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Fig. 5A. —52-year-old woman with pain and discoloration of distal digits. Decreased digital perfusion resulting from multiple small emboli. MR projection angiogram from three-dimensional volumes acquired 35 sec (A), 50 sec (B), and 5 min (C) after injection of gadolinium contrast agent. First contrast-enhanced image set shows abrupt cutoff of proper digital vessels in several fingers (arrows, A) and perfusion defects of distal digits. Local lactic acidosis associated with ischemia may be cause of arterial dilatation and early venous filling. High tissue levels of soft-tissue enhancement (presumably caused by luxury perfusion) help obscure some digital arteries.