Clinical Context
A middle-aged or older adult presents to the outpatient imaging center or hospital radiology department with symptoms suggestive of cerebrovascular disease — commonly transient ischemic attack (TIA), stroke symptoms, pulsatile tinnitus, cervical bruit, or suspected carotid artery stenosis. The ordering provider (typically a neurologist, vascular surgeon, or primary care physician) requests vascular imaging of the neck to evaluate vessel patency, luminal narrowing, dissection, or aneurysm.
The patient is registered and screened for MRI contraindications (implants, pacemaker, claustrophobia, pregnancy, renal function for contrast administration). The MRI technologist performs a non-contrast magnetic resonance angiography of the neck vessels first to assess baseline flow and anatomy. Intravenous access is established and gadolinium-based contrast is administered per protocol; the technologist then acquires contrast-enhanced MR angiographic sequences to improve vessel delineation and assess stenosis, occlusion, or extraluminal pathology. The radiologist interprets both non-contrast and contrast-enhanced series and issues a single combined report documenting findings, measurements of stenosis when present, and comparison to prior studies when available.
Typical site of service: outpatient imaging center, hospital outpatient radiology department, or inpatient radiology for admitted patients.
Typical clinical workflow: referral and order review → MRI safety screening → non-contrast MRA sequences → IV contrast administration and dynamic contrast-enhanced MRA sequences → image reconstruction and post-processing → radiologist interpretation and report generation → results communicated to ordering provider.