Contrast-Enhanced MR Angiography and Perfusion Imaging of the Hand
James W. Goldfarb1,2,
Mary G. Hochman1,
Duck Soo Kim1,3 and
Robert R. Edelman1,4
1
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical
School, 330 Brookline Ave., Boston, MA 02215.
2
Present address: Department of Medicine, Division of Cardiology, University of
Medicine and Dentistry of New Jersey, CAB Rm. 2302B, 125 Paterson St., New
Brunswick, NJ 08903.
3
Present address: Department of Radiology, University of Massachusetts Memorial
Health Care, 55 Lake Ave. N., Worcester, MA 01655.
4
Present address: Department of Radiology, Evanston Northwestern Healthcare,
2650 Ridge Ave., Evanston, IL 60201.
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Fig. 1A. —31-year-old healthy male volunteer. Normal vascular anatomy
of hand as shown on MR angiography. MR projection angiograms from
three-dimensional volumes acquired 30 (A), 50 (B), 70
(C), and 90 (D) sec after injection of gadolinium contrast
agent. In this healthy volunteer, a tourniquet was briefly applied to middle
finger. Considerably less signal enhancement distal to tourniquet (arrow
down, B) can be seen. Note loss of signal caused by mispositioning
of coil in fifth digit (arrow up, B). Venous contamination is
seen in B but not in A. RA = radial artery, UA = ulnar artery,
SA = superficial palmar arch, DA = deep palmar arch, CD = common palmar
digital arteries, PD = proper palmar digital arteries.
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Fig. 1B. —31-year-old healthy male volunteer. Normal vascular anatomy
of hand as shown on MR angiography. MR projection angiograms from
three-dimensional volumes acquired 30 (A), 50 (B), 70
(C), and 90 (D) sec after injection of gadolinium contrast
agent. In this healthy volunteer, a tourniquet was briefly applied to middle
finger. Considerably less signal enhancement distal to tourniquet (arrow
down, B) can be seen. Note loss of signal caused by mispositioning
of coil in fifth digit (arrow up, B). Venous contamination is
seen in B but not in A. RA = radial artery, UA = ulnar artery,
SA = superficial palmar arch, DA = deep palmar arch, CD = common palmar
digital arteries, PD = proper palmar digital arteries.
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Fig. 1C. —31-year-old healthy male volunteer. Normal vascular anatomy
of hand as shown on MR angiography. MR projection angiograms from
three-dimensional volumes acquired 30 (A), 50 (B), 70
(C), and 90 (D) sec after injection of gadolinium contrast
agent. In this healthy volunteer, a tourniquet was briefly applied to middle
finger. Considerably less signal enhancement distal to tourniquet (arrow
down, B) can be seen. Note loss of signal caused by mispositioning
of coil in fifth digit (arrow up, B). Venous contamination is
seen in B but not in A. RA = radial artery, UA = ulnar artery,
SA = superficial palmar arch, DA = deep palmar arch, CD = common palmar
digital arteries, PD = proper palmar digital arteries.
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Fig. 1D. —31-year-old healthy male volunteer. Normal vascular anatomy
of hand as shown on MR angiography. MR projection angiograms from
three-dimensional volumes acquired 30 (A), 50 (B), 70
(C), and 90 (D) sec after injection of gadolinium contrast
agent. In this healthy volunteer, a tourniquet was briefly applied to middle
finger. Considerably less signal enhancement distal to tourniquet (arrow
down, B) can be seen. Note loss of signal caused by mispositioning
of coil in fifth digit (arrow up, B). Venous contamination is
seen in B but not in A. RA = radial artery, UA = ulnar artery,
SA = superficial palmar arch, DA = deep palmar arch, CD = common palmar
digital arteries, PD = proper palmar digital arteries.
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Fig. 2A. —Bar graphs show percentage of signal increase resulting from
contrast agent in each acquisition for hand displayed in Figure
1A,1B,1C,1D.
Arterial and venous percentage of signal increase. Black bars indicate radial
artery, white indicate dorsal vein.
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Fig. 2B. —Bar graphs show percentage of signal increase resulting from
contrast agent in each acquisition for hand displayed in Figure
1A,1B,1C,1D.
Distal soft-tissue percentage of signal increase of individual digits at
various times after injection of contrast agent. Each group shows, left to
right, digits 1, 2, 3, 4, and 5. Third digit had poor enhancement resulting
from applied tourniquet.
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Fig. 3A. —25-year-old woman with arteriovenous malformation (AVM) of
hand. MR projection angiograms from three-dimensional volumes acquired 25
(A), 40 (B), and 70 (C) sec after injection of gadolinium
contrast agent reveal chaotic tangle of vessels, prominent arterial feeders,
and engorged early-draining veins (typical for AVM). Extent of abnormality and
larger feeding arteries are well depicted. Smaller feeding artery branches
were difficult to delineate because of limits in resolution and venous
overlap. Examination of multiplanar reformatted images was helpful in this
regard. RA = dilated radial artery, DPA = deep palmar arch.
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Fig. 3B. —25-year-old woman with arteriovenous malformation (AVM) of
hand. MR projection angiograms from three-dimensional volumes acquired 25
(A), 40 (B), and 70 (C) sec after injection of gadolinium
contrast agent reveal chaotic tangle of vessels, prominent arterial feeders,
and engorged early-draining veins (typical for AVM). Extent of abnormality and
larger feeding arteries are well depicted. Smaller feeding artery branches
were difficult to delineate because of limits in resolution and venous
overlap. Examination of multiplanar reformatted images was helpful in this
regard. RA = dilated radial artery, DPA = deep palmar arch.
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Fig. 3C. —25-year-old woman with arteriovenous malformation (AVM) of
hand. MR projection angiograms from three-dimensional volumes acquired 25
(A), 40 (B), and 70 (C) sec after injection of gadolinium
contrast agent reveal chaotic tangle of vessels, prominent arterial feeders,
and engorged early-draining veins (typical for AVM). Extent of abnormality and
larger feeding arteries are well depicted. Smaller feeding artery branches
were difficult to delineate because of limits in resolution and venous
overlap. Examination of multiplanar reformatted images was helpful in this
regard. RA = dilated radial artery, DPA = deep palmar arch.
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Fig. 4A. —Bar graphs show percentage of signal increase resulting from
contrast agent in each acquisition for hand displayed in Figure
3A,3B,3C.
Arterial and venous percentage of signal increase. Black bars indicate radial
artery, white indicate arteriovenous malformation (AVM).
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Fig. 4B. —Bar graphs show percentage of signal increase resulting from
contrast agent in each acquisition for hand displayed in Figure
3A,3B,3C.
Distal soft-tissue percentage of signal increase of individual digits at
various times after injection of contrast agent. Each group shows, left to
right, digits 1, 2, 3, 4, and 5. Venous enhancement and enhancement of AVM
were always greater than arterial enhancement. Delayed and reduced enhancement
of digits is seen compared with healthy hand (Figs.
1A,1B,1C,1D
and
2A,2B).
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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.
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Fig. 5B. —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.
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Fig. 5C. —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.
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Copyright © 2001 by the American Roentgen Ray Society.
