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Time-Resolved 3D MR Angiography with Parallel Imaging for Evaluation of Hemodialysis Fistulas and Grafts: Initial Experience

Jingbo Zhang1, Elizabeth M. Hecht2, Thomas Maldonado3 and Vivian S. Lee2

1 Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Rm. C278D, New York, NY 10021.
2 Department of Radiology, New York University Medical Center, New York, NY 10016.
3 Department of Surgery, New York University Medical Center, New York, NY 100016.


Figure 1
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  		Fig. 1A —Patient 1 in Table 1. Coronal maximum-intensity-projection (MIP) images from time-resolved 3D gadolinium-enhanced gradient-echo subtraction MR angiogram (TR/TE, 3.4/1.3; 25° flip angle; temporal resolution, 6 sec) in 72-year-old woman who had malfunctioning arteriovenous fistula (AVF). Image obtained immediately after injection of gadopentetate dimeglumine shows right heart and pulmonary artery vasculature free of contrast material in systemic circulation. Due to high temporal resolution, acquisition occurred when contrast material reached pulmonary circulation during its first pass. Unenhanced data set had been subtracted from pulmonary arterial phase data set to reduce background signal intensity.

 

Figure 2
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  		Fig. 1B —Patient 1 in Table 1. Coronal maximum-intensity-projection (MIP) images from time-resolved 3D gadolinium-enhanced gradient-echo subtraction MR angiogram (TR/TE, 3.4/1.3; 25° flip angle; temporal resolution, 6 sec) in 72-year-old woman who had malfunctioning arteriovenous fistula (AVF). Subsequent images obtained at 12 (B), 18 (C), and 24 (D) sec after contrast injection show hemodialysis AVF and entire inflow and outflow vessels in one single large field of view. A high-grade focal venous stenosis 2 cm away from left upper extremity AVF anastomosis (arrowhead, E) is seen. It is our experience that earlier time-resolved images help differentiate arterial and venous anatomy. E, Magnified MIP image of venous stenosis (arrow). Doppler sonogram (not shown) obtained within 1 month of MR angiography showed same finding.

 

Figure 3
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  		Fig. 1C —Patient 1 in Table 1. Coronal maximum-intensity-projection (MIP) images from time-resolved 3D gadolinium-enhanced gradient-echo subtraction MR angiogram (TR/TE, 3.4/1.3; 25° flip angle; temporal resolution, 6 sec) in 72-year-old woman who had malfunctioning arteriovenous fistula (AVF). Subsequent images obtained at 12 (B), 18 (C), and 24 (D) sec after contrast injection show hemodialysis AVF and entire inflow and outflow vessels in one single large field of view. A high-grade focal venous stenosis 2 cm away from left upper extremity AVF anastomosis (arrowhead, E) is seen. It is our experience that earlier time-resolved images help differentiate arterial and venous anatomy. E, Magnified MIP image of venous stenosis (arrow). Doppler sonogram (not shown) obtained within 1 month of MR angiography showed same finding.

 

Figure 4
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  		Fig. 1D —Patient 1 in Table 1. Coronal maximum-intensity-projection (MIP) images from time-resolved 3D gadolinium-enhanced gradient-echo subtraction MR angiogram (TR/TE, 3.4/1.3; 25° flip angle; temporal resolution, 6 sec) in 72-year-old woman who had malfunctioning arteriovenous fistula (AVF). Subsequent images obtained at 12 (B), 18 (C), and 24 (D) sec after contrast injection show hemodialysis AVF and entire inflow and outflow vessels in one single large field of view. A high-grade focal venous stenosis 2 cm away from left upper extremity AVF anastomosis (arrowhead, E) is seen. It is our experience that earlier time-resolved images help differentiate arterial and venous anatomy. E, Magnified MIP image of venous stenosis (arrow). Doppler sonogram (not shown) obtained within 1 month of MR angiography showed same finding.

