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Diabetes and Peripheral Arterial Occlusive Disease

Prospective Comparison of Contrast-Enhanced Three-Dimensional MR Angiography with Conventional Digital Subtraction

Karl-Friedrich Kreitner1, Peter Kalden1, Achim Neufang2, Christoph Düber1, Frank Krummenauer3, Ernst Küstner4, Gerhard Laub5 and Manfred Thelen1

1 Department of Radiology, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, D-55131 Mainz, Germany.
2 Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University Mainz, D-55131 Mainz, Germany.
3 Department of Medical Statistics and Documentation, Johannes Gutenberg-University Mainz, Obere Zahlbacher Str. 69, D-55131 Mainz, Germany.
4 Department of Endocrinology, III. Medical Clinic, Johannes Gutenberg-University Mainz, D-55131 Mainz, Germany.
5 Siemens Medical Engineering, Henkestr. 127, D-91318 Erlangen, Germany.



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  		Fig. 1. —80-year-old man with nonhealing ulcer of big toe.

A, Nonselective intraarterial digital subtraction angiogram shows only proximal segment of dorsal pedal artery (arrow).

 


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  		Fig. 1. —80-year-old man with nonhealing ulcer of big toe.

B, MR angiogram shows proximal stenosis (arrow) of dorsal pedal artery. Note, however, patent middle and distal segments of vessel and good runoff to pedal arch.

 


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  		Fig. 2. —Image quality of digital subtraction angiogram (A) and MR angiogram (B) is equivalent in 83-year-old woman with nonhealing ulcer.

 


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  		Fig. 2. —Image quality of digital subtraction angiogram (A) and MR angiogram (B) is equivalent in 83-year-old woman with nonhealing ulcer.

 


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  		Fig. 3. —84-year-old man with acute rest pain and nonhealing ulcer of right foot.

A, Intraarterial nonselective digital subtraction angiogram fails to show any patent pedal artery.

 


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  		Fig. 3. —84-year-old man with acute rest pain and nonhealing ulcer of right foot.

B and C, MR angiograms obtained from frontal (B) and lateral (C) views show patent dorsal pedal artery with relatively good runoff to pedal arch.

 


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  		Fig. 3. —84-year-old man with acute rest pain and nonhealing ulcer of right foot.

B and C, MR angiograms obtained from frontal (B) and lateral (C) views show patent dorsal pedal artery with relatively good runoff to pedal arch.

 


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  		Fig. 3. —84-year-old man with acute rest pain and nonhealing ulcer of right foot.

D, Postoperative fine-needle DSA image after distal bypass grafting shows distal anastomosis (long arrow) and runoff to pedal arch (short arrows).

 


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  		Fig 4. —69-year-old man with nonhealing ulcer of big toe.

A, Selective digital subtraction angiogram shows pedal vessel (arrow) unsuitable for distal bypass grafting.

 


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  		Fig 4. —69-year-old man with nonhealing ulcer of big toe.

B, MR angiogram reveals patent dorsal pedal artery (arrow) that was used as target vessel during bypass grafting.

 


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  		Fig. 5. —70-year-old man with nonhealing ulcer and osteomyelitis of forefoot.

A and B, Digital subtraction angiographic (DSA) image (A) and MR angiogram (B) were rated as having equivalent image quality by all observers. In B, note better depiction of metatarsal arteries and slight venous superimposition. Also, note tendency to overestimate distal anterior tibial artery stenosis in B (arrow) compared with A.

 


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  		Fig. 5. —70-year-old man with nonhealing ulcer and osteomyelitis of forefoot.

A and B, Digital subtraction angiographic (DSA) image (A) and MR angiogram (B) were rated as having equivalent image quality by all observers. In B, note better depiction of metatarsal arteries and slight venous superimposition. Also, note tendency to overestimate distal anterior tibial artery stenosis in B (arrow) compared with A.

 


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  		Fig. 5. —70-year-old man with nonhealing ulcer and osteomyelitis of forefoot.

C, Fine-needle DSA image obtained after surgery shows distal anastomosis (arrow).

 

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