HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) CME A correction has been published Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ersoy, H. Articles by Rybicki, F. J. Search for Related Content PubMed PubMed Citation Articles by Ersoy, H. Articles by Rybicki, F. J. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

MR Angiography of the Lower Extremities

¹ Cardiovascular Imaging Section, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA 02115.

View larger version (29K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —80-year-old woman with increasing pain in left foot. Coronal three-station 3D gadolinium-enhanced MR angiography (MRA) of left lower extremity arteries after IV administration of 45 mL of gadolinium-based contrast agent is performed on 1.5-T MR system. Iliac arteries are widely patent. Left superficial femoral artery is occluded at its origin. Extensive collaterals from femoral artery attempt to reconstitute run-off vessels. Note segmental reconstitution of posterior tibial artery in distal calf (arrow). After 1 week, patient developed rest pain in left foot and underwent emergency digital subtraction angiography.

View larger version (20K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —80-year-old woman with increasing pain in left foot. Digital subtraction angiography findings are identical to MRA findings except that digital subtraction angiography does not show reconstituted segment of posterior tibial artery at ankle despite significant contrast volume and delayed imaging.

View larger version (29K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —50-year-old man with claudication. Sagittal projections of axial 2D time-of-flight localizer images are used for determining most anterior and most posterior extensions of arterial territories. Rectangles represent oblique coronal MR angiography slabs that are prescribed from these sagittal projections. Note overlaps at common femoral and popliteal arteries. Also note that when blood pressure cuffs are inflated, thigh may raise anteriorly a few centimeters. Thus, slab prescribed for thigh station should have sufficient coverage anterior to artery so that image field of view fully covers artery.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —78-year-old man with claudication. Three-dimensional time-resolved gadolinium-enhanced MR angiography of left foot after administration of 10 mL of gadolinium-based contrast agent shows widely patent dorsalis pedis artery and plantar arch. Posterior tibial artery is not visualized at ankle. Peroneal artery attempts to reconstitute plantar artery (arrows).

View larger version (37K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —61-year-old man with rest pain in both feet that is worse in right foot. Three-dimensional gadolinium-enhanced MR angiography after IV administration of 45 mL of gadolinium contrast material at 1.5 T. Coronal maximum-intensity-projection image shows focal areas of stenosis (arrows) of Dacron (DuPont) graft lumen and its distal anastomosis.

View larger version (63K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —61-year-old man with rest pain in both feet that is worse in right foot. Digital subtraction angiography shows patent right common femoral artery to above-knee popliteal artery bypass graft. Note that focal areas of decreased lumen diameter on MR angiogram correspond to levels of metallic surgical clips (arrows) located around graft and at distal anastomosis site. Metallic susceptibility artifact can be recognized by characteristic signal buildup at edge of signal void area due to intravoxel phase distortions.

View larger version (37K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —35-year-old man after placement of popliteal artery-to-anterior tibial artery vein graft for treatment of claudication resulting from popliteal artery stenosis. Follow-up MR angiography (MRA) was performed at 1.5 T using 30 mL of gadolinium contrast agent. Volume-rendered image of coronal 3D gadolinium-enhanced MRA at neutral position shows mild stenosis of popliteal artery at knee level (arrow) and patent bypass graft.

View larger version (40K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —35-year-old man after placement of popliteal artery-to-anterior tibial artery vein graft for treatment of claudication resulting from popliteal artery stenosis. Follow-up MR angiography (MRA) was performed at 1.5 T using 30 mL of gadolinium contrast agent. Volume-rendered image of coronal 3D gadolinium-enhanced MRA at dorsiflexion of feet shows greater stenosis at same level (open arrow).

View larger version (50K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —35-year-old man after placement of popliteal artery-to-anterior tibial artery vein graft for treatment of claudication resulting from popliteal artery stenosis. Follow-up MR angiography (MRA) was performed at 1.5 T using 30 mL of gadolinium contrast agent. Contrast-enhanced axial fat-suppressed T1-weighted image confirms evidence of type III popliteal artery entrapment on left. During dorsiflexion of foot, popliteal artery is compressed by slip of medial head of gastrocnemius muscle (curved arrow) originating more laterally than normal.

