MRI CAROTID ANGIO

## What is MRI Carotid Angiography? ### Magnetic Resonance Imaging (MRI) This technology uses powerful magnets, radio waves, and a sophisticated computer to create detailed cross-sectional images of your body's internal structures without using ionizing radiation. ### Angiography This part of the technique is specifically designed to visualize blood vessels. When applied to the carotid arteries, it allows doctors to see the arteries and assess blood flow. ## Types of MRI Carotid Angiography ### Time-of-Flight (TOF) MRA This is a very common technique and often does not require the injection of a contrast dye. It works by highlighting flowing blood. ### Contrast-Enhanced MRA (CE-MRA) This technique involves injecting a gadolinium-based contrast agent intravenously (into a vein). The contrast agent makes the blood vessels appear brighter on the images, which can provide clearer and more detailed views, especially in complex cases or when looking for subtle abnormalities. ### Phase-Contrast MRA (PC-MRA) While less commonly used just for anatomical depiction of carotid arteries, PC-MRA can be valuable as it can not only show the structure of the blood vessels but also measure the speed and direction of blood flow within them.

### Lumen Diameter and Degree of Stenosis Measurement of the internal width (lumen) of the internal and external carotid arteries to determine if there is any narrowing (stenosis) and, if so, its severity (e.g., mild, moderate, severe percentage of blockage). ### Presence, Location, and Characteristics of Atherosclerotic Plaque Identifying any buildup of plaque (atherosclerosis) and describing its features, such as whether it is calcified (hard), soft (lipid-rich), or has an ulcerated surface (which can be more prone to breaking off). ### Evidence of Dissection Looking for signs of a tear in the artery wall. ### Aneurysm Formation Identifying any localized bulges or weakened areas in the artery wall. ### Complete Occlusion Determining if an artery is completely blocked. ### Congenital Abnormalities or Variations Noting any unusual anatomical features of the carotid arteries that you may have been born with. ### Blood Flow Patterns and Velocity If techniques like Phase-Contrast MRA are used, the speed and direction of blood flow are assessed to identify any irregularities.

To Investigate Symptoms

If you are experiencing symptoms that suggest reduced blood flow to the brain, such as a Transient Ischemic Attack (TIA), amaurosis fugax (temporary loss of vision in one eye), unexplained dizziness, or specific types of headaches.

To Determine the Cause of an Ischemic Stroke

After a stroke, an MRI Carotid Angiography can help identify if carotid artery disease was the underlying cause.

To Screen High-Risk Individuals

For individuals with multiple risk factors for stroke (like diabetes, high blood pressure, smoking, high cholesterol, strong family history), especially before major surgeries such as cardiac surgery, this test can assess their carotid artery health.

To Monitor Known Carotid Artery Disease

If you have been previously diagnosed with carotid artery stenosis, this scan can help monitor whether the condition is progressing, stable, or responding to treatment.

To Plan Appropriate Treatment

The detailed images from an MRI Carotid Angiography are crucial for planning the best course of treatment, which might include medication, lifestyle changes, carotid endarterectomy (surgical removal of plaque), or carotid angioplasty and stenting (a minimally invasive procedure to open the artery).

To Evaluate Uncommon Conditions

It can also be used to assess less common conditions affecting the carotid arteries, such as fibromuscular dysplasia (abnormal cell growth in artery walls) or carotid body tumors.

When and Who Needs to Take an MRI Carotid Angiography?

Common MRI Carotid Angio Indications

Your doctor may recommend an MRI Carotid Angiography if they suspect an issue with your carotid arteries or if you are at high risk for conditions affecting these vessels. Common indications include:

• Suspicion of carotid artery stenosis (narrowing) or occlusion (blockage): This is a primary reason for the test, as these conditions can significantly increase stroke risk.
• Evaluation after a Transient Ischemic Attack (TIA) or stroke: To determine the cause and assess the extent of artery involvement.
• Detection of aneurysms (bulges in artery walls) or arteriovenous malformations (AVMs – abnormal tangles of blood vessels).
• Assessment of vasculitis (inflammation of blood vessels) or dissection (a tear in the artery wall).
• Pre-operative planning: Before procedures like carotid endarterectomy (surgery to remove plaque) or stenting (inserting a small tube to keep the artery open).
• Monitoring of known carotid artery disease: To track the progression of a known condition or the effectiveness of treatment.

