Introduction

The early detection of atherosclerotic vascular lesions is very important for diagnostic and interventional purposes. Magnetic resonance angiography (MRA) has increasingly gained acceptance as a valid alternative to onventional digital subtraction angiography for many vascular regions. The systemic distribution of atherosclerotic manifestations requires the use of techniques which can assess the vascular system as exhaustively as possible. The recent introduction of whole-body MR scanners with surface coil technology raises the possibility of whole-body MRA examinations providing information of the patient’s complete arterial vasculature.

Whole body MRA was performed on a 45 year old male patient with suspected peripheral arterial occlusive disease (Fontaine 2b). According to patient history and clinical findings, arterial obstruction is suspected at the level of the upper leg. Prior angiographic examinations were performed in 1992 and March of 2004. However, due to atherosclerotic occlusions of the pelvic arteries, only an intravenous DSA could be performed. MR images should be acquired to assess the vascular status of the complete arterial vasculature of the body.

Examination was performed on a 1.5T Siemens MAGNETOM Avanto scanner using standard Head-, Neck-, Spine-, Peripheral Angio- and two Body Matrix coils.

The patient was placed in supine position with pads under each knee to reduce the venous backflow. Venous access was established on the right cubital vein to avoid overlapping with the left subclavian artery in the maximum intensity projection (MIP).

Four angiographic stations were acquired to obtain whole-body coverage. Station I included cranial and thoracic vessels, station II thoracic, abdominal and pelvic vessels, station III vessels of the upper leg and station IV vessels of the lower leg. Field of view (FoV) was 500 mm for each station and overlap between two stations was at least 40 mm.

After acquisition of localizer images in all four regions, a phasecontrast vessel scout was obtained for each station.

A test bolus (2 ml Magnevist) was injected to determine contrast circulation time according to the following formula: [circulation time – time to k-space center + 4 seconds]. Subsequently, a multislab time-offlight (TOF) sequence (TR = 36 ms, TE = 7.15 ms, FoV = 220 mm, Flip = 30°, BW = 73Hz/Px, slice thickness = 0.80, gap = -34%, voxel size: 0.8 mm x 0.6 mm x 0.8 mm) employing a TONE pulse was used to depict the cranial arterial vessels with sufficient spatial resolution.

Precontrast and postcontrast images of all regions were acquired using an angiographic FLASH 3D sequence in coronal orientation (see table for sequence details).

Image Findings

The presented technique is very promising for a comprehensive staging of vascular involvement of systemic atherosclerotic disease. Novel scanner and coil technology enable whole-body MRA examinations without patient repositioning while providing high SNR in short measuring times.