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Intracranial Stenosis MR Angiography

Detection and follow-up of intracranial atherosclerotic disease with non-contrast time-of-flight (TOF) and contrast-enhanced MRA

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Radyoloji department. Book Appointment →

What is Intracranial Stenosis MR Angiography?

Intracranial atherosclerotic disease (ICAD) is responsible for approximately 8-10% of ischemic strokes and is more prevalent in Asian, Hispanic, and Black populations. The most common involvement sites are the M1 segment of the middle cerebral artery, basilar artery, and intracranial carotid artery.

Time-of-flight (TOF) MR angiography uses the inflow effect of unsaturated proton spins to obtain vascular images without contrast; 3T magnets and 3D sequences provide high spatial resolution (0.5 mm). Contrast-enhanced MRA (CE-MRA) provides better assessment of distal segments and is indicated when stenosis is detected on TOF.

On TOF, signal loss may overestimate stenosis (50-70% range); the 'true' stenosis percentage is determined by digital subtraction angiography (DSA) (gold standard) using the WASID criteria. Vessel wall MRI evaluates plaque morphology and active remodeling.

Symptoms

Transient ischemic attack (TIA)
Recurrent stroke despite medical therapy
Limited stroke (lacunar)
Borderzone (watershed) infarct
Vertigo, dysarthria, ataxia
Cognitive impairment (multi-infarct dementia)

Risk Factors

Hypertension
Diabetes mellitus
Hyperlipidemia
Smoking
Asian/Hispanic/Black race
Metabolic syndrome and obesity

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • TIA or stroke history
  • Recurrent infarct despite optimal medical therapy
  • Symptomatic intracranial stenosis on imaging
  • Pre-stenting evaluation
  • Treatment response follow-up

Treatment Methods

01
3T MR angiography (TOF and CE-MRA)
02
High-resolution vessel wall MRI
03
DSA (gold standard, surgical planning)
04
Aggressive medical management (SAMMPRIS) — dual antiplatelet, statin, blood pressure control
05
Intracranial stenting (selected refractory cases)
06
Follow-up imaging (3-6 months)

Which Department to Visit?

You can visit our Radyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.