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Peripheral Vascular Disease: Combined 3D Bolus Chase and Dynamic 2D MR Angiography Compared with X-ray Angiography for Treatment Planning¹

¹ From the Departments of Radiology (N.M.K., P.A.W., M.R.P., E.V., D.W.T., R.W., Y.W.) and Surgery (H.L.B.), New York Presbyterian Hospital, Weill Medical College of Cornell University, 525 E 68th St, Rm P-519, New York, NY 10021. Received February 5, 2001; revision requested March 26; final revision received November 14; accepted December 11. Address correspondence to N.M.K. (e-mail: nmkhilna@med.cornell.edu).

View larger version (131K): [in a new window]   Figure 1. (A, B) Coronal 3D bolus chase MR angiograms (4.8/1.1) of the (A) pelvis and (B) thigh and (C, D) coronal 2D MR DSA images (9.0/1.9) obtained from the adductor canal to the feet are compared with (E, F) nonselective x-ray angiograms obtained to the knees and (G, H) selective lateral x-ray angiograms obtained below the knee in a patient with lifestyle-limiting left calf claudication. Note the excellent correlation of the significant distal left superficial femoral artery (arrow in B and F), tibioperoneal trunk (arrows in C and G), and focal distal posterior tibial artery (arrow in D and H) stenoses.

View larger version (148K): [in a new window]   Figure 2. (A, B) Coronal 3D bolus chase MR angiograms (4.8/1.1) obtained to the knees, (C) coronal 2D MR DSA image (9.0/1.9) obtained from the adductor canal to the middle portion of the calf, and (D, E) sagittal 2D MR DSA images (9.0/1.9) of the left infrapopliteal vessels in an elderly diabetic woman with left limb-threatening ischemia. (F-H) Corresponding coronal nonselective x-ray angiograms obtained to the middle portion of the calf and (I, J) sagittal selective x-ray angiograms obtained to the foot. The severe left external iliac artery stenosis is well depicted at both MR angiography (arrow in A) and x-ray angiography (arrow in F). For viewing reference, the knee joint is demonstrated with arrows in C, D, H, and I.

View larger version (155K): [in a new window]   Figure 3. (A, B) Coronal 3D bolus chase MR angiograms (4.8/1.1) obtained to the knees, (C) coronal 2D MR DSA image (9.0/1.9) of the left leg from the knee to the middle portion of the calf, and (D) sagittal 2D MR DSA image (9.0/1.9) of the left lower part of the calf and foot in a patient with left lower extremity limb-threatening ischemia associated with a thrombosed popliteal artery aneurysm. (E) Corresponding coronal nonselective x-ray angiogram of the pelvis and (F-J) sagittal selective x-ray angiograms obtained to the foot. The thrombosed popliteal artery at the knee joint is well depicted at both MR angiography (arrow in C) and x-ray angiography (arrow in H). The reconstituted peroneal artery is depicted at both MR angiography (arrow in D) and x-ray angiography (arrow in I). The peroneal artery was difficult to opacify at x-ray angiography despite vasodilation, increased full-strength volumes of contrast material, and delayed imaging.

View larger version (133K): [in a new window]   Figure 4. Discrepant (A, B) coronal 3D bolus chase MR angiographic (4.8/1.1), (C, D) coronal 2D MR DSA (9.0/1.9), (E-G) coronal x-ray angiographic, and (H, I) sagittal x-ray angiographic interpretations caused by susceptibility artifact at imaging in a patient with left calf claudication. A clip artifact (arrow in E) noted on the x-ray angiogram produced artifactual occlusion (arrow in A) of the distal left external iliac artery on the MR angiogram.

View larger version (72K): [in a new window]   Figure 5a. Discrepant (a) coronal and (b) sagittal 2D MR DSA (9.0/1.9) and (c-e) selective sagittal x-ray angiographic interpretations caused by motion artifacts at imaging in a patient with right lower extremity limb-threatening ischemia. At x-ray angiography, all three readers selected the proximal peroneal artery for outflow. However, at MR angiography only one reader selected the proximal peroneal artery for outflow; the other two readers selected the dorsal artery of the foot. All three readers graded the MR angiographic depiction of outflow segments as poor. Motion-related image blurring was believed to be the cause of the suboptimal MR angiograms. The lower leg regions were not restrained in the head coil, and no attempt was made to repeat these MR angiographic studies. However, the legs were restrained, and sedation, several repeat sequences, and pixel shifting were required to obtain the x-ray angiograms. The arrow in a and c points to the knee joint, and the arrow in b and e points to the ankle joint.

