Magnetic resonance angiographic assessment of upper extremity vessels prior to vascular access surgery: feasibility and accuracy

A contrast-enhanced magnetic resonance angiography (CE-MRA) protocol for selective imaging of the entire upper extremity arterial and venous tree in a single exam has been developed. Twenty-five end-stage renal disease (ESRD) patients underwent CE-MRA and duplex ultrasonography (DUS) of the upper extremity prior to hemodialysis vascular access creation. Accuracy of CE-MRA arterial and venous diameter measurements were compared with DUS and intraoperative (IO) diameter measurements, the standard of reference. Upper extremity vasculature depiction was feasible with CE-MRA. CE-MRA forearm and upper arm arterial diameters were 2.94 +/- 0.67 mm and 4.05 +/- 0.84 mm, respectively. DUS arterial diameters were 2.80 +/- 0.48 mm and 4.38 +/- 1.24 mm; IO diameters were 3.00 +/- 0.35 mm and 3.55 +/- 0.51 mm. Forearm arterial diameters were accurately determined with both techniques. Both techniques overestimated upper arm arterial diameters significantly. Venous diameters were accurately determined with CE-MRA but not with DUS (forearm: CE-MRA: 2.64 +/- 0.61 mm; DUS: 2.50 +/- 0.44 mm, and IO: 3.40 +/- 0.22 mm; upper arm: CE-MRA: 4.09 +/- 0.71 mm; DUS: 3.02 +/- 1.65 mm, and IO: 4.30 +/- 0.78 mm). CE-MRA enables selective imaging of upper extremity vasculature in patients requiring hemodialysis access. Forearm arterial diameters can be assessed accurately by CE-MRA. Both CE-MRA and DUS slightly overestimate upper arm arterial diameters. In comparison to DUS, CE-MRA enables a more accurate determination of upper extremity venous diameters