1. MRA Neck
Dr. Mohamed Samieh

2. MR Angiography
Angiography is a medical test that helps physicians diagnose and treat medical conditions related to blood vessels.

3. MR Angiography Neck
MRA stands for Magnetic Resonance Angiography. It is an MRI technique that specifically evaluates vessels such as arteries.
Carotid MRA evaluate the vessels of the neck

4. Carotid MRA are typically ordered for the evaluation of stroke to detect blockages and narrowing of the arteries in the neck that ultimately supply the brain. 
Symptoms related to stroke include:
weakness
sudden speech difficulties
confusion, erratic behavior
vertigo, dizziness
pain, tingling numbness

5. Carotid MRA can diagnose:
Dissection - This refers to a tear in the wall of the vessel.
Aneurysms and Vascular Tumors - Aneurysms are ballooning of the vessels

6. MRA of the carotids will evaluate:
Internal Carotid Arteries The carotid vessels arise from the aorta.
Vereberal and Basilar Arteries The basilar artery is made up by two vertebral arteries

7. Aortic Arch
This is the large vessel which arises from heart.
Parts of the soft tissues of the neck are seen in a Carotid MRA.

8. MRA Neck Indications Aneurysms and vascular tumors.
narrowing and blockage of the vessels of the neck.
Arterio -venous malformation
Stroke.
Internal Carotid Artery Occlusion.
Injury in the carotid artery.

9. MRA Neck contraindications
An implanted electronic device, such as a 1 - pacemaker 2- Metallic aneurysm clips, certain artificial 3 - heart valves and metallic hearing implants 4 - Certain vascular stents and certain metal 5 – patient with unstable neurology (make exam under anesthesia)

10. Patient Preparation 1- Have the patient go to toilet
2- Explain the procedure to patient
3- Offer the patient ear protectors
4- Ask the [patient to remove any thing containing metal

11. Position of MRA Neck Head first supine
Position the Neck in the Neck coil and immobilise with cushions
Give cushions under the legs for extra comfort
Centre the laser beam
localiser at the line
present on the coli

12. Suggested protocols , parameters and planning
A three plane must be taken in the beginning to localise and plan the sequences. Localizers are normally less than 25sec.
axial sagittal coronal
TR TE NEK thickness FOV GAP SLABs
X % No Slab

13. T2 FSE Axial Neck
Plan the axial slices on the sagittal and coronal plane axial slices is parallel to intervertebral disk. Slices must be sufficient to cover area from the midbrain to the arch of aorta . Check the positioning block in the other two planes .
TR TE NEK thickness FOV Freq DIR GAP SLABs
x R > L % anterior and inferior

14. TOF” relates to time of flight
2D TOF
TOF” relates to time of flight
Time of flight angiography (TOF) is an MRI technique to visualize flow within vessels, without the need to administer contrast.
With 2-D TOF, multiple thin imaging slices.
TR TE NEK thickness FOV MATREIX Freq DIR GAP SLABs
x x A > P % no

15. Example From Image Produce From 2D TOF

16. IVI image (Reformat ) to produce angio images