Prospective evaluation of peripheral arterial occlusive disease by 2D MR subtraction angiography

The purpose of this study was to assess the diagnostic value of two-dimensional (2D) MR subtraction angiography of lower extremities in patients with symptomatic peripheral arterial occlusive disease with conventional angiography as the standard of reference. Twenty patients were prospectively included. 2D subtraction MR angiography (MRA) consisted of multisection gradient-recalled echo (GRE) acquisitions with the shortest TE available on our machine (4 msec), obtained in the coronal plane before and after intravenous bolus administration of gadolinium chelate. MR images were reconstructed after subtraction with a maximum-pixel-intensity-projection (MIP) algorithm. MRA was performed in all cases 1–4 days before diagnostic angiography. In a prospective blinded analysis, the number and location of significant (ie, >50%) stenoses and occlusions were evaluated for each vascular segment. Sensitivity and specificity were used to evaluate MRA data. Significant stenoses (38 of 46, 83%) and occlusions (66 of 67, 99%) seen at conventional angiography were identified with MRA. The sensitivity and specificity of MRA for determination of stenoses >50% or occlusions was 100% and 97%, respectively. The location and extent of stenoses and/or occlusions on MRA and angiograms were well correlated (kappa values, r = .73, P < .05). Contrast 2D MR subtraction angiography, by providing comparable information to that of conventional angiography, is well suited to evaluate the presence and severity of atherosclerotic lesions of the lower limbs.     

Postoperative assessment of extracranial-intracranial bypass by time-resolved 3D contrast-enhanced MR angiography using parallel imaging

PURPOSE: Our goals were to assess image quality of time-resolved contrast-enhanced MR angiography (CE MRA), by using 3D data acquisition along with a parallel imaging technique that can improve temporal resolution and to compare this technique with 3D-time-of-flight (TOF) MRA in the postoperative assessment of extracranial (EC)-intracranial (IC) bypass surgery. METHODS: On a 1.5T imaging system, we performed CE MRA by using a 3D fast field-echo sequence in combination with a parallel imaging technique, to obtain images in the coronal plane centered at the postoperative site. Our patient group comprised 17 patients, including 13 after superficial temporal artery-middle cerebral artery (MCA) anastomosis, 3 after external carotid artery-MCA anastomosis, and one after extracranial vertebral artery-posterior cerebral artery anastomosis. Visualization of the anastomosis and the distal flow on the CE-MRA images was assessed comparatively with that on 3D-TOF MR angiograms obtained at the same time. In 6 patients, we also compared the efficiency of visualization on CE-MRA images with that on conventional angiograms. RESULTS: A temporal resolution of 0.8 s/frame could be achieved with the technique employed. The bypass was better demonstrated postoperatively on CE-MRA images than on 3D-TOF MR angiograms in 13 patients (76%), whereas the 2 methods were equivalent in 4 patients (24%). Good correspondence of results was observed in the 6 patients for whom CE MRA and conventional digital subtraction angiography (DSA) images were compared. CONCLUSION: CE MRA by using the parallel imaging technique can increase image acquisition speed with sufficient image quality. This technique is at least equivalent to 3D-TOF MRA to evaluate the postoperative status of EC-IC bypass.     

Contrast-enhanced 3D MRA with centric ordering in k space: A preliminary clinical experience in imaging the abdominal aorta and renal and peripheral arterial vasculature