Symptoms That Might Prompt Your Doctor to Order an MRI Carotid Angiography

Symptoms that might prompt your doctor to order an MRI Carotid Angiography include:

• Unexplained dizziness or recurrent headaches, especially if they are localized or accompanied by neurological symptoms.
• Symptoms of a TIA, such as temporary blurred vision, weakness or numbness on one side of the body, slurred speech, or difficulty understanding speech.
• A "bruit" – an abnormal whooshing sound heard by a doctor when listening to the carotid arteries with a stethoscope, suggesting turbulent blood flow.

Patient Groups Who Might Particularly Benefit From an MRI Carotid Angiography (PK)

Individuals with significant risk factors for stroke, such as:

• Hypertension (high blood pressure)
• Diabetes
• Smoking
• High cholesterol
• Family history of stroke or heart disease

Benefits of Taking the Test

High Diagnostic Value

It provides clear, detailed, and multi-angle images of the carotid arteries and surrounding structures without the use of ionizing radiation (like X-rays or CT scans).

Guides Treatment Decisions

The findings are essential for helping your doctor determine the most appropriate and effective treatment strategy to manage carotid artery disease and reduce your risk of stroke.

Monitors Condition Effectively

Allows for non-invasive tracking of disease progression or the success of interventions over time.

Early Detection

Can identify significant carotid artery problems, such as severe narrowing, sometimes even before they cause noticeable symptoms, allowing for proactive management to prevent a major health event like a stroke.

Reliable Diagnosis

The good accuracy of MRI for carotid arteries makes it a trusted method for reliable diagnosis, giving you and your doctor confidence in the findings.

Illnesses Diagnosed with MRI Carotid Angio

### Carotid Artery Stenosis Narrowing of the carotid arteries, most commonly due to atherosclerosis (plaque buildup). ### Carotid Artery Occlusion Complete blockage of a carotid artery. ### Carotid Artery Dissection A tear in the inner layer of the artery wall, which can create a false lumen or flap, leading to narrowing, blockage, or aneurysm formation. ### Carotid Artery Aneurysms A localized bulge or outpouching in the wall of the carotid artery due to weakness in the vessel wall. ### Vasculitis Affecting the Carotid Arteries Inflammation of the blood vessel walls. ### Fibromuscular Dysplasia (FMD) A non-atherosclerotic, non-inflammatory condition causing abnormal cell growth in the artery walls, leading to stenosis or aneurysms. ### Traumatic Injury Less commonly, it can be used to assess for injury to the carotid arteries after trauma. ### Tumors It may help evaluate tumors located near the carotid arteries and their potential impact on the vessels.

Diet

Usually, no specific dietary restrictions are needed for an MRI Carotid Angiography unless sedation is planned.

• If a contrast dye is anticipated, Cadabams Diagnostics staff may provide specific instructions, which could include fasting for a few hours before the scan. Please confirm this when you schedule your appointment.
• It's generally a good idea to stay well-hydrated by drinking water as you normally would.

Clothing

• Wear comfortable, loose-fitting clothing without any metal fasteners, zippers, snaps, or metallic threads. Items like jeans with metal buttons or rivets, bras with underwires or metal clasps should be avoided.
• You may be asked to change into a patient gown provided by Cadabams Diagnostics to ensure no metal interferes with the scan.

Medications

• Continue taking your usual medications as prescribed by your doctor unless specifically advised otherwise by your doctor or the staff at Cadabams Diagnostics.
• It is very important to inform our staff of all medications you are currently taking, including over-the-counter drugs and supplements.

