MRA of the carotid arteries

Magnetic resonance angiography (MRA) is increasingly used as a non-invasive method to assess carotid arteries. Contrast-enhanced MRA (CE-MRA) has benefited from rapid technological developments, including specific hardware and pulse sequence design. In the evaluation of stenoses of the extracranial internal carotid artery (ICA), CE-MRA using "first generation" CE-MRA gadolinium (Gd)-based chelates can be a substitute for conventional digital subtraction angiography (DSA), although CE-MRA tends to overestimate the degree of stenosis. Studies describing the use of high-relaxivity contrast agents like gadobenate dimeglumine (Gd-BOPTA) reveal that this agent is safe and well tolerated for CE-MRA. The use of Gd-BOPTA shows significantly better quantitative and qualitative performance than carotid CE-MRA using first generation Gd-based chelates. In fact, CE-MRA with Gd-BOTPA provides information comparable to that attainable with rotational DSA. In conclusion, high-relaxivity contrast agents combined with dedicated MRA software appear to be optimal for achieving high-quality evaluation of the carotid arteries.