Evaluation of carotid vessel wall enhancement with image subtraction after gadobenate dimeglumine-enhanced MR angiography

Francesco Sardanelli, Giovanni Di Leo, Alberto Aliprandi, Nicola Flor, Giacomo D E Papini, Luca Roccatagliata, Biagio Cotticelli, Giovanni Nano, Gianpaolo Cornalba

Research output: Contribution to journalArticlepeer-review


Objectives: This study was aimed at testing the value of image subtraction for evaluating carotid vessel wall enhancement in contrast-enhanced MR angiography (MRA). Materials and methods: IRB approval was obtained. The scans of 81 consecutive patients who underwent carotid MRA with 0.1 mmol/kg of gadobenate dimeglumine were reviewed. Axial carotid 3D T1-weighted fast low-angle shot sequence before and 3 min after contrast injection were acquired and subtracted (enhanced minus unenhanced). Vessel wall enhancement was assigned a four-point score using native or subtracted images from 0 (no enhancement) to 3 (strong enhancement). Stenosis degree was graded according to NASCET. Results: With native images, vessel wall enhancement was detected in 20/81 patients (25%) and in 20/161 carotids (12%), and scored 2.0 ± 0.6 (mean ± standard deviation); with subtracted images, in 21/81 (26%) and 22/161 (14%), and scored 2.5 ± 0.6, respectively (P <0.001, Sign test). The overall stenosis degree distribution was: mild, 41/161 (25%); moderate, 77/161 (48%); severe, 43/161 (27%). Carotids with moderate stenosis showed vessel wall enhancement with a frequency (17/77, 22%) significantly higher than that observed in carotids with mild stenosis (1/41, 2%) (P = 0.005, Fisher exact test) and higher, even though with borderline significance (P = 0.078, Fisher exact test), than that observed in carotids with severe stenosis (4/43, 9%). Conclusion: Roughly a quarter of patients undergoing carotid MRA showed vessel wall enhancement. Image subtraction improved vessel wall enhancement conspicuity. Vessel wall enhancement seems to be an event relatively independent from the degree of stenosis. Further studies are warranted to define the relation between vessel wall enhancement and histopathology, inflammatory status, and instability.

Original languageEnglish
Pages (from-to)589-594
Number of pages6
JournalEuropean Journal of Radiology
Issue number3
Publication statusPublished - Jun 2009


  • Carotid arteries
  • Image subtraction
  • MR angiography
  • Vessel wall enhancement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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