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During, the past decade. MRA has evolved from an cxperimental technique into the modality of choice for the noninvasive evaluation of renovascular disease. The recent widespread application of MRA for these indications has been driven primarily by the advent of 3D contrast-enhanced MRA. which provides a fast, reliable technique for imaging large vascular territories and generates images, after postprocessing, similar in appearance to digital subtraction angiography. The cross-sectional volumetric nature of contrast-enhanced MRA affords some advantages over conventional catheter angiography. Although 3D contrast-enhanced MRA forms the backbone of vascular MR studies, several adjunctive sequences are employed to maximize the diagnostic yield of the examination. For example. flow-dependant imaging is used to complement the morphologic images of contrast-enhanced MRA by providing hemodynamic information. As such, MRA is unique among noninvasive imaging modalities in that it offers a comprehensive evaluation of anatomy and function. The availability and reliability of MRA extend renal artery screening to a wider spectrum of patients. Current applications of renal MRA range from detection of renal artery stenosis to evaluation for renal transplant donors.

MRV offers unique diagnostic possibilities for detection and characterization of venous disease. It allows evaluation of perivascular and vascular anatomy, evolution of thromboembolic events, and assessment of vascular flow. MRI is a diagnostic tool that can be tailored for a variety of clinical dilemmas, not only DVTs. Continued improvements in hardware and software will expand the role of MRV.

Gadolinium is useful as an alternative contrast agent for diagnostic angiographic and interventional procedures in patients with renal insufficiency or a history of a severe reaction to iodinated contrast material. Gadolinium usually is used as a "problem solver" to answer specific diagnostic questions or guide interventional procedures that cannot adequately be defined with CO2 angiography. Because of dose limitations with Gd, careful planning is required prior to its use with angiography or interventional procedures.

Rationale and Objectives: This study was performed to determine if it is financially reasonable for radiology residency programs that create and maintain their own teaching files to switch from analog teaching files (ATFs) to digital teaching files (DTFs)., Materials and Methods: Radiology residency program directors were surveyed electronically about the monetary value and importance of conventional ATFs and DTFs. The costs for maintaining each type of file were calculated at the authors' institution., Results: Surveys were sent to the program directors of all 197 accredited radiology residencies. Responses were received from 48 (24%). DTFs were scored as more important than ATFs, but the difference was not significant (P = .22). DTFs were rated as less complete (P = .01) but more current (P << .001) than ATFs. DTFs included the American College of Radiology Learning File (85%), in-house productions (77%), and other commercially available products (63%). Thirty percent of respondents had a DTF integrated into a picture archiving and communication system, and 28% reported having a technician dedicated to the teaching file. Program directors ascribed total median dollar values of $250 and $3,000 per year to their ATFs and DTFs, respectively. The annual costs at the authors' institution were much higher than these ascribed values: $44,720 ($91 per case) for maintaining a DTF produced in house and $24,601 ($50 per case) for maintaining an ATF, excluding physician time., Conclusion: Program directors are more willing to pay for a DTF than an ATF. For both, the costs of maintenance are great and the relative monetary value is low.

Background: The purpose of this study was to review the results of percutaneous transluminal angioplasty (PTA), stenting, or both in the treatment of patients who present with symptoms and angiographic findings most consistent with chronic mesenteric ischemia., Study Design: A retrospective analysis of 33 consecutive patients from a single institution who underwent PTA, stenting, or both for treatment of symptoms most characteristic of chronic mesenteric ischemia was performed., Results: There were 12 men and 21 women with a mean age of 63 years (range 40 to 89 years). Median weight loss was 28 lb (range 6 to 80 lb). Postprandial pain was present in 88% of the patients (29 of 33). All lesions treated were stenoses. PTA alone was performed in 21 patients (32 vessels), and PTA and stenting were performed in 12 patients (15 vessels). PTA was technically successful in 26 of 32 vessels (81.3%); PTA plus stenting was technically successful in 15 of 15 vessels (100%) (p = 0.073). Complete alleviation of symptoms occurred immediately in 27 of the patients (82%), and 2 patients (6%) had significant improvement in symptoms. There were four immediate clinical failures (12%): two patients were found to have occult malignancy and one had immediate relief of symptoms after surgical release of the median arcuate ligament. Followup data were obtained in all patients with clinically successful procedures (mean 38 months, median 25 months, range 1 to 123 months). Angiographic followup was available in 52% of the patients (15 of 29), at a mean of 20 months. The primary longterm clinical success rate was 83.3% (24 of 29). Four of the five patients with recurrent symptoms were successfully retreated with endovascular therapy. The primary assisted longterm clinical success rate was 96.6% (28 of 29). The 5-year survival rate was 76.1%. Major complications occurred in 13% of the procedures, with a 30-day mortality rate of 0%., Conclusion: Endovascular therapy for treatment of mesenteric arterial stenoses is effective in the treatment of patients with symptoms and angiographic findings characteristic of chronic mesenteric ischemia.