 1.04 [1.02, 1.07], P < 0.001). Irregular contour of intracranial arteries was significantly associated with old age (OR: 1.05 [1.02, 1.09], P = 0.004), presence of diabetes (OR: 2.88 [1.36, 6.15], P = 0.0058), and previous ischemic stroke (OR: 3.91 [1.41, 11.16], P = 0.0092). CONCLUSION: Morphological characteristics (irregularity, tortuosity, dilatation) of intracranial arteries seen in TOF-MRA might be associated with atherosclerotic risk factors in subjects with no or mild stenosis.

Application value of TRANCE technology in lower limb arterial occlusive disease / 医疗卫生装备

Objective To explore the application value of triggered angiography non-contrast enhanced (TRANCE) technology in diagnosing lower limb arterial occlusive disease.Methods Totally 22 lower limb arterial occlusive disease patients were randomly selected,and then underwent TRANCE and DSA examinations.The arteries from the abdomen to the lower limb were divided into abdominal aorta,common iliac artery,external iliac artery,internal iliac artery,superficial femoral artery,deep femoral artery,popliteal artery,anterior tibial artery,posterior tibial artery and peroneal artery.Totally 337 sections displayed clearly were chosen to go through examinations by TRANCE and DSA.Results Of the 337 sections there were 312 ones with the same stenoses found by TRANCE and DSA,TRANCE found 16 sections with worse stenoses and 9 milder ones than by DSA.There were 153 sections with the same moderate stenoses (≥50％) displayed by TRANCE and DSA;Of the 153 sections,there were 15 ones with worse stenoses and 6 ones with milder stenoses found by TRANCE than by DSA.Kappa value of the two methods was 0.905.Conclusion TRANCE technology is a non-invasive,safe and nonradiative diagnosing method for the lower limb arterial occlusive disease.

Susceptibility Vessel Sign for the Detection of Hyperacute MCA Occlusion: Evaluation with Susceptibility-weighted MR Imaging

PURPOSE: Susceptibility vessel sign (SVS) on gradient echo image, which is caused by MR signal loss due to arterial thrombosis, has been reported in acute middle cerebral artery (MCA) infarction. However, the reported sensitivity and diagnostic accuracy of SVS have been variable. Susceptibility-weighted imaging (SWI) is a newly developed MR sequence. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the SVS. The purpose of this study was to evaluate the diagnostic values of SWI for the detection of hyperacute MCA occlusion. MATERIALS AND METHODS: Sixty-nine patients (37 males, 32 females; 46-89 years old [mean, 69.1]) with acute stroke involving the MCA territory underwent MR imaging within 6 hours after the symptom onset. MR examination included T2, FLAIR (fluid-attenuated inversion recovery), DWI, SWI, PWI (perfusion-weighted imaging), contrast-enhanced MR angiography (MRA) and contrast-enhanced T1. Of these patients, 28 patients also underwent digital subtraction angiography (DSA) within 2 hours after MR examination. Presence or absence of SVS on SWI was assessed without knowledge of clinical, DSA and other MR imaging findings. RESULTS: On MRA or DSA, 34 patients (49.3%) showed MCA occlusion. Of these patients, SVS was detected in 30 (88.2%) on SWI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SWI were 88.2%, 97.1%, 96.8%, 89.5% and 92.8%, respectively. CONCLUSION: SWI was sensitive, specific and accurate for the detection of hyperacute MCA occlusion.

Carotid Ultrasonography vs. CT or MR Angiography in the Diagnosis of the Stenosis of Vertebral Artery Origins

