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[Diagnostic pitfalls in magnetic resonance angiography]
A Carriero1, L Palumbo, A G Tonni
1Istituto di Scienze Radiologiche, Università di Chieti, Siemens, Pescara.
Abstract:
The authors report on their clinical experience with Magnetic Resonance angiography (MRA) pitfalls. January, 1989, to February, 1995, six hundred MRA examinations were performed in different vascular districts, with a 1.5-T superconductive magnet, the time-of-flight (TOF) technique and 2D and 3D acquisitions. Intracranial arteries, epiaortic vessels and renal arteries were studied with FISP 3D sequences; intracranial veins, thoracic vessels, vena cava and pelvic vessels were studied with FISP 2D sequences. Pitfalls were observed in 56 of 600 MRA exams (9.3%). Of 56 pitfalls, 26 (46.4%) were in epiaortic vessels, 15 (26.7%) in intracranial vessels, 6 (10.7%) in renal arteries, 6 (10.7%) in thoracic vessels, 1 (1.7%) in the inferior vena cava and 2 (3.5%) in iliac vessels. Stenoses were overestimated in 21 patients and underestimated in three; 16 patients were misdiagnosed and 16 were false positives. As for cerebral vascular lesions, 5 aneurysms and 7 transverse sinus thromboses were false positives, while 3 lesions were misdiagnosed as venous angiomas. As for 26 MRA exams of thoracic vessels, stenoses were overestimated in 16 patients and underestimated in 10 patients with subclavian steal syndrome, where the left vertebral artery was misinterpreted as occluded. In 6 MRA exams of thoracic vessels, 1 patient was misdiagnosed as having an aneurysm and 5 patients were misdiagnosed as having lung cancer infiltrating aorta and superior vena cava. As for renal vessels, 2 normal renal arteries were misdiagnosed as false positives and 4 stenoses were overestimated. In the inferior vena cava, a partial agenesis was misinterpreted as thrombosis. In 2 MRA exams of iliac vessels, a stenosis and a thrombosis were misinterpreted as false positives. Our experience suggests that MRA pitfalls are caused by the incorrect use of the various techniques. The pitfalls we observed can be classified as caused by three types of artifacts: saturation, turbulence and paramagnetic substance artifacts.
Insights
Magnetic Resonance Angiography (MRA) pitfalls occurred in 9.3% of 600 exams, often due to incorrect technique usage. These imaging artifacts led to misdiagnoses and inaccurate assessments of vascular conditions.
Area of Science:
- Medical Imaging
- Radiology
- Vascular Imaging
Context:
- Magnetic Resonance Angiography (MRA) is a key non-invasive imaging technique for evaluating vascular structures.
- Clinical application of MRA involves potential pitfalls that can affect diagnostic accuracy.
- Understanding these pitfalls is crucial for optimizing MRA interpretation.
Purpose:
- To report on the clinical experience with pitfalls encountered during Magnetic Resonance Angiography (MRA).
- To analyze the frequency and types of MRA pitfalls across various vascular territories.
- To identify the causes of MRA pitfalls, focusing on technique-related artifacts.
Summary:
- Six hundred MRA examinations were performed between January 1989 and February 1995 using a 1.5-T magnet and time-of-flight (TOF) techniques (2D and 3D).
- Pitfalls were identified in 9.3% of exams (56/600), predominantly in epiaortic (46.4%) and intracranial vessels (26.7%).
- Common pitfalls included over/underestimation of stenoses, misdiagnoses, and false positives, attributed to saturation, turbulence, and paramagnetic substance artifacts.
Impact:
- Highlights the importance of proper technique selection and application in MRA to minimize diagnostic errors.
- Provides valuable insights for radiologists and clinicians to improve the reliability of MRA interpretations.
- Contributes to the understanding of artifact-induced errors in vascular imaging, potentially leading to improved MRA protocols.