{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T21:17:24Z","timestamp":1777670244644,"version":"3.51.4"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:00Z","timestamp":1636416000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:00Z","timestamp":1636416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>Extracranial stenosis of the internal carotid artery (ICA) is an important cause of ischemic stroke and transient ischemic attack (TIA). It can be diagnosed using contrast-enhanced CT or MR angiography (MRA) as well as Doppler ultrasound. In this study, we assessed the diagnostic value of intracranial time-of-flight (TOF) MRA to predict extracranial ICA stenosis (ICAS).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We retrospectively analyzed consecutive patients with acute ischemic stroke or TIA and middle- (50\u201369%) or high-grade (70\u201399%) unilateral extracranial ICAS according to NASCET criteria assessed by ultrasound between January 2016 and August 2018. The control group consisted of patients without extracranial ICAS. Intraluminal signal intensities (SI) of the intracranial ICA on the side of the extracranial stenosis were compared to the contralesional side on TOF-MRA source images. SI ratios (SIR) of contralesional:lesional side were compared between groups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In total, 151 patients were included in the main analysis. Contralesional:lesional SIR in the intracranial C4-segment was significantly higher in patients with ipsilateral extracranial ICA stenosis (<jats:italic>n<\/jats:italic>\u2009=\u200951, median 74 years, 57% male) compared to the control group (<jats:italic>n<\/jats:italic>\u2009=\u2009100, median 68 years, 48% male). Mean SIR was 1.463 vs. 1.035 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) for right-sided stenosis and 1.362 vs. 1.000 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) for left-sided stenosis. Receiver-operating characteristic curve demonstrated a cut-off value of 1.086 for right-sided [sensitivity\/specificity 75%\/81%; area under the curve (AUC) 0.81] and 1.104 for left-sided stenosis (sensitivity\/specificity 70%\/84%; AUC 0.80) in C4 as a good predictor for high-grade extracranial ICAS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>SIR on TOF-MRA can be a marker of extracranial ICAS.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00415-021-10876-0","type":"journal-article","created":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T05:00:22Z","timestamp":1636434022000},"page":"2743-2749","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Can intracranial time-of-flight-MR angiography predict extracranial carotid artery stenosis?"],"prefix":"10.1007","volume":"269","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6852-057X","authenticated-orcid":false,"given":"Filiz","family":"Osmanodja","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan F.","family":"Scheitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochen B.","family":"Fiebach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramanan","family":"Ganeshan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kersten","family":"Villringer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,11,9]]},"reference":[{"issue":"1","key":"10876_CR1","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s12883-020-02032-4","volume":"21","author":"TJ van Velzen","year":"2021","unstructured":"van Velzen TJ et al (2021) Prevalence, predictors and outcome of carotid stenosis: a sub study in the Preventive Antibiotics in Stroke Study (PASS). BMC Neurol 21(1):20. https:\/\/doi.org\/10.1186\/s12883-020-02032-4","journal-title":"BMC Neurol"},{"issue":"11","key":"10876_CR2","doi-asserted-by":"publisher","first-page":"2559","DOI":"10.1161\/hs1101.098524","volume":"32","author":"AJ Grau","year":"2001","unstructured":"Grau AJ et al (2001) Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 32(11):2559\u20132566","journal-title":"Stroke"},{"key":"10876_CR3","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001081.pub3","volume":"6","author":"S Orrapin","year":"2017","unstructured":"Orrapin S, Rerkasem K (2017) Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev 6:CD001081. https:\/\/doi.org\/10.1002\/14651858.CD001081.pub3","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"10876_CR4","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1001\/jamainternmed.2019.5284","volume":"180","author":"SA Woolen","year":"2020","unstructured":"Woolen SA et al (2020) Risk of nephrogenic systemic fibrosis in patients with stage 4 or 5 chronic kidney disease receiving a group II gadolinium-based contrast agent: a systematic review and meta-analysis. JAMA Intern Med 180(2):223\u2013230. https:\/\/doi.org\/10.1001\/jamainternmed.2019.5284","journal-title":"JAMA Intern Med"},{"key":"10876_CR5","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A5771","author":"T Boujan","year":"2018","unstructured":"Boujan T et al (2018) Value of contrast-enhanced MRA versus time-of-flight MRA in acute ischemic stroke MRI. AJNR Am J Neuroradiol. https:\/\/doi.org\/10.3174\/ajnr.A5771","journal-title":"AJNR Am J Neuroradiol"},{"issue":"8","key":"10876_CR6","doi-asserted-by":"publisher","first-page":"2237","DOI":"10.1161\/STROKEAHA.107.509877","volume":"39","author":"SM