Appropriate Minimal Dose of Gadobutrol for 3D Time-Resolved MRA of the Supra-Aortic Arteries: Comparison with Conventional Single-Phase High-Resolution 3D Contrast-Enhanced MRA

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Fig 1.
Flow chart of the study population.
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Fig 2.
A, TR-MRA with 1 mL of gadobutrol with subtracted coronal MIP images shows good segmental visualization with minimal blurring or undulation of both CCAs, the extracranial ICA, and the vertebral artery. TR-MRA with 2 (B) and 3 mL (C) of gadobutrol with subtraction coronal MIP images shows clear arterial visualization. D, CE-MRA shows mild venous contamination with no influence on the diagnostic interpretation at the intracranial area. TR-MRA with 3 mL of gadobutrol (C) and CE-MRA (D) show severe stenosis of the left vertebral artery origin (arrow) in a 75-year-old man with suspected stroke.
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Fig 3.
A 52-year-old man with suspected transient ischemic attack. TR-MRA with 1 mL of gadobutrol (A) and CE-MRA (B) show moderate stenosis at the origin of the right vertebral artery (thick arrow) and mild stenosis of the left proximal extracranial ICA (thin arrow).
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Fig 4.
A 74-year-old man with suspected stroke. TR-MRA with 2 mL of gadobutrol (A) and CE-MRA (B) show moderate stenosis in the proximal extracranial ICA (thick arrow).

Table 1:

Demographic characteristics^{^a}

	Group A (1 mL) (n = 139)	Group B (2 mL) (n = 169)	Group C (3 mL) (n = 154)	P Value
Age (yr)	60.3 ± 13.6	62.2 ± 13.4	63.2 ± 14.5	.184
Male/female	80:59	94:75	83:71	.821
Body weight (kg)	63.4 ± 11.6	63.9 ± 10.3	62.4 ± 10.1	.498
Contrast dose of CE-MRA (mL)	6.3 ± 1.2	6.4 ± 1.0	6.2 ± 1.0	.498
Time between CE-MRA and TR-MRA (sec)	224 ± 21	251 ± 42	233 ± 36	.532

Table 2:

Comparison of image quality between 2 MRA techniques in the 3 groups

Arterial Segment	Group A					Group B					Group C
	CE-MRA		TR-MRA		P	CE-MRA		TR-MRA		P	CE-MRA		TR-MRA		P
	Mean	Range	Mean	Range	P	Mean	Range	Mean	Range	P	Mean	Range	Mean	Range	P
Right brachiocephalic trunk	3.96	3–4	3.58	2–4	.000	3.97	3–4	3.91	3–4	.001	3.97	3–4	3.93	3–4	.034
Right subclavian artery	3.93	2–4	3.58	1–4	.000	3.92	1–4	3.92	1–4	.655	3.93	2–4	3.94	3–4	.414
Left subclavian artery	3.77	1–4	3.27	1–4	.000	3.90	2–4	3.85	2–4	.050	3.94	3–4	3.90	3–4	.058
Right CCA	3.91	2–4	3.53	1–4	.000	3.95	3–4	3.91	3–4	.052	3.93	3–4	3.92	3–4	.655
Right extracranial ICA	3.99	3–4	3.54	3–4	.000	3.99	3–4	3.96	3–4	.059	3.99	3–4	4.00	4–4	.317
Right intracranial ICA	3.39	1–4	3.67	2–4	.000	3.45	2–4	3.88	3–4	.000	3.56	2–4	3.91	2–4	.000
Left CCA	3.83	2–4	3.22	1–4	.000	3.92	3–4	3.79	3–4	.000	3.94	3–4	3.92	3–4	.180
Left extracranial ICA	3.99	3–4	3.61	3–4	.000	3.98	3–4	3.96	3–4	.180	3.99	3–4	4.00	4–4	.157
Left intracranial ICA	3.38	1–4	3.63	2–4	.000	3.54	2–4	3.89	3–4	.000	3.62	2–4	3.90	3–4	.000
Right vertebral artery orifice	3.79	1–4	3.33	1–4	.000	3.74	2–4	3.75	2–4	.317	3.77	3–4	3.78	3–4	.705
Right vertebral artery	3.51	1–4	3.22	1–4	.000	3.62	2–4	3.81	2–4	.000	3.62	2–4	3.90	3–4	.000
Left vertebral artery orifice	3.72	3–4	3.19	1–4	.000	3.76	3–4	3.75	2–4	.405	3.77	3–4	3.77	3–4	.808
Left vertebral artery	3.55	1–4	3.20	2–4	.000	3.68	2–4	3.79	2–4	.006	3.72	2–4	3.90	2–4	.000
Basilar artery	3.85	1–4	3.69	2–4	.000	3.88	2–4	3.88	2–4	1.000	3.91	1–4	3.94	1–4	.157

Table 3:

