Click on any image below to see an enlargement of that image.

Case 1: The patient had right leg claudication after cardiac catheterization. 3D MIP reconstruction shows a severe stenosis in the proximal right superficial femoral artery. A low arterial puncture for the cardiac catheterization caused a small dissection, which was repaired surgically.
Case 2: The patient is a 69 year old male with bilateral leg claudication. 3D MIP reconstruction from the first station of the MRA (fig. 1) shows an occluded right common iliac artery. Images from the second station (fig. 2) show bilateral superficial femoral artery occlusions with distal reconstitution.
Figure 1	Figure 2
Case 3: 3D MIP reconstruction from the third station of a peripheral MRA study. Calf arteries are normal. The mild venous contamination in the left foot does not impede the evaluation of the arteries.
Case 4: 3D MIP reconstruction shows a short right popliteal artery occlusion with prompt reconstitution of the artery.
Case 5: 3D MIP image from the second station of a peripheral MRA shows diffuse atherosclerosis of both superficial femoral arteries (SFA) and a focal severe stenosis of the right SFA at the level of the adductor canal and a moderate stenosis of the left SFA at the same level.

Above images are all original MR scans performed at Parkside MR Center.

Peripheral arterial disease (PAD) is usually a manifestation of systemic atherosclerosis. As such it has the same major risk factors (diabetes mellitus, smoking, high cholesterol, and hypertension) and co-existent coronary artery disease is common. The main symptoms of PAD are intermittent claudication and ischemic rest pain. Patients with advanced disease often have diminished/absent pulses and non-healing ulcers.

The initial evaluation of patients with signs and symptoms of PAD usually involves taking systolic blood pressures from the arm and ankle and calculating the ankle-brachial index. Supplemental studies include segmental limb pressures, pulse volume recordings, toe pressures, and Duplex US interrogation. These studies can be performed at rest and after exercise-induced ischemia.

Once it has been determined that surgery is an option for a patient with severe PAD, the vascular surgeon will want a pre-operative anatomic roadmap of the arteries. This requires evaluation of the pelvic inflow arteries and the run-off arteries down to the mid-foot level. Also patients with recurrent symptoms after surgery require evaluation of their by-pass grafts. MRA is uniquely suited to meet these requirements without exposing the patient to ionizing radiation, arterial puncture, or nephrotoxic-iodinated contrast. In fact, MRA has almost completely replaced conventional angiography for this purpose.

Until recently, MRA of the legs was performed without contrast using time-offlight MRA. While this technique is good, it is also time consuming, taking 60-90 minutes to image from the renal arteries to the mid-feet. Although most of the technology for fast contrast-enhanced MRA was available in the late 1990’s, and successfully applied to the arteries above the legs, the length of coverage needed for the legs was still an obstacle for peripheral MRA. Finally a few years ago, the advent of parallel imaging and whole-body surface coil technology has enabled fast, high-resolution, contrast-enhanced, peripheral MRA. Now the arteries from the renals to the mid-feet can be imaged in less than 1 minute.

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