Arterial spin labeled carotid MR angiography: A phantom study examining the impact of technical and hemodynamic factors.

PURPOSE: To quantify the accuracy of three-dimensional (3D) radial arterial spin labeled (ASL) magnetic resonance angiography (MRA) using vascular models of carotid stenosis. METHODS: Eight vascular models were imaged at 1.5 Tesla using pulsatile flow waveforms at rates found in the internal carotid arteries (100-400 mL/min). The impacts of the 3D ASL imaging readout (fast low angle shot (FLASH) versus balanced steady-state free precession (bSSFP)), ultrashort echo time imaging using a pointwise encoding time reduction with radial acquisition (PETRA), and model stenosis severity on the accuracy of vascular model display at the location of stenosis were quantified. Accuracy was computed vis-à-vis a reference bSSFP volume acquired under no flow. Comparisons were made with standard-of-care contrast-enhanced MRA (CEMRA) and Cartesian time-of-flight (TOF) MRA protocols. RESULTS: For 50% and 70% stenoses, CEMRA was most accurate (respective accuracies of 81.7% and 78.6%), followed by ASL FLASH (75.7% and 71.8%), ASL PETRA (69.6% and 70.6%), 3D TOF (66.6% and 57.1%), ASL bSSFP (68.7% and 51.2%), and 2D TOF (65.1% and 50.6%). CONCLUSION: Flow phantom imaging studies show that ASL MRA can improve the display of hemodynamically significant carotid arterial stenosis compared with TOF MRA, with FLASH and ultrashort echo time readouts being most accurate. Magn Reson Med 75:295-301, 2016. © 2015 Wiley Periodicals, Inc