author, Stefan O. Schoenberg, MD
 Image A |
 Image B |
 Image C |
 Image D |
 Image E |
 Image F |
 Image G |
 Image H |
 Image I |
Clinical History:
Three different patients presented to our MR department with known history of peripheral arterial occlusive disease (PAOD, Fontaine stage II-III).
MR Technique:
MR-angiography (MRA) with three different techniques were performed during a single MR-exam at 3.0 Tesla (Siemens MAGNETOM Tim Trio) using a dedicated peripheral angiography matrix coil with 36 independent coil elements. Initial a non-contrast NE-MRA (images A,D,G/ “nativeSPACE”, TR=2R-R intervals, TE=34ms, voxel size 1.4 x 1.4 x 1.3mm3 ) of the calf station was acquired as well as a contrast-enhanced continuous table movement (CTM)-MRA (images B,E,H/ TR=2.4ms/ TE=1.0ms/ 1.2mm isotropic resolution). Finally a contrast-enhanced, time-resolved, high resolution TWIST-MRA (images C,F,I/ TR=2.8ms/ TE=1.1ms)/ 1.1mm isotropic resolution) was performed. The non-enhanced technique used aECG-gated, turbo-spin echo sequence. For the CTM- and the TWIST-MRA a total of 0.1 mmol/kg BW gadobutrol was injected at 1.5 mL/s, which was split 70%/30% for CTM-MRA/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 technical limitations are shown. To obtain the images of the arterial vessels, the NR-MRA subtracts the diastolic from the systolic data sets. The non-enhanced MRA in image A provides only restricted diagnostic image quality of both sides due to slight motions during the systolic and diastolic images.
In image D, the vascularization of the right lower extremity is hardly depictable due to side different in-flow, because of a high grade stenosis in the superficial femoral artery.
The vessels of the right distal extremity (image G) present extensive blurring and a resulting overestimation of the lumen. This may be a consequent of the chosen phase-encoding direction, which was perpendicular to the vessel orientation, resulting in T2w blurring artifacts but keeping the scan time as short as possible
In all three patients excellent diagnostic image quality can be depicted in both contrast-enhanced MRA techniques (images B/C; E/F, H/I).
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