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Vascular and Interventional Radiology |
1 From the Depts of Magnetic Resonance Imaging (J.F.M.M., A.R.) and Medical Physics (J.P.R., A.R., M.A.S.), Leeds General Infirmary, United Kingdom; Dept of Radiology, Bradford Royal Infirmary, Leeds (S.C.); Dept of Radiology, St James University Hospital, Leeds (I.R., D.K.); and Philips Medical Systems, Best, the Netherlands (M.K., A.K.). Received Oct 8, 1997; revision requested Nov 24; final revision received Aug 19, 1998; accepted Nov 5. Supported by Northern and Yorkshire Research and Development Directorate. Address reprint requests to J.F.M.M., CT Department, Jubillee Wing, Leeds General Infirmary, Leeds LS2 1EX, United Kingdom.
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Abstract |
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 TOP Abstract IntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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MATERIALS AND METHODS: Twenty patients underwent both conventional catheter angiography and fast three-dimensional gadolinium-enhanced MR angiography of the aorta and outflow vessels at 1.5 T; the images were acquired in three consecutive imaging locations during a single infusion of a gadolinium chelate.
RESULTS: Compared with catheter angiography, according to the findings of two blinded independent reviewers, MR angiography had sensitivities of 81% and 89% and specificities of 91% and 95%, respectively, for demonstration of insignificant (
50%) stenosis versus significant (51%–100%) stenosis. For demonstration of occlusion, the sensitivity and specificity were 94% and 97%, respectively, by consensus. There was good interobserver correlation between the two readers overall (
= 0.65 for reporting the degree of narrowing in all lesions; 0.86, for reporting of insignificant versus significant stenoses; and 0.928, for reporting of occluded versus patent segments).
CONCLUSION: Stepping-table digital subtraction contrast material–enhanced MR angiography has high accuracy compared with catheter angiography in patients with arterio-occlusive disease of the aorta and outflow vessels. These preliminary study results suggest that this technique may ultimately provide a safe, noninvasive, and cost-effective alternative to catheter angiography.
Index terms: Angiography, contrast media, 928.1211, 928.122, 988.1211, 988.122 • Angiography, technology, 928.1211, 928.122, 988.1211, 988.122 • Aorta, stenosis or obstruction, 981.721 • Arteries, stenosis or obstruction, 928.721, 988.721 • Magnetic resonance (MR), vascular studies, 928.121412, 928.12942, 988.121412, 988.12942
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Introduction |
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TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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Specific complications such as groin hematoma, vessel dissection, and distal embolization are inherent to x-ray angiography. In an attempt to make the approach less invasive, intravenous digital subtraction angiography (DSA) was used, but it had a limited and short-lived success and thus is no longer routinely used. Directly related to the invasive nature of the procedure is the requirement for hospital stay, which contributes greatly to the overall cost; although minipuncture arteriography with 3–4-F catheters eliminates this requirement, it is not universally favored (8).
Although noninvasive evaluation of the lower limb arteries is possible with two-dimensional time-of-flight imaging, this technique is susceptible to artifacts from inplane saturation and is costly because of the long examination time, and therefore, it is not widely available (9–23). Recent advances in gadolinium-enhanced three-dimensional (3D) magnetic resonance (MR) angiography have facilitated rapid, high-definition imaging of the arterial tree during the arterial phase by using a gadolinium chelate bolus (24,25). These techniques have proved to be robust, accurate, and reproducible in clinical practice and have essentially replaced time-of-flight MR angiography in many areas (25–27). In this article, we describe an approach that combines the inherent advantages of contrast material–enhanced 3D image acquisition with table movement to extend the scope of the examination beyond a single field of view and thus enable rapid and comprehensive evaluation of the aorta and lower extremity vessels. Our purpose was to compare stepping-table digital subtraction gadolinium-enhanced MR angiography of the distal aorta and lower extremity arteries with conventional catheter digital subtraction x-ray angiography in patients with arterio-occlusive disease.
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MATERIALS AND METHODS |
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TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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MR Angiography
All imaging was performed with a 1.5-T MR imaging unit equipped with prototypic gradients (maximum amplitude, 15 mT/m; slew rate, 50 mT/m/msec) (Gyroscan ACS NT; Philips Medical Systems, Best, the Netherlands). The body coil was used for signal transmission and reception.
The patients were placed in a supine position feet-first on the table, which was appropriately positioned for imaging of the abdomen and pelvis. The knees and ankles were raised on foam cushions to ensure that the vessels of the thighs and legs, after table movement, would be included in a 10-cm coronal imaging volume positioned appropriately for imaging the aortoiliac segments. No attempt was made to restrain the legs, but the patients were instructed to remain still during image acquisition.
A two-dimensional magnetization-prepared gradient-echo inflow technique was used for localization (8.0/2.3 [repetition time msec/echo time msec], 60° flip angle, 256 x 128 matrix, asymmetric [40 x 30-cm] field of view). Anteroposterior and lateral maximum intensity projection (MIP) images were generated from 40 x 3-mm-thick sections with a 7-mm intersection gap covering 40 cm in the craniocaudal direction. The total acquisition time for the localizer was 1 minute, 37 seconds; reconstruction of the MIP images took, on average, an additional 30 seconds. Localization was performed in the pelvis only; if further localization had been performed in the thighs and legs, the table position for the earlier localization and the position of the most cranial part of the imaging section with respect to the aortic bifurcation would have been lost.
