When can magnetic resonance angiography replace contrast angiograms for vascular disease?

Abstract

On the basis of the rapid proliferation of magnetic resonance methods, it seems likely that magnetic resonance angiography will obviate the need for invasive x-ray angiography in the initial screening of many patients with known or suspected vascular disease. As it relates to the stable patient with thoracic aortic disease, MRA has already replaced invasive contrast angiography and is now widely accepted as the gold standard. For abdominal aortic disease, MRA can best be considered a viable alternative, but developments need to be made before this can be considered a first-line approach. For the peripheral vasculature MRA has already assumed an important role but technical developments need to occur before this is more widely disseminated. Finally, in the extracranial cerebral vasculature, several centers are already performing therapeutic interventions based on noninvasive testing, most notably the combination of MRA and data from ultrasound-based techniques. The ultimate goal is to move as many diagnostic studies as possible into the noninvasive arena to reduce morbidity associated with straightforward diagnoses. In parallel, the invasive angiography suite will be used primarily for therapeutic work and for the occasional diagnostic study in which noninvasive testing fails to reveal a clear-cut diagnosis. Cardiovascular specialists need to assume a leadership role in developing and applying this technology to help improve the care of the large number of patients with vascular diseases.