MRA: Current Applications in Body Vascular Imaging

Slides:

Advertisements

Similar presentations

MRA of Abdominal Aortic Aneurysms Martin R. Prince, MD, PhD

Advertisements

Stent graft repair of descending aortic dissection in patients with Marfan syndrome: An effective alternative to open reoperation? Luca Botta, MD, Vincenzo.

Martin R. Prince, MD, PhD, Dasika L. Narasimham, MD, James C

Endovascular treatment of renal artery aneurysms and renal arteriovenous fistulas Zhongming Zhang, MD, Min Yang, MD, Li Song, MD, Xiaoqiang Tong, MD,

Thoracic aortic aneurysm status post stent-graft repair

Circ Cardiovasc Imaging

Directional tip control technique for optimal stent graft alignment in angulated proximal aortic landing zones Toshio Takayama, MD, PhD, Patrick J. Phelan,

Multimodality Imaging of Lower Extremity Peripheral Arterial Disease

Catheter-less angiography for endovascular aortic aneurysm repair: A new application of carbon dioxide as a contrast agent Enrique Criado, MD, Loay Kabbani,

Multimodal Imaging in the Diagnosis of Large Vessel Vasculitis: A Pictorial Review U. Salati, MBChB, MRCP(UK), Ceara Walsh, MBChB, MRCPI, Darragh Halpenny,

Avnesh S. Thakor, PhD, FRCR, James Tanner, MB, BChir, Shao J

Endovascular Therapy for Acute Trauma: A Pictorial Review

Larisse K. Lee, MD, Peter L. Faries, MD Journal of Vascular Surgery

Preliminary experience with superparamagnetic iron oxide-enhanced dynamic magnetic resonance imaging and comparison with contrast-enhanced computed tomography.

Christopher K. Zarins, MD, Rodney A. White, MD, Thomas J. Fogarty, MD

Lee J. Goldstein, MD, Combiz Rezayat, MD, Gautam V

Martin R. Prince, MD, PhD, Dasika L. Narasimham, MD, James C

Neurofibromatosis-associated massive right internal carotid artery aneurysm with a coexisting arteriovenous fistula Marlin Wayne Causey, MD, Daniel M.

Joyce Ji, MD, J. Trevor Posenau, MD, Kathryn J. Lindley, MD, Alan C

Three-dimensional spiral computed tomographic angiography: An alternative imaging modality for the abdominal aorta and its branches Geoffrey D. Rubin,

Retrograde migration of an abdominal aortic aneurysm endograft leading to postoperative renal failure Barry T. Katzen, MD, Alexandra A. MacLean, MD,

Multidetector Computed Tomography of Superior Mesenteric Artery: Anatomy and Pathologies Yan E. Zhao, MD, Zhen Jane Wang, MD, Chang Sheng Zhou, BS, Fei.

Endovascular Therapy for Acute Trauma: A Pictorial Review

Endovascular management of pararenal aortic aneurysms with multiple overlapping uncovered stents Yong-Xue Zhang, MD, Qing-Sheng Lu, MD, Jia-Xuan Feng,

Transapical endovascular repair of iatrogenic type A aortic dissection

Magnetic resonance angiography of collateral blood supply to spinal cord in thoracic and thoracoabdominal aortic aneurysm patients Walter H. Backes,

Stent graft repair of descending aortic dissection in patients with Marfan syndrome: An effective alternative to open reoperation? Luca Botta, MD, Vincenzo.

Initial experience characterizing a type I endoleak from velocity profiles using time- resolved three-dimensional phase-contrast MRI Thomas A. Hope, MD,

Novel technique for endovascular salvage of a folded aortic endograft

Salvage of bilateral renal artery occlusion after endovascular aneurysm repair with open splenorenal bypass Samuel Jessula, MDCM, Christine R. Herman,

Intraoperative contrast-enhanced cone beam computed tomography to assess technical success during endovascular aneurysm repair Christof Johannes Schulz,

Abdominal aortic aneurysm with periaortic malignant lymphoma differentiated from aneurysmal rupture by clinical presentation and magnetic resonance imaging

Case of the Month #170: The Unilateral Persistent Nephrogram After Endovascular Aortic Aneurysm Repair (EVAR): New Life in an Old Sign Ashish Mahajan,

Christopher K. Zarins, MD, Rodney A. White, MD, Thomas J. Fogarty, MD

Overt colon ischemia after endovascular aneurysm repair: The importance of microembolization as an etiology Nishan Dadian, MD, Takao Ohki, MD, Frank.

