Evaluation of chronic carotid artery occlusion by non-contrast 3D-MERGE MR vessel wall imaging: comparison with 3D-TOF-MRA, contrast-enhanced MRA, and DSA



To analyze the accuracy of a non-contrast MR vessel wall imaging technique, three-dimensional motion-sensitized driven equilibrium prepared rapid gradient echo (3D-MERGE) for diagnosing chronic carotid artery occlusion (CCAO) characteristics compared with 3D time-of-flight (TOF) MRA, and contrast-enhanced MRA (CE-MRA), using digital subtraction angiography (DSA) as a reference standard.


Subjects diagnosed with possible CCAO by ultrasound were retrospectively analyzed. Patients underwent 3.0-T MR imaging with 3D-MERGE, 3D-TOF-MRA, and CE-MRA followed by DSA within 1 week. Diagnostic accuracy of occlusion, occlusion site, and proximal stump condition were assessed independently on 3 MRI sequences and DSA. Agreement of the above indicators was evaluated in reference to DSA.


One hundred twenty-four patients with 129 suspected CCAO (5 with bilateral occlusions) met the inclusion criteria for our study. 3D-MERGE demonstrated a sensitivity, specificity, and accuracy of 97.0%, 86.7%, and 94.6%, respectively, with excellent agreement (Cohen’s κ = 0.85; 95% CI, 0.71, 0.94) for diagnosing CCAO in reference to DSA. 3D-MERGE was superior in diagnosing CCAO compared with 3D-TOF-MRA (Cohen’s κ = 0.61; 95% CI, 0.42, 0.77) and similar to CE-MRA (Cohen’s κ = 0.93; 95% CI, 0.86, 1.00). 3D-MERGE also had excellent agreement compared with DSA for assessing occlusion sites (Cohen’s κ = 0.85; 95% CI, 0.71, 0.97) and stump condition (Cohen’s κ = 0.83; 95% CI, 0.71, 0.94). Moreover, 3D-MERGE provided additional information regarding the occluded segment, such as distal lumen collapse and vessel wall lesion components.


3D-MERGE can reliably assess chronic carotid occlusive characteristics and has the ability to identify other vessel wall features of the occluded segment. This non-contrast MR vessel wall imaging technique is promising for assessment of CCAO.

Key Points

• Excellent agreement was found between 3D-MERGE and DSA for assessing chronic carotid artery occlusion, occlusion site, and proximal stump condition.

• 3D-MERGE was shown to be a more accurate and efficient tool than 3D-TOF-MRA to detect the characteristics of the occluded segment.

• 3D-MERGE provides not only luminal images for characterizing the proximal characteristics of occlusion but also vessel wall images for assessing the distal lumen and morphology of occlusion segment, which might help clinicians to optimize the treatment strategy for patients with chronic carotid artery occlusion.

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Fig. 1
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Three-dimensional motion-sensitized driven equilibrium prepared rapid gradient echo


Three-dimensional time-of-flight magnetic resonance angiography


Common carotid artery


Chronic carotid artery occlusion


Contrast-enhanced magnetic resonance angiography


Curved planar reconstruction


Computed tomographic angiography


Digital subtraction angiography


Internal carotid artery


Maximum intensity projection


Magnetic resonance angiography


Magnetic resonance imaging


Signal intensity


Signal-to-noise ratio


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This study has received funding from the grants by the Shanghai Municipal Health Commission Project (201940060), Shanghai Jiao Tong University Project (YG2016MS56), Renji Hospital Project (RJZZ18-002, 2019NYBSZX01), and National Natural Science Foundation of China (81571630; 81801650).

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Corresponding authors

Correspondence to Huilin Zhao or Jianrong Xu.

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The scientific guarantor of this publication is Huilin Zhao, MD, PhD.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.


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Zhang, J., Ding, S., Zhao, H. et al. Evaluation of chronic carotid artery occlusion by non-contrast 3D-MERGE MR vessel wall imaging: comparison with 3D-TOF-MRA, contrast-enhanced MRA, and DSA. Eur Radiol (2020). https://doi.org/10.1007/s00330-020-06989-1

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  • Carotid artery diseases
  • Arterial occlusive diseases
  • Magnetic resonance imaging
  • Digital subtraction angiography