الفهرس 
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Abstract
S
UMMARY AND C ONCLUSION
n conclusion, we found that NC-MRA (namely TOF technique) was comparable to CTA and DUS in the evaluation of lower limb PAD in the aortoiliac and femoropopliteal as well as infra-popliteal regions with accepted image quality.
The detection of hemodynamically significant stenosis with duplex ultrasound was found to be near almost as accurate to both CTA and non-contrast magnetic resonant angiography in terms of diagnostic accuracy. Compared to duplex ultrasonography, CTA and NCMRA more accurately defined the length of stenotic segments and collateral flow in both supra- and infra-popliteal segments.
Duplex ultrasonography is recommended as the 1st image modality of for determining the flow and severity of the disease due to its close resemblance to MDCT and NCMRA accuracy, wide availability, affordability, lack of need for iodinated contrast material, and non-ionizing nature, yet DUS is an operator dependent technique.
Peripheral arterial disease is common among diabetic patients with renal insufficiency, and most of the diabetic patients with end-stage renal disease (ESRD) have peripheral arterial disease so diabetic patients with peripheral arterial disease are challenging to assess.
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Summary and Conclusion
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So In patient with significant hemodynamic stenosis as well as renal insufficiency, Non-contrast magnetic resonance angiography (MRA) and duplex ultrasound offer a safe alternative in patients with renal impairment, NCMRA is considered a good alternative to CTA for better delineation of the arterial tree to avoid exposure to the contrast iodinated material, Combination between MRA as well as Duplex ultrasonography has better diagnostic accuracy.
The main drawbacks for non-contrast MRA is detection of heavy calcified plaque as the MRA is flow dependent technique and cannot detect the heavy calcified plaques so combination between both MRA and DUS is considered a solution to pick the calcified plaques when the CTA is contraindicated as in the patient with renal impairment.
To summarize NCMRA combined with ultrasound can be used as an alternative to CTA to avoid the hazard of the use of iodinating material as well as radiation hazard of CT. The main drawback is long examination time as some patient can’t tolerate the noise in addition to patient with arrhythmia as our technique is ECG gated and need almost regular heart rate