Clinical Experience in Timed Arterial Compression Contrast-enhanced Magnetic Resonance Angiography of the Hand Andreas Gutzeit, MD, Boris Eckhardt, MD,

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Clinical Experience in Timed Arterial Compression Contrast-enhanced Magnetic Resonance Angiography of the Hand Andreas Gutzeit, MD, Boris Eckhardt, MD, Jan Beranek, MD, Klaus U. Wentz, MD, Edwin Willemse, MT, Regula Jenelten, MD, Christoph A. Binkert, MD, MBA, Johannes M. Froehlich, PhD Canadian Association of Radiologists Journal Volume 61, Issue 4, Pages 206-216 (October 2010) DOI: 10.1016/j.carj.2009.11.005 Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 1 Typical cross-sectional signal intensity (SI) profile of peripheral radial artery acquired with timed arterial compression contrast-enhanced magnetic resonance angiography technique in a well-timed case. The plateau indicates indirectly that the contrast-enhanced blood was not flowing. Canadian Association of Radiologists Journal 2010 61, 206-216DOI: (10.1016/j.carj.2009.11.005) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 2 Typical cross-sectional signal intensity (SI) profile of proper digital artery acquired with the timed arterial compression contrast-enhanced magnetic resonance angiography technique. This smaller vessel presents some Gauss-type curve that may be attributed to the rather small diameter of the artery and some rest flux within the artery. Canadian Association of Radiologists Journal 2010 61, 206-216DOI: (10.1016/j.carj.2009.11.005) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 3 Arterial phase of a timed arterial compression contrast-enhanced magnetic resonance angiography of a patient with an arterial-venous malformation (big thin arrow), the distal part of the proper digital arteries is visualized (small thin arrow). Some venous contamination (arrow heads) can be seen. Canadian Association of Radiologists Journal 2010 61, 206-216DOI: (10.1016/j.carj.2009.11.005) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 4 A patient with hypothenar hammer syndrome, showing an occlusion of the ulnar artery at the level of the hypothenar eminence (arrow head). Canadian Association of Radiologists Journal 2010 61, 206-216DOI: (10.1016/j.carj.2009.11.005) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 5 A patient presenting with occlusions in the radialis indicis artery and the palmar metacarpal arteries 4 (arrow head) and 5, and stenosis in the third palmar metacarpal artery (thin arrow). Moreover, corkscrew collaterals, which indicate Buerger disease, can be seen (thick arrows). Canadian Association of Radiologists Journal 2010 61, 206-216DOI: (10.1016/j.carj.2009.11.005) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 6 (A, left) Arterial phase of a timed arterial compression contrast-enhanced magnetic resonance angiography. Please note the thumb amputation at the level of the metacarpophalangeal (MCP) joint and the sparse princeps pollicis artery (thick arrow). Venous contamination, caused by the changed anatomic situation is eminent and hampers the depiction of small arteries, for instance of the proper palmar digital artery (small arrow). Occlusion of ulnar artery at the level of the ulnocarpal joint is typical for hypothenar hammer syndrome (arrow head). (B, right) Another case of strong venous contamination already in the arterial phase, which heavily degrades the diagnostic value of this timed arterial compression contrast-enhanced magnetic resonance angiography caused by wrong timing of the cuff inflation. Canadian Association of Radiologists Journal 2010 61, 206-216DOI: (10.1016/j.carj.2009.11.005) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 7 A case of incomplete arterial filling because of multiple stenoses and occlusions of the hand and digital arteries (thin arrows), thick arrows show the curled and irregular wall morphology of the arteries, indicating marked atherosclerotic changes. Canadian Association of Radiologists Journal 2010 61, 206-216DOI: (10.1016/j.carj.2009.11.005) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 8 A patient with paleness, cold, and paraesthesia in his right ring and little finger under chillness exposure showed occlusions of the ulnar artery and digital arteries of the ring and little finger. A collateral is depicted coming from distal radial artery and flowing into the branch connection of the ulnar proper digital artery DIG II. Canadian Association of Radiologists Journal 2010 61, 206-216DOI: (10.1016/j.carj.2009.11.005) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions