Magnetic resonance angiographic assessment of upper extremity vessels prior to vascular access surgery: feasibility and accuracy

Abstract

A contrast-enhanced magnetic resonance angiography (CE-MRA) protocol for selective imaging of the entire upper extremity arterial and venous tree in a single exam has been developed. Twenty-five end-stage renal disease (ESRD) patients underwent CE-MRA and duplex ultrasonography (DUS) of the upper extremity prior to hemodialysis vascular access creation. Accuracy of CE-MRA arterial and venous diameter measurements were compared with DUS and intraoperative (IO) diameter measurements, the standard of reference. Upper extremity vasculature depiction was feasible with CE-MRA. CE-MRA forearm and upper arm arterial diameters were 2.94 +/- 0.67 mm and 4.05 +/- 0.84 mm, respectively. DUS arterial diameters were 2.80 +/- 0.48 mm and 4.38 +/- 1.24 mm; IO diameters were 3.00 +/- 0.35 mm and 3.55 +/- 0.51 mm. Forearm arterial diameters were accurately determined with both techniques. Both techniques overestimated upper arm arterial diameters significantly. Venous diameters were accurately determined with CE-MRA but not with DUS (forearm: CE-MRA: 2.64 +/- 0.61 mm; DUS: 2.50 +/- 0.44 mm, and IO: 3.40 +/- 0.22 mm; upper arm: CE-MRA: 4.09 +/- 0.71 mm; DUS: 3.02 +/- 1.65 mm, and IO: 4.30 +/- 0.78 mm). CE-MRA enables selective imaging of upper extremity vasculature in patients requiring hemodialysis access. Forearm arterial diameters can be assessed accurately by CE-MRA. Both CE-MRA and DUS slightly overestimate upper arm arterial diameters. In comparison to DUS, CE-MRA enables a more accurate determination of upper extremity venous diameters.

Feasibility of Non-contrast-enhanced Magnetic Resonance Angiography for Imaging Upper Extremity Vasculature Prior to Vascular Access Creation

“…Nonetheless, we believe that NCE-MRA images can be used for accurate appraisal of vascular diameters due to the high spatial resolution, bearing in mind our prior study which found lower spatial resolution CE-MRA diameter assessment to correspond reasonably well with DUS assessment and intra-operative measurements. 28 Second, acquisition of distal, proximal and central stations required repositioning of the patient using multiple surface coils. Future work should be aimed at the 'real world' value of an NCE-acquisition of the complete upper extremity, preferably within a single acquisition using large coverage coils in combination with continuously moving table techniques.…”

Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

“…113 CE-MRA enables accurate pre-operative detection of upper extremity arterial and venous stenosis and occlusions. 114,115 However, contrast enhanced magnetic resonance angiography (CE-MRA) is not recommended, since use of gadolinium is associated with the potential risk of a nephrogenic systemic fibrosis, especially in patients with severely impaired renal function. 116,117 Promising preliminary results for the pre-operative visualisation of arterial and venous vascular structures with non-contrast enhanced MRA (NCE-MRA) are available.…”

Imaging in Vascular Access

“… 53 CE-MRA can identify the lumen of upper extremity vessels and be more accurate in diameter determination in comparison with DUS. 65 …”