Patterns of aortic involvement in Takayasu arteritis and its clinical implications: Evaluation with spiral computed tomography angiography Jin Wook Chung,

Time-resolved magnetic resonance angiography as a noninvasive method to characterize endoleaks: initial results compared with conventional angiography

Direct sonographic-guided superior gluteal artery access for treatment of a previously treated expanding internal iliac artery aneurysm Michael M. Herskowitz,

What is the clinical utility of a 6-month computed tomography in the follow-up of endovascular aneurysm repair patients? Michael R. Go, MD, Joel E. Barbato,

Endovascular aortic aneurysm repair with carbon dioxide-guided angiography in patients with renal insufficiency Enrique Criado, MD, Gilbert R. Upchurch,

Posterior reversible encephalopathy syndrome from induced hypertension during endovascular thoracoabdominal aortic aneurysm repair Gustavo S. Oderich,

Have You Seen SAM? EJVES Short Reports

Use of magnetic resonance angiography for the preoperative evaluation of patients with infrainguinal arterial occlusive disease John R. Hoch, MD, Michael.

Evaluation of aortoiliac aneurysm before endovascular repair: Comparison of contrast- enhanced magnetic resonance angiography with multidetector row computed.

Review of Multidetector Computed Tomography Angiography as a Screening Modality in the Assessment of Blunt Vascular Neck Injuries Teresa Liang, BSc,

Three-dimensional spiral computed tomographic angiography: An alternative imaging modality for the abdominal aorta and its branches Geoffrey D. Rubin,

Combination treatment of venous thoracic outlet syndrome: Open surgical decompression and intraoperative angioplasty Darren B. Schneider, MD, Paul J.

Long-segment thoracoabdominal aortic occlusions in childhood

Improved characterization of popliteal aneurysms using gadofosveset-enhanced equilibrium phase magnetic resonance angiography Mauricio S. Galizia, MD,

Hypovolemic Shock Complex in the Trauma Setting: A Pictorial Review

Evaluation of pressure transmission and intra-aneurysmal contents after endovascular repair using the Trivascular Enovus expanded polytetrafluoroethylene.

Contrast-enhanced ultrasound versus color duplex ultrasound imaging in the follow-up of patients after endovascular abdominal aortic aneurysm repair

Carbon dioxide digital subtraction angiography as an option for detection of endoleaks in endovascular abdominal aortic aneurysm repair procedure Eijun.

Endovascular management of an acute type B aortic dissection in a patient with fibromuscular dysplasia Jeanette H. Man, BS, Abby Rothstein, MD, Parag.

Intra-operative DynaCT improves technical success of endovascular repair of abdominal aortic aneurysms Lukla Biasi, MD, Tahir Ali, MBChB, MRCS, Lakshmi.

K. Koseoglu, B. Cildag, S. Sen, M. Boga, M. Parildar EJVES Extra

First experience using intraoperative contrast-enhanced ultrasound during endovascular aneurysm repair for infrarenal aortic aneurysms Reinhard Kopp,

Endovascular treatment of renal artery aneurysms and renal arteriovenous fistulas Zhongming Zhang, MD, Min Yang, MD, Li Song, MD, Xiaoqiang Tong, MD,

Answer to Case of the Month #159

Abe DeAnda, MD, Vigneshwar Kasirajan, MD, Daniel Henry, MD, Stuart I

P Jetty, MD, G.G Barber, MD Journal of Vascular Surgery

Late renal artery stent fracture with pseudoaneurysm after fenestrated endovascular abdominal aortic aneurysm repair Shanil M. Yapa, MSc, MBBS, Kishore.