BACKGROUND: The origin of the vertebral artery (VA) is prone to be misinterpreted as having focal stenosis on computed tomography angiography (CTA) or magnetic resonance angiography (MRA) due to artifacts. Ultrasonography may be a valuable technique to reveal stenosis of the VA origin. We compared the findings for the VA origin from CTA or MRA with those from ultrasonotraphy. METHODS: We consecutively enrolled patients who underwent angiography (CTA or MRA) and carotid ultrasonography. The V2 and V1 portions of the VA were insonated to evaluate the presence of plaque or steno-occlusion. CTA or MRA data were evaluated. Stenosis or occlusion of the VA origin was categorized as present or absent. The results from the two methods were compared. RESULTS: The mean age of the 73 investigated patients was 61.1 years, and 46 (63.0%) of them were male. Among the 22 patients with steno-occlusion of the right VA on CTA or MRA, only six had stenosis on ultrasonography. Regarding the left VA, only four patients among 16 who showed steno-occlusion on CTA or MRA had steno-occlusion on ultrasonography. The level of agreement between the two methods was 82.2% on the left side and 75.3% on the right side. There were no clinical differences between the patients with and without false-positive results on CTA or MRA. CONCLUSIONS: In 16.4% (left) and 21.9% (right) of all patients, lumens with steno-occlusions observed on CTA or MRA were revealed as normal on ultrasonography. The diagnosis of VA origins could be improved by applying these two methods complementarily.

Diagnostic value and clinical significance of 3D-CE-MRA in infantile superficial hemangioma / 实用放射学杂志

Objective To investigate the diagnostic value and clinical significance of the three-dimensional contrast-enhanced MR angiography (3D-CE-MRA)in the infantile superficial hemangioma.Methods Forty-four children with superficial hemangioma un-derwent conventional and dynamic contrast-enhanced MRI.MRI scanning was started at the time of inj ection,and four dynamic pha-ses of images were acquired continually.Maximum intensity proj ection (MIP)images were reconstructed to show the blood vessels of the lesions in multiple phases.Results Forty-nine infantile superficial hemangiomas were detected by MRI,including a single le-sion in 41 patients and multiple ones in 3.3D-CE-MRA showed 37 lesions in 32 patients,and other 12 lesions were not found in 12 patients.Conclusion The conventional and dynamic contrast-enhanced MRI can reflect the location,number and the range of the su-perficial hemangioma,and show the relationship between the lesion and the surrounding tissues.3D-CE-MRA directly shows the blood supply of the tumors.

Contrast Enhanced Cerebral MR Venography: Comparison between Arterial and Venous Triggering Methods

PURPOSE: To compare the arterial and venous detection sites of triggering methods in contrast-enhanced-MR-venography (CE-MRV) for the evaluation of intracranial venous system. MATERIALS AND METHODS: 41 healthy patients underwent CE-MRV with autotriggering at either the cavernous segment of internal carotid artery with an inserted time-delay of 6 seconds (n = 20) or the superior sagittal sinus without any time-delay (n = 21). 0.1 mmol/kg gadolinium-based contrast material (Magnevist(R), Schering, Germany) was intravenously injected by hand injection. A sagittal fast-spoiled-gradient-echo-sequence ranging from one ear to the other was performed (TR/TE5.2/1.5, Matrix 310x310, 124 sections in the 15-cm-thick volume). 17 predefined venous structures were evaluated on all venograms by two neuroradiologists and defined as completely visible, partially visible, or none visible. RESULTS: The rate of completely visible structures were 272 out of 323 (84%) in the arterial triggering CE-MRV and 310 out of 340 (91%) in the venous triggering CE-MRV. The venous triggering CE-MRV demonstrated an overall superior visualization of the cerebral veins than the arterial triggering CE-MRV (Fisher exact test, p < 0.006). CONCLUSION: CE-MRV using venous autotriggering method provides higher-quality images of the intracranial venous structures compared to that of arterial.

Pseudostenosis at the Origin of the Vertebral Artery on Contrast-enhanced MRA: Correlation with Aortic Motion on Dynamic 3D Time-Resolved Contrast-Enhanced MRA

PURPOSE: The origin of the vertebral artery (VA) is a frequent site of pseudostenosis on contrast-enhanced MRA (CE-MRA). The purpose of this study is to evaluate the relationship between the motion of the aortic arch and pseudostenosis at the origin of the VA. MATERIALS AND METHODS: Our study had approval of our institutional review board. 47 patients underwent CT angiography (CTA), CE-MRA, and 3D time-resolved contrast-enhanced MRA (TR-CEMRA) within 6.87+/-9.89 days (mean+/-SD). Percent stenosis using the NASCET criteria was measured on CTA and CE-MRA. CTA was used as a reference standard to classify the CE-MRA into pseudostenosis and control group. Pseudostenosis was determined as 50%-99% stenosis observed on CE-MRA but normal to less than 50% stenosis on CTA. Aortic motion (distance between the highest position and lowest position of aortic arch) was measured on TR-CEMRA. Age, route of intravenous contrast media, motion of aortic arch, and normal distal diameter of VA were compared between the two groups. RESULTS: There were 17 patients and 23 vertebral arteries of pseudostenosis. Patients with pseudostenosis showed more aortic motion (3.61+/-1.88 vs. 2.05+/-1.97 mm) and older age (71.29+/-8.88 vs. 62.32+/-13.19 year-old). Route of intravenous contrast media and normal distal diameter of VA were not associated with pseudostenosis. CONCLUSION: VA origin is a frequent site of pseudostenosis. Older age and more motion of aortic arch are associated with pseudostenosis on CE-MRA.

