Contrast‐Enhanced Renal MRA

Anil N. Shetty1, Kostaki G. Bis1

1 William Beaumont Hospital, Royal Oak, Michigan
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Unit A28.1
DOI:  10.1002/0471142719.mia2801s11
Online Posting Date:  February, 2004
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The rapid growth of magnetic resonance imaging systems with enhanced gradient systems together with improved pulse sequences has improved the ability to image blood vessels with a spatial and temporal resolution similar to conventional X‐ray angiography. With patients who cannot undergo X‐ray angiography because they are contraindicated for iodinated contrast agents (having a creatinine level > 2.0), MRA (magnetic resonance angiography) has proven to be the modality of choice. Since the first demonstration of such contrast‐enhanced studies in the abdominal aorta, there have been continual improvements in methods due to improved hardware/software capabilities. This unit presents the MR protocols to image vascular morphology using contrast‐enhanced 3‐D‐MRA techniques. The pulse sequences described herein are based on the authors' experience with a Siemens 1.5 T Vision and 1.5 T Sonata scanners, but are expected to be equally applicable to machines from other manufacturers.

Keywords: MRA; renal MRA; contrast‐enhanced MRA; renovascular imaging

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Table of Contents

  • Commentary
  • Literature Cited
  • Figures
  • Tables
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Basic Protocol 1:

  • Normal saline (0.9% NaCl), sterile
  • Extravascular contrast agent (e.g., Magnevist, Omniscan, or Prohance), volume estimated using patient weight (usual amount is based on a single dose, 0.1 mmol/kg)
  • Disposable contrast‐agent syringes and i.v. line
  • Power injector
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Literature Cited

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   Earls, J.P., Rofsky, N.M., Decorato, D.R., Krinsky, G.A., and Weinreb, J.C. 1996. Breath‐hold single‐dose gadolinium‐enhanced three‐dimensional MR angiography: Usefulness of a timing examination and MR power injector. Radiology 201:705‐710.
   Hany, T.F., McKinnon, G.C., Leung, D.A., Pfammatter, T., and Debatin, J.F. 1997. Optimization of contrast timing for breath‐hold three‐dimensional MR angiography. J. Magn. Reson. Imaging 7:551‐556.
   Hany, T.F., Lueng, D.A., Pfammatter, T., and Debatin, J.F. 1998. Contrast‐enhanced magnetic resonance angiography of the renal arteries. Invest. Radiol. 9:653‐659.
   Ho, V.B. and Foo, T.K. 1998. Optimization of gadolinium‐enhanced magnetic resonance angiography using an automated bolus‐detection algorithm (MR smartprep). Invest. Radiol. 33:515‐523.
   Holland, G.A., Dougherty, L., Carpenter, J.P., Golden, M.A., Gilfeather, M., Slossman, F., Schnall, M.D., and Axel, L. 1996. Breath‐hold ultrafast three‐dimensional gadolinium‐enhanced MR angiography of the aorta and the renal and other visceral abdominal arteries. A.J.R. Am. J. Roentgenol 166:971‐981.
   Iglesias, J.I., Hamburger, R.J., Feldman, L., and Kaufman, J.S. 2000. The natural history of incidental renal artery stenosis in patients with aortoiliac vascular disease. Am. J. Med. 109:642‐647.
   Ito, K., Kato, J., Okada, S., and Kumazaki, T. 1997. K‐space filter effect in three‐dimensional contrast MR angiography. Acta Radiol. 38:172‐175.
   Johansson, L.O.M. and Ahlstrom, H.K. 1998. Correlation between dose rate and T1 in blood at Gd‐enhanced MR angiography. Acta Radiol. 39:579‐582.
   Lee, V.S., Rofsky, N.M., Krinsky, G.A., Stemerman, D.H., and Weinreb, J.C. 1999. Single dose breath‐hold gadolinium‐enhanced three‐dimensional MR angiography of the renal arteries. Radiology 211:69‐78.
   Prince, M.R. 1994. Gadolinium enhanced MR aortography. Radiology 191:155‐164.
   Schoenberg, S.O., Prince, M.R., Knopp, M.V., and Allenberg, J.R. 1998. Renal MR angiography. Magn. Reson. Imaging Clin. N. Am. 2:351‐370.
   Shellock, F.G. 2001. Pocket Guide to MR Procedures and Metallic Objects. Lippincott‐Raven, Philadelphia.
   Shetty, A.N., Bis, K.G., Vrachliotis, T.G., Kirsch, M., Shirkhoda, A., and Ellwood, R.E. 1998. Contrast‐enhanced 3D‐MRA with centric ordering k‐space: A preliminary experience in imaging the abdominal aorta, renal and peripheral vasculature. J. Magn. Reson. Imaging 8:603‐615.
   Shetty, A.N., Bis, K.G., Kirsch, M., Weintraub, J., and Laub, G. 2000. Contrast‐enhanced breath‐hold three‐dimensional magnetic resonance angiography in the evaluation of renal arteries: Optimization of techniques and pitfalls. J. Magn. Reson. Imaging 12:912‐923.
   Watanabe, Y., Dohke, M., Okumura, A., Amoh, Y., Ishimori, T., Oda, K., and Dodo, Y. 1998. Dynamic subtraction MR angiography: First‐pass imaging of the main arteries of the lower body. A.J.R. Am. J. Roentgenol. 170:357‐360.
   Willman, A.H., Riederer, S.J., King, B.F., Debbins, J.P., Rossman, P.J., and Ehman, R.L. 1997. Fluoroscopically triggered contrast‐enhanced three‐dimensional MR angiography with elliptical centric view order: Application to the renal arteries. Radiology 205:137‐146.
Key References
   Prince, M.R., Grist, T.M., and Debatin JK. 2002. 3D Contrast MR Angiography. 3rd revised ed. Springer‐Verlag, New York.
  Excellent presentation of technical aspects and clinical applications of contrast‐enhanced MRA methods.
   Shellock, F.G. and Kanal, E. 2001. Magnetic Resonance Procedures: Health Effects and Safety. CRC Press, Boca Raton, Fla.
  Covers important patient management issues related to MR procedures and lists metallic implants that have been tested for MR compatibility and other MR safety issues.
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