Valuables

• Leave jewelry (necklaces, earrings, watches, rings), credit cards (which can be erased by the magnet), and other valuables at home or give them to a companion for safekeeping. Lockers may be available, but it's best to minimize what you bring.

Arrival Time

• Please arrive at Cadabams Diagnostics by the acknowledged time advised during scheduling. This allows ample time for registration, completing any necessary paperwork (like a safety questionnaire), and pre-scan preparations.

Pre-requisites

Doctor's Referral

A referral from your physician is typically required to undergo an MRI Carotid Angiography at Cadabams Diagnostics.

Fasting

Generally not required unless contrast dye is planned or if you have specific conditions like diabetes where fasting might be relevant to blood sugar management. Always confirm fasting requirements with Cadabams Diagnostics staff when you book your appointment or during your pre-scan call.

Medication Adjustments

• Usually, no adjustments to your regular medications are needed.
• Important: If you are diabetic and taking Metformin (Glucophage), and if a contrast dye is planned for your scan, you may need to temporarily stop Metformin around the time of your scan. Please discuss this with your referring doctor and inform the Cadabams Diagnostics staff.

Prior Tests/Medical History

• Please inform our staff if you have had any previous imaging studies (such as CT scans, Ultrasounds, or prior MRAs) of your neck or brain. Bringing reports or images from these previous scans can be helpful for comparison.
• Kidney Function Tests: If a contrast dye is planned, a recent blood test to check your kidney function (specifically, creatinine level to calculate eGFR) may be required. This is particularly important for patients over a certain age, those with known kidney disease, diabetes, or hypertension. Cadabams Diagnostics will advise if this is necessary for you.

Best Time to Take the MRI Carotid Angiography

The MRI Carotid Angiography can generally be scheduled during Cadabams Diagnostics' regular MRI operating hours. We strive to offer convenient appointment times.

The urgency of the test will be determined by your referring doctor based on your clinical symptoms and overall medical condition. If your situation is urgent, your doctor will communicate this to us, and we will do our best to accommodate you as quickly as possible.

Eligibility

Most individuals can safely undergo an MRI Carotid Angiography. However, due to the strong magnetic field used in MRI, there are some absolute contraindications:

Absolute Contraindications (You CANNOT have an MRI if you have):

• Certain types of pacemakers or implantable cardioverter-defibrillators (ICDs): Many newer models are "MRI-conditional," but older ones are not. This must be verified.
• Some older intracranial aneurysm clips: Clips made from ferromagnetic materials.
• Cochlear (inner ear) implants.
• Certain types of neurostimulators (e.g., deep brain stimulators, spinal cord stimulators) – unless specifically confirmed as MRI-safe.
• Metallic foreign bodies in or near the eyes (e.g., metal shavings from an old injury). An X-ray may be needed to rule this out if there's any suspicion.

Relative Contraindications/Important Considerations (Discuss with your doctor and Cadabams Diagnostics staff):

• Pregnancy: While MRI is generally considered safe after the first trimester, MRI Carotid Angiography, especially with contrast dye, is typically avoided during pregnancy unless absolutely necessary and the benefits clearly outweigh potential risks. Contrast dye is generally not given to pregnant patients. If you are or might be pregnant, please inform your doctor and our staff immediately.
• Severe Claustrophobia: If you have a significant fear of enclosed spaces, discuss this with your doctor. Options like open MRI (if available and appropriate for this type of scan), pre-medication for anxiety, or mild sedation can be considered at Cadabams Diagnostics.
• Severe Kidney Disease: If a gadolinium-based contrast dye is considered essential for your scan, your kidney function must be assessed. If you have severe kidney disease, the use of contrast will be carefully evaluated due to the risk of NSF.
• Other Metal Implants: Items like artificial joints, stents, surgical staples, or plates are often MRI-safe, but it's crucial to inform staff about any metal in your body so its compatibility can be checked.