Debrey","year":"2008","unstructured":"Debrey SM et al (2008) Diagnostic accuracy of magnetic resonance angiography for internal carotid artery disease: a systematic review and meta-analysis. Stroke 39(8):2237\u20132248. https:\/\/doi.org\/10.1161\/STROKEAHA.107.509877","journal-title":"Stroke"},{"issue":"4","key":"10876_CR7","doi-asserted-by":"publisher","first-page":"761","DOI":"10.3174\/ajnr.A1464","volume":"30","author":"LS Babiarz","year":"2009","unstructured":"Babiarz LS et al (2009) Contrast-enhanced MR angiography is not more accurate than unenhanced 2D time-of-flight MR angiography for determining > or = 70% internal carotid artery stenosis. AJNR Am J Neuroradiol 30(4):761\u2013768. https:\/\/doi.org\/10.3174\/ajnr.A1464","journal-title":"AJNR Am J Neuroradiol"},{"issue":"2","key":"10876_CR8","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1002\/mrm.1910140205","volume":"14","author":"FW Wehrli","year":"1990","unstructured":"Wehrli FW (1990) Time-of-flight effects in MR imaging of flow. Magn Reson Med 14(2):187\u2013193","journal-title":"Magn Reson Med"},{"key":"10876_CR9","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-9-60","author":"B Hotter","year":"2009","unstructured":"Hotter B et al (2009) Prospective study on the mismatch concept in acute stroke patients within the first 24 h after symptom onset-1000Plus study. Bmc Neurol. https:\/\/doi.org\/10.1186\/1471-2377-9-60","journal-title":"Bmc Neurol"},{"issue":"1","key":"10876_CR10","first-page":"68","volume":"26","author":"GM Hathout","year":"2005","unstructured":"Hathout GM et al (2005) Sonographic NASCET index: a new Doppler parameter for assessment of internal carotid artery stenosis. Am J Neuroradiol 26(1):68\u201375","journal-title":"Am J Neuroradiol"},{"issue":"1","key":"10876_CR11","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/01.str.24.1.35","volume":"24","author":"HP Adams Jr","year":"1993","unstructured":"Adams HP Jr et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 24(1):35\u201341. https:\/\/doi.org\/10.1161\/01.str.24.1.35","journal-title":"Stroke"},{"issue":"6","key":"10876_CR12","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.2214\/ajr.143.6.1167","volume":"143","author":"WG Bradley","year":"1984","unstructured":"Bradley WG et al (1984) The appearance of rapidly flowing blood on magnetic-resonance images. Am J Roentgenol 143(6):1167\u20131174. https:\/\/doi.org\/10.2214\/ajr.143.6.1167","journal-title":"Am J Roentgenol"},{"issue":"3","key":"10876_CR13","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1148\/radiology.157.3.2997836","volume":"157","author":"GK Vonschulthess","year":"1985","unstructured":"Vonschulthess GK, Higgins CB (1985) Blood-flow imaging with Mr\u2014spin-phase phenomena. Radiology 157(3):687\u2013695. https:\/\/doi.org\/10.1148\/radiology.157.3.2997836","journal-title":"Radiology"},{"issue":"6","key":"10876_CR14","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.2214\/ajr.143.6.1157","volume":"143","author":"L Axel","year":"1984","unstructured":"Axel L (1984) Blood-flow effects in magnetic-resonance imaging. Am J Roentgenol 143(6):1157\u20131166. https:\/\/doi.org\/10.2214\/ajr.143.6.1157","journal-title":"Am J Roentgenol"},{"issue":"2","key":"10876_CR15","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1148\/radiol.2292030516","volume":"229","author":"EG Grant","year":"2003","unstructured":"Grant EG et al (2003) Carotid artery stenosis: gray-scale and Doppler US diagnosis\u2014society of radiologists in ultrasound consensus conference. Radiology 229(2):340\u2013346. https:\/\/doi.org\/10.1148\/radiol.2292030516","journal-title":"Radiology"},{"issue":"1","key":"10876_CR16","doi-asserted-by":"publisher","first-page":"12010","DOI":"10.1038\/s41598-021-91511-w","volume":"11","author":"CH Wu","year":"2021","unstructured":"Wu CH et al (2021) Diagnosis of extracranial carotid stenosis by MRA of the brain. Sci Rep 11(1):12010. https:\/\/doi.org\/10.1038\/s41598-021-91511-w","journal-title":"Sci Rep"},{"issue":"9","key":"10876_CR17","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1093\/eurheartj\/ehx095","volume":"39","author":"V Aboyans","year":"2018","unstructured":"Aboyans V et al (2018) 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 39(9):763\u2013816. https:\/\/doi.org\/10.1093\/eurheartj\/ehx095","journal-title":"Eur Heart J"},{"issue":"2","key":"10876_CR18","doi-asserted-by":"publisher","first-page":"I","DOI":"10.1177\/23969873211026990","volume":"6","author":"LH Bonati","year":"2021","unstructured":"Bonati LH et al (2021) European stroke organisation guideline on endarterectomy and stenting for carotid artery stenosis. Eur Stroke J 6(2):I. https:\/\/doi.org\/10.1177\/23969873211026990","journal-title":"Eur Stroke J"},{"issue":"3","key":"10876_CR19","doi-asserted-by":"publisher","first-page":"535","DOI":"10.3174\/ajnr.A6441","volume":"41","author":"AY Ibrahim","year":"2020","unstructured":"Ibrahim AY et al (2020) Fractional flow on TOF-MRA as a measure of stroke risk in children with intracranial arterial stenosis. Am J Neuroradiol 41(3):535\u2013541. https:\/\/doi.org\/10.3174\/ajnr.A6441","journal-title":"Am J