Artificial Luminal Narrowing on Contrast-Enhanced Magnetic Resonance Angiograms on an Occasion of Stent-Assisted Coiling of Intracranial Aneurysm: In Vitro Comparison Using Two Different Stents with Variable Imaging Parameters

OBJECTIVE: Intracranial stenting for stent-assisted coiling of aneurysms requires adequate follow-up imaging. The aim of this in vitro study was to compare in-stent artificial luminal narrowing on contrast-enhanced MR angiograms (CE-MRA) when applying Neuroform(R) and Enterprise(R) stents for stent-assisted coiling. MATERIALS AND METHODS: Two intracranial nitinol stents (Enterprise(R) and Neuroform(R)) were placed in silicon tubes and then imaged at 3 T and 1.5 T by the use of a T1-weighted three-dimensional spoiled gradient-echo sequence with minimal TR and TE. CE-MRAs were obtained by using different imaging planes, voxel sizes, and bandwidths, and with or without parallel imaging. Artificial lumen narrowing (ALN) was calculated and the results were compared. RESULTS: Lower magnetic field strength, axial plane perpendicular to axis of stent, and wider bandwidth resulted in a lower ALN on CE-MRA for both stents. Larger voxel size resulted in lower ALN for Neuroform(R) stent. The parallel imaging acceleration factor did not affect ALN. The mean ALN was lower for Neuroform(R), but it was not significant by a paired t test. CONCLUSION: CE-MRA of the stented lumen of vascular phantom was partially impaired with ALN. Consequently, image plane orientation, magnetic field strength, bandwidth, and voxel size should be adjusted appropriately to reduce ALN.

Role of imaging in the management of neuro-ophthalmic disorders.

Advancements in physics, computers, and imaging science in the last century have seen neuro-imaging evolving from a plain X-ray to computed tomography, magnetic resonance imaging scans, noninvasive angiography, and special sequences such as fat suppression, fluid attenuation recovery and diffusion-weighted imaging. A prompt prescription of an appropriate imaging modality and the most suitable sequence can increase the diagnostic yield, and in many instances, it can be a sight-saving and even a life-saving decision. This article discusses basic principles of neuro-imaging, its common indications, and the appropriate application in an ophthalmology practice.

Prevalence of Unruptured Intracranial Aneurysm on MR Angiography

OBJECTIVE: To evaluate the prevalence of incidentally found unruptured intracranial aneurysms (UIAs) on the brain MR angiography (MRA) from a community-based general hospital. MATERIALS AND METHODS: This was a prospectively collected retrospective study, carried out from January 2004 to December 2004. The subjects included 3049 persons from a community-based hospital in whom MRA was performed according to a standardized protocol in an outpatient setting. Age- and sex-specific prevalence of UIAs was calculated. The results by MRA were compared with intra-arterial digital subtraction angiography (DSA) findings. RESULTS: Unruptured intracranial aneurysms were found in 137 (5%) of the 3049 patients (M:F = 43:94; mean age, 60.2 years). The prevalence of UIAs was 5% (n = 94) in women and 4% (n = 43) in men, respectively (p = 0.2046) and showed no age-related increase. The most common site of aneurysm was at the distal internal carotid artery (n = 64, 39%), followed by the middle cerebral artery (n = 40, 24%). In total, 99% of aneurysms measured less than 12 mm, and 93% of aneurysms measured less than 7 mm. Direct comparisons between MRA and DSA were available in 70 patients with 83 UIAs; the results revealed two false positive and two false negative results. CONCLUSION: This community-hospital based study suggested a higher prevalence of UIAs observed by MRA than previously reported. These findings should be anticipated in the design and use of neuroimaging in clinical practice.

