Noncontrast MRA (magnetic resonance angiogram) neck radiology search pattern

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Күн бұрын

Another frequent study will encounter in neuroradiology is an MRA (magnetic resonance angiogram) of the neck. This test is frequently used to evaluate the arteries of the neck, including the carotid and vertebral arteries.
MRA of the neck can be performed without contrast using a technique called time of flight imaging, which depends on signal from flowing blood to create the image. MRA of the neck can also be performed with contrast in certain situations, such as need to better evaluate the aortic arch and great vessel origins or need to imaging dynamically.
MRA of the neck is primarily used to evaluate for vessel occlusion or narrowing, although vascular malformations may also be evaluated. It can also be used to follow up on vascular findings seen on other studies, such as doppler ultrasound of the carotids. The most common indication, however, is to evaluate for stroke, when it is combined with MRI and MRA of the brain.
This video will walk you through a step-by-step approach to evaluating an MRA of the neck, including how to approach each vessel. I use an approach that moves from anterior to posterior and then right to left. While others may have a different strategy, the most important part is to have a strategy and stick to it.
The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with atherosclerotic disease or stroke.
Check out this video and additional content on www.learnneuroradiology.com

Пікірлер: 31

@caiyu538 2 жыл бұрын

Follow your excellent series and learned a lot. Thank you for sharing them. Thumb up.

@immane75 6 жыл бұрын

Excellent thank you.

@twinkiesandwine9310 3 жыл бұрын

Hi Dr. Weinberg~ I was thrilled to find this video because I was under the impression an MRA of the neck must be done with contrast... I am scheduled for a routine head MRA as I have a family history of Moya-Moya disease and a small aneurysm that my neurosurgeon likes to check on every few years... This year she has included the neck as well but I just found out from the imaging facility that is with contrast(on the neck only)... I am concerned about having the contrast because I recently had a pelvic MRI with contrast and I'm concerned it may be too much heavy metal on my body... Any advice you have is very much appreciated-- Thank you kindly for your time, Have a beautiful night~ 😊

@LearnNeuroradiology 3 жыл бұрын

Well, the good news is that contrast is very safe. I think it is reasonable to have 1-2 doses of contrast per year indefinitely. While there is some theoretical risk from the contrast agent accumulating in your body, we give millions of doses per year and there have not been any proven bad outcomes in people with normal kidneys. If you are still concerned, it is possible to do the MRA of the neck without contrast and you can talk with your doctor about it. However, since you have moya-moya disease, it might not be the best choice, but you can discuss it with your doctor.

@blrando75 5 ай бұрын

Same concern. Is there less knowledge without contrast for allergies of dyes/contrast?

@Golds-worthy 4 жыл бұрын

Doctor does a MRA with contrast leads to a better diagnostic on a carotid artery that already showed stenosis on/around the Petrous area on a previous Non-contrast MRI ?

@LearnNeuroradiology 4 жыл бұрын

Most of the time, the petrous carotid is well visualized without contrast. On occasion, you may have too much artifact, but this will be rare. Contrast helps the most in the upper chest, where respiratory and cardiac motion degrade time of flight.

@jacobsmith9210 4 жыл бұрын

Hi Dr. thanks for the video. I have a question that I hope you can help with-would an MRA of the neck WITHOUT contrast show a dissecting aneurysm/ pseudo aneurysm of the carotid? Or would contrast be required? Thanks again

@LearnNeuroradiology 4 жыл бұрын

I'm going to say most of the time yes. It may be a little less sensitive at finding them, but as long as the patient is pretty still they can be pretty good. This is especially true for follow-up, if you already know the aneurysm is there and just want to see if it has changed. Then I think the non-contrast MRA would probably be ok.

@jacobsmith9210 4 жыл бұрын

@@LearnNeuroradiology Good to know. I appreciate you taking the time to answer!

@DKT.CC_96 4 жыл бұрын

Thanks for loading

@aubrey1008 4 жыл бұрын

My question is concerning whether an "MRA of the carotid and vertebral vessels" is necessary. I had an MRI for cervical neck pain and the results were pretty much mild arthritis which is a little worse than my last MRI 5 years ago. I had cortisone injections and doing well and may not need any surgery at this time. The report indicated that there is an asymmetric appearance of the right vertebral vessel when compared to the prior exam. On the gradient-echo localizer, there is some flow in the visualized inferior right margins of the right vertebral vessel. The gradient localized images are similar to the prior exam. Now before I had this MRI, there was a radio commercial for an EBT heart scan with real time sonography of the neck. I got this because I am almost 70 years old and the price was around $250 for both of them. This report stated that (1) No significant bilateral carotid intima - media thickening and (2). No hemodynamically significant bilateral carotid plaque or stenosis. The right carotid had no plaque noted in the right carotid bulb and the left Carotid had mild plaque noted in the left carotid build and ICA. The left common carotid artery intima-media thickness measures 1.2 mm. So with this information and really no symptoms that are apparent to me, would it be a good idea to have an MRA? They use contrast and I am concerned the contrast may harm my kidneys. I have a kidney GFR score of 59. My calcium volume score from the EBT scanner is 1066 which is above the 90th percentile for men between the ages of 65 and 70. Thank you

@LearnNeuroradiology 4 жыл бұрын

whew! There is a lot to unpack in this comment. Sometimes, on an MRI of the cervical spine, we can see something in the vertebral arteries that makes it seem like the vessel may be narrow or occluded. In those cases, we often recommend some follow-up exam, like an MRA of the neck. It sounds like that is what happened to you. I can't tell without seeing the images whether the ultrasound was enough to say that area was normal. However, MR contrast does not cause decreased kidney function and is extremely safe overall, so I don't think you need to worry about that. I recommend discussing this issue with your doctor to see if they think that you really need an MRA of the neck. They should be able to help you decide. Good luck

@aubrey1008 4 жыл бұрын

@@LearnNeuroradiology You mentioned that sometimes you can see something in the vertebral arteries that makes it seems like the vessels are occluded. What would cause this? Appreciate your answers.

