Noninvasive Evaluation of Collateral Blood Flow through Circle of Willis in Cervical Carotid Stenosis Using Selective Magnetic Resonance Angiography

Background Preoperative assessment of intracranial collateral circulation is helpful in predicting cerebral ischemia during surgical procedures for cervical internal carotid artery (ICA) stenosis. However, magnetic resonance angiography (MRA) and other less-invasive techniques cannot evaluate collateral blood flow because these techniques are nonselective. Hence, by using a newly developed selective MRA technique, we attempted to visualize collaterals via the circle of Willis in patients with ICA stenosis. Methods Twelve patients who underwent carotid endarterectomy were prospectively examined with a 1.5-T MR scanner. Both selective and nonselective MRA were obtained using a 3-dimensional time-of-flight technique, with or without a cylindrical saturation pulse that suppresses the flow signal from the region of the target ICA. Maximum intensity projection MRA images were generated and compared with digital subtraction angiography (DSA) images. Results In all patients, the distal flow signal of the ipsilateral ICA was completely suppressed on selective MRA compared with nonselective MRA. In addition, collateral blood flow through the anterior and posterior communicating arteries was visualized in 5 and 2 patients, respectively. These findings corresponded well with the DSA imaging. Conclusions Selective MRA techniques can readily suppress signals from the distal blood flow of the target artery and visualize the presence of collateral flows through the circle of Willis in patients with cervical ICA stenosis.