A fast 3D spoiled gradient-echo sequence was used for acquisition of the images (9.3/2.3, 45° flip angle, 512 x 164 matrix, one signal acquired, no flow compensation, 80% rectangular field of view (40 x 32 cm), ±45-kHz bandwidth, 10-cm imaging volume) obtained before and after contrast material administration. A total of six dynamic images were planned, three before and three after contrast material administration (10-cm volume, 25 4-mm sections reconstructed with a zero-fill algorithm to produce 50 2-mm-thick sections) (28). The imaging time per dynamic image was 32 seconds. The acquisition voxel size was 7.7 mm3 (0.8 x 2.4 x 4.0 mm).
The 3D imaging sequence was planned from the anteroposterior and lateral MIP images of the aortoiliac segments obtained from the localization study. The imaging volume was oriented coronally to give maximum coverage of the vasculature such that the femoral arteries, which form the most anterior part of the aortoiliac system when the patient is in the supine position, were located just inside the anterior aspect of the imaging volume. After carefully placing the 3D imaging volume to include the aorta, iliac arteries, and upper femoral arteries, the knees and ankles were raised on foam cushions to ensure that the posteriorly but superficially placed popliteal artery and the anterior and posterior tibial arteries at the ankles were located within the 10-cm imaging volume. Although the renal arteries were included in the imaging volume in many patients, images in the abdomen were acquired during free breathing and therefore were not evaluated.
Registration of Pre- and Postcontrast Images
A simple homemade clamp, the Glide `n' Go, was developed in-house as follows to allow accurate registration of pre- and postcontrast table positions. Two 15-cm-long pieces of wood and two 10-cm-long aluminum strips were used. Eight-millimeter holes were drilled in corresponding locations on the wood and aluminum strips, and heavy-duty, 7-mm-diameter brass bolts were used to connect the wood and aluminum device with the uppermost wood component and the brass wing nuts on top. Both assembled devices were slid onto the metal rail that runs up the middle of the table base, with the thin aluminum strip located underneath the flange of the metal runner and the wood above. Both components could be firmly fixed to the table by manually tightening the brass thumb nuts.
Positioning of the Table and Glide `n' Go Mechanism during Imaging
Following appropriate placement of the 3D fast field-echo imaging volume over the aortoiliac segment, the preparatory imaging phase was performed in this location. Figure 1a–1c shows the position of the table top and Glide `n' Go mechanism for the acquisition of precontrast images (ie, masks). Figure 1d–1f shows the position of the table top and Glide `n' Go mechanism for the acquisition of postcontrast images. The delay incurred by manually moving the table between successive image acquisitions was approximately 2 seconds.
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Catheter Angiography
All patients underwent standard outflow imaging of the aorta and lower extremities with a standard technique and digital subtraction. All imaging studies were performed by using 4- or 5-F pigtail catheters, which were placed in the distal aorta at the level of the fourth lumbar vertebra under fluoroscopic control. Nonionic contrast material (75–100 mL) was injected through an automated pump at a rate of 8–12 mL per second for aortic injections and of 6 mL per second for iliac arterial injections. The examination consisted of anteroposterior projections in all patients by means of a standard bolus-chase technique, and 30° left and right anterior-oblique images in the pelvis. Four patients underwent selective iliac arterial injections. The MR angiography and catheter angiograms were obtained within 7 days of one another; in 12 patients, MR angiography was performed before DSA.
Image Evaluation
For comparative purposes, the following arterial segments (distal aorta plus 15 segments on each side [n = 31]) were assessed: common iliac artery, internal iliac artery (origin only), external iliac artery, common femoral artery, profunda femoral artery (origin only), superficial femoral artery (upper, middle, and lower thirds because of its long course), popliteal artery above the level of the knee joint, popliteal artery below the level of the knee joint, anterior tibial artery (horizontal and vertical segments assessed separately), tibial peroneal trunk, posterior tibial artery, and peroneal artery. All MR images were reviewed in a blinded fashion by two experienced radiologists (J.F.M.M., I.R.) independently. The conventional digital subtraction angiograms were read by pairs of experienced reviewers in consensus, and the findings were considered to be the standard for diagnosis in all cases. The arterial segments were graded as having less than 50% stenosis or greater than 50% stenosis or as being occluded. A score was given to the area with the greatest narrowing in each segment. A consensus opinion was reached in instances where there was a discrepancy between the two MR angiogram readers with regard to patent versus occluded segments.
Statistical Analyses
The sensitivity, specificity, and positive and negative predictive values for determination of insignificant (50%) versus significant (51%–100%) stenosis with MR angiography were calculated for each reviewer and compared with those of catheter DSA, and 95% CIs were calculated. The interobserver variation was assessed by using the statistic.
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RESULTS |
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TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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50% stenosis) lesions were identified. One hundred thirty-three significant (51%–100% stenosis) lesions were identified, including 88 occluded segments (five aortoiliac, 38 femoropopliteal, and 45 below-the-knee segments). Table 1 shows the breakdown of the consensus readings of conventional angiograms for all segments in the 20 patients.
