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High-Spatial-Resolution Contrast-enhanced MR Angiography of the Renal Arteries: A Prospective Comparison with Digital Subtraction Angiography¹

¹ From the Magnetic Resonance Laboratory, Mayo Clinic, 200 1st St SW, Rochester, MN 55905. Received February 16, 2000; revision requested March 27; revision received May 1; accepted May 22. Supported by National Institutes of Health grants CA37993 and HL37310 and GE Medical Systems. Address correspondence to S.J.R. (e-mail: riederer@mayo.edu).

View larger version (154K): [in a new window]   Figure 1a. Significant focal stenosis (short straight arrows) at the origin of the right main renal artery in a 59-year-old woman is clearly depicted in the (a) anteroposterior digital subtraction angiogram and (b) full coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram. (c) Full coronal maximum intensity projection image of the large-FOV MR angiogram shows that the proximal right main renal arterial stenosis appears to be normal at this spatial resolution. Note the blurring in the distal right segmental arteries (curved arrow in b) indicative of renal arterial motion during imaging. There is a 99% stenosis (long straight arrow in b and c) in the left main renal artery, which results in faint but visible enhancement of the left segmental renal arteries in b and c. The left renal arteries were not seen in a. Pulse sequence parameters are as summarized in Table 1.

View larger version (106K): [in a new window]   Figure 1b. Significant focal stenosis (short straight arrows) at the origin of the right main renal artery in a 59-year-old woman is clearly depicted in the (a) anteroposterior digital subtraction angiogram and (b) full coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram. (c) Full coronal maximum intensity projection image of the large-FOV MR angiogram shows that the proximal right main renal arterial stenosis appears to be normal at this spatial resolution. Note the blurring in the distal right segmental arteries (curved arrow in b) indicative of renal arterial motion during imaging. There is a 99% stenosis (long straight arrow in b and c) in the left main renal artery, which results in faint but visible enhancement of the left segmental renal arteries in b and c. The left renal arteries were not seen in a. Pulse sequence parameters are as summarized in Table 1.

View larger version (131K): [in a new window]   Figure 1c. Significant focal stenosis (short straight arrows) at the origin of the right main renal artery in a 59-year-old woman is clearly depicted in the (a) anteroposterior digital subtraction angiogram and (b) full coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram. (c) Full coronal maximum intensity projection image of the large-FOV MR angiogram shows that the proximal right main renal arterial stenosis appears to be normal at this spatial resolution. Note the blurring in the distal right segmental arteries (curved arrow in b) indicative of renal arterial motion during imaging. There is a 99% stenosis (long straight arrow in b and c) in the left main renal artery, which results in faint but visible enhancement of the left segmental renal arteries in b and c. The left renal arteries were not seen in a. Pulse sequence parameters are as summarized in Table 1.

View larger version (135K): [in a new window]   Figure 2a. (a, b) Anteroposterior x-ray angiograms obtained in a 73-year-old man reveal a severe stenosis (short arrow in a) in the proximal left main renal artery in (a) the unsubtracted view and a distal stenosis (curved arrow in b) in the right main renal artery in (b) the digitally subtracted view. Also, segmental stenoses (long straight arrow in a and b) are seen bilaterally. (c) Coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram shows excellent correspondence to the digital subtraction angiograms for the left main renal arterial stenosis (middle straight arrow) and distal right main stenosis (curved arrow). Bilateral segmental disease (outermost straight arrows) is also well depicted. (d) Magnified coronal subvolume of the large-FOV MR angiogram depicts the proximal left main renal arterial stenosis (middle straight arrow) well, but depiction of the segmental stenoses (outermost straight arrows) and distal right main renal arterial stenosis (curved arrow) is limited by inadequate spatial resolution and interference from parenchymal enhancement. Pulse sequence parameters are as summarized in Table 1.

