Accelerated Two‐Point Dixon MR Angiography Improves Diagnostic Performance for Cervical Artery Diseases
Authors: Amemiya Shiori , Takei Naoyuki , Ueyama Tsuyoshi , Fujii Keita , Takao Hidemasa , Yasaka Koichiro , Watanabe Yusuke , Kamiya Kouhei , Abe Osamu 
Published: February 2022

BackgroundNonenhanced MR angiography (MRA) studies are often used to manage acute and chronic large cervical artery disease, but lengthy scan times limit their clinical usefulness.PurposeTo develop an accelerated cervical MRA and test its diagnostic performance.Study TypeProspective.PopulationPatients with cervical artery disease (n = 32, 17 males).Field Strength/Sequence3.0 T; accelerated two‐point Dixon three‐dimensional Cartesian spoiled gradient‐echo (FLEXA) and conventional time‐of‐flight MRA (cMRA) sequences.AssessmentAll patients underwent FLEXA (1′28″) and cMRA (6′47″) acquisitions. Quantitative evaluation (artery‐to‐background signal ratio and a blur metric) and qualitative evaluation using diagnostic performance measured by the sensitivity, specificity, and positive/negative predictive values (PPV/NPV), and vessel and plaque visualization scores from three board‐certified radiologists' (with 10, 11, and 12 years of experience) independent readings using maximum intensity projection (MIP) for luminal diseases and axial images for plaque. The reference standards were contrast‐enhanced angiography and fat‐saturated T1‐weighted images, respectively.Statistical TestsAll measures were compared between FLEXA and cMRA using the paired t, Wilcoxon signed‐rank, McNemar's, or chi‐squared test, as appropriate. Interreader agreement was assessed using Cohen's κ. P < 0.05 was considered statistically significant.ResultsThe artery‐to‐background signal ratio was significantly higher for FLEXA (FLEXA: 7.20 ± 1.63 [fat]; 4.26 ± 0.52 [muscle]; cMRA: 2.57 ± 0.49 [fat]), while image blurring was significantly less (FLEXA: 0.24 ± 0.016; cMRA: 0.30 ± 0.029). In luminal disease detection, sensitivity (FLEXA: 0.97/0.91/0.91; cMRA:0.71/0.69/0.63), specificity (FLEXA: 0.98/0.93/0.98; cMRA:0.93/0.85/0.92), PPV (FLEXA: 0.92/0.86/0.86; cMRA: 0.64/0.5/0.58), and NPV (FLEXA: 0.99/0.98/0.98; cMRA: 0.92/0.91/0.9) were significantly higher for FLEXA. interreader agreement was substantial to almost perfect for FLEXA (κ = 0.82/0.86/0.78) and moderate to substantial for cMRA (κ = 0.67/0.56/0.57). MIP visualization scores were significantly higher for FLEXA, with substantial to almost perfect interreader agreement (FLEXA: κ = 0.83/0.86/0.82; cMRA: κ = 0.89/0.79/0.79). In plaque detection, sensitivity (FLEXA: 0.9/0.9/0.7; cMRA: 0.3/0.6/0.2) and specificity (FLEXA: 1/0.87/1; cMRA: 0.93/0.63/0.97) were significantly higher for FLEXA in two of three readers. The interreader plaque detection agreement was fair to substantial (FLEXA: κ = 0.63/0.69/0.48; cMRA: κ = 0.21/0.45/0.20). Side‐by‐side plaque and vessel wall visualization was superior for FLEXA in all readers, with moderate to substantial interreader agreement (plaque: κ = 0.73/0.73/0.77; vessel wall: κ = 0.57/0.40/0.39).Data ConclusionFLEXA enhanced visualization of the cervical arterial system and improved diagnostic performance for luminal abnormalities and plaques in patients with cervical artery diseases.Level of Evidence1Technical Efficacy Stage2