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50% stenosis) lesions were reported by reviewer 1. One hundred thirty-five significant (51%–100% stenosis) lesions, including 66 occluded segments (five aortoiliac, 30 femoropopliteal, and 31 below-the-knee segments), were identified. Eight below-the-knee segments could not be evaluated because of venous overlap. Table 2 shows the breakdown of findings by reviewer 1 for all segments in the 20 patients.
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50% stenosis) lesions were reported. One hundred forty-three significant (51%–100% stenosis) lesions were identified, including 71 occluded segments (five aortoiliac, 33 femoropopliteal, and 33 below-the-knee segments). Eight below-the-knee segments could not be evaluated because of venous overlap. Table 3 shows the breakdown of findings by reviewer 2 for all segments in the 20 patients.
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= 0.65; 95% CI, 0.6, 0.7). There was excellent interobserver agreement between the two readers for reporting of insignificant (50%) versus significant (51%–100%) disease ( = 0.86; 95% CI, 0.81, 0.91) and excellent agreement for demonstration of occlusion ( = 0.928; 95% CI, 0.881, 0.975).
MR Angiography versus Conventional Angiography
For reporting of significant versus insignificant lesions, reviewer 1 showed a sensitivity of 81% (95% CI, 0.784, 0.842), specificity of 91% (95% CI, 0.893, 0.937), positive predictive value of 71% (95% CI, 0.675, 0.746), and negative predictive value of 95% (95% CI, 0.932, 0.967). Reviewer 2 showed a sensitivity of 89% (95% CI, 0.865, 0.914), specificity of 95% (95% CI, 0.93, 0.96), positive predictive value of 84% (95% CI, 0.81, 0.87), and negative predictive value of 97% (95% CI, 0.95, 0.98).
Demonstration of Occlusion
Of 88 segments reported as occluded at DSA, 62 were also reported as occluded at MR angiography by both reviewers. An additional 19 segments that were occluded at DSA were reported as patent by both MR angiogram reviewers. Nine of these segments (including five normal segments) had insignificant (50%) narrowing at MR angiography, and 10 segments were graded as having greater than 50% stenosis. Reviewer 2 agreed on the findings in five of the remaining seven segments that were occluded at DSA, but reviewer 1 reported all of the five segments as having greater than 50% narrowing at MR angiography. The remaining two segments were reported as having greater than 50% stenosis by both reviewers. In three patients, four segments that were shown to be patent at DSA (two segments that demonstrated insignificant stenosis and two that demonstrated significant stenosis) were graded as occluded at MR angiography by both reviewers. For reporting of occlusion, the consensus reading was a sensitivity of 94% (95% CI, 0.924, 0.961), specificity of 97% (95% CI, 0.959, 0.985), positive predictive value of 81% (95% CI, 0.784, 0.846), and negative predictive value of 99% (95% CI, 0.99, 0.99).
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DISCUSSION |
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TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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Therefore, most previous authors (20) have focused on either the aortoiliac segment or infrapopliteal vessels, and few have used time-of-flight imaging to evaluate all of the lower extremities because of the excessively long imaging time. In addition, the use of presaturation bands in time-of-flight imaging eliminates not only venous flow but arterial flow from inferior to superior, which is a feature of the collateral flow seen predominantly in diseased arteries (22). In clinical practice, this is well known to result in an overestimation of the length of occlusions, which is a factor of importance in optimizing therapeutic options. For these reasons, in addition to the limited availability of MR imaging equipment, time-of-flight MR angiography has not been widely incorporated into clinical practice despite its undoubted usefulness.
The aim of this study was to develop an approach for gadolinium-enhanced MR angiography of all of the lower extremity vessels. The contrast-enhanced approach offers several advantages over the time-of-flight approach, including rapid acquisition, high spatial resolution, and high signal-to-noise ratios (24–27). Because intravascular signal intensity depends entirely on gadolinium-induced T1 shortening, there is no susceptibility to inplane saturation; this enables exploitation of the 3D acquisition and coronal orientation of the imaging volume for maximum anatomic coverage with any combination of field of view and section thickness. Despite these obvious advantages, gadolinium-enhanced techniques have not been exploited in the lower extremities, because the maximum field of view obtainable with commercially available systems, about 45 cm, was substantially less than the 100 cm or greater coverage that is required in most patients for comprehensive evaluation of the lower abdominal aorta and outflow vessels. In two previous studies (29,30) in which gadolinium-enhanced MR angiography was performed in patients with arterio-occlusive disease, only the aortoiliac segments were evaluated, presumably for this reason.
In the current study, we combined the advantages of the gadolinium-enhanced 3D acquisition technique with table movement, as used in conventional angiography, to allow imaging from the aorta to the ankles. Technical success was achieved in 100% of the cases, and we found excellent correlation with DSA for reporting of significant versus insignificant stenoses, low interobserver variation between the two blinded readers, and MR angiography to be superior in enabling the identification of patent versus occluded segments (Figs 3–5). We also used digital subtraction techniques to eliminate unwanted background signal, and accurately registered subtracted angiograms were obtained in all three imaging locations with the simple homemade device in all patients. However, as with conventional angiograms, accurate registration of the pre- and postcontrast images eliminates motion in the head-foot direction only, and the trivial misregistration artifact seen on the images obtained in three patients was due to rotation of the legs between paired pre- and postcontrast imaging.
