Phantom intraluminal carotid artery thrombus on MRA

Excerpt

An 85-year-old man with a history of treated arterial hypertension and hypercholesterolemia presented with acute left hemiplegia and dysarthria due to a right anterior choroidal artery infarction (Fig. 1a). 3D gadolinium-enhanced T1-weighted MRA (gadolinium concentration 0.5 mmol/mL, flow rate of injection 1.6 mL/s, and dose 2 mL/kg bodyweight; injection rate and dose of saline flush 1.6 mL/s and 2 mL/kg bodyweight, respectively; start of MRA sequence using visual bolus tracking; MRA sequence was the only sequence performed after gadolinium administration) showed an intraluminal right common carotid artery hypointensity evoking intraluminal thrombus (Fig. 1b, c), not visualized on CTA performed 5 min later (Fig. 1d) [1]. Doppler ultrasonography showed absence of thrombus, and higher velocities at vessel’s periphery than in its centre on the right (whereas homogeneous velocities were observed in the left carotid artery) (Fig. 1e, f). ECG monitoring showed the presence of atrial fibrillation, and treatment with apixaban 5 mg bid was started.

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