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Conventional time-of-flight (TOF) MR angiography (MRA) in carotid artery stenosis relies on flow-related enhancement to produce signal from vascular structures. Intravoxel phase dispersion, due to vortices, causes loss of signal and is the reason for the tendency to overestimate the degree of stenosis. In contrast-enhanced MRA, intravascular signal is mainly dependent on T1 shortening of the blood. We compared first-pass contrast-enhanced MRA (contrast-enhanced 3D gradient echo, ce3D GRE) and contrast-enhanced 2D TOF (ce2D TOF) sequences with an unenhanced 2D TOF in 13 patients with carotid artery stenosis, assessing delineation of the carotid bifurcation, enhancement of veins and grade of stenosis. The contrast-enhanced techniques produced more morphological detail, the ce3D GRE being superior to the ce2D TOF. Four carotid arteries were reclassified into lesser stenosis categories using the ce3D GRE technique. However, seven carotid arteries (27 %) were rated as nondiagnostic on the ce3D GRE, mainly due to masking of the carotid bifurcation by veins. The latter can be avoided by decreasing the acquisition time; on our 1.5-T system we could achieve a minimum time of 23 s per 3D GRE. Further reduction of acquisition time would be necessary to incorporate this method into clinical routine, requiring higher-performance gradients, which are not available in many UK hospitals.

Using both an experimental model and clinical cases, we looked at the artefact produced by Aesculap titanium-alloy aneurysm clips on MRA. Experimentally, the volume affected by artefact was 50 % less when the clip was imaged lying parallel to the main ferromagnetic field than when lying perpendicular to it. Clinically, MRA was prospectively compared with digital subtraction angiography (DSA) in nine patients who had undergone aneurysm clipping. One patient with a non-diagnostic MRA due to movement artefact was excluded. In all other cases there was an area of signal loss surrounding the clips, obscuring the immediately adjacent vessel segments. There was good demonstration of the adjacent bifurcations in five cases and the contralateral circulation was seen well in all patients. In three cases in which the adjacent bifurcations were not seen, considerable vasospasm was suggested by MRA and confirmed with DSA. In one patient an unclipped contralateral ophthalmic artery aneurysm was identified using both modalities. In this series there were no adverse events relating to clips in either static or time-varying magnetic fields.

We report two patients with meningitis due to spirochaetal infection, both of whom showed diffusely enhancing meninges around the brain and spinal cord. In addition, there was enhancement of the cerebrospinal fluid after intravenous administration of Gd-DTPA.

We performed a blinded multireader study comparing MR angiography (MRA) with digital subtraction angiography (DSA) in 34 prospectively recruited patients who presented with acute subarachnoid haemorrhage (SAH). Two observers independently reviewed the MRA and DSA studies some months after clinical presentation. Presence of an aneurysm was rated on a 4-point confidence scale. Cases in which the initial interpretation of the observers varied were jointly reviewed to reach a consensus opinion. DSA was deliberately chosen not to represent the reference standard and the clinical course and surgical findings were used to explain significant differences between the consensus readings of MRA and DSA. Diagnostic confidence and interobserver agreement were, overall, higher on DSA than on MRA studies (ϰ DSA = 0.64 versus ϰ MRA = 0.52 with 95 % CI for Δ = ϰ DSA-ϰ MRA [–0.06, 0.31]). With both methods, discrepancies between observers were due to aneurysms overlooked rather than false-positive readings by one observer. Diagnostic accuracy therefore improved when the readings of the two observers were combined, particularly for MRA. Intermethod agreement was only fair and similar for both readers (ϰ reader 1 = 0.37 versus ϰ reader 2 = 0.32 with 95 % CI for Δ = ϰ reader 1-ϰ reader 2 [–0.02, 0.11]). Both interobserver and intermethod agreements improved when the data were analysed on a per-study (positive or negative study) rather than on a per-aneurysm basis. Differences in the consensus reading were due to five aneurysms (four single and one multiple) detected only with MRA and five (two single and three multiple) detected only with DSA. MRA and DSA should be regarded as complementary in the investigation of patients with acute SAH. DSA can no longer be regarded as the reference standard.