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Contrast-enhanced magnetic resonance angiography following subintimal recanalization
Ehab Abdel-Gawad1, Nancy Harthun, Patrick Norton
1Department of Radiology, El Menia University Hospital, El Menia, Egypt.
Insights
Contrast-enhanced magnetic resonance angiography (ceMRA) can assess lower extremity runoff vessels after subintimal recanalization (SIR). A hybrid approach combining 3D and 2D ceMRA techniques is recommended for optimal runoff assessment.
Area of Science:
- Vascular imaging
- Interventional radiology
- Magnetic Resonance Imaging
Background:
- Subintimal recanalization (SIR) is a key endovascular technique for treating peripheral artery disease.
- Accurate assessment of lower extremity runoff vessels post-SIR is crucial for evaluating treatment success.
- Contrast-enhanced magnetic resonance angiography (ceMRA) offers a non-invasive imaging modality for vascular assessment.
Purpose of the Study:
- To characterize the appearance of lower extremity runoff vessels after SIR using ceMRA.
- To compare the efficacy of two distinct ceMRA techniques in visualizing these vessels.
- To evaluate the diagnostic performance of ceMRA against intra-arterial digital subtraction angiography (DSA).
Main Methods:
- Six patients undergoing SIR were evaluated using stepping table 3D ceMRA and time-resolved 2D MRA within 3 days post-procedure.
- Both ceMRA techniques were compared with intra-arterial digital subtraction angiography (DSA) as the gold standard.
- Image acquisition focused on assessing patency and characteristics of recanalized lower extremity arteries.
Main Results:
- A total of 15 arteries were successfully recanalized across the six patients.
- 3D ceMRA enabled visualization of all above-the-knee segments, but postprocedural hyperemia hindered trifurcation vessel assessment.
- 2D MRA, with its superior temporal resolution, effectively mitigated venous contamination and reliably confirmed the patency of recanalized calf vessels.
Conclusions:
- Diagnostic quality MRA studies of lower extremity runoff vessels post-SIR are feasible.
- A hybrid MRA approach, integrating stepping table MR DSA and time-resolved 2D MRA for calf assessment, is necessary for comprehensive runoff evaluation.
- This combined technique enhances the diagnostic accuracy of MRA in the post-SIR setting.
Purpose:
To describe the appearance of lower extremity runoff vessels following subintimal recanalization (SIR) on contrast-enhanced magnetic resonance angiography (ceMRA) and compare 2 different ceMRA techniques.
Methods:
A total of 6 patients underwent stepping table 3-dimensional (3D) ceMRA and time-resolved 2-dimensional (2D) MRA within 1 to 3 days (mean 1.83 days) following SIR. The 2 techniques were compared with intra-arterial digital subtraction angiography (DSA).
Results:
A total of 15 arteries were recanalized in 6 patients. Three-dimensional ceMRA allowed evaluation of patency in all segments above the knee. Postprocedural hyperemia impaired the assessment of the trifurcation vessels on 3D ceMRA. Due to its higher temporal resolution 2D MRA was not affected by venous contamination and allowed reliable confirmation of patency of the recanalized vessels.
Conclusions:
Diagnostic MRA studies of the lower extremity runoff vessels following SIR is possible, but a hybrid technique using a stepping table MR DSA and a time-resolved sequence like 2D MRA of the calf station is necessary for runoff assessment.
