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Intraarterial MR Angiography and DSA in Patients with Peripheral Arterial Occlusive Disease: Prospective Comparison¹

¹ From the Departments of Radiology (R.W.H., G.B., H.G.H., C.H., A.L.J., D.B.) and Angiology (M.A., K.J., C.T.), University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland; and Biocenter, University of Basel, Basel, Switzerland (A.C.S.). Received September 10, 2004; revision requested November 18; final revision received July 25, 2005; final version accepted August 11. Address correspondence to R.W.H. (e-mail: rhuegli{at}uhbs.ch).

View larger version (69K): [in a new window]   Figure 1a: Coronal images in a 68-year-old man with left-sided lower leg claudication. (a) T1-weighted two-dimensional fast low-angle shot scout image of the thigh (repetition time msec/echo time msec, 8.5/4.0; flip angle, 35°; matrix, 256 x 256; field of view, 500 x 375 mm; voxel size, 2.6 x 2.0 x 2.0 mm; acquisition time, 20 seconds). (b) MIP of a mask-subtracted three-dimensional gradient-echo image of the distal superficial and proximal popliteal arteries obtained with low-dose intraarterial MR angiography (2.8/1.1; flip angle, 20°; matrix, 448 x 314; field of view, 380 x 380 mm; voxel size, 0.8 x 1.2 x 1.3 mm; number of partitions, 48; acquisition time, 27 seconds). Several moderate and significant stenoses are depicted. Note the lesion (arrow) that was underestimated as a moderate stenosis with intraarterial MR angiography. An eccentric lesion (arrowhead) in the distal femoral artery was rated correctly as a significant stenosis with both modalities. (c) Corresponding intraarterial DSA image shows the same lesion (arrow) and eccentric lesion (arrowhead) seen in b.

View larger version (59K): [in a new window]   Figure 1b: Coronal images in a 68-year-old man with left-sided lower leg claudication. (a) T1-weighted two-dimensional fast low-angle shot scout image of the thigh (repetition time msec/echo time msec, 8.5/4.0; flip angle, 35°; matrix, 256 x 256; field of view, 500 x 375 mm; voxel size, 2.6 x 2.0 x 2.0 mm; acquisition time, 20 seconds). (b) MIP of a mask-subtracted three-dimensional gradient-echo image of the distal superficial and proximal popliteal arteries obtained with low-dose intraarterial MR angiography (2.8/1.1; flip angle, 20°; matrix, 448 x 314; field of view, 380 x 380 mm; voxel size, 0.8 x 1.2 x 1.3 mm; number of partitions, 48; acquisition time, 27 seconds). Several moderate and significant stenoses are depicted. Note the lesion (arrow) that was underestimated as a moderate stenosis with intraarterial MR angiography. An eccentric lesion (arrowhead) in the distal femoral artery was rated correctly as a significant stenosis with both modalities. (c) Corresponding intraarterial DSA image shows the same lesion (arrow) and eccentric lesion (arrowhead) seen in b.

View larger version (57K): [in a new window]   Figure 1c: Coronal images in a 68-year-old man with left-sided lower leg claudication. (a) T1-weighted two-dimensional fast low-angle shot scout image of the thigh (repetition time msec/echo time msec, 8.5/4.0; flip angle, 35°; matrix, 256 x 256; field of view, 500 x 375 mm; voxel size, 2.6 x 2.0 x 2.0 mm; acquisition time, 20 seconds). (b) MIP of a mask-subtracted three-dimensional gradient-echo image of the distal superficial and proximal popliteal arteries obtained with low-dose intraarterial MR angiography (2.8/1.1; flip angle, 20°; matrix, 448 x 314; field of view, 380 x 380 mm; voxel size, 0.8 x 1.2 x 1.3 mm; number of partitions, 48; acquisition time, 27 seconds). Several moderate and significant stenoses are depicted. Note the lesion (arrow) that was underestimated as a moderate stenosis with intraarterial MR angiography. An eccentric lesion (arrowhead) in the distal femoral artery was rated correctly as a significant stenosis with both modalities. (c) Corresponding intraarterial DSA image shows the same lesion (arrow) and eccentric lesion (arrowhead) seen in b.