@LearnNeuroradiology 4 жыл бұрын

Yes, usually the vessels should be dark because the flowing blood in them doesn't create any signal on the image. If the flow stops, or is clotted, it becomes bright. You can't always tell, which is why we usually recommend dedicated vessel imaging.

@AsmaAli1983 4 ай бұрын

Thanks

@LearnNeuroradiology 3 ай бұрын

You're welcome!

@elizabethdorchester5307 4 жыл бұрын

HI Dr great video thanks . May i ask if you would reccomend a MRA . Im having severe headaches . Dizzness . Weakness in my arms . Shoulders. Fingers and legs . My right hip is giving way and if i walk as little as a few feet my legs burn and hurt . Im bed bound now its just got worse and worse . I was about to go doctors as its got so bad but then covid 19 happened and i just stayed at home. If i do anything my muscles become so weak i cant move them as in whole arm goes floppy . It started slowly maybe 3 month's or more ago but i just ignored it . I also have burning in my feet and forarms and a sort of itiching and pins and needles everywear. My muscles go so weak my bones make noises but when some strenth returns the joint noise is not as bad . Im in a lot of trouble i know it and even my breathing sounds laboured and everythings hurting badly. Im thinking its lack of blood flow and was considering a full body MRA . Would you advise i do this or would any other tests be better to see my arterys. I know i should go to hospital but with this covid its so hard. Sorry to bother you with this . Your advice would be very very appreciate . Thank you i. So weak hands are locking up and im so fatigued im litrally sleeping for 15 hours a day and twitching and all sorts. Im normally fit and active prior to this . Thank you sorry to write such a long text. Something brought me to your page and i need to sort this out. Thanks you Dr

@LearnNeuroradiology 4 жыл бұрын

Hi Elizabeth. Thanks for the comment. I'm sorry you're going through all of that, as it sounds quite difficult for you. I know it's also hard because people don't want to go out in the setting of covid-19. However, I think to address this you probably need to see a doctor. Many doctors are doing telemedicine visits, which is the best way to talk to a doctor while minimizing your risk. If you have a doctor in your area, I suggest you give them a call and see if they are doing telemedicine visits. If not, you might try calling other doctors offices in you area to see if they are.

@elizabethdorchester5307 4 жыл бұрын

LearnNeuroradiology Thanks for getting back to me Dr its much appreciated . Your a really nice person and i know you have and will continue to help a lot of peoole . Thank you

@mya92c17 Жыл бұрын

When i stretch my neck i have fast heart beat and also a pulsatile tinnitus in right ear. Would an anghio mri without contrast show any vein compression? I am scared of contrast and i also have panick attacks and i don't want to trigger because of this fear. Also can head and neck anghio Mri be done without contrast?

@LearnNeuroradiology Жыл бұрын

Yes, most MRA and MR venography of the neck can be done without contrast. Although you should know that contrast is quite safe and has minimal risk. Good luck

@immane75 4 жыл бұрын

hello Dr hope you're fine . Having troubles differentiating internal internal carotid dissection from thrombosis on CT . any tips much appriciated .

@LearnNeuroradiology 4 жыл бұрын

This is a good question. It can be hard to tell the difference, and many times people will have both. The easiest way to tell the difference is the location of the filling defect. Dissection is usually peripheral (along the wall of the vessel, like a crescent), and causes smooth tapering of the diameter of the vessel. If you view it from the side (like on coronal or sagittal imaging), the vessel will taper like a blade of grass or a flame. Isolated thrombus usually sits in the center of the vessel occupying the lumen. Contrast usually partially goes around it. It usually doesn't adhere to one wall more than the other. There is overlap between the two. Sometimes distal to a dissection, there can be some thrombus in the center of the vessel, but that isn't the dominant feature. In smaller vessels, like the vertebral arteries, a dissection will sometimes smoothly taper to complete occlusion. Also sometimes you just can't tell, but we take a guess. A young person with no other risk factors for thrombus, think about dissection.

@immane75 4 жыл бұрын

@@LearnNeuroradiology Thank you very much for this thorough explanantion , helped me a lot . Thank you very much .

@LearnNeuroradiology 4 жыл бұрын

Check out the sample cases on this page: learnneuroradiology.com/vascularcapstone/ Look at sample case B, left carotid dissection.

@mdbbar3759 2 жыл бұрын

👋 hiiii with non contrast would this also rule out bloodflow issues?

@LearnNeuroradiology 2 жыл бұрын

Yes, most of the time you would see any significant narrowing causing blood flow issues. MRA can be used along with ultrasound or CTA as needed to be definitive