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A major limitation in conventional catheter angiography is poor demonstration of stenoses and/or the failure to demonstrate patent vessels because of differing flow rates in the two legs due to proximal stenoses. This is highlighted in the present study by the substantial number of segments visualized by using MR angiography but not by using DSA. This limitation of x-ray angiography can be reduced by using multiple and selective administrations of contrast material, but in some cases, the intravascular concentration of iodinated contrast material is inadequate to demonstrate patent segments. The reason for the MR angiographic demonstration of segments that are thought to be occluded at DSA is uncertain, but it may be related to the potency of gadolinium as a contrast material compared with that of iodinated contrast material, the high sensitivity of the 3D technique for the detection of tissues with contrast material–induced T1 shortening, and the long acquisition time of MR angiography, which allows retrograde filling through the collateral arteries with proximal occlusion.
We were encouraged by the fact that only eight arterial segments (1.2% of segments overall, all infrapopliteal) in three patients were obscured because of venous overlap, despite our use of the crude approach of using the same contrast material dose and the same image delay time in all patients and the fact that data acquisition was not complete until 2 minutes after commencement of the gadolinium infusion. We assume that the lack of venous overlap in the face of good arterial opacification was related to the fact that the slow infusion of the gadolinium-based contrast material sufficiently lowers the T1 of arterial blood to generate high signal intensity, but the corresponding venous concentration, which peaks later and is lowered by the muscle and skin extraction of the gadolinium-based contrast material, does not cause a sufficiently short T1 to be visible in the majority of patients during imaging in the legs.
A promising resolution to the potential image quality compromise owing to venous enhancement is to use a tailored approach in each patient. In this manner, the potential for faster image acquisitions would be enabled by exploiting various combinations of faster gradients, fewer sections in the thighs and legs (made possible because the superficial femoral and below-the-knee arteries follow an almost straight line throughout their course), and partial Fourier acquisition, in combination with a lower, weight-adjusted volume of gadolinium chelate and bolus detection (31,32) to ensure image acquisition while the gadolinium chelate is within the imaging field. Thus, the MR angiographic approach would be effectively converted from a "stepping-table" technique to a "bolus-chasing" technique, as is used by some commercial companies in the design of their angiographic equipment.
We did not attempt to evaluate the renal arteries in the current study for two reasons: (a) the relatively long breath hold of 32 seconds and (b) the inclusion of the renal arteries in all patients would have led to the exclusion of the lower leg arteries from the field of view in very tall patients. However, these two limitations could have easily been overcome by acquiring fewer sections or using faster gradient capability and by accepting slightly less coverage in very tall patients or increasing the field of view accordingly.
Regardless of the fact that the inplane resolution of MR angiography is less than that of DSA, 3D gadolinium-enhanced MR angiography has been shown to have high accuracy compared with DSA for the evaluation of the renal arteries (25), mesenteric arteries (27), pulmonary arteries (26), aortoiliac segments (29,30), and, as in this study, the aorta and peripheral arteries. The inplane resolution of x-ray angiography by using a smaller field of view than that used with MR angiography and digital techniques with a 1,024 matrix size currently cannot be matched with MR angiography. Nonetheless, by using a 3D approach and 512 matrix resolution in the frequency-encoding direction, MR angiography generates good inplane and good through-plane spatial resolution and thus allows retrospective image manipulation with construction of an infinite number of projections; with catheter angiography, information can be acquired only by performing further projections with additional doses of contrast material.
In the current study, we did not exploit all of the advantages of 3D acquisition because only MIP images were included in the analysis. Inspecting the individual sections in addition to the MIP images, although more time-consuming, might have increased the accuracy, because visualization of eccentric stenoses probably would have been enhanced. In addition, segments obscured by venous overlap, as was seen in eight instances in our study, might be separated from overlying veins.
In the current study, radio-frequency tuning was performed in the aortoiliac segments only. Therefore, although the flip angle was optimized for these segments, it was not optimized for the thigh or leg arterial segments. Since the completion of this study, radio-frequency tuning has been performed individually in all three imaging locations, and the appropriate flip angle is now used in all imaging locations for pre- and postcontrast image sets.
In the current study, we did not systematically compare the cost of MR angiography with that of catheter DSA. The two examinations compare favorably in terms of imaging time (16–29 minutes for MR angiography). MR angiography offers potential savings in hospital admission costs, catheters and other consumables, and radiology personnel; 16 of the 20 examinations in our study were performed by a single radiologist and a single technologist in attendance. Since the completion of this study, we have acquired automated table movement (Mobitrak patch software; Philips Medical Systems), and with the use of an MR imaging–compatible automated pump injector and simpler method for image localization, the examination can be performed single-handedly by a technologist in less than 15 minutes. Therefore, MR angiography is likely to compete closely with catheter DSA in terms of cost, ease of performance, and acceptability to the patient and physician.
In conclusion, in this preliminary study, stepping-table digital subtraction gadolinium-enhanced MR angiography of the aorta and outflow arteries with slow infusion of a gadolinium chelate enabled high-definition, noninvasive imaging from the aorta to the ankles, with high accuracy compared with catheter techniques. This technique offers the potential for noninvasive examination of patients with peripheral vascular disease before angioplasty or surgical reconstruction.
