Soft tissue enhancement on time-resolved peripheral magnetic resonance angiography.
OBJECTIVE
To evaluate the incidence and locations of soft tissue enhancement on time-resolved two-dimensional projection magnetic resonance angiography (MRA) of the calf and foot.


METHODS
Time-resolved two-dimensional projection MRA of the knee, calf, and foot, performed at 1.5 Tesla using the head coil, was retrospectively reviewed in 326 patients. Soft tissue enhancement of the foot was identified and graded by blinded review. Subsequently, patient medical records were reviewed to determine the presence or absence of diabetes, cellulitis, gangrene, and ulceration of the foot and presence of neuropathic joints.


RESULTS
Enhancing spots were identified in 228 patients. For those feet without clinical abnormalities, diabetic patients had an average of 1.2 enhancing spots per foot, while nondiabetics had only 0.6 (P < 0.001). Higher-grade lesions were more prevalent in diabetics and in heavier patients. Of 64 patients with follow-up, 8 (13%) developed cellulitis (N = 4) or ulceration (N = 4) at the location of an enhancing spot, including 5 diabetic and 3 nondiabetic patients.


CONCLUSIONS
Pedal soft tissue enhancement frequently occurs on time-resolved gadolinium (Gd):MRA of the feet. The etiology is uncertain, but the high frequency in diabetic patients and observation of progression to cellulitis/ulceration suggest this soft tissue enhancement may identify sites of subclinical pedal soft tissue injury.
Zhang
Hong Lei
HL
Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA.
Kent
K Craig
KC
Bush
Harry L
HL
Winchester
Priscilla A
PA
Watts
Richard
R
Wang
Yi
Y
Prince
Martin R
MR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000473:pathology; D002481:Cellulitis / Q000473:pathology; D003238:Connective Tissue / Q000473:pathology*; D003925:Diabetic Angiopathies / Q000473:pathology; D005260:Female; D005528:Foot / Q000098:blood supply; D005534:Foot Diseases / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D007592:Joint Diseases / Q000473:pathology; D007866:Leg; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply; D010523:Peripheral Nervous System Diseases / Q000473:pathology; D012189:Retrospective Studies