Infragenual cuff-compression reduces venous contamination in contrast-enhanced MR angiography of the calf

Purpose: To reduce venous contamination at the calf level in three-dimensional contrast-enhanced MR angiography (CE-MRA) by applying continuous infragenual cuff-compression. Materials and Methods: Ten patients with clinically relevant peripheral arterial occlusive disease (PAOD) underwent dynamic three-dimensional CE-MRA of the calf. Six consecutive measurements were acquired with the first measurement serving as mask. Cuff-compression of 50 mmHg was attached below the knee. To allow intraindividual comparison, compression was applied unilaterally. The cuff was inflated three minutes before scanning and was continued throughout the MRA session. Venous contamination and arterial visualization scores were ranked using a five-point rating scale. Contrast-to-noise ratios (CNRs) of superficial enhancing calf-veins on the uncompressed and compressed calf sides were evaluated. An asymmetry index (AI) defined by CNRmeanuncompressed/CNRmeancompressed was introduced to describe the ratio in venous contrast agent supply between both sides quantitatively. Results: Three-dimensional CE-MRA of the calves demonstrated significantly lower superficial venous contamination scores (P<0.004) and clearly improved arterial visualization (P<0.009) on the compressed side. Additionally, AI values were larger than 1 (P<0.02), indicating a higher contrast agent supply in the superficial veins on the uncompressed side. Conclusion: Infragenual cuff-compression minimizes venous overlay in three-dimensional CE-MRA at calf level by reduction of contrast agent supply in the superficial veins.