Abstract
Catheter angiography is the acknowledged clinical gold standard for upper extremity arterial assessment. However, it is invasive and can be particularly challenging in the upper extremity, as iodinated contrast injection can initiate vasospasm and pain, particularly in young adults. MR evaluation of the upper extremity and hand vessels can provide a noninvasive comprehensive assessment, particularly since the advent of gadolinium-enhanced MRA (Gd MRA) in the early 1990s [1]. Indications for upper extremity MR angiography or venography are varied, including atherosclerosis, trauma, thromboembolic phenomena, and vasculitides. Benefits of MRA include lack of ionizing radiation, no requirement for iodinated contrast, and ability to acquire functional information including flow direction and velocity. Advances in magnet and coil technology have enabled continued improvements in spatial and/or temporal resolution. For successful imaging, a clear understanding of vascular anatomy, patient preparation, imaging protocols, and potential pathology is required. Some potential challenges that are faced when evaluating the arm are small caliber distal vessels, anatomic variants, relatively slow blood flow, and short arteriovenous transit times.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Prince MR, Yucel EK, Kaufman JA, Harrison DC, Geller SC. Dynamic gadolinium-enhanced three-dimensional abdominal MR arteriography. J Magn Reson Imaging. 1993;3:877–881.
Sinnatamby CS. Upper limb. In: Last’s Anatomy: Regional and Applied. London: Churchill Livingstone, 1999; 35–106.
Rodriguez-Niedenfuhr M, Vazquez T, Nearn L, Ferreira B, Parkin I, Sanudo JR. Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat. 2001;199(Pt 5):547–566.
Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet. 1961;113:409–424.
Stepansky F, Hecht EM, Rivera R, et al. Dynamic MR angiography of upper extremity vascular disease: pictorial review. Radiographics. 2008;28(1):e28.
Lee VS. Cardiovascular MRI: Physical Principles to Practical Protocols. Philadelphia: Lippincott Williams and Wilkins; 2006.
Rofsky NM. MR angiography of the hand and wrist. Magn Reson Imaging Clin N Am. 1995;3:345–359.
Connell DA, Koulouris G, Thorn DA, Potter HG. Contrast-enhanced MR angiography of the hand. Radiographics. 2002;22:583–599.
Earls JP, Rofsky NM, DeCorato DR, Krinsky GA, Weinreb JC. Breath-hold single-dose gadolinium-enhanced three-dimensional MR aortography: usefulness of a timing examination and MR power injector. Radiology. 1996;201:705–710.
Pruessmann KP, Weiger M, Scheidegger MB, Boesiger P. SENSE: sensitivity encoding for fast MRI. Magn Reson Med. 1999;42:952–962.
Sodickson DK, Manning WJ. Simultaneous acquisition of spatial harmonics (SMASH): fast imaging with radiofrequency coil arrays. Magn Reson Med. 1997;38:591–603.
Griswold MA, Jakob PM, Heidemann RM, et al. Generalized autocalibrating partially parallel acquisitions (GRAPPA). Magn Reson Med. 2002;47:1202–1210.
Brauck K, Maderwald S, Vogt FM, Zenge M, Barkhausen J, Herborn CU. Time-resolved contrast-enhanced magnetic resonance angiography of the hand with parallel imaging and view sharing: initial experience. Eur Radiol. 2007;17:183–192.
Korosec FR, Frayne R, Grist TM, Mistretta CA. Time-resolved contrast-enhanced 3D MR angiography. Magn Reson Med. 1996;36:345–351.
Lee VS, Martin DJ, Krinsky GA, Rofsky NM. Gadolinium-enhanced MR angiography: artifacts and pitfalls. AJR Am J Roentgenol. 2000;175:197–205.
Hughes K, Hamdan A, Schermerhorn M, Giordano A, Scovell S, Pomposelli F, Jr. Bypass for chronic ischemia of the upper extremity: results in 20 patients. J Vasc Surg. 2007;46:303–307.
Banis JC Jr, Rich N, Whelan TJ Jr. Ischemia of the upper extremity due to noncardiac emboli. Am J Surg. 1977;134:131–139.
