Feasibility of Non-contrast-enhanced Magnetic Resonance Angiography for Imaging Upper Extremity Vasculature Prior to Vascular Access Creation

• Published in: European journal of vascular and endovascular surgery Vol. 43; no. 1; pp. 88 - 94
• Main Authors: Bode, A.S, Planken, R.N, Merkx, M.A.G, van der Sande, F.M, Geerts, L, Tordoir, J.H.M, Leiner, T
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2012
• Subjects: Adult; Aged; Arteriovenous shunt, surgical; Arteriovenous Shunt, Surgical - adverse effects; Case-Control Studies; Contrast Media; Feasibility Studies; Female; Humans; Kidney failure, chronic; Kidney Failure, Chronic - therapy; Magnetic Resonance Angiography; Male; Middle Aged; Nephrogenic fibrosing dermopathy; Netherlands; Predictive Value of Tests; Preoperative Care; Renal Dialysis; Surgery; Upper extremity; Upper Extremity - blood supply; Young Adult; Netherlands; Arteriovenous shunt, surgical; Nephrogenic fibrosing dermopathy; Upper extremity; Kidney failure, chronic; Magnetic resonance angiography
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2011.09.012

Abstract Objectives Preoperative mapping of arterial and venous anatomy helps to prevent postoperative complications after vascular access creation. The use of gadolinium in contrast-enhanced (CE) magnetic resonance angiography (MRA) has been linked to nephrogenic systemic fibrosis in patients with end-stage renal disease (ESRD). The purpose of this study was to evaluate non-contrast-enhanced (NCE) MRA for assessment of upper extremity and central vasculature and to compare it with CE-MRA. Methods NCE and CE-MRA images were acquired in 10 healthy volunteers and 15 patients with ESRD. In each data set, two observers analysed 11 arterial and 16 venous segments with regard to image quality (0–4), presence of artefacts (0–2) and vessel-to-background ratio. Results More arterial segments were depicted using CE-MRA compared to NCE-MRA (99% vs. 96%, p  = 0.001) with mean image quality of 3.80 vs. 2.68, ( p  < 0.001) and mean vessel-to-background ratio of 6.47 vs. 4.14 ( p  < 0.001). Ninety-one percent of the venous segments were portrayed using NCE-MRA vs. 80% using CE-MRA ( p  < 0.001). Mean image quality and vessel-to-background ratio were 2.41 vs. 2.21 ( p  = 0.140) and 5.13 vs. 3.88 ( p  < 0.001), respectively. Conclusions Although arterial image quality and vessel-to-background ratios were lower, NCE-MRA is considered a feasible alternative to CE-MRA in patients with ESRD who need imaging of the upper extremity and central vasculature prior to dialysis access creation.