The objective of this study was to determine the clinical utility of a contrast-enhanced, centric reordered, three-dimensional (3D) MR angiography (MRA) pulse sequence in imaging the abdominal aorta and renal and peripheral lower extremity arteries. Twenty-eight MRA studies were performed on 23 patients and four volunteers at 1.5 T using a 3D contrast-enhanced, centric reordered pulse sequence. In 20 patients, the abdominal aorta and renal arteries were imaged, and in seven patients, the lower extremity arteries were imaged. In 19 patients, a total of 51 renal vessels were evaluated (33 renal arteries using .1 mmol/kg of gadopentetate dimeglumine and 18 renal arteries using .2 mmol/kg of gadoteridol). A total of 70 peripheral arterial segments were assessed using .2 mmol/kg of gadoteridol. Correlation with conventional angiography was made for the following 14 cases: renal artery stenosis (four cases), abdominal aortic stenosis (one case), arteriovenous fistula in a transplant kidney (one case), renal arteriovenous malformation (one case), common iliac artery aneurysms (one case), and peripheral lower extremity (six cases). Of the 70 peripheral arterial segments evaluated, in 35, there was correlation with x-ray angiography. The mean percent of aortic signal enhancement was significantly higher in the .2 mmol/kg dose group (370.8 ± 190.3) than in the .1 mmol/kg dose group (184.5 ± 128.9) (P = .02). However, there was no apparent difference between the two doses for visualization of the renal and accessory renal arteries. There was concordance between the contrast-enhanced 3D MRA studies and conventional angiography in all cases of renal artery and peripheral arterial stenoses and occlusions, including visualization of reconstituted peripheral arterial segments. There was no evidence of spin dephasing effects at sites of stenoses on the 3D contrast-enhanced MRA studies. Contrast-enhanced, centric reordered, 3D MRA can rapidly image the abdominal aorta and renal and accessory renal arteries, as well as peripheral lower extremity arteries, with high resolution. Accurate depiction of the vascular lumen at sites of stenosis is made because of the lack of spin dephasing effects, even with hemody-namically significant stenoses. Additional larger clinical trials are required with this promising technique.     

磁共振B-TFE技术肾动脉成像与CE-MRA对照

目的：探讨磁共振三维平衡式快速场梯度回波（B-TFE）技术非对比剂血管成像在肾动脉成像中的临床应用价值。方法：选择17例临床怀疑有肾动脉狭窄的患者行B-TFE和CE-MRA检查;B-TFE组并行采集加速因子取值为1和2。B-TFE组在横轴面图像上测量双侧肾动脉在不同加速因子时的信号噪声比（SNR）、肾动脉与肾周脂肪的对比噪声比（CNR）,CE-MRA组在冠状面图像上分别测量肾动脉的SNR和CNR。所有原始数据经三维MIP重组后由两位放射科医师对肾动脉三维图像质量、肾动脉狭窄程度、肾动脉分支显示及肾静脉伪影等情况进行评分。测量数据和图像评分进行统计学处理。结果：B-TFE组加速因子为1时图像的SNR为118.0±25.1（左）和105.9±29.1（右）,CNR为103.7±33.5（左）和93.1±26.5（右）;B-TFE组加速因子为2时SNR为93.5±23.1（左）和81.5±31.7（右）,CNR为83.1±34.5（左）和69.8±28.8（右）。CE-MRA组肾动脉的SNR为103.8±31.5（左）和93.1±40.8（右）,CNR为88.7±30.1（左）和79.7±38.6（右）。组内和组间SNR及CNR差异均无统计学意义（P〉0.05）。B-TFE图像上肾动脉分支的显示情况好、肾静脉伪影较CE-MRA小,2组间肾动脉三维图像质量、狭窄程度的显示无明显差异。结论：3DB-TFE肾动脉成像技术具有较高的图像信噪比和对比噪声比,可以作为一种新的无创性磁共振血管成像技术应用于肾动脉成像。     

Assessment of aortoiliac and renal arteries: MR angiography with parallel acquisition versus conventional MR angiography and digital subtraction angiography

PURPOSE: To prospectively compare the image quality, sensitivity, and specificity of three-dimensional gadolinium-enhanced magnetic resonance (MR) angiography accelerated by parallel acquisition (ie, fast MR angiography) with MR angiography not accelerated by parallel acquisition (ie, conventional MR angiography) for assessment of aortoiliac and renal arteries, with digital subtraction angiography (DSA) as the reference standard. MATERIALS AND METHODS: The study was approved by the institutional review board; informed consent was obtained from all patients. Forty consecutive patients (33 men, seven women; mean age, 63 years) suspected of having aortoiliac and renal arterial stenoses and thus examined with DSA underwent both fast (mean imaging time, 17 seconds) and conventional (mean imaging time, 29 seconds) MR angiography. The arterial tree was divided into segments for image analysis. Two readers independently evaluated all MR angiograms for image quality, presence of arterial stenosis, and renal arterial variants. Image quality, sensitivity, and specificity were analyzed on per-patient and per-segment bases for multiple comparisons (with Bonferroni correction) and for dependencies between segments (with patient as the primary sample unit). Interobserver agreement was evaluated by using kappa statistics. RESULTS: Overall, the image quality with fast MR angiography was significantly better (P=.001) than that with conventional MR angiography. At per-segment analysis, the image quality of fast MR angiograms of the distal renal artery tended to be better than that of conventional MR angiograms of these vessels. Differences in sensitivity for the detection of arterial stenosis between the two MR angiography techniques were not significant for either reader. Interobserver agreement in the detection of variant renal artery anatomy was excellent with both conventional and fast MR angiography (kappa=1.00). CONCLUSION: Fast MR angiography and conventional MR angiography do not differ significantly in terms of arterial stenosis grading or renal arterial variant detection.     

