Atherosclerosis: Investigating Underlying Pathology with Whole-Body MR Angiography

Whole Body Magnetic Resonance AngiographyAtherosclerosis has become a serious health problem in developed coun­tries, and has emerged as the main cause of morbidity and mortality world­wide. Treatment strat­egies, in­cluding surgical and per­cu­taneous catheter-based inter­ventions, as well as pha­r­­m­­­a­co­logi­cal treat­ment, depend on the accurate clas­sification of athero­sclerotic disease with respect to location, extent, and severity of arterial involvement. For this pur­pose, several im­aging tech­niques are in clinical use, in­cluding convention­al cathe­ter angiog­raphy, duplex ultra­sound, CT an­gio­graphy, and MR angiography.

Ninety percent of ath­ero­sclerotic lesions are identified below the aortic bifurcation. Thus, the lower limbs are the most frequently affected vas­cu­lar territory. Presently, periph­eral vascular disease accounts for 50,000 to 60,000 percutaneous trans­luminal an­gio­plasties, im­plan­tation of 110,000 vas­cular prostheses, and 50,000 am­putations an­nually in the U.S. alone.

Peripheral vascular disease is frequently asso­ciated with carotid, coro­nary, and renal arterial disease, reflecting the systemic nature of athero­sclerotic disease.1


Applications in Peripheral Vascular Disease

In one study, 180 consecutive pa­tients (3000 vas­cular seg­ments) with sus­pected peripheral vascular disease under­went whole-body MR Angiography. All patients were in­itially referred for the assessment of pelvic and lower ex­tremity arterial vas­culature.

Whole-body MR Angiography revealed ad­ditional and clinically relevant di­sease in 42 out of 180 patients (48 vas­cular segments), in­cluding renal artery stenosis (27 cases), carotid arterial sten­osis (21 cases), sub­clavian ar­tery sten­osis (five cases), and ab­dominal aortic an­eurysm (seven cases).

  • Coronary artery disease. Studies on the prevalence of coronary artery disease in patients with peripheral vascular disease show that the history, clin­ical exam­ination, and electrocardiography re­sults typ­ic­ally in­dicate…2
  • Cerebrovascular disease. The link between peripheral vascular disease and cere­bro­vascular di­sease seems to be weak­er than that between pe­riph­eral vascular and coronary artery disease…3
  • Carotid lesions. The fact that 21 unsuspected carotid le­sions were identified in 17 patients in the des­cribed series em­pha­sizes the fact that the history is often too focused and biased by the primary…
  • Hypertension. Approximately one-fourth of patients with peripheral vascular disease have hyper­ten­sion. The possibility of renal artery stenosis…


Whole-Body MRA and Vascular Screening

Expert panels through­out the world have advocated targeting high-risk indi­viduals for pri­mary preven­tion. Risk factors known to predict car­dio­vascular events…

♦ The Value of Screening

Arguments are on­going about the value of screening all pa­tients with peripheral vascular disease, symp­tomatic or not, particularly for carotid di­sease and aortic an­eurysms. Patients with claudication are un­doubtedly more likely…Full Body Magnetic Resonance Angiography

When discussing the value of screening patients for ab­dominal aortic aneurysms, several points must be con­sidered. For unknown reasons, the prev­alence of ab­dominal aortic aneurysms…



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  1. Ulusoy FR, Yolcu M, Ipek E, et al. Coronary Artery Disease Risk Factors, Coronary Artery Calcification and Coronary Bypass Surgery. J Clin Diagn Res. 2015 May;9(5):OC06-10.
  2. Bourantas CV, Crake T, Zhang Y3, et al. Intravascular imaging in cardiovascular aging. Exp Gerontol. 2017 May 15.
  3. Amini A, Gordon I, Wilson S, Williams RA. Noncompressible arteries correlate with increased cardiovascular mortality at 2 years. Ann Vasc Surg. 2013 Oct;27(7):918-23.
  4. Stackelberg O, Wolk A, Eliasson K, et al. Lifestyle and Risk of Screening-Detected Abdominal Aortic Aneurysm in Men. J Am Heart Assoc. 2017 May 10;6(5).
Stefan G. Ruehm, MD
Stefan G. Ruehm, MD
Professor of Radiology, University of California, Los Angeles | Faculty Page