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MR Angiography of the Hand with Subsystolic Cuff-Compression Optimization of Injection Parameters

Thomas M. Gluecker1, Georg Bongartz1, Hans Peter Ledermann1 and Deniz Bilecen1

1 All authors: Department of Diagnostic Radiology, University Hospital Basel, Petersgraben 4, Basel, Switzerland 4032.


Figure 1
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  		Fig. 1 —Maximum intensity projection from reconstructed 3D contrast-enhanced MR angiography of both hands of 25-year-old healthy male volunteer after IV administration of Gadovist (gadobutrol, Schering) using a flow rate of 0.5 mL/s. Imaging sequence was obtained 40 seconds after initiation of contrast injection. Subsystolic cuff compression is applied to upper arm on right side. Major venous contamination (venous contamination score = 2) is observed on noncompressed left side.

 

Figure 2
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  		Fig. 2 —Maximum intensity projections from reconstructed 3D contrast-enhanced MR angiography of hand of 25-year-old healthy male volunteer after IV administration of Gadovist (gadobutrol, Schering). Only right extremity where cuff compression was applied is displayed. Images in top row were obtained using flow rate of 0.5 mL/s; middle row, 1.0 mL/s; and bottom row, 1.5 mL/s. Images were subsequently obtained at 20, 40, 60, 80, 100, 120, and 140 seconds after initiation of contrast injection (images at 20 sec did not show any vascular signal and are not displayed). Least venous contamination was present when flow rate of 0.5 mL/s was used. Note absence of palmar deep arch. Major venous overlay is observed starting 80 seconds after contrast administration for all injection flow rates.

 

Figure 3
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  		Fig. 3A —Bar graphs show average contrast-to-noise ratio (CNR) of arteries and veins on compressed side. No significant impact of various flow rates on arterial CNR is seen.

 

Figure 4
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  		Fig. 3B —Bar graphs show average contrast-to-noise ratio (CNR) of arteries and veins on compressed side. Least venous contamination is seen with lowest flow rate, 0.5 mL/s (p < 0.005).

 

Figure 5
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  		Fig. 4A —Bar graphs show evaluation of image quality by two independent reviewers. Arterial visualization score. Both reviewers rated data quality as good for all three flow rates. Although slightly best rating was given for flow rate of 0.5 mL/s, no statistically significant differences were present (p > 0.05).

 

Figure 6
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  		Fig. 4B —Bar graphs show evaluation of image quality by two independent reviewers. Venous contamination score. Bar graph of reviewers' assessment of venous contamination score while subsystolic cuff compression was used shows that lowest venous contamination score was observed with flow rate of 0.5 mL/s (p < 0.05).

 

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