Renal arteries: optimization of three-dimensional gadolinium-enhanced MR angiography with bolus-timing-independent fast multiphase acquisition in a single breath hold.

PURPOSE: To compare two different three-dimensional (3D) gadolinium-enhanced magnetic resonance (MR) angiographic techniques. MATERIALS AND METHODS: In 26 patients suspected of having renal artery stenosis, results with fast multiphase 3D MR angiography were compared to those with standard 3D MR angiography in 37 patients. With both techniques, 31-second breath-hold acquisitions were performed. Multiphase angiography comprised five discrete 6.4-second acquisitions without bolus timing, and standard angiography comprised a single acquisition based on test-bolus timing. Two readers evaluated images obtained with both techniques in terms of image quality, artifacts, and vessel conspicuity. Accuracy of findings on the multiphase 3D MR angiograms for assessment of renal artery stenosis was determined by comparing them to digital subtraction angiograms and surgical findings. RESULTS: In the early arterial phase, multiphase 3D MR angiograms showed no image degradation by venous overlay, whereas standard 3D MR angiograms depicted at least minor overlay in 53 of 83 renal arteries (P < .001). Less parenchymal enhancement in the early arterial phase resulted in a higher vessel conspicuity for the divisions and segmental arteries (P < .001). Both readers detected and correctly graded 18 of 20 stenoses on the multiphase angiograms with almost perfect interobserver agreement (kappa > 0.89). CONCLUSION: Renal multiphase 3D MR angiography is an accurate technique requiring no bolus timing. The performance of early arterial phase imaging leads to improved depiction, particularly of the distal renovascular tree, compared to that with standard single-phase 3D MR angiography.     

Two-dimensional coronary MRA: limitations and artifacts

Our purpose was to assess image quality and interpretation problems of two-dimensional (2D) coronary MR angiograms. The coronary arteries of 27 subjects (12 normal volunteers and 15 patients) were evaluated with 2D coronary MR angiography (MRA). Coronary MRA was performed with a fat-suppressed electrocardiographically gated breath-hold gradient-echo sequence with k-space segmentation using a 1.5-T imager. Image quality throughout the study was occasionally degraded by: image ghosting (22%), ringing (19%), and/or blurring (22%) and incomplete fat-suppression (19%). Intermittent difficulties with breathholding were encountered in 44% of subjects. When limiting the analysis to those images with optimal image quality, interpretative difficulties were sometimes found: misregistration due to inconsistent breathholding (37%); difficulty in distinguishing veins from arteries (37%); obscured anatomy due to overlapping structures (26%); and poor visualization of portions of the left main coronary artery (59%). Two-dimensional coronary MRA studies have image quality and interpretive problems which need to be understood and addressed before routine clinical scanning is initiated.Correspondence to: A. J. Duerinckx     

Three-dimensional time-of-flight MR angiography using selective inversion recovery RAGE with fat saturation and ECG-triggering: Application to renal arteries

A three-dimensional (3D), ECG-triggered, selective inversion recovery (SIR) rapid gradient-echo (RAGE) technique is proposed to obtain MR angiograms of the main renal arteries. By using the selective inversion recovery and fat saturation, the background is significantly suppressed while blood maintains a high signal intensity as compared with conventional 3D time-of-flight (TOF) MR angiography. The sequence is ECG-triggered so that blood in-flow is maximized during systole, and intravoxel dephasing and pulsatile flow artifacts are minimized by collecting data during diastole. As a result, vessel boundary blurring and ghosting artifacts due to background motion are dramatically reduced, and the conspicuity and lumen definition of the arteries are significantly improved. High-quality MR angiograms of the main renal arteries with excellent blood/tissue contrast and suppression of motion artifacts have been consistently obtained for normal volunteers, with the length of visualization being 51 ± 07 mm for the left, and 57 ± 06 mm for the right renal arteries, significantly greater than using conventional 3D TOF pulse sequences. Statistical analysis was performed by using a one-sided Student's t test. Key words: renal artery; MR angiography; three-dimensional MR imaging.     