View larger version (155K): [in a new window]   Figure 2b. (a, b) Anteroposterior x-ray angiograms obtained in a 73-year-old man reveal a severe stenosis (short arrow in a) in the proximal left main renal artery in (a) the unsubtracted view and a distal stenosis (curved arrow in b) in the right main renal artery in (b) the digitally subtracted view. Also, segmental stenoses (long straight arrow in a and b) are seen bilaterally. (c) Coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram shows excellent correspondence to the digital subtraction angiograms for the left main renal arterial stenosis (middle straight arrow) and distal right main stenosis (curved arrow). Bilateral segmental disease (outermost straight arrows) is also well depicted. (d) Magnified coronal subvolume of the large-FOV MR angiogram depicts the proximal left main renal arterial stenosis (middle straight arrow) well, but depiction of the segmental stenoses (outermost straight arrows) and distal right main renal arterial stenosis (curved arrow) is limited by inadequate spatial resolution and interference from parenchymal enhancement. Pulse sequence parameters are as summarized in Table 1.

View larger version (120K): [in a new window]   Figure 2c. (a, b) Anteroposterior x-ray angiograms obtained in a 73-year-old man reveal a severe stenosis (short arrow in a) in the proximal left main renal artery in (a) the unsubtracted view and a distal stenosis (curved arrow in b) in the right main renal artery in (b) the digitally subtracted view. Also, segmental stenoses (long straight arrow in a and b) are seen bilaterally. (c) Coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram shows excellent correspondence to the digital subtraction angiograms for the left main renal arterial stenosis (middle straight arrow) and distal right main stenosis (curved arrow). Bilateral segmental disease (outermost straight arrows) is also well depicted. (d) Magnified coronal subvolume of the large-FOV MR angiogram depicts the proximal left main renal arterial stenosis (middle straight arrow) well, but depiction of the segmental stenoses (outermost straight arrows) and distal right main renal arterial stenosis (curved arrow) is limited by inadequate spatial resolution and interference from parenchymal enhancement. Pulse sequence parameters are as summarized in Table 1.

View larger version (125K): [in a new window]   Figure 2d. (a, b) Anteroposterior x-ray angiograms obtained in a 73-year-old man reveal a severe stenosis (short arrow in a) in the proximal left main renal artery in (a) the unsubtracted view and a distal stenosis (curved arrow in b) in the right main renal artery in (b) the digitally subtracted view. Also, segmental stenoses (long straight arrow in a and b) are seen bilaterally. (c) Coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram shows excellent correspondence to the digital subtraction angiograms for the left main renal arterial stenosis (middle straight arrow) and distal right main stenosis (curved arrow). Bilateral segmental disease (outermost straight arrows) is also well depicted. (d) Magnified coronal subvolume of the large-FOV MR angiogram depicts the proximal left main renal arterial stenosis (middle straight arrow) well, but depiction of the segmental stenoses (outermost straight arrows) and distal right main renal arterial stenosis (curved arrow) is limited by inadequate spatial resolution and interference from parenchymal enhancement. Pulse sequence parameters are as summarized in Table 1.

View larger version (178K): [in a new window]   Figure 3a. Fibromuscular dysplasia indicated by a string of beaded stenoses in a 59-year-old woman is clearly visible in the middle portion of the right main renal artery (straight arrow) on the (a) anteroposterior digital subtraction angiogram and (b) full coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram but is less clearly depicted on the (c) magnified coronal subvolume maximum intensity projection image of the large-FOV MR angiogram. Note also the right accessory renal artery (curved arrow) is well depicted in b and is only faintly depicted in c owing to inferior spatial resolution. Pulse sequence parameters are as summarized in Table 1.

View larger version (154K): [in a new window]   Figure 3b. Fibromuscular dysplasia indicated by a string of beaded stenoses in a 59-year-old woman is clearly visible in the middle portion of the right main renal artery (straight arrow) on the (a) anteroposterior digital subtraction angiogram and (b) full coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram but is less clearly depicted on the (c) magnified coronal subvolume maximum intensity projection image of the large-FOV MR angiogram. Note also the right accessory renal artery (curved arrow) is well depicted in b and is only faintly depicted in c owing to inferior spatial resolution. Pulse sequence parameters are as summarized in Table 1.

View larger version (155K): [in a new window]   Figure 3c. Fibromuscular dysplasia indicated by a string of beaded stenoses in a 59-year-old woman is clearly visible in the middle portion of the right main renal artery (straight arrow) on the (a) anteroposterior digital subtraction angiogram and (b) full coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram but is less clearly depicted on the (c) magnified coronal subvolume maximum intensity projection image of the large-FOV MR angiogram. Note also the right accessory renal artery (curved arrow) is well depicted in b and is only faintly depicted in c owing to inferior spatial resolution. Pulse sequence parameters are as summarized in Table 1.

