Pathology of Hand Vessels

Atherosclerosis in the hand vessels is rare. Indications for imaging of the hand vessels in general may include arterial mapping prior to plastic surgery or radial artery bypass grafting (Fig. 15), hy-pothenar hammer syndrome [24], suspected em-boli from cardiac disease or atherosclerotic lesions in the subclavian artery, Raynaud's syndrome, thrombangitis obliterans (Fig. 16) (Winiwarter-Buerger's disease), scleroderma, rheumatoid arthritis, vasculitis and repetitive trauma. Ray-naud's syndrome or suspected distal emboli are particular indications for CE MRA, since DSA is generally not performed because of the risk of complications.

Thrombangitis Obliterans

Fig. 16a, b. Thrombangitis obliterans (Wini-warter-Buerger's disease) in a 28-year old male patient. The MIP reconstructions of a CE 3D MRA dataset (Gd-BOPTA, 0.1 mmol/kg) demonstrate a missing deep arch together with occlusion of numerous metacarpal and digital arteries and interruption of the superficial arch [Images courtesy of Dr. G. Schneider]

Fig. 16a, b. Thrombangitis obliterans (Wini-warter-Buerger's disease) in a 28-year old male patient. The MIP reconstructions of a CE 3D MRA dataset (Gd-BOPTA, 0.1 mmol/kg) demonstrate a missing deep arch together with occlusion of numerous metacarpal and digital arteries and interruption of the superficial arch [Images courtesy of Dr. G. Schneider]

Buergers Fingers

Fig. 17. CE 3D MRA dataset (Gd-BOPTA, 0.1 mmol/kg) in a patient with an angioma-like tumor of the finger. The MlP reconstruction demonstrates the tumor (arrow) as an early enhancing mass. Furthermore, an arterial supply of the lesion by the radial and ulnar digital artery (arrowheads) of the 3rd finger can be demonstrated. This is important for surgical planning [Image courtesy of Dr. G. Schneider]

Fig. 17. CE 3D MRA dataset (Gd-BOPTA, 0.1 mmol/kg) in a patient with an angioma-like tumor of the finger. The MlP reconstruction demonstrates the tumor (arrow) as an early enhancing mass. Furthermore, an arterial supply of the lesion by the radial and ulnar digital artery (arrowheads) of the 3rd finger can be demonstrated. This is important for surgical planning [Image courtesy of Dr. G. Schneider]

Another indication would be for the pre-surgi-cal evaluation of soft-tissue tumors of the hand and fingers since MRA can be combined noninva-sively with imaging of the tumor in a one-stop shop procedure (Fig. 17).

In general, interpretation of hand MR an-giograms can be considered difficult because of the numerous variations in hand vasculature.

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