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Arterial Pseudostenosis on First-Pass Gadolinium-Enhanced Three-Dimensional MR Angiography

New Observation of a Potential Pitfall

¹ Department of Radiologic Sciences, Medical College of Pennsylvania, 3300 Henry Ave., 5th Level, Philadelphia, PA 19129.
² Department of Radiology, Thomas Jefferson University Hospital, 132 S. 10th St., Ste. 1096 Main, Philadelphia, PA 19107.

View larger version (91K): [in a new window]   Fig. 1A. —56-year-old woman examined for possible renovascular hypertension. Coronal source MR image of first-pass three-dimensional (3D) gadolinium-enhanced MR angiogram (fast spoiled gradient-echo; TR/TE, 13/2.3 msec; flip angle, 60°; slice thickness, 1.5 mm; acquisition time, 107 sec) shows moderate stenosis of proximal left renal artery (arrow).

View larger version (106K): [in a new window]   Fig. 1B. —56-year-old woman examined for possible renovascular hypertension. Coronal source MR image of second-pass acquisition shows only minimal narrowing of left renal artery (arrowhead).

View larger version (62K): [in a new window]   Fig. 1C. —56-year-old woman examined for possible renovascular hypertension. Coronal maximum-intensity-projection image of 3D phase-contrast MR angiography sequence (34/8.6; encoding velocity, 30 cm/sec) shows minimal narrowing of left renal artery (straight arrow). Accessory left renal artery is shown (curved arrow).

View larger version (114K): [in a new window]   Fig. 1D. —56-year-old woman examined for possible renovascular hypertension. Slightly oblique anterior projection of iodinated contrast angiography reveals minimal narrowing of proximal left renal artery (arrowhead) and accessory left renal artery (arrow).

View larger version (89K): [in a new window]   Fig. 2A. —58-year-old man with history of coronary artery disease and chest pain. Sagittal source image (A) and maximum-intensity-projection image (B) of first-pass three-dimensional (3D) gadolinium-enhanced MR angiography (fast spoiled gradient-echo; TR/TE, 13/2.3 msec; flip angle, 60°; slice thickness, 1.5 mm; acquisition time, 107 sec) show moderate stenosis of origin of left common carotid artery (arrow).

View larger version (93K): [in a new window]   Fig. 2B. —58-year-old man with history of coronary artery disease and chest pain. Sagittal source image (A) and maximum-intensity-projection image (B) of first-pass three-dimensional (3D) gadolinium-enhanced MR angiography (fast spoiled gradient-echo; TR/TE, 13/2.3 msec; flip angle, 60°; slice thickness, 1.5 mm; acquisition time, 107 sec) show moderate stenosis of origin of left common carotid artery (arrow).

View larger version (93K): [in a new window]   Fig. 2C. —58-year-old man with history of coronary artery disease and chest pain. Sagittal source image (C) and maximum-intensity-projection image (D) of second-pass 3D gadolinium-enhanced MR angiogram show normal caliber of origin of left common carotid artery (arrowhead).

View larger version (88K): [in a new window]   Fig. 2D. —58-year-old man with history of coronary artery disease and chest pain. Sagittal source image (C) and maximum-intensity-projection image (D) of second-pass 3D gadolinium-enhanced MR angiogram show normal caliber of origin of left common carotid artery (arrowhead).

View larger version (149K): [in a new window]   Fig. 3A. —Pulsatile phantom on coronal gadolinium-enhanced fast gradient-echo three-dimensional MR angiography (TR/TE, 7/2.3 msec; flip angle, 50°; matrix, 256 x 256; number of excitations, 0.5; fat suppression; acquisition time, 15 sec). MR image acquired 4 sec after rapid gadolinium bolus initiation, causing gadolinium concentration to vary during acquisition, shows pseudostenosis (arrow).

View larger version (153K): [in a new window]   Fig. 3B. —Pulsatile phantom on coronal gadolinium-enhanced fast gradient-echo three-dimensional MR angiography (TR/TE, 7/2.3 msec; flip angle, 50°; matrix, 256 x 256; number of excitations, 0.5; fat suppression; acquisition time, 15 sec). MR image acquired approximately 25 sec after rapid bolus initiation shows pseudostenosis (arrow) to be less severe than in A.

View larger version (160K): [in a new window]   Fig. 3C. —Pulsatile phantom on coronal gadolinium-enhanced fast gradient-echo three-dimensional MR angiography (TR/TE, 7/2.3 msec; flip angle, 50°; matrix, 256 x 256; number of excitations, 0.5; fat suppression; acquisition time, 15 sec). MR image acquired approximately 45 sec after rapid bolus initiation shows no pseudostenosis (arrow).

View larger version (145K): [in a new window]   Fig. 3D. —Pulsatile phantom on coronal gadolinium-enhanced fast gradient-echo three-dimensional MR angiography (TR/TE, 7/2.3 msec; flip angle, 50°; matrix, 256 x 256; number of excitations, 0.5; fat suppression; acquisition time, 15 sec). MR image obtained during slow injection, causing steady concentration of inflowing gadolinium, shows no pseudostenosis (arrow).

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