MRA (Magnetic Resonance Angiogram) Pelvis

1 Major Symptom or Complaint presented as primary indication

1.1 Aching pain in extremity, relieved by rest

• 1.1.1 Peripheral Arteria (or Vascular) Disease suspected

2 Working Diagnosis or Rule Out presented as primary indication

2.1 Aneurysm, Suspected of aorta or iliac vessels

• 2.1.1 Pulsatile Mass on PE

2.2 Peripheral Arterial Disease Suspected

2.2.1 ABI<0.9

2.2.2 Risk Factors ONE

• 2.2.2.1 Diabetes
• 2.2.2.2 Hypercholesterolemia
• 2.2.2.3 Smoker

2.2.3 Symptoms or Findings ONE

• 2.2.3.1 Aching Pain in extremity relieved by rest
• 2.2.3.2 Asymmetric Blood Pressure in Arms
• 2.2.3.3 Asymmetric Pulses
• 2.2.3.4 Bruit
• 2.2.3.5 Palpable Arterial Thrill
• 2.2.3.6 Positive or Suspicious Doppler exam

2.3 Claudication

• 2.3.1 Peripheral Arterial (or Vascular) Disease suspected

3 Abnormal Physical Exam Finding presented as primary indication

3.1 Asymmetric Blood Pressure in Legs

• 3.1.1 Peripheral Arterial (or Vascular) Disease suspected

3.2 Asymmetric Pulses

• 3.2.1 Peripheral Arterial (or Vascular) Disease suspected

3.3 Bruit

• 3.3.1 Peripheral Arterial (or Vascular) Disease suspected

3.4 Palpable Arterial Thrill

• 3.4.1 Peripheral Arterial (or Vascular) Disease suspected
• 3.4.2 AVM Suspected

3.5 Pulsatile Mass, Aneurysm suspected

4 Abnormal Lab or Imaging presented as primary indication

4.1 Positive or Suspicious Doppler exam

• 4.1.1 Peripheral Arterial (or Vascular) Disease suspected

5 Significant Prior Medical History presented as primary indication

5.1 Aneurysm, known from prior exams

• 5.1.1 Preoperative
• 5.1.2 Interval follow up after endovascular treatment at 1 week, 1 month, 3 months, and 6 months and at 6-month intervals thereafter
• Ichiro Sakamoto, Eijun Sueyoshi, Shiro Hazama, Kenji Makino, Akifumi Nishida, Tetsuji Yamaguchi, Kiyoyuki Eishi, and Masataka Uetani Endovascular Treatment of Iliac Artery Aneurysms Radiographics October 2005 25:S213-S227

5.2 Prior to Uterine Artery embolization for bleeding or embolization of fibroids (myomata)

5.3 Trauma, vascular injury suspected

References

• Hurst’s The Heart 11th Edition Valentin Fuster, R. Wayne Alexander, and Robert A. O’Rourke, Eds.; Copyright ©2006 The McGraw-Hill Companies. Chapterr 101. Diagnosis and Management of Diseases of the Peripheral Arteries and Veins Paul W. Wennberg, Thom W. Rooke
• Emile R. Mohler, III; Peripheral Arterial Disease: Identification and Implications; Arch Intern Med 2003 163: 2306-2314
• White, Robert I., Jr, Pollak, Jeffrey, Persing, John, Henderson, Katharine J., Thomson, J. Grant, Burdge, Catherine M. Long-Term Outcome of Embolotherapy and Surgery for High-Flow Extremity Arteriovenous Malformations J Vasc Interv Radiol 2000 11: 1285-1295
• Schwartz’s Principles of Surgery, 8th Edition F. Charles Brunicardi, et al Copyright © 2005, The McGraw-Hill Companies, Inc.Chapter 15. Skin and Subcutaneous Tissue Scott L. Hansen, Stephen J. Mathes, David M. Young
• Albrecht, Thomas, Foert, Ellen, Holtkamp, Robin, Kirchin, Miles A., Ribbe, Constanze, Wacker, Frank K., Kruschewski, Martin, Meyer, Bernhard C. 16-MDCT Angiography of Aortoiliac and Lower Extremity Arteries: Comparison with Digital Subtraction Angiography Am. J. Roentgenol. 2007 189: 702-711
• Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG, “Chapter 9. Pelvic Mass” (Chapter). Schorge JO, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG: Williams Gynecology: http://www.accessmedicine.com/content.aspx?aID=3153525 accessed 4/08/10
• Pelvic CT angiography: application to blunt trauma using 64MDCT. J Uyeda, SW Anderson, J Kertesz, and JA Soto Emerg Radiol, Mar 2010; 17(2): 131-7