View larger version (86K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —57-year-old man with left renal artery stent referred for imaging of renal and lower extremity arteries. Three-dimensional gadolinium-enhanced MR angiography was performed at 1.5 T. Imaging parameters are bandwidth, 31.25 MHz/s; TR/TE, 8.8/2.9; slice thickness, 1.3 mm (A) and bandwidth, 62.5 MHz/s; 5.9/1.4; slice thickness, 0.8 mm (B). Metallic susceptibility artifact from stent (arrow) is less when using wider bandwidth with shorter TE in comparison with narrower bandwidth and longer TE.

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —57-year-old man with left renal artery stent referred for imaging of renal and lower extremity arteries. Three-dimensional gadolinium-enhanced MR angiography was performed at 1.5 T. Imaging parameters are bandwidth, 31.25 MHz/s; TR/TE, 8.8/2.9; slice thickness, 1.3 mm (A) and bandwidth, 62.5 MHz/s; 5.9/1.4; slice thickness, 0.8 mm (B). Metallic susceptibility artifact from stent (arrow) is less when using wider bandwidth with shorter TE in comparison with narrower bandwidth and longer TE.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —33-year-old man with ischemic left foot. Coronal time-resolved images acquired using 3D time-resolved imaging of contrast kinetics (TR/TE, 5.2/1.3; slice thickness, 1.8 mm, interpolated to 0.9-mm; matrix, 320 x 224; number of excitations, 1) performed at 1.5 T using 12 mL of gadolinium contrast agent followed by 20 mL of saline, both at rate of 2.5 mL/s. Temporal resolution of time-resolved images is one image per 9 seconds. Scanning delay is 10 seconds. Contrast arrives in both calf arteries 28 seconds after antecubital IV injection. Venous enhancement begins at 46 seconds, allowing 180-second window for artery-only imaging. Left popliteal artery is occluded, with segmental reconstitution of left anterior tibial and posterior tibial arteries. Left peroneal artery is not visualized. Right posterior tibial artery is occluded at origin, but right peroneal and right anterior tibial arteries are widely patent. Blood flow arrival time is same on both sides.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —72-year-old woman with claudication that is worse on right side. Coronal 3D gadolinium-enhanced MR angiography images before (A) and after (B) mask subtraction. Note that MR angiogram after mask subtraction (B) allows visualization of more vessel segments and smaller branches than nonsubtracted image.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —72-year-old woman with claudication that is worse on right side. Coronal 3D gadolinium-enhanced MR angiography images before (A) and after (B) mask subtraction. Note that MR angiogram after mask subtraction (B) allows visualization of more vessel segments and smaller branches than nonsubtracted image.

View larger version (70K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —22-year-old man after kidney transplantation presented with extensive varicose veins in left calf. Three-dimensional gadolinium-enhanced MR angiography was performed at 1.5 T after administration of 45 mL of gadolinium contrast material. Coronal MR angiogram shows aneurysm of infrarenal abdominal aorta and left common and internal iliac arteries. Note left persistent sciatic artery (solid arrow) identified as ectatic and dominant inflow vessel to popliteal region. Left common femoral and external iliac arteries are hypoplastic (open arrow), and left superficial femoral artery is atretic. Left thigh is supplied by widely patent profunda femoral artery branches. Transplanted kidney is seen in left iliac fossa (asterisk).

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —22-year-old man after kidney transplantation presented with extensive varicose veins in left calf. Three-dimensional gadolinium-enhanced MR angiography was performed at 1.5 T after administration of 45 mL of gadolinium contrast material. Sagittal oblique maximum-intensity-projection image shows widely patent transplanted renal artery anastomosed to left external iliac artery (curved arrow).

View larger version (67K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10 —74-year-old woman with occluded left superficial femoral artery imaged with unenhanced MR angiography. Pulse sequence parameters are described in text. Imaging parameters were as follows: Aortoiliac station: TR/TE, 3 R-R ECG intervals/80; 256 x 256 matrix interpolated to 512 x 512; 2-mm slice thickness (interpolated to 1 mm); parallel imaging factor, 2; field of view, 400 x 380 mm; total acquisition time, 4 minutes. Thigh station: 3RR/80; 256 x 256 matrix; 3-mm slices (interpolated to 1.5 mm); parallel imaging factor, 1.5; field of view 400 x 380 mm; total acquisition time, 3.5 minutes. (Courtesy of Dr. Masaaki Akahane, University of Tokyo, Japan)

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati