The significance of MR angiography for the diagnosis of carotid stenoses

Arteriosclerosis of the supra-aortic vessels is a known risk factor for cerebrovascular disease. Large multicenter studies like NASCET and ECST have proven the protective effects of the surgical treatment of severe (>70%) carotid artery stenoses. The exact detection and grading of stenoses of the carotid arteries is a prerequisite for a successful therapy. Besides the gold-standard examination, digital subtraction angiography (DSA), MR angiography (MRA) is being used increasingly. MRA allows a non-invasive, high-resolution depiction of the supra-aortic vessels without ionizing radiation in only 20 s. This article first illustrates the MRA-techniques, and the indications and limitations of MRA. Next, the diagnostic accuracy of MRA is compared to DSA and ultrasound. The clinical value of MRA for the detection of stenoses of the carotid arteries is discussed on the basis of clinical examples.