Name of the Procedure:

Common Name: Magnetic Resonance Angiography (MRA)
Technical Term: Magnetic Resonance Angiography without contrast followed by with contrast, upper extremity (HCPCS Code: C8936)

Summary

Magnetic Resonance Angiography (MRA) of the upper extremity is a medical imaging procedure used to visualize blood vessels in the arms without using invasive techniques. The procedure starts with imaging without contrast (a special dye that enhances visibility), followed by imaging with contrast to provide detailed views of the blood vessels.

Purpose

Medical Conditions Addressed:

• Blockages or narrowings in blood vessels.
• Aneurysms (vessel wall ballooning).
• Vascular malformations.
• Blood clots.
• Evaluate the condition before and after vascular surgery.

Goals & Outcomes:

• Accurate diagnosis of vascular conditions.
• Detailed images for planning surgical or medical treatment.
• Monitoring the effectiveness of ongoing treatments.

Indications

Symptoms & Conditions:

• Unexplained arm pain or weakness.
• Swelling or abnormal blood flow.
• History of vascular disease.
• Suspected vascular injury.
• Prior to or following vascular surgical procedures.

Patient Criteria:

• Individuals with symptoms indicating vascular problems.
• Patients who require detailed vascular imaging for treatment planning.

Preparation

Pre-procedure Instructions:

• Fasting may be required for several hours before the procedure.
• Patients may need to adjust their medication, particularly blood thinners.
• Allergies to contrast dye or kidney function may need to be assessed.

Diagnostic Tests:

• Blood tests to assess kidney function.
• Initial non-invasive evaluations like Doppler ultrasound.

Procedure Description

1. Initial Setup:

   • The patient lies on the MRI table.
   • Initial conventional MRI scans are taken of the upper extremity without the use of contrast dye.

2. Contrast Administration:

   • A small catheter is placed in a vein, typically in the arm, for contrast injection.
   • A gadolinium-based contrast dye is injected into the bloodstream.

3. Imaging:

   • MRI scans are repeated with the contrast dye circulating, providing enhanced images of the blood vessels.
   • The series of scans may take 20-30 minutes for each phase.

Tools & Equipment:

• MRI machine.
• Contrast dye (gadolinium-based).
• IV catheter for contrast administration.

Anesthesia or Sedation:

• Generally, no anesthesia or sedation is required. Sedation may be considered for claustrophobic patients.

Duration

The entire procedure typically takes about 1 to 1.5 hours.

Setting

Performed in hospitals or outpatient imaging centers equipped with MRI facilities.

Personnel

• Radiologist (Interpreting the images).
• MRI Technologist (Operates the MRI machine and assists with the procedure).
• Nursing staff (Assists with intravenous catheter placement and patient care).

Risks and Complications

Common Risks:

• Mild discomfort or bruising at the IV site.
• Claustrophobia or anxiety during the MRI.

Rare Risks:

• Allergic reaction to contrast dye.
• Nephrogenic systemic fibrosis (NSF) in patients with severe kidney problems.
• Potential for incorrect diagnosis if images are unclear.

Management of Complications:

• Monitoring and treating allergic reactions.
• Ensuring hydration and monitoring kidney function.

Benefits

• Non-invasive and highly detailed imaging of blood vessels.
• Helps in accurate diagnosis and treatment planning.
• Immediate benefits in identifying vascular issues, with detailed images available shortly after the procedure.

Recovery

Post-procedure Care:

• Monitor for any adverse reaction to contrast dye.
• Ensure patient stays hydrated to help clear the dye from the body.

Recovery Time:

• Most patients can resume normal activities immediately.
• Follow-up depends on the findings and the underlying condition.

Alternatives

Other Options:

• CT Angiography (CTA): Uses X-rays and iodine-based contrast dye.
• Doppler Ultrasound: Non-invasive, but less detailed.
• Traditional Angiography: Invasive with catheter insertion.

Pros & Cons:

• MRA: Detailed images without radiation but can be expensive and time-consuming.
• CTA: Faster but involves radiation exposure.
• Ultrasound: Non-invasive and cost-effective but not as detailed.
• Traditional Angiography: Highly detailed but invasive with higher risk.

Patient Experience

During Procedure:

• Lying still in the MRI machine, occasional noise from the MRI machine.
• Little to no discomfort during the contrast injection.

After Procedure:

• Possible mild discomfort at IV site.
• Clear instructions provided for post-procedure care.
• Follow-up with the referring physician to discuss results.

Pain Management & Comfort:

• Non-invasive nature means minimal discomfort.
• Sedation options available if necessary.