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MRA of the Pelvis

Basics: What is an MRA of the Pelvis?

MRA stands for “magnetic resonance angiography”. An MRA of the Pelvis is a relatively quick (30 minutes), extremely accurate andnoninvasive test (other than an IV) that is used to gain a close look at the arteries in your pelvis. It is extremely useful for finding narrowed or blocked arteries, which leads to poor circulation (ischemia), and pain (claudication). Note: An MRA of the Pelvis is usually obtained at the same time as an MRA of the Lower Extremities.

Additional:
An MRA of the pelvis is most important for patients with claudication, which is pain in the legs with exertion, due to the muscles not getting enough oxygenated blood. An example would be pain in the calves after walking a few blocks. This is usually due to narrowing from atherosclerosis, the same disease that causes narrowing of the coronary blood vessels in the heart (heart attack), and also can impact the vessels of the neck and head (stroke). An MRA of the pelvis is usually performed at the same time as an MRA of the lower extremities in order to comprehensively evaluate blood flow all the way from the hips to the ankles can be completed.

The standard test for many years has been an invasive angiogram (Runoff). Now, an MRA of the pelvis and lower extremities is actually better in that it provides extremely accurate 3D images, while an invasive runoff is still usually 2D. In addition, it is not invasive, does not use radiation, and the MRI dye/contrast has no significant effects on the kidneys (other than in extremely unusual cases), whereas an invasive angiogram uses a type of dye that may damage the kidneys in patients with renal failure. As is the case in other areas of the body, there is absolutely no reason to perform a standard diagnostic angiogram of the legs (runoff), unless the physician is going into to fix something. This may include putting a stent in, or using a machine to shave plaque from the vessels, or perhaps to open up a clogged artery in a leg with medicine. In addition, the average bill for an invasive angiogram at the hospital may be up around $10,000, whereas a non-invasive MRA of the lower extremities is less than $2000.

For Patients: Why would a physician order an expensive and invasive angiogram, which uses radiation, instead of a better, less expensive, non radiation based, non invasive test? There are a number of reasons. A few years back, 3T MRA was not available, and many physicians don’t realize that this is a cheaper, better, safer test. Even many vascular and interventional surgeons don’t realize this. Some vascular and interventional surgeons who rely on the angiograms, are slow to change. You (the patient) needs to take the initiative here, and insist on the better, less expensive and non-invasive test.

Answers to commonly asked questions about MRA of the pelvis:

Q: How do I decide whether to get an MRA of the pelvis versus a CTA?

A: I would always get an MRA rather than a CTA unless the patient can’t get an MRI(pacemaker, etc.). MRA uses no radiation, and the bones on CTA make it much harder to read. In addition, patients with renal insufficiently, may be at risk of additional injury to the kidneys from CTA contrast (dye). However, if the patient can’t have an MRA, then CTA is still an excellent exam, and should be obtained instead of invasive angiography. CTA does provide some unique information that MRA does not, as it demonstrates calcific plaque. This may be important in treatment planning, and may end up being a complimentary study.

Discussion of images above:

1. Complete occlusion of the left external iliac artery at its origin for a length of 7.5 cm with reconstitution just proximal to its termination by the left internal iliac artery and other branches.
2. Focal 70% stenosis along the proximal left common iliac artery.
3. Focal high grade, greater than 90% stenosis of the bilateral internal iliac artery origins.

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