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Diagnostic Accuracy of Time-Resolved 2D Projection MR Angiography for Symptomatic Infrapopliteal Arterial Occlusive Disease

Hong Lei Zhang1, Neil M. Khilnani1, Martin R. Prince1, Priscilla A. Winchester1, Piyush Golia1, Patrick Veit1, Richard Watts1 and Yi Wang1

1 All authors: Department of Radiology, Weill Medical College of Cornell University, 416 E 55th St., Cornell MRI, New York, NY 10022.



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  		Fig. 1A. —55-year-old man with claudication. Two-dimensional projection MR angiogram showing division of calf and pedal arteries into 10 segments. Coronal view shows seven arterial segments of calf. BKPA = below-knee popliteal artery, ATA = anterior tibial artery, PTA = posterior tibial artery.

 


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  		Fig. 1B. —55-year-old man with claudication. Two-dimensional projection MR angiogram showing division of calf and pedal arteries into 10 segments. Sagittal view shows three arterial segments of foot. DP = dorsalis pedis artery.

 


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  		Fig. 2A. —61-year-old man with nonhealing left foot ulcer. X-ray digital subtraction angiogram (A) and MR angiogram (B) of left knee and calf show significant stenoses (thin arrows) of popliteal artery and occlusion of anterior tibial artery (thick arrows). Findings of blinded interpretation were in agreement for all three reviewers.

 


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  		Fig. 2B. —61-year-old man with nonhealing left foot ulcer. X-ray digital subtraction angiogram (A) and MR angiogram (B) of left knee and calf show significant stenoses (thin arrows) of popliteal artery and occlusion of anterior tibial artery (thick arrows). Findings of blinded interpretation were in agreement for all three reviewers.

 


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  		Fig. 3A. —72-year-old woman with claudication. Both X-ray digital subtraction angiogram (A) and MR angiogram (B) of left knee and upper calf show widely patent popliteal artery (arrows) with single-vessel run-off via widely patent anterior tibial artery (arrowheads).

 


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  		Fig. 3B. —72-year-old woman with claudication. Both X-ray digital subtraction angiogram (A) and MR angiogram (B) of left knee and upper calf show widely patent popliteal artery (arrows) with single-vessel run-off via widely patent anterior tibial artery (arrowheads).

 


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  		Fig. 4A. —92-year-old man with nonhealing ulcer and osteomyelitis of left foot. Sagittal X-ray digital subtraction angiogram (A) and MR angiogram (B) show occluded anterior and posterior tibial arteries, which are reconstituted at ankle via peroneal artery collaterals.

 


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  		Fig. 4B. —92-year-old man with nonhealing ulcer and osteomyelitis of left foot. Sagittal X-ray digital subtraction angiogram (A) and MR angiogram (B) show occluded anterior and posterior tibial arteries, which are reconstituted at ankle via peroneal artery collaterals.

 


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  		Fig. 5A. —59-year-old woman with right foot ulcer. On both sagittal X-ray digital subtraction angiogram (A) and MR angiogram (B), metal artifact (arrows) partially obscures lower peroneal artery.

 


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  		Fig. 5B. —59-year-old woman with right foot ulcer. On both sagittal X-ray digital subtraction angiogram (A) and MR angiogram (B), metal artifact (arrows) partially obscures lower peroneal artery.

 


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  		Fig. 6A. —46-year-old woman with right calf cellulitis. Coronal X-ray digital subtraction angiogram (A) and MR angiogram (B) of right trifurcation show stenosis of tibioperoneal trunk (arrows), which was graded as not significant on MR angiography but significant on X-ray digital subtraction angiography.

 


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  		Fig. 6B. —46-year-old woman with right calf cellulitis. Coronal X-ray digital subtraction angiogram (A) and MR angiogram (B) of right trifurcation show stenosis of tibioperoneal trunk (arrows), which was graded as not significant on MR angiography but significant on X-ray digital subtraction angiography.

 


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  		Fig. 7A. —73-year-old man with claudication. On sagittal X-ray digital subtraction angiography (A), right lateral plantar artery was diagnosed as occluded (arrows) by all reviewers because it never fills, even on delayed X-ray digital subtraction angiography images. However, on time-resolved MR angiograms.

 


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  		Fig. 7B. —73-year-old man with claudication. On sagittal X-ray digital subtraction angiography (A), right lateral plantar artery was diagnosed as occluded (arrows) by all reviewers because it never fills, even on delayed X-ray digital subtraction angiography images. However, on time-resolved MR angiograms, lateral plantar artery is slowly filled by gadolinium contrast and is patent (arrowheads). In this case, MR angiography was considered more likely to be correct than X-ray digital subtraction angiography.

 


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  		Fig. 7C. —73-year-old man with claudication. Lateral plantar artery is slowly filled by gadolinium contrast and is patent (arrowheads). In this case, MR angiography was considered more likely to be correct than X-ray digital subtraction angiography.

 


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  		Fig. 7D. —73-year-old man with claudication. Lateral plantar artery is slowly filled by gadolinium contrast and is patent (arrowheads). In this case, MR angiography was considered more likely to be correct than X-ray digital subtraction angiography.

 

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