Magnetic resonance angiography of the aorta, iliac, and femoral arteries.

BACKGROUND

Successful management of patients with peripheral vascular disease requires detailed vascular imaging, usually performed by contrast arteriography. Recently, magnetic resonance angiography (MRA) has been shown to be a noninvasive technique with greater sensitivity than contrast arteriography for detecting distal runoff vessels in patients with peripheral arterial occlusive disease. However, to supplant the need for contrast arteriography and provide a completely noninvasive evaluation of patients with occlusive disease, accurate imaging of the inflow vessels and the runoff vessels is necessary.

METHODS

We used both conventional arteriography and MRA in preoperative studies of the aorta, iliac, and femoral vessels of 47 patients. Conventional arteriography and MRA studies were compared for their ability to detect vessel patency and the presence of hemodynamically significant stenoses. Independent interventional plans were developed based on the information provided by each technique. The findings of conventional and MRA studies were verified by intraoperative arteriography or direct operative exploration.

RESULTS

Results of the two studies were identical in 41 (87%) of 47 patients or 600 (98%) of 614 segments imaged. MRA accurately detected patent and occluded arterial segments (sensitivity 99.6%, specificity 100%, positive predictive value 100%, negative predictive value 98.6%) and hemodynamically significant stenoses. Therapeutic plans based on either MRA or conventional arteriography were identical for each patient.

CONCLUSIONS

MRA provides comparable results to contrast arteriography in the proximal arterial system and superior results for imaging the distal vasculature. This noninvasive technique may replace contrast arteriography in a large number of patients in the future.