From the Guidelines
You likely require a Magnetic Resonance Angiography (MRA) with contrast if your healthcare provider is trying to evaluate conditions such as renal artery stenosis, as it provides detailed imaging of blood vessels and can help detect abnormalities. However, the decision to use contrast should be made by your healthcare provider based on your individual clinical needs and the potential benefits versus risks, as contrast agents carry a small risk of allergic reactions and are contraindicated in patients with severe kidney dysfunction 1. Some of the key benefits of MRA with contrast include:
- High sensitivity and specificity for detecting renal artery stenosis, with studies showing a sensitivity of 93.7% and a specificity of 80% 1
- Ability to depict areas of infarction within the kidney and visualize outer cortical necrosis, cortical necrosis with large patches, diffuse cortical necrosis, and both cortical and medullary necrosis 1
- Noninvasive method to evaluate for renal artery stenosis, without exposing the patient to ionizing radiation 1 On the other hand, non-contrast MRA (NC-MRA) with steady-state free precession imaging can help avoid contrast utilization and avoid the risk of nephrogenic systemic fibrosis (NSF), and has been shown to be effective in detecting significant arterial stenosis (>50%) with a sensitivity of 78% to 100% and a specificity of 82% to 99% 1. Ultimately, the choice between MRA with contrast and non-contrast MRA should be based on your individual clinical needs and the potential benefits versus risks, and should be made in consultation with your healthcare provider 1.
From the FDA Drug Label
The studies included 749 subjects: 457 were evaluated in Study C, with an average age of 68 (range 25–93); 64% were male; 80% white, 28% black, and 16% Asian An additional 292 subjects were evaluated in Study D, with an average age of 55 (range 18–88); 54% were male; 68% white, 7% black, and 22% Asian. Efficacy was evaluated based on anatomical visualization and performance for distinguishing between normal and abnormal anatomy.
The decision to require a Magnetic Resonance Angiography (MRA) with contrast depends on the individual's specific medical condition and the judgment of a healthcare professional. There is no direct information in the provided drug label that supports a definitive answer to whether you require an MRA with contrast. However, the label does discuss the use of gadobutrol injection for MRA in patients with known or suspected disease of the supra-aortic arteries or renal arteries 2.
- The label presents data on the efficacy of gadobutrol injection MRA compared to non-contrast MRA and computed tomographic angiography (CTA) in visualizing and distinguishing between normal and abnormal anatomy.
- Key points include the improvement in visualization and diagnostic performance with the use of gadobutrol injection MRA.
- However, the label does not provide guidance on when an MRA with contrast is required for individual patients. This decision should be made by a healthcare professional based on the patient's specific medical needs and conditions.
From the Research
Determining the Need for Magnetic Resonance Angiography (MRA) with Contrast
To determine if you require a Magnetic Resonance Angiography (MRA) with contrast, consider the following points:
- The decision to use contrast in MRA depends on the specific condition being diagnosed and the individual's medical history 3, 4.
- Contrast-enhanced MRA is commonly used to assess peripheral arterial disease, as it provides high-quality images of the arteries without the need for ionizing radiation 3.
- However, the use of gadolinium-based contrast agents carries a risk of dose-related adverse effects, and efforts have been made to reduce the required dose using techniques such as deep learning 5.
- Non-contrast MRA protocols are also available and may be suitable for patients with chronic kidney disease or other conditions that make contrast agents unsafe 4.
- The accuracy of MRA in assessing vascular pathology has been demonstrated in various studies, including those comparing MRA to other imaging modalities such as duplex ultrasonography 6.
Considerations for Specific Conditions
- For intracranial vascular disease, MRA offers a noninvasive alternative for studying blood vessels within the brain, and clinical protocols may comprise combinations of time-of-flight and phase-contrast acquisitions 7.
- For peripheral arterial disease, contrast-enhanced MRA is a valuable tool, but the choice of contrast agent and technique should be carefully considered to minimize risks 3, 5.
- For patients requiring hemodialysis access, MRA can provide accurate assessments of upper extremity vasculature, including arterial and venous diameters 6.