Retrospective analysis of Routine T2 weighted brain MRI for detecting cervical internal carotid artery steno-occlusive disease

Abstract

Objective: To determine accuracy of signal alteration replacing normal flow voids in routine T2WI MRI brain for identifying cervical carotid steno-occlusive disease.

Methods: Neuroimaging data on patients with ischemic stroke was collected, only patients with both MRI brain T2WI and CT angiography of neck vessels (CTA) were included and the information was analyzed retrospectively. Flow void signals on routine axial T2 WI were analyzed by a neuroradiologist blinded to CTA of neck vessels and compared with CTA of neck vessels as gold standard to determine accuracy of altered flow void signals in identifying carotid steno-occlusive disease.

Results: Total of 278 patients, 34 patients with both T2WI and CTA were included. 15/34(44.1%) showed altered flow voids in cavernous ICA on axial T2WI while 19/34(55.8%) with normal flow voids were considered intra cohort controls.18/19(94.7%) showed normal patency of ICA on both T2WI and CTA of neck vessels. All 15 patients with altered flow void on T2WI showed changes on cervical CTA conferring high specificity of 100%. Homogenously altered signal corresponded to occlusion in 100% (4/4) while heterogenous signals indicated significant stenosis in 88.8 % (8/9). Further, 100 % specificity of normal flow voids on T2WI to exclude significant steno-occlusive disease in cervical ICA was noted.

Conclusions: Loss of normal flow void signal on T2WI is highly specific indicator of significant steno-occlusive carotid disease and its absence vice versa of normal vessels.