Continuous table movement MRA for diagnosis of generalized atherosclerotic disease

Continuous-table-movement-MRA-a.jpg

A

Continuous-table-movement-MRA-b-TimCT_rot-small2.gif

B

Continuous-table-movement-MRA-c-CFULL.jpg

C

Clinical History: 
This 48 year old woman presented to the department of vascular surgery due to recurrent pain in both legs. She suffers from hypertension, hyperlipidemia and coronary artery disease. She has previously been diagnosed with a high-grade stenosis of the right internal carotid artery and occlusion of the left internal carotid artery, andis as well status post dilatation and stenting of the circumflex coronary artery. Additional relevant vascular disease and surgery include occlusion of the right subclavian artery, aortobifemoral bypass grafting due to high-grade stenosis, and occlusion of the common, external and internal iliac arteries on both sides.

Diagnosis:
Occlusion of the right subclavian artery, status post aortobifemoral bypass grafting with slight narrowing of the aorta directly proximal to the graft, diminutive native arterial vessels in the lower extremities with three-vessel runoff bilaterally.

MR Technique: 
MRA images were acquired on a 3T open bore MR System (Magnetom Verio, Siemens Healthcare, Erlangen, Germany) using a dedicated 36 element peripheral angiography array coil and two standard 6 element body surface coils in combination with a table integrated spine array coil. The MRA exam was performed using a continuous table movement technique (SyngoTimCT, TR/TE 2.8/1.1ms, reconstructed voxel size 1 x 1 x 1.3mm3, acquisition time 77sec). Pre- and post-contrast images were acquired for later subtraction. 30 ml of a standard 0.5 molar contrast agent were administered at a flow rate of 1.5 ml/sec.

Imaging Findings:
In addition to the previously known occlusion of the right subclavian artery (A, arrow) and the aortobifemoral bypass graft(A, arrowheads),a narrowing of the abdominal aorta in the area of the anastomosis directly proximal to the bypass graft can be detected (B, arrowhead). Due to the replacement of the distal abdominal aorta and the common as well as the external iliac artery on both sides by vesselgrafts, the internal iliac artery is occluded bilaterally and cannot be seen (B). The native vessels of the lower extremity are diminutive with multiple vessel-wall irregularities, most likely due to diffuse arteriosclerotic disease. However, three-vessel runoff is present in both calves (A&B).

Despite motion artifacts caused by breathing, additional supplemental information is available within the abdomen. Specifically, the left kidney shows several triangular scars, most likely due to thrombembolic ischemia also caused by arteriosclerotic vessel disease (C, circles).