Dynamic contrast-enhanced MR angiography and MR imaging of the carotid artery: high-resolution sequences in different acquisition planes

BACKGROUND AND PURPOSE: First-pass contrast-enhanced MR angiography has become the technique of choice for studying the carotid bifurcation, but this method has some limitations. We evaluated the clinical utility of performing 3D contrast-enhanced MR angiography in the axial plane immediately after performing angiography in the coronal plane. METHODS: Cervical carotid arteries of 80 consecutive patients were studied on a 1.5-T MR imager with phased-array coils. Coronal 3D MR angiography was performed after administering a bolus injection of contrast material (20 mL) with automatic triggering. This was immediately followed by an axial acquisition. We measured carotid diameters on the contrast-enhanced MR angiograms as well as on intra-arterial digital subtraction angiograms according to established criteria. We also evaluated original source MR angiograms. RESULTS: Angiograms obtained in the axial plane correlated better with the intra-arterial digital subtraction angiograms than did the coronal angiograms. When first-pass contrast-enhanced MR angiography was incomplete because of a failure of triggering, the second-phase acquisition provided sufficient image quality. Original source images suffered from ring artifacts, low axial resolution, and a low level of soft-tissue visualization. Axial-based source images showed flow-independent contrast filling to the patent lumen with sufficient visualization of plaque morphology, thickened arterial wall, and surrounding disease processes, such as tumors. CONCLUSION: With the addition of a 1-minute second-phase 3D acquisition in a different plane immediately after first-pass contrast-enhanced MR angiography, one can obtain a more accurate depiction of the carotid bifurcation, insurance against failure of triggering, and diagnostic source images.     

Black blood magnetic resonance angiography with Dy-DTPA polymer: Effect on arterial intraluminal signal intensity,lumen diameter,and wall thickness

Four rabbits in which atherosclerotic disease was induced by diet and balloon angioplasty underwent conventional angiography and MR angiography (MRA) using a black blood pulse sequence before and 10 minutes after the iv injection of a macromolecular contrast agent, NC 100283 (1.0 mmol/kg), a dysprosium diethylenetriaminepentaacetic acid hexamethylenediamine copolymer (Dy-DTPA polymer). Intraluminal signal intensity, apparent wall thickness, and lumen size measurements of the aorta and proximal common iliac arteries on precontract MRA images were compared with postcontrast images. Aortic lumen diameter measurements on the precontrast and postcontrast MRA studies were compared with lumen diameters from conventional angiograms. Intraluminal signal intensity decreased on postcontrast MRA images compared with precontrast images, with an average loss of signal equal to 29% (P < .05). Apparent wall thickness decreased by 24% (P < .05). Lumen diameter and area were generally larger (average of 15% and 33%, respectively) on postcontrast MRA images than on precontrast images. Aortic lumen diameter measurements from postcontrast MRA agreed closely (95% confidence interval of the mean difference was ?.2 to .3 mm), and precontrast MRA images tended to underestimate aortic lumen diameter (95% confidence interval of the mean difference was .3 to .8 mm) compared with conventional angiography. Postcontrast MRA with NC 100283, a macromolecular Dy-DTPA contrast agent, provides more accurate assessment of aortic lumen diameter than precontrast MRA, using conventional angiography as the standard reference.     

Time-of-flight MR angiography of kidney transplants

The aim of the study was to apply time-of-flight MR angiography to renal transplant arteries with comparison of two- and three-dimensional (2D and 3D) sequences and to correlate the findings with colour flow sonography (CFS) and digital subtraction angiography (DSA). A total of 102 MR studies were performed in 101 patients: 87 with the 2D-FLASH sequence (18 repeated after Gd-DOTA administration), 49 with the 3D-FISP (both in 34). All patients were also studied with CFS and 15 with intra-arterial DSA. The 3D sequence produced good-quality MR angiograms in 94% of cases (82% in 2D). Gd-DOTA infusion improved the quality of the 2D angiograms in 7 of 18 cases. Only these patients were included in the remainder of the evaluation (90 patients with 103 arteries). CFS showed 72 normal and 10 abnormal arteries. In this group, the 2D sequence led to 7 (12%) false positives of stenosis and the 3D sequence yielded 1 (3%). Correlation between MR angiography and DSA was obtained for 21 arteries (15 patients) with suspicion of arterial complications. The 2D-FLASH (n = 13) and the 3D-FISP (n = 12) MR sequences allowed the correct diagnosis of all main artery complications (14 stenoses and 4 thromboses) without any false negatives and without discordance when both sequences were performed (n = 4). In the 3 other cases with a normal main artery, 2 segmental thromboses were correctly identified by both sequences and 1 stenosis of a segmental branch was correctly identified by the 2D sequence only but misdiagnosed as a thrombosis with the 3D sequence. Grading of the severity of stenoses was inaccurate with both sequences. It is concluded that the 3D time-of-flight MR sequence provides better MR angiograms than the 2D, with fewer false positives for stenosis. No false-negative arterial complications were noted. Correspondence to: N. Grenier     