View larger version (26K): [in a new window]   Figure 4a. (a) Bar graph shows that for high-spatial-resolution small-FOV MR angiography (white bars), depiction of the segmental renal arteries was adequate or more than adequate for diagnosis in 19 (76%) of 25 of the patients. Segmental arteries were depicted adequately at only four (17%) of 23 of the large-FOV MR angiographic examinations (gray bars). (b) Bar graph shows that degradation of image quality for segmental renal arterial depiction owing to motion is nearly identical for high-spatial-resolution small-FOV MR angiography (white bars) and large-FOV MR angiography (gray bars). Motion degradation is not visible or is minimal in more than 80% of patients.

View larger version (23K): [in a new window]   Figure 4b. (a) Bar graph shows that for high-spatial-resolution small-FOV MR angiography (white bars), depiction of the segmental renal arteries was adequate or more than adequate for diagnosis in 19 (76%) of 25 of the patients. Segmental arteries were depicted adequately at only four (17%) of 23 of the large-FOV MR angiographic examinations (gray bars). (b) Bar graph shows that degradation of image quality for segmental renal arterial depiction owing to motion is nearly identical for high-spatial-resolution small-FOV MR angiography (white bars) and large-FOV MR angiography (gray bars). Motion degradation is not visible or is minimal in more than 80% of patients.

View larger version (153K): [in a new window]   Figure 5a. Example of an MR angiographic study with no visible motion in the region of the segmental renal arteries in a 78-year-old man. (a) Anteroposterior digital subtraction angiogram shows severe proximal main renal arterial stenoses (curved arrows in a-d) bilaterally, which are well depicted on the (b) coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram. The segmental renal arteries are also well depicted on both the (c) anteroposterior selective digital subtraction angiogram of the left main renal artery and (d) magnified coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram. A left accessory renal artery (straight arrows in a, b, and d) is also well depicted. Pulse sequence parameters are as summarized in Table 1. PRE = preangioplasty image.

View larger version (154K): [in a new window]   Figure 5b. Example of an MR angiographic study with no visible motion in the region of the segmental renal arteries in a 78-year-old man. (a) Anteroposterior digital subtraction angiogram shows severe proximal main renal arterial stenoses (curved arrows in a-d) bilaterally, which are well depicted on the (b) coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram. The segmental renal arteries are also well depicted on both the (c) anteroposterior selective digital subtraction angiogram of the left main renal artery and (d) magnified coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram. A left accessory renal artery (straight arrows in a, b, and d) is also well depicted. Pulse sequence parameters are as summarized in Table 1. PRE = preangioplasty image.

View larger version (110K): [in a new window]   Figure 5c. Example of an MR angiographic study with no visible motion in the region of the segmental renal arteries in a 78-year-old man. (a) Anteroposterior digital subtraction angiogram shows severe proximal main renal arterial stenoses (curved arrows in a-d) bilaterally, which are well depicted on the (b) coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram. The segmental renal arteries are also well depicted on both the (c) anteroposterior selective digital subtraction angiogram of the left main renal artery and (d) magnified coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram. A left accessory renal artery (straight arrows in a, b, and d) is also well depicted. Pulse sequence parameters are as summarized in Table 1. PRE = preangioplasty image.

View larger version (101K): [in a new window]   Figure 5d. Example of an MR angiographic study with no visible motion in the region of the segmental renal arteries in a 78-year-old man. (a) Anteroposterior digital subtraction angiogram shows severe proximal main renal arterial stenoses (curved arrows in a-d) bilaterally, which are well depicted on the (b) coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram. The segmental renal arteries are also well depicted on both the (c) anteroposterior selective digital subtraction angiogram of the left main renal artery and (d) magnified coronal maximum intensity projection image of the high-spatial-resolution small-FOV MR angiogram. A left accessory renal artery (straight arrows in a, b, and d) is also well depicted. Pulse sequence parameters are as summarized in Table 1. PRE = preangioplasty image.