Stellenwert der MR-Angiographie in der Diagnostik der peripheren AVK

During the last 20 years MR-angiography (MRA) proofed to be an alternative to the classic x-ray-DSA. In daily routine contrast-enhanced MRA (CE-MRA) has become the preferred imaging technique over other MR-methods like "phase contrast"- or "inflow" angiography. Using a moving-table- technique the CE-MRA of the infrarenal aorta, the pelvis and lower extremities including vessels below the knee can be achieved with a single exam in less than 30 minutes. No exposure to radiation and freely rotatable imaging planes are advantages of the CE-MRA as well as very well tolerated contrast media. Gadolinium (Gd) containing MR-contrast is not nephrotoxic and cause less side effects compared to iodine-containing contrast used in x-ray based exams like DSA or Angio-CT. However, in the case of severe kidney disease administration of MR-contrast can cause nephrogenic systemic fi-brosis (NSF). Therefore Gd-based contrast should not be used in patients with a GFR <30 ml/min/1,73 m ². The main reasons to choose MRA within the diagnostic evaluation of peripheral arterial disease (PAOD) are on the one hand inconclusive Duplex-findings in pts. with an ancle-brachial index <0,9. On the other hand MRA is a very useful tool for planning catheter-based or surgical interventions. Performance, limitations and pitfalls of MRA are discussed.