High-spatial-resolution contrast-enhanced MR angiography of the renal arteries: a prospective comparison with digital subtraction angiography

PURPOSE: To evaluate a high-spatial-resolution three-dimensional (3D) contrast material-enhanced magnetic resonance (MR) angiographic technique for detecting proximal and distal renal arterial stenosis. MATERIALS AND METHODS: Twenty-five patients underwent high-spatial-resolution small-field-of-view (FOV) 3D contrast-enhanced MR angiography of the renal arteries, which was followed several minutes later by more standard, large-FOV 3D contrast-enhanced MR angiography that included the distal aorta and iliac arteries. For both acquisitions, MR fluoroscopic triggering and an elliptic centric view order were used. Two readers evaluated the MR angiograms for grade and hemodynamic significance of renal arterial stenosis, diagnostic quality, and presence of artifacts. MR imaging results for each patient were compared with those of digital subtraction angiograms. RESULTS: The high-spatial-resolution small-FOV technique provided high sensitivity (97%) and specificity (92%) for the detection of renal arterial stenosis, including all four distal stenoses encountered. The portrayal of the segmental renal arteries was adequate for diagnosis in 19 (76%) of 25 patients. In 12% of the patients, impaired depiction of the segmental arteries was linked to motion. CONCLUSION: The combined high-spatial-resolution small-FOV and large-FOV MR angiographic examination provides improved spatial resolution in the region of the renal arteries while maintaining coverage of the abdominal aorta and iliac arteries.     

Hepatic blood supply: comparison of optimized dual phase contrast-enhanced three-dimensional MR angiography and digital subtraction angiography

PURPOSE: To optimize and determine the value of dual-phase contrast material-enhanced three-dimensional (3D) magnetic resonance (MR) angiography for preoperative evaluation of the blood supply to the liver. MATERIALS AND METHODS: Dual phase 3D MR angiography of the hepatic arteries and portal vein was performed in 140 patients. In 80 patients, the value of fat saturation, digital image subtraction, an anticholinergic agent, and a high-caloric meal were evaluated. In the next 60 patients, MR angiographic and digital subtraction angiographic (DSA) image quality and diagnostic value were compared. RESULTS: Fat-saturated images were of significantly better quality (P < .01) than non-fat-saturated images. Digital image subtraction was useful in only 23 of 40 patients. The injection of an anticholinergic agent was superfluous, whereas administration of a high-caloric meal helped in demonstration of the superior mesenteric artery and portal vein. Classification on MR angiograms of the arterial blood supply was correct in 57 of 60 patients. All arterial and portal venous lesions were seen on MR angiograms, and MR angiograms had a significantly higher subjective image-quality ranking than did DSA images in the evaluation of the portal vein (P < .05). CONCLUSION: Fat saturation and use of a high-caloric meal improve the results of MR angiography of hepatic vessels. MR angiography was comparable to DSA for evaluation of the arterial system and was superior for demonstration of the portal vein; therefore, MR angiography could replace intraarterial DSA.     

Time‐resolved three‐dimensional magnetic resonance digital subtraction angiography without contrast material in the brain: Initial investigation

Purpose

To evaluate a novel magnetic resonance (MR) angiography (MRA) of three‐dimensional (3D) MR digital subtraction angiography (MRDSA) without contrast material, which is essentially 3D true steady‐state free precession (SSFP) with selected inversion recovery (IR) pulse using multiple cardiac phase acquisitions with a short increment delay in the assessment of normal cranial arteries, as a feasibility study before clinical use.

Materials and Methods

Serial MRA images using 3D MRDSA without contrast material were acquired from 10 healthy volunteers. Visualization of normal cranial arteries with time‐spatial labeling inversion pulse (Time‐SLIP) MRDSA was qualitatively compared with the conventional MRA method, 3D time‐of‐flight (TOF)‐MRA.

