MR Angiography of the Hand Arteries

After institutional review board approval and informed consent were obtained for this HIPAA-compliant investigation, a three-dimensional electrocardiographically gated variable flip angle (VFA) fast spin-echo magnetic resonance (MR) angiography technique was evaluated as an unenhanced method for imaging hand arteries in 13 subjects (including four patients) at 3.0 T; this included evaluation of vessel visualization with warming and cooling in seven subjects. Examinations were evaluated for image quality and vessel conspicuity. Clear separation of arteries from veins was achieved in all subjects, with excellent vessel conspicuity and depiction of stenoses. Warming improved vessel visualization in healthy volunteers. VFA MR angiography is a high-spatial-resolution technique that enables the assessment of vascular reactivity in response to temperature challenge. RSNA, 2009 1 From the Department of Radiology (MRI), New York University Langone Medical Center, 530 First Ave, Basement Schwartz Bldg, New York, NY 10016 (R.P.L., P.S., I.P.A., E.M.H., J.S.B., D.R.S., K.M., Q.C., H.R., V.S. Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article.I maging is vital in the work-up and management of vascular hand abnormalities, including thromboembolic disease, vasculitides, trauma, and vascular malformations. The standard of reference for hand evaluation is digital subtraction angiography (1). However, digital subtraction angiography has associated risks of puncture site complications, ionizing radiation, and iodine nephrotoxicity and can also be a painful procedure for patients. In addition, vasodilators are frequently required for optimal visualization of the small arteries of the hand, which are highly reactive to noxious stimuli (2). Contrast materialenhanced magnetic resonance (MR) angiography has been advocated as a suitable noninvasive alternative (3-5), but small vessel caliber, relatively slow arterial flow, and short arteriovenous transit times can hamper arterial visualization (1,6). Attempts to shorten imaging times can compromise spatial resolution or signal-to-noise ratio.An unenhanced technique is desirable, particularly in patients with vasculitides or concurrent renovascular disease, in whom renal function may be compromised and nephrogenic systemic fibrosis becomes a potential clinical concern (7). Time-of-flight and phase-contrast techniques have been reported (8) but are limited by long imaging times and limited coverage (1).An electrocardiographically gated spin-echo-based MR angiographic technique was initially described by Wedeen et al (9) and was later adapted into a three-dimensional (3D) single-shot fast spin-echo (FSE) technique by Miyazaki et al (10) on the basis of the principle that black blood images can be obtained in fast-flowing blood with spin-echo sequences.Promising results have been obtained with this technique for the lower extremities (1...

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“…Time-of-flight and phase-contrast techniques have been reported (8) but are limited by long imaging times and limited coverage (1).…”

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confidence: 99%

Three-dimensional Electrocardiographically Gated Variable Flip Angle FSE Imaging for MR Angiography of the Hands at 3.0 T: Initial Experience

et al. 2009

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“…In the future, noninvasive MR angiography techniques will probably be used instead of conventional angiography as these methods are under fast development. This will require more economical resources and has still limitations in accuracy at digital arterial level [14].…”

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confidence: 99%

Directional Doppler and angiography in the assessment of the postoperative function of the microvascular anastomoses: a comparative study

Vilkki¹,

Metsa²,

Seppänen³

2016

J Hand Microsurg

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Purpose The aim was to evaluate the achieved patency rates and to compare directional Doppler with angiography in the assessment of the vascular patency. Methods Two different methods were used in evaluation of the vascular function of reconstructed fingers and hands. Directional Doppler mapping of anastomosed arteries was compared with conventional angiographical study in the same individuals in the examination of 110 arteries.Results The results showed equal findings in majority of examined vessels (93%) using both methods. There was erroneous interpretation in Doppler study of 4 arteries and in 3 angiographies the interpretation differed from Doppler study mainly due to projection difficulty. There were also 4 digital arteries which were considered open in Doppler study but angiography showed arterial recanalization or neovascularization phenomenon. Conclusion The patency rates at digital artery level (70%) were lower than at metacarpal and forearm level (81%) The results were in concordance with previous studies.

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“…Although the patient required urgent attention, we should perform colour Doppler echography, which is a reliable modality for the transcutaneous assessment of blood flow in small vessels, for such patients. Emergent magnetic resonance angiography performed using optimised protocols is a considerably effective imaging modality for the non-invasive visualisation of the occluded arterial segments of the digital arteries without contrast, 3 if available; however, this modality was not available in our institution. The use of these modalities before and after medical intervention could prevent the risk of contrast-induced vasospasm.…”

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confidence: 99%