Percutaneous vascular intervention based on gadolinium-enhanced MR angiography

To determine if gadolinium-enhanced magnetic resonance angiography (Gd-MRA) could be used to reliably plan percutaneous vascular procedures.

Over the course of 13 months, 31 patients underwent attempted percutaneous intervention solely on the basis of a preceding Gd-MRA study. A total of 49 arterial segments were targeted (28 extremities, 21 visceral). Five segments in four patients were not treated (less impressive disease severity on conventional catheter angiography [CA] in four segments, diffuse intrarenal atherosclerosis in one segment). Interventions attempted were percutaneous transluminal angioplasty (n = 10), angioplasty with stent placement (n = 29), and thrombolysis (n = 3). Interventions were successful in all segments, except two because of the inability to cross an occlusion.

Good to strong correlation was noted between Gd-MRA and CA regarding stenosis severity and length and the presence of poststenotic dilatation. MRA underestimated the complexity of stenosis. Subjective quality and preintervention confidence were excellent in the majority of MRA studies and satisfactory in the rest. The overall value in "procedural planning" was judged high in 40 segments, satisfactory in five segments, and poor in four segments. The procedural planning and positive predictive values of MRA were significantly lower for visceral arteries compared to iliac and peripheral arteries.

In most cases, Gd-MRA reliably yielded the anatomic and diagnostic information necessary to plan percutaneous vascular interventions noninvasively and without iodinated contrast. In the authors' practice, Gd-MRA is becoming a key imaging modality in the workup of patients in whom percutaneous intervention is anticipated.