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Assessment of Gadolinium-Enhanced Time-Resolved Three-Dimensional MR Angiography for Evaluating Renal Artery Stenosis

Hatsuko Masunaga1, Yasuo Takehara1, Haruo Isoda1, Tatsuya Igarashi1, Masahiro Sugiyama1, Satoshi Isogai1, Nami Kodaira1, Hiroyasu Takeda1, Atsushi Nozaki2 and Harumi Sakahara1

1 Department of Radiology, Hamamatsu University School of Medicine, 3600 Handa, Hamamatsu 431-3192, Japan.
2 General Electric Yokogawa Medical Systems, Ltd., 4-7-127 Asahigaoka, Hino, Tokyo 191-8503, Japan.



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  		Fig. 1. —Diagram for time-resolved three-dimensional MR angiography. Rapid acquisitions of 7.5 sec (range, 7.0-7.6 sec) are repeated four or five times during single breath-hold. Imaging delay from initiation of contrast bolus was 5 sec. After patient breathed for 10 sec, another 2-4 acquisitions were performed to obtain venous phase images.

 


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  		Fig. 2. —Changes of average signal-to-noise ratios of vascular and background tissues at different phases on subtracted time-resolved three-dimensional MR angiograms in 28 patients in whom arterial phase images were obtained in third data set. In third data set of arterial phase, strong arterial enhancement and suppressed venous enhancement are seen. In fourth data set, signal-intensity differences between artery and vein rapidly decreased. In postcontrast data sets (from second to fifth data sets), signal intensity of fat is extremely decreased by subtraction. {diamondsuit} = aorta, {blacksquare} = right renal artery, {blacktriangleup} = left renal artery, x = inferior vena cava, asterisks = right renal vein, [UNK] = left renal vein, + = fat, horizontal lines = muscle.

 


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  		Fig. 3A. —71-year-old man with suspected renal cell carcinoma. Coronal MR angiogram of arterial phase (maximum intensity projection) shows accessory left renal artery (arrow) superior to main left renal artery.

 


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  		Fig. 3B. —71-year-old man with suspected renal cell carcinoma. MR angiogram of arterial phase oblique subvolume maximum intensity projection clearly shows accessory left renal artery (arrows) from aorta to renal hilum.

 


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  		Fig. 3C. —71-year-old man with suspected renal cell carcinoma. Intraarterial digital subtraction angiogram shows accessory left renal artery (arrow).

 


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  		Fig. 4A. —48-year-old man with Stanford type B aortic dissection. Coronal MR angiogram of arterial phase (maximum intensity projection) shows two right renal arteries, and less enhancement of inferior right renal artery (solid arrows) and lower pole of right kidney (open arrows). True lumen is visualized as a bandlike opacification (asterisks).

 


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  		Fig. 4B. —48-year-old man with Stanford type B aortic dissection. Coronal MR angiogram of early venous phase (maximum intensity projection) shows sufficient enhancement of inferior right renal artery (arrows) and lower pole of right kidney.

 


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  		Fig. 4C. —48-year-old man with Stanford type B aortic dissection. MR angiogram of arterial phase axial subvolume maximum intensity projection of upper abdominal aorta shows superior right renal artery (arrow) branching from true lumen.

 


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  		Fig. 4D. —48-year-old man with Stanford type B aortic dissection. MR angiogram of arterial phase axial subvolume maximum intensity projection of abdominal aorta at lower level than C shows inferior right renal artery (arrow) and false lumen visible with less enhancement than true lumen and superior right renal artery (curved arrow, C).

 


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  		Fig. 4E. —48-year-old man with Stanford type B aortic dissection. Intraarterial digital subtraction angiogram of arterial phase does not show inferior right renal artery. Note true lumen visualized as bandlike opacification (asterisks).

 


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  		Fig. 5A. —71-year-old man with progressive renal dysfunction and hypertension. Coronal MR angiogram of arterial phase (maximum intensity projection) shows severe stenoses greater than 70% at origins of both renal arteries (arrows).

 


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  		Fig. 5B. —71-year-old man with progressive renal dysfunction and hypertension. Intraarterial digital subtraction angiogram shows severe stenoses of both renal arteries (arrows).

 

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