DIAGNOSTIC YIELD OF CERVICAL MAGNETIC RESONANCE ANGIOGRAPHY IN STROKE IMAGING – A RETROSPECTIVE ANALYSIS

Abstract

Cervical vascular imaging is widely used in modern stroke imaging to define the stroke etiology and to plan surgical vascular interventions. Cervical magnetic resonance angiography (cMRA) has high sensitivity for detecting structural changes in the cervical arterial wall and is a radiation-free alternative to computed tomography angiography (CTA). We aimed to determine the diagnostic yield of emergency cMRA in patients with stroke symptoms.

We retrospectively analyzed patients (n=385) who underwent a cMRA and a brain MRI imaging at the comprehensive stroke center hospital between 2013 and 2021 due to the suspicion of recent stroke or dissection. We analyzed the findings from cMRA and brain MRI studies and recorded cardiovascular risk factors and symptoms from the MRI referrals.

We found an abnormal finding related to the acute symptoms in 7.3% (28/385) of all cMRA scans, with significantly higher rates among patients with acute brain MRI findings (21.1%) vs. those without (2.8%, OR 3.2, p<0.001). Patients with coronary artery disease had 4-fold increased odds of abnormal cMRA findings (OR 3.95, p=0.005). Patients with two or more cardiovascular risk factors had 3-fold increased odds of abnormal cMRA findings (OR 3.18, p=0.024).

Emergency cMRA combined with brain MRI for stroke has a modest overall positivity. Patients with acute findings in brain MRI had more findings in cMRA, underscoring the need for selective use to optimize resource allocation.