Utilidad de la angioresonancia en la planificación preoperatoria de reconstrucción mamaria mediante colgajos libres abdominales DIEP, SIEA y TRAM / Usefulness of magnetic resonance angiography in the preoperative study for breast reconstruction using epigastric flaps

Background: Mammary reconstruction after surgery for breast cancer can be performed with free abdominal flaps such as DIEP (deep inferior epigastric perforator), TRAM (transverse rectus abdominis musculocutaneus) y SIEA (superficial inferior epigastric artery). Aim: To report our experience with the use of magnetic resonance angiography to plan mammary reconstruction. Material and Methods: The superficial epigastric vascular axis and the connections between the superficial and deep axis were explored with magnetic resonance angiography in 25 patients aged 32 to 63 years. Dominant perforating arteries (those with the greater caliber and predominant distribution through adipose tissue), were localized. Their intramuscular trajectory and that of the deep epigastric artery were also studied. The findings of magnetic resonance were compared with those of intraoperative Doppler ultrasound examination dissection during operation. Results: There was a 100 percent concordance between magnetic resonance findings and those of intraoperative Doppler. However in two patients a perforating artery with an adequate caliber was missed with magnetic resonance. Conclusions: Magnetic resonance angiography is useful in the planning of mammary reconstruction with epigastric flaps.

Objetivos: Dar a conocer nuestra experiencia en la toma de decisiones para la reconstrucción mamaria con colgajos libres de tejido abdominal mediante angioresonancia. Materiales y Métodos: Nuestra muestra corresponde a 25 pacientes intervenidos entre los años 2007-2009. Mediante angioresonancia se exploró el eje vascular epigástrico superficial, así como las conexiones entre el sistema profundo y superficial, localizando las perforantes dominantes (las de mayor calibre y distribución predominante por la grasa), su trayecto intramuscular y estudiando el trayecto de la arteria epigástrica profunda. Resultados: Los hallazgos en la angioresonancia fueron utilizados en el mareaje preoperatorio y contrastados con los hallazgos evidenciados por la ultrasonografía y durante la disección intraoperatoria de los colgajos, siendo la información obtenida congruente en un 100 por ciento de los casos, lo que facilita la decisión del colgajo a disecar, acortando los tiempo operatorios y dando mayor seguridad al cirujano. Conclusiones: La angioresonancia es un método útil en el estudio preoperatorio otorgando el beneficio adicional de no irradiar a los pacientes.

MR angiography imaging of absence vertebral artery causing of pulsatile tinnitus: a case report / Imagen angiográfica a través de RM de la ausencia de arteria vertebral causante de tinitus pulsatil: reporte de caso

Absence of the vertebral artery is rare, and incidentally encountered in radiological imaging technics. We reported a 74 years old man suffering from pulsatile tinnitus with absence of the left vertebral artery. The purpose of the case report is the description absence of the vertebral artery causing of pulsatile tinnitus, in order to offer useful data to anatomists, otorhinolaryngologist, radiologists, vascular, head and neck surgeons.

La ausencia de la arteria vertebral es rara, y accidentalmente encuentrada en técnicas de imagen radiológica. Reportamos un hombre de 74 años que sufre de tinnitus pulsátil con la ausencia de la arteria vertebral izquierda. El propósito del reporte del caso es la descripción de la ausencia de arteria vertebral que causante del tinitus pulsátil, con el fin de ofrecer datos útiles para anatomistas, otorrinolaringólogos, radiólogos, cirujanos vasculares y de cabeza y cuello.

Advances in preoperative MR angiography for lower limb arterial diseases in diabetic patients / 介入放射学杂志

The incidence of diabetes has been increasing with each passing year and diabetic peripheral vascular disease has been one of the serious complications, which increasingly threatens the numerous sufferers' health. The preoperative imaging evaluation measures for the peripheral vascular disease include Doppler ultrasound (DUS), CT angiography (CTA). MR angiography (MRA). Digital subtractionangiography (DSA). In the situation of today that both the imaging equipments and imaging technology are developing swiftly, it is necessary to make an evaluation of these imaging ways. This paper aims to discuss the clinical value, the limitation and the progresses of the above devices, and to summarize the advantages and the recent advances of preoperative MR angiography used for observing lower limb arterial diseases in diabetic patients. Medical researches have showed that MRA , as a non-invasive method with almost the same high diagnostic accuracy as DSA, is an ideal technique for making preoperative evaluation and long-term postoperative checkup.