McCready RA, Bryant MA, Divelbiss JL. Combined thenar and hypothenar hammer syndromes: case report and review of the literature. J Vasc Surg. 2008;48:741–744.
Robbs JV, Carrim AA, Kadwa AM, Mars M. Traumatic arteriovenous fistula: experience with 202 patients. Br J Surg. 1994;81:1296–1299.
Lim RP, Storey P, Atanasova IP, et al. Three-dimensional electrocardiographically gated variable flip angle FSE imaging for MR angiography of the hands at 3.0 T: initial experience. Radiology. 2009;252:874–881.
Fayad LM, Hazirolan T, Bluemke D, Mitchell S. Vascular malformations in the extremities: emphasis on MR imaging features that guide treatment options. Skeletal Radiol. 2006;35:127–137.
Dayicioglu D, Martell EG, Ogilvie M, Gozu A, Panthaki ZJ, Armstrong MB. Vascular anomalies of the upper extremity in children. J Craniofac Surg. 2009;20:1025–1029.
van Rijswijk CS, van der Linden E, van der Woude HJ, van Baalen JM, Bloem JL. Value of dynamic contrast-enhanced MR imaging in diagnosing and classifying peripheral vascular malformations. AJR Am J Roentgenol. 2002;178:1181–1187.
Flinterman LE, Van Der Meer FJ, Rosendaal FR, Doggen CJ. Current perspective of venous thrombosis in the upper extremity. J Thromb Haemost. 2008;6:1262–1266.
Kahn SR, Elman EA, Bornais C, Blostein M, Wells PS. Post-thrombotic syndrome, functional disability and quality of life after upper extremity deep venous thrombosis in adults. Thromb Haemost. 2005;93:499–502.
Sadowski EA, Bennett LK, Chan MR, et al. Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology. 2007;243:148–157.
Li W, Salanitri J, Tutton S, et al. Lower extremity deep venous thrombosis: evaluation with ferumoxytol-enhanced MR imaging and dual-contrast mechanism--preliminary experience. Radiology. 2007;242:873–881.
Mistretta CA. Undersampled radial MR acquisition and highly constrained back projection (HYPR) reconstruction: potential medical imaging applications in the post-Nyquist era. J Magn Reson Imaging. 2009;29:501–516.
Lustig M, Donoho D, Pauly JM. Sparse MRI: The application of compressed sensing for rapid MR imaging. Magn Reson Med. 2007;58(6):1182–1195.
Wang J, Yarnykh VL, Molitor JA, et al. Micro magnetic resonance angiography of the finger in systemic sclerosis. Rheumatology (Oxford). 2008;47:1239–1243.
von Morze C, Xu D, Purcell DD, et al. Intracranial time-of-flight MR angiography at 7T with comparison to 3T. J Magn Reson Imaging. 2007;26:900–904.
Miyazaki M, Sugiura S, Tateishi F, Wada H, Kassai Y, Abe H. Non-contrast-enhanced MR angiography using 3D ECG-synchronized half-Fourier fast spin echo. J Magn Reson Imaging. 2000;12:776–783.
Isogai J, Kobayashi Y, Ogawa Y, et al. A novel non-contrast MRA technique using Time-Spatial Labeling Inversion Pulse in combination with flow-spoiled FBI for the assessment of small arteries of the finger. Proc Int Soc Magn Reson Med. 15th Meeting 2007;Berlin:3152.
Sheehan JJ, Fan Z, Carr JC, Li D. Non contrast MRA of the hand in patients with Raynauds disease usng flow sensitized dephasing prepared SSFP. Proc Int Soc Magn Reson Med 17th Meeting 2009;Honolulu:423.
Acknowledgments
We wish to thank Martha Helmers for her expert illustration and assistance with preparation of the figures.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Lim, R.P., Lee, V.S. (2012). MRA: Upper Extremity and Hand Vessels. In: Carr, J., Carroll, T. (eds) Magnetic Resonance Angiography. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1686-0_22
Download citation
DOI: https://doi.org/10.1007/978-1-4419-1686-0_22
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4419-1685-3
Online ISBN: 978-1-4419-1686-0
eBook Packages: MedicineMedicine (R0)