Angiography

Digital subtraction angiography is the accepted reference for vascular imaging and grading of vessel stenosis. This test, however, is invasive, and uses nephrotoxic agents and ionizing radiation, making it a poor choice for first-line diagnosis of vascular disease. Duplex ultrasound is a widely used, non-invasive modality to perform vascular imaging, but this technique is operator dependent and has a high percentage of failed exams usually as a result of an inadequate acoustic window or patient habitus. Computed tomography angiography features non-invasive, cross-sectional imaging of the entire arterial and venous vasculature from head to toe, but this modality suffers similar limitations as digital subtraction angiography, and vessel wall calcifications may influence image analysis and rendering. Cardiovascular magnetic resonance (CMR) angiography has emerged as an excellent non-invasive angiographic substitute to digital subtraction angiography. Over the past three decades a series of CMR angiography approaches have been developed to pass the different hurdles inherently linked to vessel imaging. As such, dedicated CMR angiography sequences are nowadays available to study accurately the arterial and venous vessels in all parts of the human body. CMR angiography is either a standalone or can be part of a more comprehensive CMR approach including vessel wall imaging, quantitative flow imaging, and perfusion imaging of the end-organ. The aim of this chapter is to provide the reader with a comprehensive review of how CMR angiography is performed in clinical practice and how well this technique competes with other vascular imaging modalities.