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Acknowledgments |
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Footnotes |
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Author contributions: Guarantors of integrity of entire study, J.F.M.M., J.P.R.; study concepts, J.F.M.M., J.P.R.; study design, all authors; definition of intellectual content, J.F.M.M.; literature research, J.F.M.M., J.P.R., A.R., M.K.; clinical studies, J.F.M.M., S.C., I.R., D.K.; data acquisition, J.F.M.M., J.P.R., I.R., D.K.; data analysis, J.F.M.M., J.P.R., M.A.S.; statistical analysis, J.F.M.M., J.P.R.; manuscript preparation, J.F.M.M., J.P.R., A.R., A.K., M.A.S.; manuscript editing, J.F.M.M., A.R., A.K.; manuscript review, J.F.M.M., J.P.R.
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TOPAbstractIntroductionMATERIALS AND METHODSRESULTSDISCUSSIONReferences |
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R. W. Huegli, M. Aschwanden, G. Bongartz, K. Jaeger, H.-G. Heidecker, C. Thalhammer, A.-C. Schulte, C. Hashagen, A. L. Jacob, and D. Bilecen Intraarterial MR Angiography and DSA in Patients with Peripheral Arterial Occlusive Disease: Prospective Comparison Radiology, June 1, 2006; 239(3): 901 - 908. [Abstract] [Full Text] [PDF]
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P. J. Schaefer, F. P. Boudghene, H. J. Brambs, M. Bret-Zurita, J. L. Caniego, R. A. Coulden, H. B. Gehl, R. Hammerstingl, A. Huber, R. J. Mendez, et al. Abdominal and Iliac Arterial Stenoses: Comparative Double-blinded Randomized Study of Diagnostic Accuracy of 3D MR Angiography with Gadodiamide or Gadopentetate Dimeglumine Radiology, March 1, 2006; 238(3): 827 - 840. [Abstract] [Full Text] [PDF]
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 M Nylaende, A Kroese, E Stranden, B Morken, G Sandbaek, A. Lindahl, H Arnesen, and I Seljeflot Markers of vascular inflammation are associated with the extent of atherosclerosis assessed as angiographic score and treadmill walking distances in patients with peripheral arterial occlusive disease Vascular Medicine, February 1, 2006; 11(1): 21 - 28. [Abstract] [PDF]
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A. Feydy, P. Anract, B. Tomeno, A. Chevrot, and J.-L. Drape Assessment of Vascular Invasion by Musculoskeletal Tumors of the Limbs: Use of Contrast-enhanced MR Angiography Radiology, February 1, 2006; 238(2): 611 - 621. [Abstract] [Full Text] [PDF]
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M. Lapeyre, H. Kobeiter, P. Desgranges, A. Rahmouni, J.-P. Becquemin, and A. Luciani Assessment of Critical Limb Ischemia in Patients with Diabetes: Comparison of MR Angiography and Digital Subtraction Angiography Am. J. Roentgenol., December 1, 2005; 185(6): 1641 - 1650. [Abstract] [Full Text] [PDF]
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R. Ouwendijk, M. C. J. M. Kock, K. Visser, P. M. T. Pattynama, M. W. de Haan, and M. G. M. Hunink Interobserver Agreement for the Interpretation of Contrast-Enhanced 3D MR Angiography and MDCT Angiography in Peripheral Arterial Disease Am. J. Roentgenol., November 1, 2005; 185(5): 1261 - 1267. [Abstract] [Full Text] [PDF]
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N. Zorger, M. Volk, O. W. Hamer, M. Lenhart, J. Seitz, B. Butz, and C. Paetzel Intraarterial Gadolinium-Enhanced MR Angiography in Humans for the Detection of Infrainguinal Arterial Stenoses Before and After Percutaneous Angioplasty Am. J. Roentgenol., October 1, 2005; 185(4): 867 - 872. [Abstract] [Full Text] [PDF]
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A.-C. Schulte, G. Bongartz, R. Huegli, M. Aschwanden, K. A. Jaeger, W. Ostheim-Dzerowycz, A. L. Jacob, and D. Bilecen Intraarterial Versus IV Gadolinium Injections for MR Angiography: Quantitative and Qualitative Assessment of the Infrainguinal Arteries Am. J. Roentgenol., September 1, 2005; 185(3): 735 - 740. [Abstract] [Full Text] [PDF]
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J. K. Willmann, B. Baumert, T. Schertler, S. Wildermuth, T. Pfammatter, F. R. Verdun, B. Seifert, B. Marincek, and T. Bohm Aortoiliac and Lower Extremity Arteries Assessed with 16-Detector Row CT Angiography: Prospective Comparison with Digital Subtraction Angiography Radiology, September 1, 2005; 236(3): 1083 - 1093. [Abstract] [Full Text] [PDF]
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R. Ouwendijk, M. de Vries, P. M. T. Pattynama, M. R. H. M. van Sambeek, M. W. de Haan, T. Stijnen, J. M. A. van Engelshoven, and M. G. M. Hunink Imaging Peripheral Arterial Disease: A Randomized Controlled Trial Comparing Contrast-enhanced MR Angiography and Multi-Detector Row CT Angiography Radiology, September 1, 2005; 236(3): 1094 - 1103. [Abstract] [Full Text] [PDF]