Clinical presentation and vascular imaging in giant cell arteritis of the femoropopliteal and tibioperoneal arteries. Analysis of four cases Federico.

Endoleaks after endovascular graft treatment of aortic aneurysms: Classification, risk factors, and outcome Reese A. Wain, MD, Michael L. Marin, MD,

J. V. Robbs, Ch. M. , F. R. C. S. , R. R. Human, F. C. S. (S. A. ), P

Spontaneous recanalization of a middle cerebral artery occlusion with subsequent carotid endarterectomy Andrew J. Jackson, BSc, MBChB, MRCS, Amit Patel,

Magnetic Resonance Angiography and Detection of Renal Artery Stenosis in a Patient With Impaired Renal Function EMANUEL FARRUGIA, M.D. Mayo Clinic Proceedings

Mesenteric vascular insufficiency and claudication following acute dissecting thoracic aortic aneurysm Thomas H. Cogbill, M.D., A.Erik Gundersen, M.D.,

Percutaneous fenestrated endovascular aortic graft treatment of aortocaval fistula with aortic pseudoaneurysms secondary to penetrating trauma Sheila.

Phlegmasia cerulea dolens secondary to an aortoiliac aneurysm

Presentation transcript:

MRA: Current Applications in Body Vascular Imaging Viesha A. Ciura, MD, Mark J. Lee, MD, Drew C. Schemmer, MD Canadian Association of Radiologists Journal Volume 60, Issue 3, Pages 133-142 (June 2009) DOI: 10.1016/j.carj.2009.05.008 Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 1 Time-resolved imaging of contrast kinetics (TRICKS) magnetic resonance (MR) angiography (MRA) of the thoracic outlet in a 55-year-old man in the challenged positioning (arm abducted), showing critical mechanical stenosis of the left subclavian vein (red arrow). There are multiple collaterals, showing holdup of contrast proximally and peripherally. Technique: 7.5 mL Gadovist (Berlex; Bayer Healthcare Pharmaceuticals, Montville, NJ), 20 mL NS push, matrix 256 × 192, 2-mm thick, TR: 1 sec. NS = normal saline. Canadian Association of Radiologists Journal 2009 60, 133-142DOI: (10.1016/j.carj.2009.05.008) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 2 Bilateral subclavian vein stenosis. (A) Conventional angiogram, showing residual thrombosis in the right subclavian vein. Note the meniscus, which represents an intraluminal thrombus. (B) Second conventional angiogram in the same patient, demonstrating moderate stenosis of the left subclavian vein (green arrow). (C) TRICKS MRA of both arms in the challenged positioning (both arms abducted), showing congruency with the digital subtraction angiography (DSA) venogram: right subclavian vein residual thrombosis and moderate stenosis of the left subclavian vein (red arrow). Technique: 7.5 mL Gadovist, 15 mL NS bolus push, matrix 256 × 192, 2-mm thick, TR: 2 sec. Canadian Association of Radiologists Journal 2009 60, 133-142DOI: (10.1016/j.carj.2009.05.008) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 3 Clinical history of right leg claudication. This case demonstrates the directional differences between conventional contrast-enhanced (CE) MRA and temporal MRA studies (TRICKS). (A) CE-MRA, in which injected contrast fills as many vessels as possible over time, and the resultant display erroneously represents a falsely patent artery by retrograde arterial flow (blue arrow). (B) Temporal MRA (TRICKS) accurately identifying an occlusion of the same peroneal artery because of multiple progressive MRA images and prograde filling (red arrow) of the anterior tibial and posterior tibial arteries with retrograde filling of the peroneal artery. There is no sacrifice of image quality or signal-to-noise ratio because of temporal speed. Technique: 7.5 mL Gadovist, 20 mL NS bolus push, matrix 256 × 160, 2-mm thick, Sp 1 mm, TR: 2 sec. Sp = spacing. Canadian Association of Radiologists Journal 2009 60, 133-142DOI: (10.1016/j.carj.2009.05.008) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 4 (A–C) Renal artery stenosis. CE-MRA examination of the right renal artery, showing mildly irregular but patent renal arterial lumen after 6-mm balloon angioplasty. In these situations, noninvasive