Do I require a Magnetic Resonance Angiography (MRA) of the brain with contrast?

From the Guidelines

You likely do not require a Magnetic Resonance Angiography (MRA) of the brain with contrast unless you have a specific medical condition that warrants its use, such as a suspected aneurysm, arteriovenous malformation, or vascular abnormality, as determined by your healthcare provider in consultation with the latest guidelines from reputable sources such as the American College of Radiology 1.

When considering the need for an MRA with contrast, it's essential to weigh the benefits against the potential risks, including allergic reactions to the contrast agent, particularly in patients with kidney problems. The decision should be based on your individual medical situation and the clinical judgment of your healthcare provider.

Some key points to consider include:

• The use of MRA with contrast is usually appropriate for the surveillance monitoring of patients with known, treated cerebral aneurysm, as well as for those with suspected cerebral vasospasm or high-flow vascular malformations 1.
• For patients with a known, untreated cerebral aneurysm, MRA head without IV contrast or CTA head with IV contrast is usually appropriate for surveillance monitoring, with the panel not agreeing on recommending MRA head with IV contrast due to insufficient medical literature 1.
• In cases of suspected CNS vasculitis, MRA head without IV contrast or MRI head without and with IV contrast is usually appropriate for initial imaging, and these procedures can be complementary 1.

Given the potential risks and the availability of alternative imaging modalities, the most recent and highest quality study suggests that MRA with contrast should be used judiciously and based on specific clinical indications 1. It's crucial to discuss your specific situation with your healthcare provider to determine the most appropriate imaging strategy for your care.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Magnetic Resonance Angiography (MRA) of the Brain with Contrast

The decision to require a Magnetic Resonance Angiography (MRA) of the brain with contrast depends on various factors, including the specific condition being diagnosed or monitored. Here are some key points to consider:

• The use of contrast-enhanced MRA can improve the conspicuity of both cerebral arteries and veins compared to non-enhanced inflow MRA 2.
• Time-resolved contrast-enhanced MR angiography (TR-CE-MRA) at 3.0T has been shown to have good sensitivity for brain arteriovenous malformation (bAVM) detection and good agreement with digital subtraction angiography (DSA) for determining nidus size and the type of venous drainage 3.
• Low-dose contrast-enhanced time-resolved angiography with stochastic trajectories and iterative reconstruction (IT-TWIST-MRA) can provide clinically feasible 4D MR-DSA images and delineate arteriovenous shunts (AVS) even with low-dose gadolinium-based contrast agent (GBCA) 4.
• In the evaluation of the occlusion status of coiled intracranial aneurysms, 3D time-of-flight MRA (TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3T have been shown to be equivalent, with TOF-MRA being preferred due to the absence of contrast administration 5.

Key Considerations

Some key considerations when deciding whether to require an MRA of the brain with contrast include:

• The specific condition being diagnosed or monitored, such as brain arteriovenous malformation (bAVM) or arteriovenous shunts (AVS)
• The availability and quality of alternative imaging modalities, such as digital subtraction angiography (DSA) or catheter angiography
• The potential benefits and risks of contrast administration, including the risk of adverse reactions or nephrotoxicity
• The patient's individual characteristics, such as kidney function or history of contrast allergy

Imaging Modalities

Different imaging modalities may be used in conjunction with MRA, including:

• Digital subtraction angiography (DSA)
• Catheter angiography
• Time-of-flight MRA (TOF-MRA)
• Contrast-enhanced MRA (CE-MRA)
• Time-resolved contrast-enhanced MR angiography (TR-CE-MRA)
• Low-dose contrast-enhanced time-resolved angiography with stochastic trajectories and iterative reconstruction (IT-TWIST-MRA) 6, 3, 4, 5