Noncontrast magnetic resonance angiography for the diagnosis of peripheral vascular disease

Contrast-enhanced magnetic resonance angiography (MRA) provides excellent assessment of the peripheral arterial vasculature and is considered an important adjunctive diagnostic modality for the assessment of peripheral arterial disease. However, given the high prevalence of chronic kidney disease in patients with peripheral arterial disease, the association of gadolinium contrast media with nephrogenic systemic fibrosis, and recent concern with consequences of long-term deposition of gadolinium in the brain, there has been a renewed interest in noncontrast MRA approaches. Recent improvements in pulse sequences combined with instrumentation have facilitated the development of newer noncontrast MRA sequences that provide high spatial resolution, allowing the evaluation of distal (infrageniculate and pedal) vessels of importance in patients with critical limb ischemia. Further, many of these sequences are time efficient and versatile, allowing rapid evaluation of the entire lower extremity vasculature. In this comprehensive review, we outline historic techniques and compare these with newer approaches such as quiescent interval slice-selective MRA, 3-dimensional fast spin echo, and velocity-sensitive MRA that are emerging as an alternative to computed tomographic angiography or digital subtraction angiography for the evaluation of lower limb arteries in patients with peripheral arterial disease. Technical details and applications in clinical practice will be discussed.