MRA advances for PAD and aorta (non-contrast techniques, vessel wall imaging)

**magnetic resonance angiography (MRA) Advances for peripheral arterial disease (PAD) and Aorta: Non-Contrast Techniques and Vessel Wall Imaging**

Magnetic resonance angiography has evolved to include multiple technique options that expand its clinical applicability:

**Non-contrast MRA techniques:** When gadolinium-based contrast is contraindicated (e.g., severe renal insufficiency, prior allergic reaction), non-contrast MRA sequences provide viable alternatives for vascular imaging. These include time-of-flight (TOF) and various flow-based techniques that do not require exogenous contrast agents.

**Contrast-enhanced MRA:** Where safe, CE-MRA remains the preferred MR technique, offering superior image quality and faster acquisition times compared to non-contrast methods.

**Vessel wall imaging:** Specialized MR sequences enable direct visualization of the arterial wall, proving particularly valuable in diagnosing and monitoring large vessel vasculitis and characterizing arterial dissection. These techniques provide information beyond luminal assessment alone.

MRA serves as an alternative first-line imaging modality in patients for whom computed tomography angiography (CTA) is inappropriate, with modality selection guided by disease characteristics and patient-specific factors according to major PAD and disease-specific guidance. [@prince2016] [@aha2016][@acc2025] [@esvs2019-aaa] [@esvs2018-esvs]