Contrast-Enhanced Subtraction MR Angiography in Occlusive Disease of the Pelvic and Lower Limb Arteries: Results of a Prospective Intraindividual Comparative Study with Digital Subtraction Angiography in 76 Patients

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Abstract
The purpose of this work was to evaluate the feasibility and clinical use of MR angiography (MRA) for examining the pelvic and lower limb arteries in patients with arterial occlusive disease. Seventy-six patients with clinical signs of peripheral arterial occlusive disease were included in the study. MRA was performed using a fast contrast-enhanced high-resolution 3D technique that covered the area from the distal abdominal aorta to the distal lower limbs in two examination steps. In all patients, diagnostic images comparable with those of conventional intraarterial digital subtraction angiography (DSA) could be obtained. No false-negative findings were seen in the iliac, femoral, or popliteal arteries. Ten to 16% of the mild stenoses and 6-14% of the severe stenoses, mainly in the crural vessels, were overgraded compared with intraarterial DSA. Particularly in patients with proximal severe obstructions or occlusions, the crural segments could be depicted more clearly due to decreased arterial runoff in conventional angiography. The consistency of the excellent depiction of the vascular territories of the distal aorta and the pelvic and lower limb arteries in a standardized setting suggests great potential for the use of MRA in the primary diagnosis of peripheral arterial occlusive disease.