Optimization of Contrast-Enhanced Peripheral MR Angiography with Mid-Femoral Venous Compression (VENCO)

Purpose: To compare a standard protocol for contrast-enhanced three-dimensional magnetic resonance angiography (3D CE-MRA) of the lower extremities to a high spatial resolution protocol with venous compression (VENCO) at the mid-femoral level. Material and Methods: 12 patients with peripheral arterial occlusive disease (8-males; age range, 52-74 years: mean 67.1 years: 4 females; age range, 57-71 years: mean 62.1 years) were examined once with a standard MR angiography (MRA) protocol, and a second time with a high spatial resolution protocol in combination with mid-femoral venous compression (60 mm Hg) for the last two stations. All imaging was performed on a 1.5 T whole-body MR scanner (Magnetom Sonata®, Siemens Medical Solutions, Erlangen, Germany) using a dedicated coil and paramagnetic contrast agent (gadodiamide, Omniscan®, Amersham, Oslo, Norway). Signal-to-noise ratios (SNR) and contrast-to-noise ratios (CNR) were calculated and image quality as well as venous overlay were assessed on a five-point scale for both examinations. Statistical significance was established at p < 0.05. Results: Mean SNR and CNR values of the two lower stations with VENCO were statistically significantly higher in comparison to the standard protocol (66 ± 8 vs. 52 ± 11 and 53 ± 9 vs. 41 ± 8, respectively; p < 0.01). The same was true for overall image quality with VENCO (4.0 ± 0.2 vs. 3. 4 ± 0.8; p ± 0.05) and presence of venous overlay (3.5 ± 0.4 vs. 4.1 ± 0.9; p < 0.05), respectively. Conclusion: VENCO 3D CE-MRA is simple to put into practice and advances the performance of multi-station MRA strategies for assessment of the peripheral arterial vasculature.