MRA Head - 10/4/24 

 

EXAMINATION: MRA HEAD WO MRA NECK W AND MRI HEAD W AND WO CONTRAST, obtained on 10/4/2024 6:34 AM

 

INDICATION:  Acute stroke with worsening left sided weakness, evaluate for

worsening stroke and examine neck vessels

 

COMPARISON: Brain MRI, 10/4/2024

 

TECHNIQUE: Multiplanar multisequence MRI of the brain with and without

intravenous contrast.  3-D time-of-flight MRA of the head without intravenous

contrast with MIP reformats.  2-D time-of-flight MRA of the neck without

intravenous contrast with MIP reformats.  Postcontrast MRA of the neck with MIP

reformats.

Percent stenosis of the internal carotid arteries was calculated according to

the NASCET criteria.

 

CONTRAST: Intravenous contrast was administered.

 

FINDINGS: 

 

Brain MRI:

 

Increasing multiple small scattered areas of restricted diffusion within the

right MCA vascular territory compared to prior exam from 10/3/2024. There are

corresponding mildly expansile T2 FLAIR hyperintensities. The midline structures

are within normal limits. No hydrocephalus and no midline shift. The major

intracranial flow voids are preserved. Orbits are normal. The bilateral mastoid

air cells are clear. The paranasal sinuses are clear. No abnormal signal loss on

T2 fast field echo images to suggest intracranial blood products. Nonspecific

mild T2 FLAIR hyperintensities of the white matter. No abnormal parenchymal or

extra-axial enhancement on postcontrast images on somewhat motion degraded

images.

 

Head MRA:

 

The visualized distal vertebral arteries are patent. The basilar artery is

patent. Partial fetal origin of the left PCA. Both PCAs and major branches are

patent. The visualized distal internal carotid arteries are patent. Both ACAs

and major branches are patent. There is high-grade narrowing at the level of the

right MCA bifurcation. There is occlusion of the superior division branch. There

is high-grade narrowing of the very proximal portion of the inferior division.

There are decreased right MCA branches compared to the contralateral side. The

left MCA and major branches are patent.

 

Neck MRA:

 

Apparent common origin of the brachiocephalic trunk and the left common carotid

artery. The very proximal bilateral vertebral arteries are not well assessed due

to loss of signal. Otherwise the bilateral neck vertebral arteries are patent.

40% luminal narrowing of the proximal left internal carotid artery. Less than

30% luminal narrowing of the proximal right internal carotid artery.

 

IMPRESSION:

 

Brain MRI:

1.  Increasing multiple small scattered areas of acute/subacute ischemic

infarcts within the right MCA vascular territory compared to prior exam on

12/5/2023.

2.  No evidence of hemorrhagic conversion at this point in time.

3.  Findings were communicated to the patient's nurse at 9:22 a.m. on 12/6/2023.

 

Head MRA:

1.  Occlusion of the superior division branch of the right MCA.

2.  High-grade narrowing of the very proximal portion of the inferior division

of the right MCA.

3.  Consider consultation with neuro interventional radiology.

4.  Findings were communicated to the patient's nurse at 9:22 a.m. on 12/6/2023.

 

Neck MRA:

1.  40% luminal narrowing of the proximal left internal carotid artery.

2.  Less than 30% luminal narrowing of the proximal right internal carotid

artery.

3.  The origin of both vertebral arteries is not well assessed. The bilateral

neck vertebral arteries are otherwise patent.

 

Signed by Alastor Wood, MD on 10/4/2024 9:23 AM