Distribution of venous contamination at CE-MRA and TR-MRA in the 3 groups^{^a}

Arterial Segment	Group A				Group B				Group C
Arterial Segment	Grade 0	Grade 1	Grade 2	Grade 3	Grade 0	Grade 1	Grade 2	Grade 3	Grade 0	Grade 1	Grade 2	Grade 3
Right brachiocephalic trunk	138/137	1/1	0/1	0/0	164/165	4/4	1/0	0/0	154/154	0/0	0/0	0/0
Right subclavian artery	61/118	77/19	1/2	0/0	64/123	104/40	1/6	0/0	59/115	93/35	2/4	0/0
Left subclavian artery	128/136	11/0	0/3	0/0	164/168	5/1	0/0	0/0	142/147	10/6	2/1	0/0
Right CCA	110/134	29/4	0/1	0/0	146/156	23/12	0/1	0/0	112/139	41/14	1/1	0/0
Right extracranial ICA	25/101	114/38	0/0	0/0	21/119	148/50	0/0	0/0	5/111	148/43	1/0	0/0
Right intracranial ICA	24/108	109/31	6/0	0/0	24/120	138/49	6/0	1/0	30/114	120/39	4/1	0/0
Left CCA	125/133	14/5	0/1	0/0	158/167	11/2	0/0	0/0	140/148	13/5	1/1	0/0
Left extracranial ICA	28/103	111/36	0/0	0/0	24/111	145/58	0/0	0/0	15/109	137/45	2/0	0/0
Left intracranial ICA	25/97	102/40	12/2	0/0	19/115	142/53	8/1	0/0	32/112	115/42	7/0	0/0
Right vertebral artery orifice	122/137	17/1	0/1	0/0	151/160	17/6	1/3	0/0	132/145	22/7	0/2	0/0
Right vertebral artery	54/112	84/27	1/0	0/0	68/139	101/29	0/1	0/0	45/126	104/27	5/1	0/0
Left vertebral artery orifice	132/139	7/0	0/0	0/0	166/167	3/1	0/1	0/0	143/151	10/3	0/0	1/0
Left vertebral artery	51/115	86/24	2/0	0/0	63/145	105/24	1/0	0/0	51/131	101/22	2/1	0/0
Basilar artery	29/119	103/16	6/4	1/0	51/142	105/25	13/2	0/0	36/134	111/20	7/0	0/0

Table 4:

Evaluation of stenosis at CE-MRA and TR-MRA in the 3 groups

CE-MRA	Group A TR-MRA					Group B TR-MRA					Group C TR-MRA
CE-MRA	0	1	2	3	Total	0	1	2	3	Total	0	1	2	3	Total
0	1766	2	3	2	1773	2149	1	0	0	2150	1947	1	0	0	1948
1	6	57	4	0	67	0	98	2	0	100	1	102	1	0	104
2	1	4	69	1	75	3	3	76	0	82	0	4	75	0	79
3	0	0	0	31	31	0	0	0	34	34	1	0	0	24	25
Total	1773	63	76	34	1946	2152	102	78	34	2366	1949	107	76	24	2156

Table 5:

Comparison of SNR between 2 MRA techniques in the 3 groups^{^a}

Arterial Segment	Group A			Group B			Group C
Arterial Segment	CE-MRA	TR-MRA	P	CE-MRA	TR-MRA	P	CE-MRA	TR-MRA	P
Right brachiocephalic trunk	211.2 ± 50.6	144.0 ± 47.6	.000	203.0 ± 45.3	211.2 ± 61.1	.019	204.0 ± 116.0	230.8 ± 65.9	.011
Right subclavian artery	150.8 ± 41.0	97.8 ± 32.0	.000	144.2 ± 36.6	154.0 ± 81.9	.099	135.2 ± 37.0	167.4 ± 110.7	.000
Left subclavian artery	163.3 ± 35.3	100.9 ± 29.3	.000	157.0 ± 34.0	154.0 ± 40.4	.276	152.3 ± 36.6	174.9 ± 45.7	.000
Right CCA	172.1 ± 45.5	103.9 ± 32.6	.000	164.8 ± 42.1	156.4 ± 48.7	.017	157.1 ± 44.9	173.8 ± 47.3	.000
Right extracranial ICA	190.4 ± 63.9	107.0 ± 38.9	.000	177.4 ± 53.5	166.4 ± 57.4	.003	176.5 ± 54.5	193.1 ± 61.3	.001
Right intracranial ICA	280.1 ± 77.4	136.3 ± 46.6	.000	289.9 ± 172.2	226.3 ± 74.7	.000	274.5 ± 71.3	280.1 ± 77.2	.364
Left CCA	200.6 ± 48.8	112.9 ± 33.3	.000	189.7 ± 45.9	172.2 ± 43.2	.000	183.6 ± 50.1	200.2 ± 52.0	.000
Left extracranial ICA	220.8 ± 66.0	120.1 ± 38.5	.000	204.2 ± 59.3	184.9 ± 62.0	.000	199.8 ± 61.5	224.1 ± 70.8	.000
Left intracranial ICA	300.5 ± 73.2	144.9 ± 47.1	.000	295.3 ± 63.5	240.4 ± 66.1	.000	291.1 ± 70.8	301.7 ± 82.5	.137
Right vertebral artery	165.3 ± 52.9	71.8 ± 27.7	.000	158.4 ± 57.3	115.8 ± 57.9	.000	158.0 ± 55.2	136.2 ± 56.4	.000
Left vertebral artery	169.6 ± 60.7	73.7 ± 25.6	.000	167.4 ± 53.8	122.1 ± 49.8	.000	170.6 ± 55.3	149.1 ± 52.2	.000
Basilar artery	223.2 ± 59.5	80.7 ± 29.5	.000	229.9 ± 55.4	136.1 ± 62.8	.000	230.5 ± 46.9	165.5 ± 54.9	.000