The value of non- and super-selective 4D-MRA in the assessment of internal carotid artery occlusion: comparison with TOR-MRA and CE-MRA

Motivation: 4D-MR angiography techniques have been developed to visualize both luminal stenosis and collateral circulation. Goal(s): This study aimed to assess whether 4D-MRA (4D-PACK and 4D-S-PACK) can be used as a noninvasive alternative to intraarterial DSA in internal carotid artery occlusion (ICAO). Approach: We prospective enrolled patients diagnosed as internal carotid artery occlusion by ultrasound or CTA and scheduled for intra-arterial DSA for this study. All patients underwent carotid multi-contrast MR imaging and DSA. Results: 4D-PACK and 4D-S-PACK can be used to diagnose ICAO, type of Circle of Willis (CoW), collateral circulation via CoW and blood flow direction of cerebral arteries. Impact: We offered a noninvasive alternative to intraarterial DSA to diagnose ICAO, type of CoW, collateral circulation via CoW and blood flow direction. By using three durations, we could greatly reduce time cost while ensuring the accuracy of 4D-PACK and 4D-S-PACK.