Results

In all volunteers, serial 3D MRDSAs containing hemodynamic information were successfully imaged. The results of visualization of the branches of the cranial arteries with Time‐SLIP MRDSA were comparable to those of 3D TOF‐MRA. The mean scores ± standard deviations for normal cerebral arteries (internal carotid arteries, middle cerebral arteries, anterior cerebral arteries, posterior cerebral arteries, and basilar arteries) were 2.4 ± 0.5, 2.3 ± 0.5, 2.0 ± 0.7, 2.3 ± 0.7, and 2.5 ± 0.7, respectively.

Conclusion

Time‐SLIP 3D MRDSA is a simple method for obtaining hemodynamic information. Although more MR sequence improvement is needed, it can play an important role in assessing cranial arteries without contrast material. J. Magn. Reson. Imaging 2009;30:214–218. © 2009 Wiley‐Liss, Inc.     

MR angiography of the renal artery: comparison of breath-hold two-dimensional phase-contrast cine technique with the phased-array coil and breath-hold two-dimensional time-of-flight technique with the body coil

Breath-hold 2D phase-contrast (PC) cine MR angiography with a phased-array coil and 2D time-of-flight (TOF) MR angiography were performed in the renal arteries and their findings were compared. Breath-hold 2D thin slice PC and TOF MR angiography were performed in 10 normal volunteers for renal arteries. A PC technique with k-space segmentation was utilized with the phased-array coil. A PC technique provided visualization of the renal artery more distally than a TOF technique (4.8 ± 0.5cm vs.3.7 ± 0.8 cm). With cardiac triggering, distal renal arteries were well demonstrated in PC MR angiography. On PC images, up- or downward movements of the mid to distal renal arteries with aortic pulsatility were recognized. The quality of the images was better with the PC than with the TOF technique (3.4 vs. 2.7). The mid to distal portions of the renal arteries translationally move with aortic pulsatility. To consistently visualize and evaluate them on MR angiography, cardiac triggering might be required to reduce the effects of pulsatile motions of the renal artery in the use of a phased-array coil.     

肾动脉高分辨力三维增强磁共振血管成像术:透视触发和并行采集技术使用初探

目的:评估透视触发和并行采集技术用于肾动脉高分辨力三维增强磁共振血管成像术的可行性和对肾动脉的显影诊断效果。方法:90例临床诊断或怀疑肾动脉或腹主动脉病变的患者行高分辨力肾动脉三维增强磁共振血管成像(3D CE MRA)。使用透视触发软件启动肾动脉3D CE MRA扫描,扫描采用K空间中心填充法和加速因子为2的并行采集技术。分析图象质量和病变显示情况,并与其它检查结果对照。结果:肾动脉3D CE MRA显示了90例患者共810支动脉段(100%显示率),平均显示等级为3.88。3D CE MRA显示8例11支副肾动脉,显示等级均为4.0。肾动脉段级分支的显示率为73%(66/90例)。所有病例在动脉显示区静脉均未显影或显影很淡,平均等级为0.20。3D CE MRA发现639支动脉段正常;66支动脉段管壁不规则;55支动脉段轻度狭窄;37支动脉段严重狭窄;2支动脉段闭塞;11支动脉段动脉瘤形成。其中96支肾动脉存在狭窄,11支副肾动脉均正常。共有43例病例,肾动脉3D CE MRA与其它血管成像技术作了比较,3D CE MRA的检查结果与之完全符合。结论:透视触发并行采集肾动脉高分辨力3D CE MRA简单可行,成像时间短,空间分辨力高,能清楚显示肾动脉且无静脉污染。     

Intra-arterial MR angiography in the iliac system: initial clinical experience with 25 patients

The aim of this study was to evaluate intra-arterial magnetic resonance angiography (MRA) of the iliac arteries. Therefore, 25 consecutive patients (17 male, 8 female) suffering from symptomatic occlusive disease of the lower limbs were investigated prospectively. Catheter angiography was performed before MRA and served as the standard of reference. Contrast-enhanced intra-arterial MRA was performed using a 1.5 Tesla MRI system. Contrast agent (gadodiamide) was injected by a conventional pigtail-shaped angiography catheter placed in the abdominal aorta. Vascular lesions were assessed by four investigators. The degree of stenosis was compared with the findings of conventional catheter angiography. Additionally, the diagnostic quality of the MR angiograms was assessed by the investigators using a semi quantitative five-point scale. All lesions shown by catheter angiography were detected and correctly localized by intra-arterial MRA. MR angiograms exhibit a specificity of 95% and a sensitivity of 96% for stenoses of 50% or more. The diagnostic quality of the images was judged from good to excellent, on average. Intra-arterial MRA exhibits a specificity and sensitivity comparable with intravenous angiography. The image quality appears to be adequate for supporting MR-guided vascular intervention.     

