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

• Published in: European radiology 2008, Vol.18 (1), p.158-167
• Main Authors: Planken, Nils R., Tordoir, Jan H., Duijm, Lucien E., van den Bosch, Harrie C., van der Sande, Frank M., Kooman, Jeroen P., de Haan, Michiel W., Leiner, Tim
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Aged; Aged, 80 and over; Arm - blood supply; Arm - diagnostic imaging; Arteriovenous Shunt, Surgical; Contrast Media - administration & dosage; Diagnostic Radiology; Feasibility Studies; Female; Gadolinium DTPA - administration & dosage; Hemodialysis; Hospitals; Humans; Image Processing, Computer-Assisted; Imaging; Internal Medicine; Interventional Radiology; Kidney diseases; Kidney Failure, Chronic - therapy; Magnetic Resonance Angiography - instrumentation; Magnetic Resonance Angiography - methods; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Patients; Radiology; Renal Dialysis - methods; Statistics, Nonparametric; Surgery; Ultrasonic imaging; Ultrasonography, Doppler, Duplex; Ultrasound; Vascular-Interventional; Veins & arteries; Venous access
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-007-0714-y

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.