Strategically acquired gradient echo (STAGE)-derived MR angiography might be a superior alternative method to time-of-flight MR angiography in visualization of leptomeningeal collaterals

Objectives This study aimed to compare the performance of strategically acquired gradient echo (STAGE)-derived MR angiography and time-of-flight MR angiography (TOF-MRA) in visualization of leptomeningeal collaterals (LMCs). Methods Between May 2018 and January 2020, 75 participants (47 healthy volunteers and 28 intracranial atherosclerotic disease [ICAD] patients) undergoing TOF-MRA and STAGE-MRA were prospectively included. Image quality was scored at the internal carotid artery (ICA) terminus, proximal middle cerebral artery (MCA), and LMCs. Quantitative analysis included calculation of contrast-to-noise ratios (CNRs) in the M1–4 segments and number of LMCs counted in the line signal intensity profiles. Comparisons of image qualitative scores, CNRs, and number of LMCs were calculated using the Wilcoxon rank-sum test. Results Image qualitative scores were significantly higher in STAGE-MRA than in TOF-MRA for the ICA terminus, proximal MCA, and LMCs ( p s < 0.05) in 75 participants. When referred to digital subtraction angiography (DSA) in 25 ICAD patients, STAGE-MRA showed higher qualitative scores only at LMCs. CNRs in the M1–4 segments were significantly higher in STAGE-MRA than in TOF-MRA (218.7 ± 90.7 vs 176.2 ± 72.6, 195.7 ± 86.0 vs 146.6 ± 71.7, 176.4 ± 71.6 vs 125.8 ± 61.1, 126.2 ± 62.9 vs 78.8 ± 43.6; all p s < 0.001). STAGE-MRA showed more LMCs (11.4 ± 3.4) than TOF-MRA (8.4 ± 3.3) with p < 0.05. Conclusions STAGE-MRA might be superior to TOF-MRA in qualitative and quantitative assessment of LMCs in both healthy volunteers and ICAD patients; thus, it may serve as an alternative method in evaluating LMC. Key Points • Strategically acquired gradient echo (STAGE)-derived magnetic resonance angiography is a newly developed sequence with a pair of rephasing/dephasing gradient echoes. • STAGE-MRA enables higher image qualitative score, improves contrast-to-noise ratio, and shows greater number of leptomeningeal collaterals (LMCs) in healthy volunteers and patients with intracranial atherosclerotic disease. • LMC visualization by STAGE-MRA shows good to excellent inter-observer agreement.