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Technology Insight: magnetic resonance angiography for the evaluation of patients with peripheral artery disease

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 677–687 (2007)Cite this article

Abstract

Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis. Although clinical history in conjunction with ankle–brachial index and evaluation of segmental pressures/waveforms is sufficient to diagnose PAD in a large percentage of patients, imaging is required for disease localization and treatment planning. Contrast-enhanced magnetic resonance angiography (CE-MRA) is a noninvasive, three-dimensional technique that has emerged as a front-line imaging approach for comprehensive evaluation of PAD. Technical advances such as parallel imaging and moving-table, time-resolved angiography and extended field-of-view approaches have greatly improved the accuracy of CE-MRA. In the clinical setting, CE-MRA can be extremely helpful in the initial diagnosis as well as subsequent management of patients with PAD. Continued hardware and software improvements will enable further refinements in imaging protocol for peripheral MRA, consolidating its clinical role for the evaluation of patients with PAD.

Key Points

  • Peripheral arterial disease (PAD) represents a common manifestation of systemic atherosclerosis

  • Peripheral magnetic resonance angiography (MRA) could aid in the management of patients with PAD and, in particular, in those with an indication for revascularization

  • MRA techniques, with and without contrast, can be used in the study of lower-extremity vessels; however, contrast-enhanced MRA represent the preferred approach because of its ability to provide a high-resolution three-dimensional data-set of images

  • High-quality peripheral MRA studies incorporate a series of technical advancements (e.g. moving-table technique, parallel imaging, strategies for correct timing of image acquisition)

  • With peripheral contrast-enhanced MRA, unwanted venous contrast opacification during image acquisition at the calf level (venous contamination) remains one of the most common pitfalls

  • Peripheral MRA is a safe and accurate technique for the diagnosis and management of lower-extremity arterial disease, with important advantages such as safety, higher diagnostic accuracy and better repeatability when compared with other techniques such as invasive angiography CT angiography and duplex ultrasonography

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Figure 1: Black-blood imaging of the superficial femoral artery (magnified in the insert) revealing the absence of atherosclerotic disease.
Figure 2: Contrast-enhanced magnetic resonance angiography of the peripheral vasculature.
Figure 3: Peripheral contrast-enhanced magnetic resonance angiography with moving-table technique.
Figure 4: Dedicated time-resolved contrast-enhanced magnetic resonance angiography of the legs showing progressive contrast opacification of distal circulation during (A) initial, (B) intermediate and (C) late time frames.
Figure 5: Suggested diagnostic algorithm in patients with known or suspected peripheral artery disease.
Figure 6: Ilio-femoral arterial disease detected by contrast-enhanced magnetic resonance angiography.
Figure 7: Multistation contrast-enhanced magnetic resonance angiographies for peripheral vessel disease.

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Acknowledgements

Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. and AJ Einstein is Assistant Professor at the Department of Medicine, Division of Cardiology and Department of Radiology, S Dellegrottaglie is Adjunct Instructor of Medicine, J Sanz is Assistant Professor, and F Macaluso is a Research Radiology Technologist, at the Zena and Michael A Wiener Cardiovascular Institute and the Marie-Josée and Henry R Kravis Center for Cardiovascular Health, Mount Sinai Medical Center, Columbia University College of Physicians and Surgeons, New York, NY.,

    Santo Dellegrottaglie, Javier Sanz, Frank Macaluso & Andrew J Einstein

  2. Division of Cardiovascular Medicine. Subha Raman is Associate Professor of Medicine and S Rajagopalan is Professor of Medicine and Radiology, Division of Cardiovascular Medicine, OP Simonetti is Associate Professor of Internal Medicine and Radiology, and Director of Cardiovascular MRI and CT Research, Ohio State University, Columbus, OH, USA.,

    Subha Raman, Orlando P Simonetti & Sanjay Rajagopalan

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Correspondence to Sanjay Rajagopalan.

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OP Simonetti has served as Director of Cardiovascular MRI Research and Development at Siemens Medical Solutions, Inc.

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Dellegrottaglie, S., Sanz, J., Macaluso, F. et al. Technology Insight: magnetic resonance angiography for the evaluation of patients with peripheral artery disease. Nat Rev Cardiol 4, 677–687 (2007). https://doi.org/10.1038/ncpcardio1035

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