View larger version (82K): [in a new window]   Figure 5b. Discrepant (a) coronal and (b) sagittal 2D MR DSA (9.0/1.9) and (c-e) selective sagittal x-ray angiographic interpretations caused by motion artifacts at imaging in a patient with right lower extremity limb-threatening ischemia. At x-ray angiography, all three readers selected the proximal peroneal artery for outflow. However, at MR angiography only one reader selected the proximal peroneal artery for outflow; the other two readers selected the dorsal artery of the foot. All three readers graded the MR angiographic depiction of outflow segments as poor. Motion-related image blurring was believed to be the cause of the suboptimal MR angiograms. The lower leg regions were not restrained in the head coil, and no attempt was made to repeat these MR angiographic studies. However, the legs were restrained, and sedation, several repeat sequences, and pixel shifting were required to obtain the x-ray angiograms. The arrow in a and c points to the knee joint, and the arrow in b and e points to the ankle joint.

View larger version (68K): [in a new window]   Figure 5c. Discrepant (a) coronal and (b) sagittal 2D MR DSA (9.0/1.9) and (c-e) selective sagittal x-ray angiographic interpretations caused by motion artifacts at imaging in a patient with right lower extremity limb-threatening ischemia. At x-ray angiography, all three readers selected the proximal peroneal artery for outflow. However, at MR angiography only one reader selected the proximal peroneal artery for outflow; the other two readers selected the dorsal artery of the foot. All three readers graded the MR angiographic depiction of outflow segments as poor. Motion-related image blurring was believed to be the cause of the suboptimal MR angiograms. The lower leg regions were not restrained in the head coil, and no attempt was made to repeat these MR angiographic studies. However, the legs were restrained, and sedation, several repeat sequences, and pixel shifting were required to obtain the x-ray angiograms. The arrow in a and c points to the knee joint, and the arrow in b and e points to the ankle joint.

View larger version (76K): [in a new window]   Figure 5d. Discrepant (a) coronal and (b) sagittal 2D MR DSA (9.0/1.9) and (c-e) selective sagittal x-ray angiographic interpretations caused by motion artifacts at imaging in a patient with right lower extremity limb-threatening ischemia. At x-ray angiography, all three readers selected the proximal peroneal artery for outflow. However, at MR angiography only one reader selected the proximal peroneal artery for outflow; the other two readers selected the dorsal artery of the foot. All three readers graded the MR angiographic depiction of outflow segments as poor. Motion-related image blurring was believed to be the cause of the suboptimal MR angiograms. The lower leg regions were not restrained in the head coil, and no attempt was made to repeat these MR angiographic studies. However, the legs were restrained, and sedation, several repeat sequences, and pixel shifting were required to obtain the x-ray angiograms. The arrow in a and c points to the knee joint, and the arrow in b and e points to the ankle joint.

View larger version (104K): [in a new window]   Figure 5e. Discrepant (a) coronal and (b) sagittal 2D MR DSA (9.0/1.9) and (c-e) selective sagittal x-ray angiographic interpretations caused by motion artifacts at imaging in a patient with right lower extremity limb-threatening ischemia. At x-ray angiography, all three readers selected the proximal peroneal artery for outflow. However, at MR angiography only one reader selected the proximal peroneal artery for outflow; the other two readers selected the dorsal artery of the foot. All three readers graded the MR angiographic depiction of outflow segments as poor. Motion-related image blurring was believed to be the cause of the suboptimal MR angiograms. The lower leg regions were not restrained in the head coil, and no attempt was made to repeat these MR angiographic studies. However, the legs were restrained, and sedation, several repeat sequences, and pixel shifting were required to obtain the x-ray angiograms. The arrow in a and c points to the knee joint, and the arrow in b and e points to the ankle joint.

View larger version (107K): [in a new window]   Figure 6a. (a) Coronal 2D MR DSA (9.0/1.9) and (b) selective frontal x-ray angiograms of the lower part of the thigh and upper part of the calf of a patient with right lower extremity claudication. (b) One of the three readers read stenosis of the above-knee popliteal artery (arrow) at x-ray angiography. (a) None of the readers read stenosis (arrow) at MR angiography. Overlapping geniculate branches potentially obscuring a stenosis on a single-projection view may cause this discrepancy.

View larger version (68K): [in a new window]   Figure 6b. (a) Coronal 2D MR DSA (9.0/1.9) and (b) selective frontal x-ray angiograms of the lower part of the thigh and upper part of the calf of a patient with right lower extremity claudication. (b) One of the three readers read stenosis of the above-knee popliteal artery (arrow) at x-ray angiography. (a) None of the readers read stenosis (arrow) at MR angiography. Overlapping geniculate branches potentially obscuring a stenosis on a single-projection view may cause this discrepancy.