Extravascular findings on run-off MR angiography: frequency, location and clinical significance

The aim of this study was to analyze the prevalence, location and clinical relevance of extravascular findings (EVFs) on magnetic resonance angiography (MRA) of the run-off vasculature.

In this retrospective study, we analyzed run-off MRAs of 194 consecutive patients (45 women and 149 men, median age 68 years, IQR 58-74 years). Our patient cohort consisted predominantly of individuals with known (n = 165, 85%) or suspected (n = 15, 8%) peripheral artery disease (PAD). All MRA examinations were performed between 2012 and 2018 on a 3 Tesla MRI scanner using a standardized protocol. Two radiologists re-evaluated the MRA images to identify EVFs, which were classified into findings with major (category I), moderate (category II) and minor (category III) clinical significance.

A total of 501 EVFs were found in 172 of the 194 patients (89%). Twenty-seven findings (5%) were assigned to category I, 189 (38%) to category II and 285 (57%) to category III. 23 of 194 patients (12%) had at least one EVF with major clinical relevance (category I). Most of the 27 category I EVFs were observed in the soft tissues (n = 13, 48%). The remaining category I EVFs were found in the musculoskeletal (n = 7, 26%), urogenital (n = 4, 15%), lymphatic (n = 2, 7%) and gastrointestinal (n = 1, 4%) system. The majority of the category I EVFs were infectious (n = 14, 52%) or neoplastic (n = 10, 37%) pathologies.

Clinically relevant EVF can be encountered frequently on run-off MRA examinations. These results illustrate the importance of evaluating all organ systems when reporting MRA examinations, despite the clinical focus being the patients' vascular status.