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Intraarterial Gadolinium-Enhanced MR Angiography in Humans for the Detection of Infrainguinal Arterial Stenoses Before and After Percutaneous Angioplasty

Niels Zorger1, Markus Volk1, Okka W. Hamer1, Markus Lenhart1, Johannes Seitz1, Bernhard Butz1 and Christian Paetzel1

1 Department of Radiology, University of Regensburg, Klinikum, Franz Josef Strauss Allee 11, Regensburg 93042, Germany.



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  		Fig. 1A —61-year-old man with arteriosclerotic obstructive disease and pain in left lower leg. Selective intraarterial digital subtraction angiogram obtained before angioplasty with sheath in left superficial femoral artery (injection rate, 5 mL/sec; total volume, 10 mL) shows 3-cm occlusion (grade 4) of distal superficial femoral artery.

 


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  		Fig. 1B —61-year-old man with arteriosclerotic obstructive disease and pain in left lower leg. Three-dimensional anteroposterior fast low-angle shot subtracted MR angiogram after power injection of 2.5 mL of gadodiamide diluted in saline solution through sheath in superficial femoral artery (injection rate, 2.5 mL/sec; total volume, 30 mL) reveals occlusion (grade 4) of superficial femoral artery correctly detected by all four observers. Note reconstitution of distal superficial femoral artery and popliteal artery by small collateral vessels (arrow).

 


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  		Fig. 1C —61-year-old man with arteriosclerotic obstructive disease and pain in left lower leg. Selective intraarterial digital subtraction angiogram of trifurcation before angioplasty shows stenosis that is greater than 50% (grade 2) (arrow) of proximal tibial artery and stenoses that are less than 50% (arrowheads) of proximal tibial artery. No relevant stenoses of proximal posterior tibial artery or peroneal artery (grade 0) are present.

 


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  		Fig. 1D —61-year-old man with arteriosclerotic obstructive disease and pain in left lower leg. Three-dimensional anteroposterior fast low-angle shot subtracted intraarterial MR angiogram after power injection of 2.5 mL of gadodiamide diluted in saline solution through sheath in superficial femoral artery confirms diagnosis of stenosis of proximal tibial artery (arrow) that is greater than 50%. Three additional stenoses were overestimated by two observers (grade 3, more than one lesion with 50% or greater stenosis). No relevant stenoses of proximal posterior tibial artery or peroneal artery (grade 0) are present.

 


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  		Fig. 1E —61-year-old man with arteriosclerotic obstructive disease and pain in left lower leg. Selective intraarterial digital subtraction angiogram of superficial femoral artery obtained after balloon dilation (diameter of balloon, 5 mm; length of balloon, 4 cm) shows no relevant (> 50%) residual stenosis (grade 1).

 


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  		Fig. 1F —61-year-old man with arteriosclerotic obstructive disease and pain in left lower leg. Intraarterial MR angiogram obtained after angioplasty shows that overestimation of residual stenosis in superficial femoral artery (arrow) is due to calcification. Source images revealed stenosis of less than 50% (grade 1). This variability in degree of stenosis might be potential pitfall of this method. Peripheral pulses were palpable after angioplasty. Left ankle–brachial index improved from 0.50 to 0.83 after angioplasty.

 

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