[Contrast-enhanced MR angiography (CEMRA) in peripheral arterial occlusive disease (PAOD): conventional moving table
T von Kalle1, A Gerlach, A Hatopp
1Radiologisches Institut, Klinikum Stuttgart, Katharinenhospital. t.vonkalle@olgahospital.de
Insights
A hybrid contrast-enhanced MR angiography (CEMRA) technique improved visualization of the aortopedal arterial system in peripheral arterial occlusive disease (PAOD) patients. This method is superior for evaluating the cruropedal region due to reduced venous overlap.
Area of Science:
- Radiology and Imaging
- Vascular Imaging
- Magnetic Resonance Angiography
Background:
- Peripheral arterial occlusive disease (PAOD) requires comprehensive imaging of the aortopedal arterial system.
- Contrast-enhanced MR angiography (CEMRA) is a key diagnostic tool for PAOD.
- Optimizing CEMRA protocols is crucial for accurate diagnosis and treatment planning.
Purpose of the Study:
- To prospectively compare the diagnostic quality and clinical usefulness of two CEMRA protocols in patients with PAOD.
- To evaluate the visualization of the entire aortopedal arterial system, including iliac, femoral, popliteocrural, and pedal arteries.
Main Methods:
- A randomized study involving 80 PAOD patients (median age 70) using a 1.5 T MRI system and a peripheral vascular coil.
- Protocol A: Single injection of Gd-BOPTA with craniocaudal acquisition.
- Protocol B: Hybrid technique with two injections of Gd-BOPTA, optimizing acquisition for different arterial segments (popliteocrural/pedal then aortoiliac/femoral).
Main Results:
- Protocol B (hybrid technique) achieved diagnostically good or satisfactory visualization in 29 of 40 patients, compared to 16 of 40 with Protocol A.
- The hybrid technique significantly reduced arteriovenous overlap, particularly in the cruropedal region (5 cases vs. 19 cases).
- Excluding the pedal station, both protocols provided good visualization in 35 of 40 patients, highlighting the hybrid technique's advantage for distal assessment.
Conclusions:
- The moving table hybrid CEMRA technique is superior to the conventional craniocaudal approach for PAOD evaluation.
- This hybrid method offers improved diagnostic accuracy by minimizing venous overlap, especially in the critical cruropedal segments.
- The hybrid CEMRA protocol is particularly suitable for detailed diagnostic evaluation of the cruropedal region in PAOD patients.
Purpose:
In peripheral arterial occlusive disease (PAOD), angiographic evaluation of the entire aortopedal arterial system is mandatory. In a randomized study, two different protocols of CEMRA were evaluated prospectively to compare their diagnostic quality and clinical usefulness.
Patients And Methods:
80 patients (males n = 60, females n = 20, median age = 70 years, diabetics n = 27) with PAOD were examined with a 1.5 T system (40 mT/m) using a dedicated phased array peripheral vascular coil. Protocol A consisted of a single injection of Gd-BOPTA with consecutive craniocaudal image acquisition and protocol B of two injections, with the first injection of Gd-BOPTA followed by image acquisition of the popliteocrural and pedal segments and the second injection followed by acquiring the aortoiliac and femoral segments (hybrid technique). The evaluation of the arterial system was directed to the iliac, femoral, popliteocrural and pedal arteries.
Results:
The visualization of the entire aortopedal vascular system was of diagnostically good or satisfactory quality in 16 of 40 patients using protocol A and in 29 of 40 patients using protocol B (iliac 40 vs. 37, femoral 40 vs. 40, popliteocrural 35 vs. 37, pedal 16 vs. 29); without the pedal station the number increased to 35 of 40 patients for both protocols. The reason of diagnostic limitations was an arteriovenous overlap in 24 of 80 cases, with 19 of 40 cases for protocol A and 5 of 40 for protocol B, located exclusively in the cruropedal region.
Conclusion:
Moving table hybrid CEMRA is superior to conventional technique in craniocaudal direction by producing less venous overlap of arteries and is especially more suitable for the diagnostic evaluation of the cruropedal region.
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