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T. Leiner, A. G. H. Kessels, P. J. Nelemans, G. B. C. Vasbinder, M. W. de Haan, P. E. J. H. M. Kitslaar, K. Y. J. A. M. Ho, J. H. M. Tordoir, and J. M. A. van Engelshoven Peripheral Arterial Disease: Comparison of Color Duplex US and Contrast-enhanced MR Angiography for Diagnosis Radiology, May 1, 2005; 235(2): 699 - 708. [Abstract] [Full Text] [PDF]
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O. A. Meissner, J. Rieger, C. Weber, U. Siebert, B. Steckmeier, M. F. Reiser, and S. O. Schoenberg Critical Limb Ischemia: Hybrid MR Angiography Compared with DSA Radiology, April 1, 2005; 235(1): 308 - 318. [Abstract] [Full Text] [PDF]
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R. Janka, C. Fellner, E. Wenkel, W. Lang, W. Bautz, and F. A. Fellner Contrast-enhanced MR Angiography of Peripheral Arteries including Pedal Vessels at 1.0 T: Feasibility Study with Dedicated Peripheral Angiography Coil Radiology, April 1, 2005; 235(1): 319 - 326. [Abstract] [Full Text] [PDF]
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H. L. Zhang, N. M. Khilnani, M. R. Prince, P. A. Winchester, P. Golia, P. Veit, R. Watts, and Y. Wang Diagnostic Accuracy of Time-Resolved 2D Projection MR Angiography for Symptomatic Infrapopliteal Arterial Occlusive Disease Am. J. Roentgenol., March 1, 2005; 184(3): 938 - 947. [Abstract] [Full Text] [PDF]
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D. Bilecen, A.-C. Schulte, H. G. Heidecker, M. Aschwanden, R. Huegli, K. A. Jaeger, W. Ostheim-Dzerowycz, and G. Bongartz Lower Extremity: Low-Dose Contrast Agent Intraarterial MR Angiography in Patients--Initial Results Radiology, January 1, 2005; 234(1): 250 - 255. [Abstract] [Full Text] [PDF]
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F. M. Vogt, W. Ajaj, P. Hunold, C. U. Herborn, H. H. Quick, J. F. Debatin, and S. G. Ruehm Venous Compression at High-Spatial-Resolution Three-dimensional MR Angiography of Peripheral Arteries Radiology, December 1, 2004; 233(3): 913 - 920. [Abstract] [Full Text] [PDF]
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H. L. Zhang, B. Y. Ho, M. Chao, K. C. Kent, H. L. Bush, P. L. Faries, A. I. Benvenisty, and M. R. Prince Decreased Venous Contamination on 3D Gadolinium-Enhanced Bolus Chase Peripheral MR Angiography Using Thigh Compression Am. J. Roentgenol., October 1, 2004; 183(4): 1041 - 1047. [Abstract] [Full Text] [PDF]
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 G H Roditi and G Harold Magnetic resonance angiography and computed tomography angiography for peripheral arterial disease Imaging, August 1, 2004; 16(3): 205 - 229. [Abstract] [Full Text] [PDF]
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C. U. Herborn, M. Goyen, H. H. Quick, S. Bosk, S. Massing, K. Kroeger, D. Stoesser, S. G. Ruehm, and J. F. Debatin Whole-Body 3D MR Angiography of Patients with Peripheral Arterial Occlusive Disease Am. J. Roentgenol., June 1, 2004; 182(6): 1427 - 1434. [Abstract] [Full Text] [PDF]
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R. Bezooijen, H. C. M. van den Bosch, A. V. Tielbeek, G. R. P. Thelissen, K. Visser, M. G. M. Hunink, L. E. M. Duijm, J. Wondergem, J. Buth, and P. W. M. Cuypers Peripheral Arterial Disease: Sensitivity-encoded Multiposition MR Angiography Compared with Intraarterial Angiography and Conventional Multiposition MR Angiography Radiology, April 1, 2004; 231(1): 263 - 271. [Abstract] [Full Text] [PDF]
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 U. J. Krause, T. Pabst, W. Kenn, G. Wittenberg, and D. Hahn Time-Resolved Contrast-Enhanced Magnetic Resonance Angiography of the Lower Extremity Angiology, March 1, 2004; 55(2): 119 - 125. [Abstract] [PDF]
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C. U. Herborn, W. Ajaj, M. Goyen, S. Massing, S. G. Ruehm, and J. F. Debatin Peripheral Vasculature: Whole-Body MR Angiography with Midfemoral Venous Compression--Initial Experience Radiology, March 1, 2004; 230(3): 872 - 878. [Abstract] [Full Text] [PDF]
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F. A. Fellner, M. Requardt, W. Lang, C. Fellner, W. Bautz, and A. Cavallaro Peripheral Vessels: MR Angiography with Dedicated Phased-Array Coil with Large-Field-of-View Adapter—Feasibility Study Radiology, July 1, 2003; 228(1): 284 - 289. [Abstract] [Full Text] [PDF]
