Magnetic resonance angiography used to detect kinking in the iliac arteries in endurance athletes with claudication

In endurance athletes, leg complaints upon maximal exercise caused by now l imitations in the iliac arteries are frequently encountered. We theorize th at functional kinking of the vessels, which occurs especially during hip fl exion, may be a cause for such flow limitations. Conventional diagnostic te sts cannot demonstrate such kinkings. Using gadolinium-enhanced magnetic resonance angiography, a 3D dataset of t he aorto-iliac arteries could be obtained with the hips flexed. An image pr ocessing procedure was developed using a new segmentation algorithm to be a ble to use standard surface rendering techniques to visualize the arteries with an improved 3D appearance. These techniques were applied in the curren t study in 42 endurance athletes with documented flow limitations in the il iac arteries. As a control group 16 national level competitive cyclists wit hout flow limitations in the iliac arteries were studied. Forty-six affected legs were examined in 42 patients. In all patients and r eference persons image quality was adequate and the segmentation algorithm could be applied. In 22 affected legs (48%) a kinking in the common iliac a rtery could be demonstrated, compared with one leg (3%) in the control grou p. In 13 affected legs (28%) a kinking in the external iliac artery could b e demonstrated, compared with three legs (9%) in the control group. It can be concluded that flow limitations in the iliac arteries in enduranc e athletes are associated with kinkings in the common and/or the external i liac arteries. Magnetic resonance angiography with the hips flexed followed by this newly developed segmentation algorithm is effective to visualize a nd score these kinkings.