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Original article

Vol. 145 No. 2728 (2015)

In-vivo phase contrast magnetic resonance angiography of the cerebrovascular system: a comparative study with duplex sonography

  • Kety Hsieh
  • Katja Stein
  • Marie-Luise Mono
  • Frauke Kellner-Weldon
  • Rajeev Kumar Verma
  • Christian Weisstanner
  • Lukas Andereggen
  • Michael Reinert
  • Jan Gralla
  • Gerhard Schroth
  • Marwan El-Koussy
Cite this as:
Swiss Med Wkly. 2015;145:w14155


PURPOSE: Assessment of the cerebral blood flow (CBF) is crucial in the evaluation of patients with steno-occlusive diseases of the arteries supplying the brain for prediction of stroke risk. Quantitative phase contrast magnetic resonance angiography (PC-MRA) can be utilised for noninvasive quantification of CBF. The aim of this study was to validate in-vivo PC-MRA data by comparing them with colour-coded duplex (CCD) sonography in patients with cerebrovascular disease.

METHODS AND MATERIALS: We examined 24 consecutive patients (mean age 63 years) with stenosis of arteries supplying the brain using PC-MRA and CCD. Velocities were measured in a total of 209 stenotic and healthy arterial segments (110 extra- and 99 intracranial).

RESULTS: Moderate to good correlation of velocity measurements between both techniques was observed in all six extracranial and five out of seven intracranial segments (p <0.05). Velocities measured with CCD sonography were generally higher than those obtained by PC-MRA. Reversal of flow direction was detected consistently with both methods.

CONCLUSION: PC-MRA represents a robust, standardised magnetic resonance imaging technique for blood flow measurements within a reasonable acquisition time, potentially evolving as valuable work-up tool for more precise patient stratification for revascularisation therapy. PC-MRA overcomes relevant weaknesses of CCD in being not operator-dependent and not relying on a bone window to assess the intracranial arteries.


