Percutaneous vascular intervention based on gadolinium-enhanced MR angiography

PURPOSE: To determine if gadolinium-enhanced magnetic resonance angiography (Gd-MRA) could be used to reliably plan percutaneous vascular procedures. PATIENTS AND METHODS: Over the course of 13 months, 31 patients underwent a ttempted percutaneous intervention solely on the basis of a preceding Gd-MR A study. A total of 49 arterial segments were targeted (28 extremities, 21 visceral). Five segments in four patients were not treated (less impressive disease severity on conventional catheter angiography [CA] in four segment s, diffuse intrarenal atherosclerosis in one segment), Interventions attemp ted were percutaneous transluminal angioplasty (n = 10), angioplasty with s tent placement (n = 29), and thrombolysis (n = 3). Interventions were succe ssful in all segments, except two because of the inability to cross an occl usion. RESULTS: Good to strong correlation was noted between Gd-MRA and CA regardi ng stenosis severity and length and the presence of poststenotic dilatation , MRA underestimated the complexity of stenosis, Subjective quality and pre intervention confidence were excellent in the majority of MRA studies and s atisfactory in the rest. The overall value in "procedural planning" was jud ged high in 40 segments, satisfactory in five segments, and poor in four se gments. The procedural. planning and positive predictive values of MRA were significantly lower for visceral arteries compared to iliac and peripheral arteries. CONCLUSION: In most cases, Gd-MRA reliably yielded the anatomic and diagnos tic information necessary to plan percutaneous vascular interventions nonin vasively and without iodinated contrast. In the authors' practice, Gd-MRA i s becoming a key imaging modality in the workup of patients in whom percuta neous intervention is anticipated.