author, Stefan O. Schoenberg, MD
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Clinical History:
This 75-year-old woman presented to our angiography department with a longstanding history of peripheral arterial occlusive disease, hypertension, Hypercholesterolemia and rest pain in the right calf (Fontaine stage III).
Diagnosis:
Peripheral arterial occlusive disease, Fontaine stage II.
MR Technique:
During a single MR-exam at 3.0Tesla, patients underwent NE-MRA (images A/ “nativeSPACE”, TR=2R-R intervals, TE=34ms, voxel size 1.4 x 1.4 x 1.3mm3) of the calf station as well as contrast-enhanced continuous table movement (CTM)-MRA (images B/ TR=2.4ms/ TE=1.0ms/ 1.2mm isotropic resolution) and a time-resolved, high resolution TWIST-MRA (images C/ TR=2.8ms/ TE=1.1ms)/ 1.1mm isotropic resolution). The examination was performed on a 32-channel scanner (Siemens MAGNETOM Tim Trio) using a dedicated peripheral angiography matrix coil with 36 independent coil elements. For the NE-MRA a non-enhanced, ECG-gated, turbo-spin echo sequence was acquired. For the contrast-enhanced techniques a total of 0.1 mmol/kg BW gadobutrol was injected at 1.5 mL/s using a power injector (70% for CTM-MRA and 30% for TWIST-MRA). For more technical details concerning the MR protocol, please refer to the case “Peripheral arterial oclusive disease, Fontaine stage IIA. MR-Angiography of the lower extremities, comparing non-enhanced and contrast-enhanced MRA techniques.”
Imaging Findings:
In the coronal MIP-images three different MR-angiography techniques are presented (A.1/2 NE-MRA, B.1/2 CTM-MRA, C.1/2 TWIST-MRA). Due to motion artifacts, the non-enhanced MRA do not yield diagnostic image quality of the left lower extremity. This is a consequent of the ECG-triggered sequence, which acquires images during systole and diastole and subtracts the diastolic from the systolic data set. Motion between the acquisition of the systolic and diastolic images leads to mis-subtraction and non-diagnostic image quality of the arterial vascular tree. Excellent diagnostic image quality can be found for both contrast-enhanced techniques.
On both sides, the tibial posterior artery is the main vessel in the calf station, whereby the right side shows a few, short, high-grade stenoses. The tibial anterior artery is occluded in the proximal part, but in both contrast-enhanced techniques the vessel presents a longer definable lumen. In the close up (A.2 NE-MRA, B.2 CTM-MRA, C.2 TWIST-MRA) of the right side a high grade stenosis of the tibia-peroneal trunk can be depicted.
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