Magnetic resonance angiography of the hand and wrist: evaluation of patients with severe ischemic disease.

Conventional arteriography is considered the standard for the evaluation of patients with severe ischemic disease of the hand and wrist. Magnetic resonance (MR) has been shown to be a reliable noninvasive alternative to conventional arteriography. The authors prospectively evaluated this technology in 11 patients with Raynaud's syndrome and severe ischemic disease of the upper extremity. MR angiograms were compared with results from surgery in seven cases and conventional arteriography in four cases. There was excellent correlation between MR angiography and the results of surgery and conventional arteriography. In all cases, MR correctly predicted the patency or lack of patency of the distal and ulnar arteries, and superficial and deep palmar arches. In three cases, portions of the palmar arches oriented parallel to the plane were not adequately seen. Common and proper digital arteries were incompletely seen with both conventional and MR angiography. MR angiography is a reliable noninvasive method to evaluate patients with severe upper-extremity ischemic disease, accurately depicting the peripheral vessels through the level of the palmar arches. Anatomic vascular depiction is adequate for determination of patency of the major vessels for preoperative evaluation for reconstructive surgery and sympathectomy.