RadteraMRA Neck (Carotid/Vertebral) With and Without Contrast
MR+ ContrastVascular
Indications
- Carotid stenosis / TIA / stroke
- Carotid or vertebral dissection
- Pulsatile tinnitus
- Subclavian steal
- Vascular survey with brain MRA
Patient prep
- MRI safety screening
- IV access for contrast-enhanced MRA (CEMRA)
- eGFR per policy
- Head/neck (neurovascular) coil
Contrast
Agentgadolinium-based (e.g., gadobutrol)
RouteIV
Dose0.1-0.2 mmol/kg (or fixed ~15-20 mL)
TimingBolus-tracked arterial first pass; often a venous/delayed phase
Technique
- Supine, head-first, neurovascular coil from aortic arch to circle of Willis
- Contrast-enhanced MRA (coronal 3D spoiled GRE) is standard for the neck arteries
- Bolus tracking or test bolus to time arterial phase; power injector preferred
- Add axial T1 fat-sat through neck for dissection (intramural hematoma)
Series / Sequences
| # | Series / Sequence | Plane | Weighting / Recon | Thickness | Notes |
|---|---|---|---|---|---|
| 1 | Cor 3D CEMRA | coronal | T1 GRE +C | 1-1.5 mm | Arch to circle of Willis, arterial phase |
| 2 | Cor CEMRA delayed | coronal | T1 GRE +C | 1-1.5 mm | Optional venous/equilibrium phase |
| 3 | Ax T1 fat-sat | axial | T1 FS | 3-4 mm | Add for suspected dissection (crescent hematoma) |
| 4 | MIP reconstructions | multiple | MRA MIP | N/A | Carotid bifurcation projections |
Key points
- CEMRA preferred over 2D/3D TOF for neck (less flow-related artifact, better arch coverage).
- Measure stenosis using NASCET criteria on source/MIP.
- Fat-sat T1 axials key for dissection; consider non-contrast 2D TOF if CEMRA contraindicated.
- Time arterial phase carefully to avoid venous contamination.
References
• ACR-ASNR-SPR Practice Parameter for MR Angiography
• Radiopaedia: Carotid MRA / dissection
• ACR Appropriateness Criteria: Cerebrovascular Disease - Stroke/TIA
• Radiopaedia: Carotid MRA / dissection
• ACR Appropriateness Criteria: Cerebrovascular Disease - Stroke/TIA
Source: Researched — verify against your institution
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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.