MR angiography (MRA) is an MRI study of the blood vessels. It utilizes MRI technology to detect, diagnose and aid the treatment of heart disorders, stroke, and blood vessel diseases. MRA provides detailed images of blood vessels without using any contrast material, although today a special form of contrast is usually given to make the MRI images even clearer. The procedure is painless, and the magnetic field is not known to cause tissue damage of any kind.
Common Uses of the MRA Procedure
Preparation For The Procedure
The magnetic field used for MRA will pull on any iron-containing object in the body, such as a heart pacemaker, intrauterine device, vascular access port, metal plate, or pins, screws or staples. You will be given a questionnaire to answer regarding these issues. The radiologist or technologist should know about any such item and also whether you have ever had a bullet in your body, whether you ever worked with metals, or if you have had a joint replacement. If there is any question, an x-ray can be taken to detect metal objects. The radiologist also should know if you have fillings in your teeth, which could distort images of the facial region or brain. Braces make it harder to properly adjust the MRI unit. You will be asked to remove hairpins, jewelry, eyeglasses, hearing aids, and any dental work that can be taken out. Some wigs contain metal and must be removed. Red dyes used in tattoos and permanent eyeliner may contain metallic iron, but this is rarely a problem. You should report any drug allergies to the radiologist or technologist, and should mention if there is any possibility that you might be pregnant.
You can eat normally before the exam (unless told differently), but a young child should not eat or drink for about four hours if they are receiving a sedative. The rules vary at different MRI facilities, so be sure to check with your medical center about eating and drinking before the exam. Medications may be taken as usual. Some patients will feel uncomfortably confined (claustrophobic) when enclosed in an MRI unit. If necessary, you will be given a sedative to help put you at ease, though probably less than one in every 20 patients will need this. You will wear a lightweight medical gown for the exam.
The traditional MRI unit is a large tube surrounded by a circular magnet, in which the patient lies without moving for several seconds at a time. The patient is placed on a wheeled bed that is moved into the magnet. In recent years patient-friendly units have been designed, and examination in such units is becoming increasingly available. These machines are both shorter and wider than a conventional MRI unit, and do not fully enclose the patient. Some of the newer open-MRI units are even open on all sides, making them attractive to patients who tend toward claustrophobia.
How The Procedure Works
Exposing the patient to radio waves in a strong magnetic field generates data that are used by a computer to create images of tissue slices that may be viewed in any plane or from any direction. The magnetic field lines up atomic particles in the tissues called protons, which are then spun by a beam of radio waves and produce signals that are picked up by a receiver in the scanner. It is these signals that are processed by the computer to produce images. The resulting images are very sharp and detailed, which means they are able to detect tiny changes from the normal pattern that are caused by disease or injury.
Special settings are used to image various structures, such as arteries in the case of MRA
How the Procedure is Performed
The patient is placed on a special table and positioned inside the opening of the MRI unit. A typical exam consists of two to six imaging sequences, each taking two to 15 minutes. Each sequence provides a specific image orientation and a specified degree of image clarity or contrast. Depending on the type of exam being done, the total time needed can range from 10 to 60 minutes, not counting the time needed to change clothing, have an IV put in and answer questions. When contrast material is needed, a substance called gadolinium is given by IV injection during one of the imaging sequences. It highlights blood vessels, making them stand out from surrounding tissues.
The radiologist and technologist leave the examining room during the actual imaging process, but the patient can communicate with them at any time using an intercom. We allow a friend to stay nearby, or a parent if a child is being examined. When the exam is completed you will be asked to wait to make sure that more images are not needed.
What Will I Experience During The Procedure?
The technologist will make you as comfortable as possible, but at times the magnet may be within a few inches of your face. For those who become very uncomfortable when enclosed in a small space, a mild sedative is nearly always effective. You may notice a warm feeling in the area being studied. This is normal, but do not hesitate to report it if it bothers you. If you receive a contrast material injection there may be some local discomfort at the IV site. The loud tapping or knocking noises that are heard during certain parts of the exam disturb some patients; earplugs may help.
Interpretation Of The Results
A radiologist experienced in MRI will analyze the results and send a report to your physician, along with an interpretation of the findings. Your physician in turn will discuss the MRA findings with you. Some centers now send diagnostic reports and images over the Internet, speeding up the process.
Benefits vs. Risks
Limitations of MR Angiography
MRA does not image calcium, as does CT angiography. The procedure should be avoided in any patient having a pacemaker, implanted neurostimulator, metallic ear implant, or metallic object within the eye socket. It should also be avoided if there is a bullet fragment or if the patient has a port for delivering insulin or chemotherapy. For patients who are very claustrophobic, adequate nursing staff must be on hand to monitor sedation. The clearness of MRA images does not yet match those obtained by conventional angiography. MRI of small vessels, in particular, may not be adequate for diagnosis and treatment planning. Sometimes it may be difficult to separate images of arteries from veins by MRA.