Investigation of Inpatient Rehabilitation Outcomes in different Ischemic Stroke Disease Types : Relationships with Leukoaraiosis in MRI / The Japanese Journal of Rehabilitation Medicine

<b>Purpose</b> : The aim of this study is to investigate inpatient rehabilitation outcomes in different ischemic stroke disease types. Subjects and methods : Subjects were 178 patients with ischemic stroke transferred from stroke units or emergency units for inpatient rehabilitation at Kami-iida Rehabilitation Hospital. For all patients, National Institutes of Health Stroke Scale (NIHSS) scores were measured on admission. Functional Independence Measure (FIM) scores were also measured both on admission and discharge, and FIM-gain (FIM-g) and FIM-efficiency (FIM-e) values were calculated. The disease types of ischemic stroke were : lacunar (LI) in 16 patients ; atherothrombosis (AI) in 23 ; branch-atheromatous-disease (BAD) in 59 ; artery to artery embolism (A to A) in 18; cardiogenic embolism (CE) in 34 ; undetermined embolism (unable to differentiate from A to A and cardiogenic embolism) in 22 ; the 6 remaining patients were not categorized. Results : There were no significant differences in the NIHSS scores and FIM scores on admission between disease types except for the NIHSS scores in the LI patients. The FIM-e value in A to A patients was significantly lower than those in other types (<i>p</i><0.05). Moreover, A to A patients have a tendency of severe leukoaraiosis and their MRAs demonstrated high rates of stenosis (≥50%) or occlusion with intracranial arteries. Conclusion : In A to A embolism, significantly lower FIM-e values were found and FIMs at discharge were affected by leukoaraiosis on the basis of large-vessel arteriosclerosis. Our study revealed that inpatient rehabilitation outcomes differed for each ischemic stroke type and appeared to be influenced by leukoaraiosis.

High Resolution Time Resolved Contrast Enhanced MR Angiography Using k-t FOCUSS

PURPOSE: Recently, the Recon Challenge at the 2009 ISMRM workshop on Data Sampling and Image Reconstruction at Sedona, Arizona was held to evaluate feasibility of highly accelerated acquisition of time resolved contrast enhanced MR angiography. This paper provides the step-by-step description of the winning results of k-t FOCUSS in this competition. MATERIALS AND METHODS: In previous works, we proved that k-t FOCUSS algorithm successfully solves the compressed sensing problem even for less sparse cardiac cine applications. Therefore, using k-t FOCUSS, very accurate time resolved contrast enhanced MR angiography can be reconstructed. Accelerated radial trajectory data were synthetized from X-ray cerebral angiography images and provided by the organizing committee, and radiologists double blindly evaluated each reconstruction result with respect to the ground-truth data. RESULTS: The reconstructed results at various acceleration factors demonstrate that each components of compressed sensing, such as sparsifying transform and incoherent sampling patterns, etc can have profound effects on the final reconstruction results. CONCLUSION: From reconstructed results, we see that the compressed sensing dynamic MR imaging algorithm, k-t FOCUSS enables high resolution time resolved contrast enhanced MR angiography.

High Resolution Time Resolved Contrast Enhanced MR Angiography Using k-t FOCUSS

PURPOSE: Recently, the Recon Challenge at the 2009 ISMRM workshop on Data Sampling and Image Reconstruction at Sedona, Arizona was held to evaluate feasibility of highly accelerated acquisition of time resolved contrast enhanced MR angiography. This paper provides the step-by-step description of the winning results of k-t FOCUSS in this competition. MATERIALS AND METHODS: In previous works, we proved that k-t FOCUSS algorithm successfully solves the compressed sensing problem even for less sparse cardiac cine applications. Therefore, using k-t FOCUSS, very accurate time resolved contrast enhanced MR angiography can be reconstructed. Accelerated radial trajectory data were synthetized from X-ray cerebral angiography images and provided by the organizing committee, and radiologists double blindly evaluated each reconstruction result with respect to the ground-truth data. RESULTS: The reconstructed results at various acceleration factors demonstrate that each components of compressed sensing, such as sparsifying transform and incoherent sampling patterns, etc can have profound effects on the final reconstruction results. CONCLUSION: From reconstructed results, we see that the compressed sensing dynamic MR imaging algorithm, k-t FOCUSS enables high resolution time resolved contrast enhanced MR angiography.

