MR angiography in acute cerebral ischemia of the anterior circulation: A Preliminary report

PURPOSE: To determine the prevalence of major vessel occlusion in cases of acute cerebral ischemia of the anterior circulation by using MR angiography and to assess the frequency of spontaneous thrombolysis. METHODS: Thirty patients with an initial clinical diagnosis of possible acute stroke of the anterior circulation made within 24 hours of the event were studied with conventional T2-weighted MR imaging and with two-dimensional and three-dimensional time-off-light MR angiography, Studies were repeated if the initial study showed partial or complete occlusion, RESULTS: Of the 30 patients studied, six (20%) had a final diagnosis of a transient ischemic attack and 24 (80%) had a stroke of the anterior circulation as confirmed by T2 abnormalities and persistence of clinical symptoms. Twelve (50%) of the stroke patients had a major vessel abnormality, either partial or complete occlusion, at MR angiography. Of these 12 patients, nine subsequently had follow-up MR angiography, and only two of these had a change in the findings. One patient with diminished now signal had progression of the occlusion and another patient had flow signal in a vessel where no flow was seen initially. CONCLUSION: MR angiography can show patients with acute cerebral ischemia and major vascular occlusive disease. Of those with partial or complete occlusion, progression of thrombus or spontaneous recanalization occurs infrequently.