Phase-contrast Magnetic Resonance Angiography of Foot at Ultra-high field 5T System: Visualization of Distal Small Vessels and Enhancement by Warm Water Immersion.

Background: Ultra-high field strength MR system has been proved to offer improved visualization of the distal intracranial vessels and branches, but its effectiveness on peripheral vasculatures was not investigated. We aim to assess the visualization of lower-extremity vessels using three-dimensional phase contrast MR angiography (3D PC-MRA) at 5T field-strength through the feet with warm water immersion (WWI).

Methods: Participants were prospectively recruited and underwent 3T, 5T 3D PC-MRA on feet with and without WWI (water temperature between 40 to 45 ℃ for a duration of 10minutes). Patients with suspected lower-extremity vessel diseases underwent CTA for lesion identification. Signal-to-noise ratio (SNR), subjective scoring, quantitative vessel segmentation and flow velocity were performed to assess vessel visualization before and after WWI. Friedman's test was conducted to determine statistical significance.

Results: Out of thirty participants (mean age, 46.2±5.9; males, 20; lower-extremity vessel disease, 10), 900 vessel segments were available for evaluation. 5T images showed significantly higher scores of image quality and foot vessel visualization than 3T (all P <.05). WWI further improved the visualizing scores (percentage of score 3: 40.2% vs 66.2%, P =.008), SNR (44.27 vs 67.78, P <.001), total branch count (151.92 ± 29.17 vs 225.63 ± 16.76; P <.001), and the flow velocity (0.72 ± 0.03 vs 0.48 ± 0.11cm/s; P <.001).

Conclusion: 3D PC-MRA at 5T effectively visualizes foot vessels in patients with lower-extremity disease. Furthermore, WWI can significantly enhance the depiction of distal and small vessels.