The Utility of Contrast Enhanced MR Angiography as a First Stage Diagnostic Modality for Treatment Planning in Lower Extremity Arterial Occlusive Disease

Abstract

Introduction: The aim of this study was to evaluate the applicability of contrast enhanced magnetic resonance angiography (ce-MRA) as a first stage imaging tool for individual treatment planning in patients with lower extremity arterial occlusive disease.Patients and Methods: Between August, 2003 and June, 2004, in 128 consecutive patients (182 extremities) with clinical manifestations of lower limb ischemia eligible for invasive therapy, treatment was planned based on clinical assessment, ankle/brachial pressure index measurements combined with ce-MRA. Additional duplex ultrasonography (DUS) or digital subtraction angiography (DSA) was done when necessary. Ce-MRA findings were compared with findings during open surgical, endovascular or combined procedures.Results: In 28 extremities (15%) ce-MRA was found inconclusive and additional imaging was performed. In the remaining patients (85% of the extremities (n = 154), treatment was initiated as planned. However, in 19 (11%) of these patients, the treatment plan was altered. In 7 of them, procedural findings did not correspond with those at the time of ce-MRA, including 6 patients (3%) with a falsely diagnosed stenosis or occlusion.In total, 62 patients received non-operative treatment (34%), 65 an endovascular procedure (36%), 49 open surgical reconstruction (27%) and 6 a combined treatment.Conclusions: We conclude that in the majority of patients treatment can be planned based on ce-MRA images, although sometimes additional DUS or DSA may be required.