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M. Miyazaki, H. Takai, S. Sugiura, H. Wada, R. Kuwahara, and J. Urata Peripheral MR Angiography: Separation of Arteries from Veins with Flow-spoiled Gradient Pulses in Electrocardiography-triggered Three-dimensional Half-Fourier Fast Spin-Echo Imaging Radiology, June 1, 2003; 227(3): 890 - 896. [Abstract] [Full Text] [PDF]
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A. Huber, J. Scheidler, B. Wintersperger, A. Baur, M. Schmidt, M. Requardt, N. Holzknecht, T. Helmberger, A. Billing, and M. Reiser Moving-Table MR Angiography of the Peripheral Runoff Vessels: Comparison of Body Coil and Dedicated Phased Array Coil Systems Am. J. Roentgenol., May 1, 2003; 180(5): 1365 - 1373. [Abstract] [Full Text] [PDF]
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M. Goyen, C. U. Herborn, K. Kroger, T. C. Lauenstein, J. F. Debatin, and S. G. Ruehm Detection of Atherosclerosis: Systemic Imaging for Systemic Disease with Whole-Body Three-dimensional MR Angiography-- Initial Experience Radiology, April 1, 2003; 227(1): 277 - 282. [Abstract] [Full Text] [PDF]
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R. Wyttenbach, S. Gianella, M. Alerci, A. Braghetti, L. Cozzi, and A. Gallino Prospective Blinded Evaluation of Gd-DOTA- versus Gd-BOPTA-enhanced Peripheral MR Angiography, as Compared with Digital Subtraction Angiography Radiology, April 1, 2003; 227(1): 261 - 269. [Abstract] [Full Text] [PDF]
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A. Ofer, S. S. Nitecki, S. Linn, M. Epelman, D. Fischer, T. Karram, D. Litmanovich, H. Schwartz, A. Hoffman, and A. Engel Multidetector CT Angiography of Peripheral Vascular Disease: A Prospective Comparison with Intraarterial Digital Subtraction Angiography Am. J. Roentgenol., March 1, 2003; 180(3): 719 - 724. [Abstract] [Full Text] [PDF]
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J. K. Willmann, S. Wildermuth, T. Pfammatter, J. E. Roos, B. Seifert, P. R. Hilfiker, B. Marincek, and D. Weishaupt Aortoiliac and Renal Arteries: Prospective Intraindividual Comparison of Contrast-enhanced Three-dimensional MR Angiography and Multi-Detector Row CT Angiography Radiology, March 1, 2003; 226(3): 798 - 811. [Abstract] [Full Text] [PDF]
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P. V. Pandharipande, V. S. Lee, P. M. Reuss, H. W. Charles, R. J. Rosen, G. A. Krinsky, J. C. Weinreb, and N. M. Rofsky Two-Station Bolus-Chase MR Angiography with a Stationary Table: A Simple Alternative to Automated-Table Techniques Am. J. Roentgenol., December 1, 2002; 179(6): 1583 - 1589. [Abstract] [Full Text] [PDF]
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C. Loewe, M. Schoder, T. Rand, U. Hoffmann, J. Sailer, T. Kos, J. Lammer, and S. Thurnher Peripheral Vascular Occlusive Disease: Evaluation with Contrast-Enhanced Moving-Bed MR Angiography Versus Digital Subtraction Angiography in 106 Patients Am. J. Roentgenol., October 1, 2002; 179(4): 1013 - 1021. [Abstract] [Full Text] [PDF]
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J. S. Swan, T. J. Carroll, T. W. Kennell, D. M. Heisey, F. R. Korosec, R. Frayne, C. A. Mistretta, and T. M. Grist Time-resolved Three-dimensional Contrast-enhanced MR Angiography of the Peripheral Vessels Radiology, October 1, 2002; 225(1): 43 - 52. [Abstract] [Full Text] [PDF]
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M. R. Prince, S. G. Chabra, R. Watts, C. Z. Chen, P. A. Winchester, N. M. Khilnani, D. Trost, H. A. Bush, K. C. Kent, and Y. Wang Contrast Material Travel Times in Patients Undergoing Peripheral MR Angiography Radiology, July 1, 2002; 224(1): 55 - 61. [Abstract] [Full Text]
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N. M. Khilnani, P. A. Winchester, M. R. Prince, E. Vidan, D. W. Trost, H. L. Bush Jr, R. Watts, and Y. Wang Peripheral Vascular Disease: Combined 3D Bolus Chase and Dynamic 2D MR Angiography Compared with X-ray Angiography for Treatment Planning Radiology, July 1, 2002; 224(1): 63 - 74. [Abstract] [Full Text] [PDF]
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C. J. Konkus, J. M. Czum, and J. T. Jacobacci Contrast-Enhanced MR Angiography of the Aorta and Lower Extremities with Routine Inclusion of the Feet Am. J. Roentgenol., July 1, 2002; 179(1): 115 - 117. [Full Text] [PDF]
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M. Goyen, H. H. Quick, J. F. Debatin, M. E. Ladd, J. Barkhausen, C. U. Herborn, S. Bosk, H. Kuehl, M. Schleputz, and S. G. Ruehm Whole-Body Three-dimensional MR Angiography with a Rolling Table Platform: Initial Clinical Experience Radiology, July 1, 2002; 224(1): 270 - 277. [Abstract] [Full Text]