  1. Wada T, Kodaira K, Fujishiro K, Okamura T. Correlation of common carotid flow volume measured by ultrasonic quantitative flowmeter with pathological findings. Stroke. 1991;22(3):319–23.
  2. Amin-Hanjani S, Rose-Finnell L, Richardson D, Ruland S, Pandey D, Thulborn KR, et al. Vertebrobasilar Flow Evaluation and Risk of Transient Ischaemic Attack and Stroke study (VERiTAS): rationale and design. Int J Stroke. 2010;5(6):499–505.
  3. Levine RL, Turski PA, Turnipseed WD, Dulli DA, Grist TM. Vasodilatory responses and magnetic resonance angiography. Extracranial and intracranial intravascular flow data. J Neuroimaging. 1997;7(3):152–8.
  4. Ogasawara K, Ogawa A, Yoshimoto T. Cerebrovascular reactivity to acetazolamide and outcome in patients with symptomatic internal carotid or middle cerebral artery occlusion: a xenon-133 single-photon emission computed tomography study. Stroke. 2002;33(7):1857–62.
  5. Pantano P, Baron JC, Lebrun-Grandie P, Duquesnoy N, Bousser MG, Comar D. Regional cerebral blood flow and oxygen consumption in human aging. Stroke. 1984;15(4):635–41.
  6. Jungreis CA, Yonas H, Firlik AD, Wechsler LR. Advanced CT imaging (functional CT). Neuroimaging Clin N Am. 1999;9(3):455–64.
  7. Butcher K, Parsons M, Allport L, Lee SB, Barber PA, Tress B, et al. Rapid assessment of perfusion-diffusion mismatch. Stroke. 2008;39(1):75–81.
  8. Zhao M, Amin-Hanjani S, Ruland S, Curcio AP, Ostergren L, Charbel FT. Regional cerebral blood flow using quantitative MR angiography. AJNR Am J Neuroradiol. 2007;28(8):1470–3.
  9. Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg. 1982;57(6):769–74.
  10. Baumgartner RW, Mathis J, Sturzenegger M, Mattle HP. A validation study on the intraobserver reproducibility of transcranial color-coded duplex sonography velocity measurements. Ultrasound Med Biol. 1994;20(3):233–7.
  11. Zananiri F V, Jackson PC, Goddard PR, Davies ER, Wells PN. An evaluation of the accuracy of flow measurements using magnetic resonance imaging (MRI). J Med Eng Technol. 1991;15(4-5):170–6.
  12. Ley S, Unterhinninghofen R, Ley-Zaporozhan J, Schenk JP, Kauczor HU, Szabo G. Validation of magnetic resonance phase-contrast flow measurements in the main pulmonary artery and aorta using perivascular ultrasound in a large animal model. Invest Radiol. 2008;43(6):421–6.
  13. Machida H, Komori Y, Ueno E, Shen Y, Hirata M, Kojima S, et al. Spatial factors for quantifying constant flow velocity in a small tube phantom: comparison of phase-contrast cine-magnetic resonance imaging and the intraluminal Doppler guidewire method. Jpn J Radiol. 2009;27(9):335–41.
  14. Calderon-Arnulphi M, Amin-Hanjani S, Alaraj A, Zhao M, Du X, Ruland S, et al. In vivo evaluation of quantitative MR angiography in a canine carotid artery stenosis model. AJNR Am J Neuroradiol. 2011;32(8):1552–9.
  15. BrayJM, Galland F, Lhoste P, Nicolau S, Dubas F, Emile J, et al. Colour Doppler and duplex sonography of the carotid artery bifurcations. Prospective, double-blind study. Neuroradiology 1995;37(3):219-24
  16. Baumgartner RW, Mattle HP, Schroth G. Assessment of >/=50% and <50% intracranial stenoses by transcranial color-coded duplex sonography. Stroke. 1999;30(1):87–92.
  17. Amin-Hanjani S, Du X, Zhao M, Walsh K, Malisch TW, Charbel FT. Use of quantitative magnetic resonance angiography to stratify stroke risk in symptomatic vertebrobasilar disease. Stroke. 2005;36(6):1140–5.
  18. Zhao M, Charbel FT, Alperin N, Loth F, Clark ME. Improved phase-contrast flow quantification by three-dimensional vessel localization. Magn Reson Imaging. 2000;18(6):697–706.
  19. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.
  20. Oktar SO, Yucel C, Karaosmanoglu D, Akkan K, Ozdemir H, Tokgoz N, et al. Blood-flow volume quantification in internal carotid and vertebral arteries: comparison of 3 different ultrasound techniques with phase-contrast MR imaging. AJNR Am J Neuroradiol. 2006;27(2):363–9.
  21. Stadlbauer A, van der Riet W, Globits S, Crelier G, Salomonowitz E. Accelerated phase-contrast MR imaging: comparison of k-t BLAST with SENSE and Doppler ultrasound for velocity and flow measurements in the aorta. J Magn Reson Imaging. 2009;29(4):817–24.
  22. Meckel S, Leitner L, Bonati LH, Santini F, Schubert T, Stalder AF, et al. Intracranial artery velocity measurement using 4D PC MRI at 3 T: comparison with transcranial ultrasound techniques and 2D PC MRI. Neuroradiology. 2013;55(4):389–98.
  23. Jiang J, Strother C, Johnson K, Baker S, Consigny D, Wieben O, et al. Comparison of blood velocity measurements between ultrasound Doppler and accelerated phase-contrast MR angiography in small arteries with disturbed flow. Phys Med Biol. 2011;56(6):1755–73.
  24. Ranke C, Creutzig A, Becker H, Trappe HJ. Standardization of carotid ultrasound: a hemodynamic method to normalize for interindividual and interequipment variability. Stroke. 1999;30(2):402–6.
  25. Schoning M, Walter J. Evaluation of the vertebrobasilar-posterior system by transcranial color duplex sonography in adults. Stroke. 1992;23(9):1280–6.
  26. Obata T, Shishido F, Koga M, Ikehira H, Kimura F, Yoshida K. Three-vessel study of cerebral blood flow using phase-contrast magnetic resonance imaging: effect of physical characteristics. Magn Reson Imaging. 1996;14(10):1143–8.
  27. O’Brien KR, Cowan BR, Jain M, Stewart RA, Kerr AJ, Young AA. MRI phase contrast velocity and flow errors in turbulent stenotic jets. J Magn Reson Imaging. 2008;28(1):210–8.
  28. Eichenberger AC, Jenni R, von Schulthess GK. Aortic valve pressure gradients in patients with aortic valve stenosis: quantification with velocity-encoded cine MR imaging. AJR Am J Roentgenol. 1993;160(5):971–7.
  29. Douville Y, Johnston KW, Kassam M. Determination of the hemodynamic factors which influence the carotid Doppler spectral broadening. Ultrasound Med Biol. 1985;11(3):417–23.
  30. Enzmann DR, Ross MR, Marks MP, Pelc NJ. Blood flow in major cerebral arteries measured by phase-contrast cine MR. AJNR Am J Neuroradiol. 1994;15(1):123–9.

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