Which is better for quantifying a high grade stenosis

SK45 · Joined: 30 Jun 2009 Posts: 4

What is the better modality to quantify a high grade stenosis of the vertebral arteries . I want to NOTE I am not asking for bleeds ,nor aneurysims ,but for HIGH GRADE STENOSIS of the vertebral arteries.

I was under the impression that CT angiogram was better at picking up on BLEEDS and that stenosis was better quantified through MR angiograom with contrast of course.

Now the gold standard would be invasive angiogram ,but again I am asking specifically to give opinions on which is best for quantifying stenosis in the vertebral arteries , is it CT angiogram or MR angiogram with contrast .

Once I receive a response I would like to then differ this same question as to identifying particular pathology of the stenosis , such as arthero plaque or thrombis and which better quantifies those as well.

Please assist . TIA ( no pun intended !)

SK45 · Joined: 30 Jun 2009 Posts: 4

I wonder if there are radiology forums where in a highly qualified RAD well versed in vascular radiology specific to this would respond ?

SK45 · Joined: 30 Jun 2009 Posts: 4

Are there no MR techs here that do these procedures and have conferred with the RADS ( as I would think techs would ) as to what is the best diagnostic tool to quantify a high grade stenosis , and again no invasive angiograms , but the 2 mentioned CT and MR angios.

Anybody ????

SK45 · Joined: 30 Jun 2009 Posts: 4

Ignore I have found the answer, as I THOUGHT the MR angiogram is best for quantifying the degree of stenosis in the vertebral arteries ( or any of the arteries to the brain) My focus was specific as to the vertebral atreries.

I wondered because x patient had Mr and CT angiogram with and without contrast.

The left vertebral artery showed high grade stenosis in both prox and distal regions . The MR angiogram was done FIRST and that was the finding.

the next day a CT angiogram was done and the dictation noted similar findings , but similar was in question ,hence THIS CT angiogram stated there was a very small stenosis of the prox region of left vertebral .

Now obviously these are not really similar findings considering the MR angiogram stated 2 areas of HIGH GRADE STENOSIS at Proximal and distal portion of the vertebral , so NO ,I do not find that similar.

The patient had a stroke which is why these diagnostic scans were performed. the patient had a battery of other tests to RULE out or diagnose some other pathology as reason for stroke.

The MRI of the brain showed scarring to the Left pons, Left basal ganglia and the left occipital cortex, these scarred areas where the direct result of a stroke due to ischemia . however no other source could be identified even though the patient had extensive cardiac work up to include a transesphogeal echocardiogram , no PFO, ASD ,VSD or other thrombolic source were identified.

The only finding were the 2 high grade areas of stenosis of the left vertebral artery diagnosed by MR angiogram ,but the questionable CT angiogram that was done a day later only mentioned the small stenotic area of prox portion of left vertebral.

The CAUSE of this patients stroke is in question .

Anyone with good knowledge of the vasculature of the brain as well as strokes want to add their 2 cents ?

I opine the high grade stenosis found at proximal and distal regions of the left verterbral artery are the cause of stroke .