View larger version (70K): [in a new window]   Figure 2a: Images obtained in a 65-year-old woman with left-sided lower leg claudication show significant stenosis at the origin of the peroneal (arrowhead) and posterior tibial (straight arrow) arteries and collateralization extending from the tibioperoneal trunk to the peroneal artery and fading with vessel occlusion in the descending part of the anterior tibial artery (curved arrow). (a) Coronal MIP of a mask-subtracted three-dimensional gradient-echo image of the proximal calf arteries acquired with intraarterial MR angiography (3.5/1.3; flip angle, 20°; matrix, 448 x 307; field of view, 380 x 326 mm; voxel size, 0.8 x 1.1 x 1.0 mm; acquisition time, 33 seconds). (b, c) Corresponding intraarterial DSA images obtained in the early (b) and late (c) phases of the examination.

View larger version (81K): [in a new window]   Figure 2b: Images obtained in a 65-year-old woman with left-sided lower leg claudication show significant stenosis at the origin of the peroneal (arrowhead) and posterior tibial (straight arrow) arteries and collateralization extending from the tibioperoneal trunk to the peroneal artery and fading with vessel occlusion in the descending part of the anterior tibial artery (curved arrow). (a) Coronal MIP of a mask-subtracted three-dimensional gradient-echo image of the proximal calf arteries acquired with intraarterial MR angiography (3.5/1.3; flip angle, 20°; matrix, 448 x 307; field of view, 380 x 326 mm; voxel size, 0.8 x 1.1 x 1.0 mm; acquisition time, 33 seconds). (b, c) Corresponding intraarterial DSA images obtained in the early (b) and late (c) phases of the examination.

View larger version (99K): [in a new window]   Figure 2c: Images obtained in a 65-year-old woman with left-sided lower leg claudication show significant stenosis at the origin of the peroneal (arrowhead) and posterior tibial (straight arrow) arteries and collateralization extending from the tibioperoneal trunk to the peroneal artery and fading with vessel occlusion in the descending part of the anterior tibial artery (curved arrow). (a) Coronal MIP of a mask-subtracted three-dimensional gradient-echo image of the proximal calf arteries acquired with intraarterial MR angiography (3.5/1.3; flip angle, 20°; matrix, 448 x 307; field of view, 380 x 326 mm; voxel size, 0.8 x 1.1 x 1.0 mm; acquisition time, 33 seconds). (b, c) Corresponding intraarterial DSA images obtained in the early (b) and late (c) phases of the examination.

View larger version (123K): [in a new window]   Figure 3: Coronal MIPs of a mask-subtracted three-dimensional gradient-echo image of the infrapopliteal arteries obtained with intraarterial MR angiography (3.5/1.3; flip angle, 20°; matrix, 448 x 307; field of view, 380 x 326 mm; voxel size, 0.8 x 1.1 x 1.0 mm; acquisition time, 33 seconds) in a 57-year-old woman with left-sided claudication symptoms (left image) and a 71-year-old man with right-sided claudication symptoms (right image). In the left image, intraarterial MR angiography reveals venous overlay that does not disturb the readout. Patent anterior tibial (arrowhead) and peroneal (arrow) arteries are seen; the peroneal artery is seen collateralizing on the distal tibial posterior artery. In the right image, severe venous contamination hampers the readout, with multiple stenoses visible in the anterior tibial artery (straight arrows). The peroneal artery (curved arrow) cannot be fully appreciated.

View larger version (138K): [in a new window]   Figure 4: Images in a 79-year-old woman with right-sided lower leg claudication who had undergone total knee replacement. Left: Coronal MIP of a mask-subtracted three-dimensional gradient-echo image of the knee obtained with low-dose intraarterial MR angiography (2.8/1.1; flip angle, 20°; matrix, 448 x 314; field of view, 380 x 380 mm; voxel size, 0.8 x 1.2 x 1.3 mm; acquisition time, 27 seconds) shows a short significant stenosis (arrow) in the popliteal artery at the level of the total knee arthroplasty. However, the lack of collateral vessels and the frank visualization of the vessel distal to the prosthesis indicate that there may not be any significant stenosis at the popliteal level. Right: Corresponding intraarterial DSA image with a lateral view of the knee and popliteal artery (inset) reveals a patent popliteal vessel (arrowheads) without stenoses.