3D T2-Weighted Sampling Perfection with Application-Optimized Contrasts Using Different Flip Angle Evolutions (SPACE) and 3D Time-of-Flight (TOF) MR Angiography Fusion Imaging for Occluded Intracranial Arteries

OBJECTIVE: Determining the course of occluded vessels in advance will increase the success rate and safety of mechanical thrombectomy (MT). Herein, we evaluate the usefulness of MR fusion images created via 3D T2-weighted sampling perfection with application-optimized contrasts using different flip angle evolutions (T2-SPACE) and 3D time-of-flight (TOF)-MRA for visualization of occluded vessels in patients with acute ischemic stroke (AIS) before MT. METHODS: We enrolled 26 patients with AIS caused by intracranial large vessel occlusion who presented at our hospital and underwent MRI with fusion images unaffected by motion artifacts in our study. All patients underwent T2-SPACE and TOF-MRA followed by MT. We created fusion images of the T2-SPACE and TOF-MRA by combining a translucent image of the occluded artery produced by the flow void effect in T2-SPACE with the same vessel in a TOF-MRA image. Fusion images were compared with post-recanalization angiography and post-recanalization MRA, respectively, and the degree of agreement in depiction of M1 runs and M2 branching beyond the occlusion on three levels was assessed. Imaging evaluations were performed independently by two endovascular specialists. RESULTS: The interobserver agreement of the MRI findings about the concordance of the occluded vessel’s run was excellent (kappa was 0.87 [confidence interval: 0.61–1.12]). In all, 21 patients (80.8%) had excellent imaging, four (15.4%) had fair imaging, and one (3.8%) had a divided opinion of the rating between excellent and fair imaging. No cases were judged to be poorly drawn. Even if there was a localized signal loss, its distal portion could be delineated, so it did not affect the estimation of the entire vessel run, and we found that the anatomical structures of the occluded vessels were distinctly visible in the fusion images. CONCLUSION: We demonstrated that MR fusion images derived using T2-SPACE and MRA methodologies could determine the courses of occluded vessels prior to MT performed for AIS. Fusion MR imaging may have potential as a preoperative test for ensuring effective and safe MT procedures.