Peripheral vascular surgery and magnetic resonance arteriography - a review

Objectives: to review the current status of lower limb MRA. Design: a literature review based predominantly on a MEDLINE database searc h of English-language publications from January 1991 to October 2000. Materials and methods: twenty-eight articles, concerning non-enhanced MRA ( 13), gadolinium-enhanced MRA (14) or both (1), met the predefined requireme nt for quality. Results: gadolinium-enhanced MRA (CE-MRA) seems to be more accurate, quicke r and associated with fewer problems than non-enhanced (TOF) MRA. TOF-MRA h as a sensitivity and specificity of 93% (range 64-100%) and 88% (range 57-1 00%) respectively, and CE-MRA presents values of 96% (range 71-100%) and 96 % (63-100%), respectively, using conventional arteriography as the gold sta ndard. Some articles report a substantial incidence of runoff vessels suita ble for distal bypass visible on MRA but invisible on conventional arteriog raphy. Gadolinium contrast is given intravenously and is generally well tol erated and has no known nephrotoxicity. Conclusion: CE-MRA is accurate compared to conventional arteriography, has the potential to increase the limb salvage rate for selected patients, is n on-invasive and well tolerated.