Peripheral arterial disease. Contrast-enhanced 3D MR angiography of the lower leg and foot compared with conventional angiography

PURPOSE: To determine whether contrast-enhanced 3D MR angiography (CE MRA) could replace digital subtraction angiography (DSA) for the evaluation of atherosclerotic peripheral vascular disease of the lower leg and foot. MATERIAL AND METHODS: Thirty-five patients with symptoms of atherosclerotic disease of the leg were examined prospectively with CE MRA of the foot and the lower legs as well as with DSA from the aorta to the pedal arches. The MRA technique was focused on optimal imaging of the arteries of the foot. RESULTS: The agreement between CE MRA and DSA for grading of stenosis was moderate to good (weighted kappa-values 0.48-0.80). The sensitivity of CE MRA for detection of significant stenosis (> or = 50%) was 92% and the specificity was 64% with DSA as gold standard. CONCLUSION: CE MRA is a fairly accurate method for the demonstration of atherosclerotic disease below the knee including the pedal arches. It can replace DSA for the assessment of distal arteries in patients with impaired renal function. However, image quality and resolution still needs to be improved before CE MRA can become the method of choice in all patients.     

3D contrast-enhanced MR angiography of the run-off vessels: value of image subtraction

The diagnostic gain associated with image subtractions was assessed regarding contrast-enhanced 3D magnetic resonance angiography (MRA) image sets of the pelvic and lower extremity arteries. The MRA strategy combined a dedicated vascular coil with a single injection, two-station protocol. Voxel-by-voxel signal intensity subtraction was performed on MRA image sets obtained before and during dynamic infusion of a para-magnetic contrast agent. Non-subtracted and subtracted MRA image sets were assessed for the presence of occlusive (four grades) disease, using DSA as the standard of reference. In addition, SNR and CNR were recorded for each vascular segment on both the non-subtracted and subtracted images. While CNR values of subtracted images exceeded those of non-subtracted images (P < 0.05), there was no difference in diagnostic performance. For the detection of hemodynamically significant disease, non-subtracted and subtracted MRA provided overall sensitivity and specificity of 90.2%/90.3% and 95.1%/95.6%, respectively. Concordance between non-subtracted and subtracted MRA was excellent (Kappa = 0.86).     

Comparative assessment of helical CT-angiography, 2D TOF MR-angiography and 3D gadolinium enhanced MRA in aorto-iliac occlusive disease

PURPOSE: To compare helical CT-angiography (CTA) and two techniques of MR angiography (MRA) to conventional angiography in aorto-iliac occlusive disease. MATERIALS AND METHODS: The abdominal aorta and iliac arteries in 22 patients (4 for preoperative assessment of abdominal aortic aneurysm and 18 for peripheral vascular disease) were imaged using four techniques: digital subtraction angiography ("gold standard"), 2D TOF MR angiography, 3D Gd-enhanced MR angiography and helical CT angiography. Source (CTA and 2D TOF MRA) and MIPed images (after subtraction measures before and after gadolinium injection for 3D Gd-MRA) were reviewed. RESULTS: Sensitivity, specificity and accuracy for the detection of significant (>50%) stenosis and occlusion of aorto-iliac arteries were respectively: 38%, 89%, 77% for 2D TOF MRA; 75%, 71%, 72% for 3D Gd-MRA and 95%, 90%, 92% for CTA. Excluding the internal iliac arteries, results were 54%, 96%, 88% for 2D TOF MRA; 96%, 80%, 83% for 3D Gd-MRA and 92%, 93%, 95% for CTA. CONCLUSION: 3D Gd-MRA, a technique with potential for further improvement, is superior to 2D TOF MRA for detecting significant stenosis and occlusion of aorto-iliac arteries. Results at Gd-MRA are nearly similar to those at CTA (after excluding internal iliac arteries). Results at Gd-MRA are not affected by calcified plaque.