Magnetic resonance-guided percutaneous angioplasty of femoral and popliteal artery stenoses using real-time imaging and intra-arterial contrast-enhanced magnetic resonance angiography.
OBJECTIVE
The aim of this study was to demonstrate the possibility of performing magnetic resonance (MR)-guided interventional therapy for femoral and popliteal artery stenoses with commercially available materials supported by MR real-time imaging and intra-arterial MR angiography.


METHODS
A total of 15 patients suffering from symptomatic arterial occlusive disease of the lower limbs with 19 stenoses were included. Interventional intra-arterial digital subtraction angiography was performed before and after angioplasty on each patient as standard of reference. MR images were acquired on a 1.5-T MR scanner. A fast-low-angle shot (FLASH) 3D sequence was applied for a contrast enhanced MR-angiography (ceMRA). A total of 5 mL of diluted gadodiamide was injected via the arterial access. Maximum intensity projections (MIPs) were used as roadmaps and localizers for the interactive positioning of a continuously running 2D-FLASH sequence with a temporal solution of 2 images/second. The lesion was crossed by a balloon-catheter, which was mounted on a guidewire. The visibility was provided by the radiopaque markers on the balloon and was improved by injection of 1 mL of gadolinium into the balloon. Postinterventional control was performed by intra-arterial MR angiography and catheter angiography.


RESULTS
Stenoses were localized by intra-arterial MR angiography. The guidewire/balloon combination was visible, and the balloon was placed correctly to cover the entire stenoses. Balloon dilation reduced the degree of stenosis by approximately 57% on average. No complications were observed.


CONCLUSIONS
MR-guided balloon dilation of femoral and popliteal artery stenoses supported by real-time MR imaging and intra-arterial MR angiography is feasible with commercially available materials.
Paetzel
Christian
C
Department of Diagnostic Radiology, University of Regensburg-Klinikum, Regensburg, Germany. CP2002@T-Online.de
Zorger
Niels
N
Bachthaler
Maike
M
Hamer
Okka W
OW
Stehr
Alexander
A
Feuerbach
Stefan
S
Lenhart
Markus
M
Völk
Markus
M
Herold
Thomas
T
Kasprzak
Piotr
P
Nitz
Wolfgang R
WR
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D002406:Catheterization, Peripheral; D003251:Constriction, Pathologic / Q000628:therapy; D003287:Contrast Media; D005260:Female; D005263:Femoral Artery / Q000473:pathology*; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000473:pathology*; D011856:Radiographic Image Enhancement / Q000379:methods; D015642:Radiology, Interventional; D014283:Triiodobenzoic Acids
D003287:Contrast Media; D014283:Triiodobenzoic Acids; C064925:gadodiamide; C044834:iodixanol; D019786:Gadolinium DTPA