Neuroradiol"},{"issue":"2","key":"10876_CR20","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1159\/000346803","volume":"1","author":"DS Liebeskind","year":"2013","unstructured":"Liebeskind DS, Feldmann E (2013) Fractional flow in cerebrovascular disorders. Interv Neurol 1(2):87\u201399. https:\/\/doi.org\/10.1159\/000346803","journal-title":"Interv Neurol"},{"issue":"1","key":"10876_CR21","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1111\/jon.12101","volume":"25","author":"DS Liebeskind","year":"2015","unstructured":"Liebeskind DS et al (2015) Noninvasive fractional flow on MRA predicts stroke risk of intracranial stenosis. J Neuroimaging 25(1):87\u201391. https:\/\/doi.org\/10.1111\/jon.12101","journal-title":"J Neuroimaging"},{"issue":"2","key":"10876_CR22","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1111\/jon.12489","volume":"28","author":"M Miura","year":"2018","unstructured":"Miura M et al (2018) Decreased signal intensity ratio on MRA reflects misery perfusion on SPECT in patients with intracranial stenosis. J Neuroimaging 28(2):206\u2013211. https:\/\/doi.org\/10.1111\/jon.12489","journal-title":"J Neuroimaging"},{"issue":"11","key":"10876_CR23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0080124","volume":"8","author":"X Leng","year":"2013","unstructured":"Leng X et al (2013) Magnetic resonance angiography signal intensity as a marker of hemodynamic impairment in intracranial arterial stenosis. PLoS ONE 8(11):e80124. https:\/\/doi.org\/10.1371\/journal.pone.0080124","journal-title":"PLoS ONE"},{"issue":"7","key":"10876_CR24","doi-asserted-by":"publisher","first-page":"E46","DOI":"10.1111\/ijs.12080","volume":"8","author":"X Leng","year":"2013","unstructured":"Leng X et al (2013) Signal intensity ratio as a novel measure of hemodynamic significance for intracranial atherosclerosis. Int J Stroke 8(7):E46. https:\/\/doi.org\/10.1111\/ijs.12080","journal-title":"Int J Stroke"},{"issue":"2","key":"10876_CR25","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1161\/01.Str.14.2.256","volume":"14","author":"S Uematsu","year":"1983","unstructured":"Uematsu S et al (1983) Measurement of carotid blood-flow in man and its clinical-application. Stroke 14(2):256\u2013266. https:\/\/doi.org\/10.1161\/01.Str.14.2.256","journal-title":"Stroke"},{"issue":"5","key":"10876_CR26","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1007\/s00330-007-0835-3","volume":"18","author":"O Naggara","year":"2008","unstructured":"Naggara O et al (2008) Asymmetry of intracranial internal carotid artery on 3D TOF MR angiography: a sign of unilateral extracranial stenosis. Eur Radiol 18(5):1038\u20131042. https:\/\/doi.org\/10.1007\/s00330-007-0835-3","journal-title":"Eur Radiol"},{"issue":"4","key":"10876_CR27","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.21037\/cdt.2020.03.12","volume":"10","author":"ME Porambo","year":"2020","unstructured":"Porambo ME, DeMarco JK (2020) MR imaging of vulnerable carotid plaque. Cardiovasc Diagn Ther 10(4):1019\u20131031. https:\/\/doi.org\/10.21037\/cdt.2020.03.12","journal-title":"Cardiovasc Diagn Ther"},{"issue":"3","key":"10876_CR28","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1161\/01.Str.31.3.615","volume":"31","author":"PM Rothwell","year":"2000","unstructured":"Rothwell PM et al (2000) Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. Stroke 31(3):615\u2013621. https:\/\/doi.org\/10.1161\/01.Str.31.3.615","journal-title":"Stroke"},{"key":"10876_CR29","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-020-01831-z","author":"TC Wu","year":"2020","unstructured":"Wu TC et al (2020) Correlation of internal carotid artery diameter and carotid flow with asymmetry of the circle of Willis. Bmc Neurol. https:\/\/doi.org\/10.1186\/s12883-020-01831-z","journal-title":"Bmc Neurol"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-021-10876-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-021-10876-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-021-10876-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,21]],"date-time":"2022-04-21T14:20:32Z","timestamp":1650550832000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-021-10876-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,9]]},"references-count":29,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10876"],"URL":"https:\/\/doi.org\/10.1007\/s00415-021-10876-0","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,9]]},"assertion":[{"value":"20 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 October 2021","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 October 2021","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 November 2021","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Jochen B Fiebach reports personal fees from Abbvie, AC Immune, Artemida, Bioclinica, Biogen, BMS, Brainomix, Cerevast, Daiichi-Sankyo, Eisai, F.Hoffmann-La Roche AG, Eli Lilly, Guerbet, Ionis Pharmaceuticals, IQVIA, Janssen, Julius clinical, Jung diagnostics, Lysogene, Merck, Nicolab, Premier Research, Siemens, and Tau Rx, outside the submitted work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"In accordance with the Berlin State legislation, no separate ethics committee approval was required for this retrospective analysis.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}