Superficial Femoral Artery / PAOD IIb of the Left Leg

Clinical History

49-year-old male presenting with predominantly left-sided intermittent claudication (PAOD stage IIb [Fontaine]). As part of the diagnostic work-up, contrast-enhanced MR angiography (first-pass and steady-state imaging) was performed. The wall irregularities detected in the first-pass 3D-MRA can be more precisely differentiated with the help of the steady-state imaging.

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MR Imaging

MR imaging was performed using a Siemens Avanto MR scanner (1.5 T). For further details please click the link below.

Sequence Protocol

Fig. 1. MIP of the 3D-MRA in the first-pass phase. The image shows multiple stenoses in the course of the proximal superficial femoral artery which do not appear to be hemodynamically relevant (3 arrows).

Fig. 2. Curved MPR of the corresponding vascular segment in the steady state phase showing a severe short-segment stenosis (solid-line arrow).

Fig. 3A-C. Axial reconstructions in the corresponding vascular segment in the steady-state phase above [3A], at the level of [3B] and below [3C] the stenosis (see arrows).

Comments

This case illustrates the significance and added value of the high-resolution examination in the steady-state phase. An apparently hemodynamically irrelevant stenosis of the proximal superficial femoral artery is identified clearly by high resolution steady-state imaging as a severe, short-segment stenosis.

Diagnosis

Short-segment high-grade stenosis of the proximal superficial femoral artery in a symptomatic PAOD patient which could only be conclusively identified in the steady-state phase.

Authors

T. Albrecht, MD, B. Frericks, MD, and B. Meyer, MD, Charité - Campus Benjamin Franklin, Berlin, Germany. The patient was examined at the Imaging Science Institute Siemens - Charité, Berlin, Germany.