MR diagnosis of vertebral artery dissection: value of 3D time-of-flight and true fast imaging with steady-state precession fusion imaging

OBJECTIVES We hypothesized that 3D time-of-flight (TOF) and true fast imaging with steady-state precession (true-FISP) fusion imaging could provide more information regarding the arterial vessel wall. The purpose of this study was to compare the accuracy of lesion detection and the diagnostic confidence of VAD between TOF images alone and fused TOF and true-FISP images. METHODS Fifty patients were studied: 17 had VAD and 33 had vertebral artery hypoplasia. Fusion images of the vertebral artery were reconstructed using a workstation. A receiver-operating characteristic (ROC) analysis was conducted with a continuous rating scale from 1 to 100 to compare observer performance in VAD detection. Five radiologists participated in the observer performance test, and their performances with TOF images were compared with those using fused images. RESULT The observers found that the mean areas under the best-fit ROC curve for TOF images alone and fused TOF images were 0.66 ± 0.05 and 0.93 ± 0.04, which were significantly different (P < 0.01). CONCLUSION The fusion images provided more information regarding the arterial vessel wall. Fused images aided distinction between vertebral artery dissection versus vertebral artery hypoplasia. KEY POINTS • New MR techniques can help to differentiate flowing blood from static blood products. • Fused TOF and true-FISP images differentiate the lumen and the arterial wall, improving diagnostic performance. • Fused images may be superior to time-of-flight MR angiography alone.