 

Figure 5
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  		Fig. 1E —Patient 1 in Table 1. Coronal maximum-intensity-projection (MIP) images from time-resolved 3D gadolinium-enhanced gradient-echo subtraction MR angiogram (TR/TE, 3.4/1.3; 25° flip angle; temporal resolution, 6 sec) in 72-year-old woman who had malfunctioning arteriovenous fistula (AVF). Subsequent images obtained at 12 (B), 18 (C), and 24 (D) sec after contrast injection show hemodialysis AVF and entire inflow and outflow vessels in one single large field of view. A high-grade focal venous stenosis 2 cm away from left upper extremity AVF anastomosis (arrowhead, E) is seen. It is our experience that earlier time-resolved images help differentiate arterial and venous anatomy. E, Magnified MIP image of venous stenosis (arrow). Doppler sonogram (not shown) obtained within 1 month of MR angiography showed same finding.

 

Figure 6
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  		Fig. 2A —Patient 7 in Table 1. Volume-rendered and maximum-intensity-projection (MIP) images from time-resolved 3D gadolinium-enhanced gradient-echo subtraction MR angiogram (TR/TE, 3.5/1.2; 25° flip angle; temporal resolution, 9 sec) in 74-year-old man with right upper extremity arteriovenous fistula (AVF), who presented with pulsatile mass in arm. Volume-rendered reconstruction images show two venous aneurysms (arrows) just distal to AVF (arrowhead), 3 cm apart.

 

Figure 7
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  		Fig. 2B —Patient 7 in Table 1. Volume-rendered and maximum-intensity-projection (MIP) images from time-resolved 3D gadolinium-enhanced gradient-echo subtraction MR angiogram (TR/TE, 3.5/1.2; 25° flip angle; temporal resolution, 9 sec) in 74-year-old man with right upper extremity arteriovenous fistula (AVF), who presented with pulsatile mass in arm. Volume-rendered reconstruction images show two venous aneurysms (arrows) just distal to AVF (arrowhead), 3 cm apart.

 

Figure 8
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  		Fig. 2C —Patient 7 in Table 1. Volume-rendered and maximum-intensity-projection (MIP) images from time-resolved 3D gadolinium-enhanced gradient-echo subtraction MR angiogram (TR/TE, 3.5/1.2; 25° flip angle; temporal resolution, 9 sec) in 74-year-old man with right upper extremity arteriovenous fistula (AVF), who presented with pulsatile mass in arm. Magnified MIP image shows venous aneurysms. Patient underwent subsequent conventional angiography (not shown) 3 weeks later, which showed two venous aneurysms.

 

Figure 9
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  		Fig. 3A —Patient 4 in Table 1. Maximum-intensity-projection (MIP) images from time-resolved 3D gadolinium-enhanced gradient-echo subtraction MR angiogram (TR/TE, 3.2/1.1; 25° flip angle; temporal resolution, 9 sec) in 88-year-old woman with left upper extremity arteriovenous fistula (AVF) and abnormal focal physical examination (thrill and pulsatility at the site of AVF). Image obtained with time-resolved MR angiography shows hemodialysis AVF and entire inflow and outflow vessels in single large field of view.

 

Figure 10
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  		Fig. 3B —Patient 4 in Table 1. Maximum-intensity-projection (MIP) images from time-resolved 3D gadolinium-enhanced gradient-echo subtraction MR angiogram (TR/TE, 3.2/1.1; 25° flip angle; temporal resolution, 9 sec) in 88-year-old woman with left upper extremity arteriovenous fistula (AVF) and abnormal focal physical examination (thrill and pulsatility at the site of AVF). Magnified view of two tandem venous stenoses in shoulder (long arrow) and mild focal venous stenosis in mid arm (short arrow).

 

Figure 11
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  		Fig. 3C —Patient 4 in Table 1. Maximum-intensity-projection (MIP) images from time-resolved 3D gadolinium-enhanced gradient-echo subtraction MR angiogram (TR/TE, 3.2/1.1; 25° flip angle; temporal resolution, 9 sec) in 88-year-old woman with left upper extremity arteriovenous fistula (AVF) and abnormal focal physical examination (thrill and pulsatility at the site of AVF). Magnified view in oblique sagittal plane of mild focal venous stenosis (arrowhead) in the lower arm with mild prestenotic aneurysmal dilatation of vein adjacent to anastomosis.

 

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