MR angiography of peripheral arteries

Peripheral vascular obstructive disease (PVOD) is a common disorder in western society caused by atherosclerotic disease in 80-90% of cases. The incidence can be as high as 2.8 newly discovered cases of patients with PVOD per 1000 patients per year. However, as PVOD is a progressive disease, many more patients consult a doctor each year, adding up to a prevalence of registered symptomatic PVOD in general practice of 4.7%. Fortunately, improved surgical and percutaneous transluminal angioplasty techniques for the treatment of PVOD are now available. However, accurate diagnosis by detection, grading and characterization of atherosclerotic lesions are essential prerequisites for a positive outcome of treatment. X-ray angiography is still the gold standard for diagnosing peripheral vascular obstructive disease, but although its spatial and temporal resolution cannot be surpassed by other modalities, its leading position is fading. Techniques like Duplex ultrasonography, CT angiography and MR angiography are much less (or non-) invasive and yield significant data supporting an accurate diagnosis. However, Duplex ultrasonography is very operator dependent and CT angiography utilizes X-rays as well as potentially harmful contrast material. Although MR angiography can be performed non-invasively, the use of contrast-enhanced MR angiography (CE-MR angiography) has revolutionized the diagnostic accuracy of MR angiography. Not only is the quality superior to conventional (flow-dependent) MR angiography, it also allows superb reconstruction and is very fast. The purpose of this article is to describe the principles, usefulness and limitations of both inflow and CE-MR angiography for depiction of the peripheral arteries.