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OBJECTIVE: The objective of our study was to prove the feasibility and clinical relevance of fast contrast-enhanced time-resolved 3D MR angiography (MRA) with submillimeter spatial resolution at a high magnetic field strength.
SUBJECTS AND METHODS: Twenty-one patients (five women, 16 men; mean age +/- SD, 65 +/- 14 years) were examined on a 3-T whole-body MR system with an 8-element phasedarray coil for preoperative evaluation of the pedal arterial system and assessment of the visualized vessels to serve as a graft touch-down site in pedal bypass surgery. Time-resolved 3D MRA of the foot was performed after automatic injection of 0.2 mmol/kg of gadobenate dimeglumine using a sagittal gradient-echo T1-weighted sequence (TR/TE, 4.2/1.6; flip angle, 30 degrees ; field of view, 290 mm; matrix, 352; 120 slices; slice thickness, 0.8 mm) with a spatial resolution of 0.8 x 0.8 x 1.6 mm reconstructed to 0.6 x 0.6 x 0.8 mm and a temporal resolution of 3.9 seconds using keyhole and sensitivity-encoding (SENSE) technology (SENSE factors: 4 in anteroposterior direction and 2 in right-left direction). Dynamic subtractions and rotating maximum intensity projections were calculated. The original image data sets were transferred to a dedicated workstation for objective signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) analysis of the arteries. Subjective image analysis regarding image quality and diagnostic findings was performed by two radiologists in consensus.
RESULTS: In all patients, images of diagnostic quality were obtained. Despite the known limitations regarding signal intensity measurements in images acquired with the use of parallel imaging technique, SNR and CNR proved to be excellent, with mean +/- SD values of 294 +/- 158 and 248 +/- 144, respectively. Although most of the patients had diabetic foot syndrome with arteriovenous shunting, the arteries and the potential vessel for bypassing could be clearly separated from the veins in each case due to the temporal information given by our study. The ability to reliably discriminate arteries from veins is of high clinical relevance in planning pedal bypass surgery.
CONCLUSION: Fast contrast-enhanced time-resolved 3D MRA of the foot at 3 T is feasible and of high clinical value for the preoperative evaluation of the arterial supply of the foot.