How Vascular MRI Can Help Identify Conditions Associated With Stroke Risk

Key Takeaways

• A vascular MRI, also called MR angiography or MRA, is a scan that shows the arteries and veins in the head and neck without needles into the bloodstream or radiation.
• MRA is often used to help identify existing conditions that are associated with a higher risk of stroke, such as carotid artery narrowing, aneurysms, and blood clots.
• MRA is not a stroke prediction test. It is one piece of a larger stroke-risk evaluation that includes blood pressure, cholesterol, personal and family history, and other factors your physician looks at together.
• Most patients who get a vascular MRI have been referred because of specific symptoms, known risk factors, or a follow-up plan after a TIA or stroke.
• Smart Scan Medical Imaging offers outpatient vascular MRI (MRA) at four Wisconsin locations, with results typically returned to your provider within 24 to 48 hours. Request an appointment when your provider orders vascular imaging.

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What Does Vascular MRI (MRA) Actually Show?

A vascular MRI, or MRA, shows the arteries and veins in a specific part of the body, most often the head and neck when the focus is stroke risk. It gives radiologists and referring providers a detailed picture of blood vessels so they can look for narrowing, blockages, bulges (aneurysms), and other structural changes that might affect blood flow to the brain.

Here is what that looks like in plain terms:

• MRA uses the same MRI machine as a regular MRI, but the pictures focus on the blood vessels instead of the surrounding tissue.
• It does not use radiation. It uses strong magnets and radio waves.
• It usually does not require injecting anything through a catheter (a thin tube threaded through an artery). Some MRA scans use IV contrast, but many do not.
• It can look at the carotid arteries in the neck, the arteries at the base of the brain, and the veins that drain blood back out of the brain.

At Smart Scan Medical Imaging, MRA is one of several vascular imaging tools available, alongside vascular ultrasound (offered at the Milwaukee location) for cases where a different modality is more appropriate. Every vascular MRI at Smart Scan is read by board-certified, fellowship-trained radiologists with subspecialty focus in vascular and neuroradiology. 

What Conditions Linked to Stroke Risk Can MRA Help Identify?

MRA can help identify several conditions that are associated with a higher risk of stroke, including carotid artery narrowing, brain aneurysms, blood clots in the veins that drain the brain, and other blood-vessel abnormalities. Finding these conditions early can support treatment plans that help lower risk.

Common findings that MRA can help evaluate include:

• Carotid artery narrowing (stenosis). Buildup of plaque in the arteries in the neck that carry blood to the brain. The American Heart Association's 2021 stroke-prevention guideline supports initial evaluation of carotid stenosis with a non-invasive test such as CTA, MRA, or ultrasonography rather than catheter angiography.
• Intracranial artery narrowing. Similar plaque buildup or narrowing in the arteries at the base of the brain.
• Cerebral aneurysms. Weak, bulging areas in an artery wall in or around the brain.
• Arteriovenous malformations (AVMs). Abnormal tangles of blood vessels that can be present from birth.
• Cerebral venous sinus thrombosis (CVST). A blood clot in the veins that drain blood out of the brain, evaluated with magnetic resonance venography (MRV).
• Follow-up after TIA or stroke. MRA is often part of the workup to understand what caused a warning stroke (TIA) or full stroke and to guide next steps.

None of these findings are a diagnosis on their own. They are pieces of information your care team uses alongside your history, exam, and other tests.

How Does This Imaging Fit Into a Physician's Broader Stroke-Risk Evaluation?

Vascular imaging fits in as one part of a broader stroke-risk evaluation. A physician who is thinking about stroke risk usually looks at multiple factors together, including:

• Blood pressure
• Cholesterol and other lipid measures
• Diabetes and blood sugar control
• Heart rhythm, particularly atrial fibrillation
• Smoking history and other lifestyle factors
• Personal history of TIA, stroke, or heart disease
• Family history
• Current symptoms
• Imaging findings from MRI, MRA, ultrasound, or CT

According to the CDC, leading causes of stroke include high blood pressure, high cholesterol, smoking, obesity, and diabetes, and 1 in 3 U.S. adults has at least one of these conditions or risk factors.

Who Typically Gets Referred for a Vascular MRI (MRA)?

Patients typically get referred for a vascular MRI when their physician wants a detailed look at blood vessels in the head and neck. That usually happens for one of a few reasons:

• After a TIA or stroke. MRA is often part of the workup to look for the cause.
• After stroke-like symptoms. Sudden vision changes, weakness, numbness, or speech difficulty that have been evaluated in the emergency room and need further investigation.
• When symptoms suggest a vascular problem. Chronic dizziness, unusual headaches, ringing in the ears with a pulsing quality, or new neurological symptoms.
• When there is a family history or personal history of aneurysm or vascular disease.
• As part of monitoring a known condition. For example, following a known aneurysm or previously identified carotid narrowing over time.

Most patients do not choose vascular imaging on their own. They are referred by a primary care provider, neurologist, cardiologist, or vascular specialist who has a specific question to answer. At Smart Scan, those referrals go to board-certified, fellowship-trained radiologists with subspecialty focus in vascular and neuroradiology, who work closely with the referring provider to answer that question clearly in the report.

Why Does Imaging Identify Existing Conditions Rather Than Predicting Future Events?

Imaging shows what is present right now. Predicting the future is a different task that depends on factors an image cannot capture, including how risk factors are managed over time.

A vascular MRI can tell your physician:

• Whether there is currently narrowing in a specific artery, and how significant it is
• Whether there is an aneurysm or other structural finding
• Whether previously known findings have changed compared with earlier images

It cannot tell your physician:

• Whether or when you will have a stroke
• Whether every risk factor is under control
• How well future treatment will work

When Should You Talk to a Doctor About Vascular Risk Factors?

You should talk to your doctor about vascular risk factors any time you have a personal or family history that raises questions, when you notice new symptoms, or during routine checkups if it has not come up recently. A good conversation with your provider is often more useful than any single scan.

Reasons to bring this up include:

• Personal history of TIA, stroke, heart attack, or aneurysm
• Family history of stroke, aneurysm, or early heart disease
• High blood pressure, high cholesterol, or diabetes
• Smoking or a history of smoking
• New neurological symptoms
• Age 55 or older, since stroke risk roughly doubles every 10 years after 55, according to the American Stroke Association

Your provider can help you understand where imaging fits in and where lifestyle, medication, and monitoring might be more important. Sometimes vascular imaging is helpful. Sometimes it is not the right next step.

Ready to Schedule Vascular MRI Follow-Up in Wisconsin?

If your provider has recommended a vascular MRI, Smart Scan Medical Imaging can typically schedule your scan quickly, at a comfortable outpatient location, with results returned to your provider soon after.

Request an appointment for a vascular MRI at Smart Scan Medical Imaging in Eau Claire, Wausau, Madison, or Milwaukee, or call (855) 694-3300. Our team can also help coordinate results and answer questions about insurance coverage.

Frequently Asked Questions