A thorough safety screening will be conducted by Cadabams Diagnostics staff before your MRI Carotid Angiography.

Procedure for Taking an MRI Carotid Angiography

Check-in & Preparation

Upon arrival at Cadabams Diagnostics, you'll confirm your personal details and appointment.

• You will be asked to complete an MRI safety questionnaire to identify any potential contraindications.
• You may be asked to change into a hospital gown to ensure there are no metallic items on your clothing.
• You must remove all metallic objects, including jewelry, watches, hearing aids, dentures (if they contain metal and are removable), hairpins, and any clothing with metal.

IV Line (if contrast dye is used)

If your MRI Carotid Angiography requires a contrast agent, a small intravenous (IV) line (a thin plastic tube) will be inserted into a vein in your arm or hand by a qualified technologist or nurse. This is similar to having a blood test.

Positioning

You will be asked to lie down on a cushioned, motorized table that will slide into the center of the MRI scanner. The scanner is a large, tube-shaped machine that is open at both ends.

• A special device called a "coil" may be placed around your head and neck. This coil acts as an antenna to help receive the radio wave signals and capture high-quality images of your carotid arteries.

During the Scan

• Stillness is Key: It is crucial to remain very still during the entire scanning process. Movement can blur the images and may require parts of the scan to be repeated, lengthening the procedure.
• Loud Noises: The MRI machine makes loud knocking, tapping, buzzing, or whirring sounds as it operates. This is normal. You will be provided with earplugs or headphones to significantly reduce the noise. Sometimes, you can listen to music through the headphones.
• Communication: The MRI technologist will operate the scanner from an adjacent control room. They will be able to see you through a window, hear you, and speak with you via an intercom system at all times. You will also be given a call bell or squeeze ball to alert the technologist if you need assistance or feel uncomfortable.- Sensations: You won't feel the magnetic field or radio waves. Some people report a slight warming sensation in the area being scanned; this is normal. If contrast dye is injected, you might feel a cool sensation spreading through your arm and body, and sometimes a brief metallic taste in your mouth. These sensations are temporary.

Duration

The actual scanning time for an MRI Carotid Angiography usually takes about 30 to 60 minutes, depending on the specific sequences being run and whether contrast is used. Your total time at Cadabams Diagnostics will be longer to account for preparation and any post-scan procedures.

Once the scan is complete, the table will slide out of the scanner. If an IV line was placed, it will be removed.

Caution Before Taking the Test

It is vitally important for your safety and for the quality of the MRI Carotid Angiography that you inform the Cadabams Diagnostics technologist or radiologist before your scan if you:

• Are pregnant or suspect you might be pregnant.
• Have any metal implants or devices in your body. This includes, but is not limited to:
  • Pacemakers or implantable cardioverter-defibrillators (ICDs)
  • Aneurysm clips (especially older types in the brain)
  • Stents (cardiac, carotid, or other vascular stents)
  • Artificial heart valves
  • Artificial joints (hip, knee replacements)
  • Cochlear implants or other ear implants
  • Neurostimulators (for pain, brain function, etc.)
  • Infusion pumps (e.g., insulin pumps)
  • Shrapnel, bullets, or other metallic fragments
  • Surgical staples, wires, or screws
  • Intrauterine devices (IUDs) that may contain metal
  • Body piercings that cannot be removed
• Have a history of kidney problems, kidney disease, or are on dialysis, especially if a contrast dye is planned for your scan.
• Have any allergies, particularly to medications, iodine, or previous contrast agents used in CT scans or MRIs.
• Suffer from claustrophobia (fear of enclosed spaces) or severe anxiety.
• Have recently had surgery.
• Are currently breastfeeding and a contrast dye is planned. While most contrast agents are considered safe, you may be advised on specific precautions.

Providing this information ensures that your MRI Carotid Angiography can be performed safely and effectively at Cadabams Diagnostics.