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Dynamic Contrast-Enhanced MR Angiography from the Distal Aorta to the Ankle Joint with a Step-by-Step Technique

A. Huber1, A. Heuck1, A. Baur1, T. Helmberger1, T. Waggershauser1, A. Billing2, M. Heiss2, R. Petsch1,3 and M. Reiser1

1 Department of Clinical Radiology, Klinikum der LMU, Großhadern, Marchioninistr. 15, 81377 München, Germany.
2 Department of Surgery, Klinikum der LMU, Großhadern, 81377 München, Germany.
3 Siemens AG, Medizintechnik, 91052 Erlangen, Germany.



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  		Fig. 1A. —26-year-old healthy male volunteer. Maximal-intensity-projection reconstructions of subtracted MR angiography data sets of vessels from distal aorta to ankle joint. Maximal-intensity-projection reconstruction shows distal aorta, common iliac arteries, proximal parts of internal iliac arteries, external iliac arteries, and proximal parts of common femoral arteries. Note branching to internal iliac artery (arrow).

 


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  		Fig. 1B. —26-year-old healthy male volunteer. Maximal-intensity-projection reconstructions of subtracted MR angiography data sets of vessels from distal aorta to ankle joint. Maximal-intensity-projection reconstruction at upper leg level shows superficial femoral arteries, proximal popliteral arteries, and branches of deep femoral arteries (arrow).

 


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  		Fig. 1C. —26-year-old healthy male volunteer. Maximal-intensity-projection reconstruction of subtracted MR angiography data sets of vessels from distal aorta to ankle joint. Maximal-intensity-projection reconstruction at lower leg level shows distal parts of politeal arteries and three major arteries of lower leg down to ankle. Note anterior tibial artery (large short arrow), posterior tibial artery (small short arrow), and peroneal artery (long arrow).

 


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  		Fig. 2A. —63-year-old man with peripheral arterial occlusive disease. Digital subtraction angiogram of pelvic region reveals stent graft in right external iliac artery (large short arrow) and luminal irregularities in left external iliac artery without hemodynamically significant stenosis (small short arrows).

 


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  		Fig. 2B. —63-year-old man with peripheral arterial occlusive disease. Digital subtraction angiogram of proximal upper leg reveals occlusion of right superficial femoral artery (arrow) in its proximal part.

 


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  		Fig. 2C. —63-year-old man with peripheral arterial occlusive disease. Digital subtraction angiogram of distal upper leg reveals only collateral arteries on right side and hemodynamically significant stenosis in left superficial femoral artery (long arrow), occlusion of left superficial femoral artery (short arrow), as well as collateral vessels (arrowheads).

 


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  		Fig. 2D. —63-year-old man with peripheral arterial occlusive disease. Digital subtraction angiogram of knee and proximal lower leg reveals refilling of right distal popliteal artery (arrow).

 


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  		Fig. 2E. —63-year-old man with peripheral arterial occlusive disease. Digital subtraction angiogram of distal lower leg reveals anterior tibial artery (small long arrows), posterior tibial artery (small short arrows), and peroneal artery (large short arrow) on right side and anterior and posterior tibial arteries (curved arrows) on left side.

 


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  		Fig. 2F. —63-year-old man with peripheral arterial occlusive disease. Maximal-intensity-projection reconstruction (inverted) of subtracted data set obtained from MR angiography shows false-positive findings of occlusion in external iliac artery caused by stent graft (arrow) and luminal irregularities in left external iliac artery.

 


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  		Fig. 2G. —63-year-old man with peripheral arterial occlusive disease. Maximal-intensity-projection reconstruction (inverted) of subtracted data set obtained from MR angiography reveals occlusion of right superficial femoral artery (large short arrow) in its proximal part. Note hemodynamically significant stenosis in left superficial femoral artery (small long arrow), occlusion of left superficial femoral artery (small short arrow), collateral vessels (arrowheads), and refilling of popliteal artery (large long arrow).

 


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  		Fig. 2H. —63-year-old man with peripheral arterial occlusive disease. Maximal-intensity-projection reconstruction (inverted) of subtracted data set obtained from MR angiography shows refilling of right distal popliteal artery (solid arrow) and patent anterior tibial artery, posterior tibial artery, and peroneal artery on right side and anterior and posterior tibial arteries on left side. One false-positive occlusion is located in proximal anterior tibial artery (open arrow).

 


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  		Fig. 3. —Bar chart shows mean signal-to-noise ratio values of veins, arteries, and adjacent soft tissue determined on source images dependent on time of measurement and on region. Note deep veins in lower leg during third measurement show higher signal-to-noise ratio than arteries. However, when mask is subtracted, arteries show higher signal-to-noise ratio in subtracted data set. White, black, and striped bars indicate veins, arteries, and soft tissue, respectively.

 


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  		Fig. 4. —Bar chart shows contrast-to-noise ratios of major arteries and adjacent soft tissue (muscle in upper and lower leg, mesenteric fat and bowel in pelvic region) obtained from first measurement taken after gadolinium administration at each level before and after subtraction of gadolinium measurement taken before gadolinium administration. White and gray bars indicate before and after subtraction, respectively.

 

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