Magnetic resonance angiography of the distal lower extremity

Objective: To assess magnetic resonance angiography (MRA) for demonstration of arterial patency in the ankle and foot of patients with peripheral vascular disease. Methods: Peripheral MRA of the ankle and foot was performed on 34 limbs of 31 insulin-dependent diabetics. 2-D time-of-flight MRA (TR 33 ms/TE 7.7 ms/inferior saturation band) was performed with 16 cm field of view. Pre- or intra-operative angiographic correlation was available in all cases. Results: In 24 limbs MRA was compared to conventional angiography. MRA showed more patent run-off vessel segments (120) than angiography (100). In 10 limbs MRA was compared to intraoperative angiography and for the detection of patent vessel segments showed a sensitivity of 87.5% (42/48) with a 95% confidence interval of 75% to 95% and a specificity of 95% (38/40) with a 95% confidence interval of 83% to 99%. Pitfalls included difficulty in visualizing flow at the bifurcation of the peroneal artery, in the plantar arch and retrograde flow in the lateral plantar artery. Conclusions: MRA is sensitive for the detection of patent arteries in the ankle and foot but artefacts may cause overdiagnosis of focal stenoses or occlusions.