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D O Kessel, I Robertson, J V Patel, S Simpson, and E J Taylor Angiographic strategies when iodinated contrast medium is undesirable Imaging, December 15, 2001; 13(5): 349 - 356. [Abstract] [Full Text] [PDF]
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T. F. Hany, T. J. Carroll, R. A. Omary, E. Esparza-Coss, F. R. Korosec, C. A. Mistretta, and T. M. Grist Aorta and Runoff Vessels: Single-Injection MR Angiography with Automated Table Movement Compared with Multiinjection Time-resolved MR Angiography—Initial Results Radiology, October 1, 2001; 221(1): 266 - 272. [Abstract] [Full Text] [PDF]
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T. K. F. Foo, V. B. Ho, M. N. Hood, H. B. Marcos, S. L. Hess, and P. L. Choyke High-Spatial-Resolution Multistation MR Imaging of Lower-Extremity Peripheral Vasculature with Segmented Volume Acquisition: Feasibility Study Radiology, June 1, 2001; 219(3): 835 - 841. [Abstract] [Full Text] [PDF]
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C. Manke, W. R. Nitz, B. Djavidani, M. Strotzer, M. Lenhart, M. Völk, S. Feuerbach, and J. Link MR Imaging-guided Stent Placement in Iliac Arterial Stenoses: A Feasibility Study Radiology, May 1, 2001; 219(2): 527 - 534. [Abstract] [Full Text]
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 M. J. W. Koelemay, J. G. Lijmer, J. Stoker, D. A. Legemate, and P. M. M. Bossuyt Magnetic Resonance Angiography for the Evaluation of Lower Extremity Arterial Disease: A Meta-analysis JAMA, March 14, 2001; 285(10): 1338 - 1345. [Abstract] [Full Text] [PDF]
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R. Watts, Y. Wang, M. R. Prince, P. A. Winchester, N. M. Khilnani, and K. C. Kent Anatomically Tailored k-Space Sampling for Bolus-Chase Three-dimensional MR Digital Subtraction Angiography Radiology, March 1, 2001; 218(3): 899 - 904. [Abstract] [Full Text]
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A. Huber, A. Heuck, A. Baur, T. Helmberger, T. Waggershauser, A. Billing, M. Heiss, R. Petsch, and M. Reiser Dynamic Contrast-Enhanced MR Angiography from the Distal Aorta to the Ankle Joint with a Step-by-Step Technique Am. J. Roentgenol., November 1, 2000; 175(5): 1291 - 1298. [Abstract] [Full Text] [PDF]
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P. J. Nelemans, T. Leiner, H. C. W. de Vet, and J. M. A. van Engelshoven Peripheral Arterial Disease: Meta-analysis of the Diagnostic Performance of MR Angiography Radiology, October 1, 2000; 217(1): 105 - 114. [Abstract] [Full Text]
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 T. Leiner, K. Y. J.A.M. Ho, J. M.A. van Engelshoven, and Y. Watanabe Techniques of Dynamic Subtraction Contrast-enhanced MR Angiography RadioGraphics, July 1, 2000; 20(4): 1113 - 1114. [Full Text] [PDF]
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J. F. Glockner, A. R. Forauer, H. Solomon, C. R. Varma, and W. H. Perman Three-Dimensional Gadolinium-Enhanced MR Angiography of Vascular Complications After Liver Transplantation Am. J. Roentgenol., May 1, 2000; 174(5): 1447 - 1453. [Abstract] [Full Text] [PDF]
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S. G. Ruehm, T. F. Hany, T. Pfammatter, E. Schneider, M. Ladd, and J. F. Debatin Pelvic and Lower Extremity Arterial Imaging: Diagnostic Performance of Three-Dimensional Contrast-Enhanced MR Angiography Am. J. Roentgenol., April 1, 2000; 174(4): 1127 - 1135. [Abstract] [Full Text] [PDF]
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N. M. Rofsky and M. A. Adelman MR Angiography in the Evaluation of Atherosclerotic Peripheral Vascular Disease Radiology, February 1, 2000; 214(2): 325 - 338. [Abstract] [Full Text]
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 E. K. Yucel, C. M. Anderson, R. R. Edelman, T. M. Grist, R. A. Baum, W. J. Manning, A. Culebras, and W. Pearce Magnetic Resonance Angiography : Update on Applications for Extracranial Arteries Circulation, November 30, 1999; 100(22): 2284 - 2301. [Full Text] [PDF]
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A. N. Shetty, K. G. Bis, A. J. Duerinckx, and V. R. Narra Lower Extremity MR Angiography: Universal Retrofitting of High-Field-Strength Systems with Stepping Kinematic Imaging Platforms—Initial Experience Radiology, January 1, 2002; 222(1): 284 - 291. [Abstract] [Full Text] [PDF]
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S. K. Yoo, R. Watts, P. A. Winchester, R. Zabih, Y. Wang, and M. R. Prince Postprocessing Techniques for Time-resolved Contrast-enhanced MR Angiography Radiology, February 1, 2002; 222(2): 564 - 568. [Abstract] [Full Text] [PDF]
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