Assessment of Carotid Geometry by Using the Contrast-enhanced MR Angiography

PURPOSE: To evaluate the geometry of carotid artery by assessing the images of contrast-enhanced MR angiography (CE-MRA) and interrelationships between the geometry of carotid artery and clinical factors. MATERIALS AND METHODS: 216 consecutive patients who performed supraaortic CE-MRA with fast spoiled gradient-echo imaging were included. Their medical records were reviewed for variable information including risk factors predictive of generalized atherosclerotic disease (age, hypertension (HTN), diabetes mellitus, hyperlipidema, and smoking), sex, body weight, height, and body mass index (BMI). We reviewed the CE-MRA with carotid origin (3 types), carotid artery tortuosity, angle of internal carotid artery bifurcation, the type of aortic arch branching, and the presence of the coiling of carotid artery. RESULTS: Multinomial logistic regression analysis showed that significantly contributed clinical backgrounds for carotid origin were the age and the BMI. With an increase of age at 1, the probability that the type of carotid origin become from type 1 to type 2 was 0.9 times (p=0.004) in right carotid artery (RCA), 0.9 times (p=0.031) in left carotid artery (LCA), 0.9 times that are likely to be type3 from type 2 (p<0.001) in RCA and 0.9 times in LCA (p=0.009). Increase in BMI at 1 increased odds of becoming type 2 as 1.1 times (p=0.067) in RCA, 1.1 times (p=0.009) in LCA and increased chance of becoming type 3 as 1.2 times (p=0.001) in RCA, 1.2 times (p=0.003) in LCA. Mean value of right and left carotid tortuosity were 240.9+/-69.0degrees and 154.4+/-55.0degrees, respectively. CONCLUSION: The BMI, age, sex and presence of HTN affects the geometry of carotid arteries, the site of origin and tortuosity of carotid artery specifically.

Assessment of Carotid Geometry by Using the Contrast-enhanced MR Angiography

PURPOSE: To evaluate the geometry of carotid artery by assessing the images of contrast-enhanced MR angiography (CE-MRA) and interrelationships between the geometry of carotid artery and clinical factors. MATERIALS AND METHODS: 216 consecutive patients who performed supraaortic CE-MRA with fast spoiled gradient-echo imaging were included. Their medical records were reviewed for variable information including risk factors predictive of generalized atherosclerotic disease (age, hypertension (HTN), diabetes mellitus, hyperlipidema, and smoking), sex, body weight, height, and body mass index (BMI). We reviewed the CE-MRA with carotid origin (3 types), carotid artery tortuosity, angle of internal carotid artery bifurcation, the type of aortic arch branching, and the presence of the coiling of carotid artery. RESULTS: Multinomial logistic regression analysis showed that significantly contributed clinical backgrounds for carotid origin were the age and the BMI. With an increase of age at 1, the probability that the type of carotid origin become from type 1 to type 2 was 0.9 times (p=0.004) in right carotid artery (RCA), 0.9 times (p=0.031) in left carotid artery (LCA), 0.9 times that are likely to be type3 from type 2 (p<0.001) in RCA and 0.9 times in LCA (p=0.009). Increase in BMI at 1 increased odds of becoming type 2 as 1.1 times (p=0.067) in RCA, 1.1 times (p=0.009) in LCA and increased chance of becoming type 3 as 1.2 times (p=0.001) in RCA, 1.2 times (p=0.003) in LCA. Mean value of right and left carotid tortuosity were 240.9+/-69.0degrees and 154.4+/-55.0degrees, respectively. CONCLUSION: The BMI, age, sex and presence of HTN affects the geometry of carotid arteries, the site of origin and tortuosity of carotid artery specifically.