MRA surveillance is recommended every 6 months for the first year, with another examination if the patient's blood pressure, creatinine, and/or glomerular filtration rate levels become abnormal. Canadian Association of Radiologists Journal 2009 60, 133-142DOI: (10.1016/j.carj.2009.05.008) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 5 A 58-year-old woman with a clinical history of hypertension and elevated creatinine. (A) Prestent MRA, demonstrating severe left renal artery stenosis (green arrow) with high flow signal void in renal ostium. (B) Prestent axial multiplanar reconstructed (MPR) allows for the delineation of the stenosis length and underlying native renal calibre. This facilitates preprocedural selection of the most accurate and safe renal artery stent. Technique: MRA 7.5 mL Gadovist, 15 mL NS bolus push, matrix 256 × 192, 0.71 NEX, 2.4-mm thick, Sp 1.2 mm. (C, D) Two DSA images show severe left renal artery stenosis with normal nephrogram. (E) DSA image, showing a 7 × 12-mm MR-compatible stent after balloon angioplasty and reveals excellent improvement in vessel calibre. (F, G) Post-MRA visualization of left renal artery with MR compatible cobalt chromium Racer (Medtronic, Minneapolis, MN) stent in situ. Sagittal (F) and MPR (G) images further delineate the calibre of the stent. NEX = number of excitations. Canadian Association of Radiologists Journal 2009 60, 133-142DOI: (10.1016/j.carj.2009.05.008) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 6 A 73-year-old woman with bilateral renal artery stenoses, who had previously had a left stainless steel renal stent inserted. (A, B) DSA-guided insertion of MR-compatible cobalt chromium Racer stent in the right renal artery. The stainless steel stent in the left renal artery is indicated by the red arrow. (C–F) Post–MR-compatible Racer stent insertion. Multiple direct coronal and reconstructed axial MRA projections of the renal arteries, as well as MPR and vessel analysis reformations of the right renal artery after stenting. Note the significant metallic susceptibility artifact in the region of the left renal artery with its stainless steel stent (E). The orange arrow (F) points to the stainless steel stent in the left renal artery, which makes interpretation of the arterial lumen nondiagnostic. Canadian Association of Radiologists Journal 2009 60, 133-142DOI: (10.1016/j.carj.2009.05.008) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 7 Inflammatory abdominal aortic aneurysm (AAA) treated with a Medtronic nitinol stent 1 month earlier. (A) Preoperative Gadovist-enhanced MRA of the abdominal aorta clearly showing enhancing mural thickening of the infrarenal aorta (red arrows). Intraluminal aortic thrombus (black) and luminal contrast (grey) are also well delineated. (B) MRA MIP, showing visceral anatomy and luminal aortic contours. (C) Postoperative coronal MRA of MR-compatible (nitinol-Medtronic) EVAR, with patent limb grafts and persistent aortic mural thickening and enhancement. No evidence of endoleak. MIP = maximum intensity projection. Canadian Association of Radiologists Journal 2009 60, 133-142DOI: (10.1016/j.carj.2009.05.008) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 8 MRA for preoperative endovascular aneurysm repair (EVAR) workup. Accurate spatial resolution allows endovascular radiologists to document renal anatomy, infrarenal aortic neck lengths, and pelvic arterial dimensions. Canadian Association of Radiologists Journal 2009 60, 133-142DOI: (10.1016/j.carj.2009.05.008) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions

Figure 9 Axial MRA image of postoperative EVAR of infrarenal AAA. Contrast is seen in each widely patent limb graft. However, there is contrast seen in the aneurysm sac external to the graft stent (green arrows) consistent with a significant type II endoleak. Canadian Association of Radiologists Journal 2009 60, 133-142DOI: (10.1016/j.carj.2009.05.008) Copyright © 2009 Canadian Association of Radiologists Terms and Conditions