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Patient Male 30 years old
Injury due to firearm with repair surgery five years ago. Arteriovenous fistula at the level of femoral vessels.

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Comment by radRounds Radiology Network on November 3, 2008 at 11:18pm
Thanks for a great case, discussion, and great image!!
Comment by Eduardo Parra on November 3, 2008 at 2:41pm
Excellent case! Now I get it. Multiple adquisitons like DSA . Wonderful, thank you very much for give me your explanation.
Comment by Michele Anzidei on November 2, 2008 at 12:53pm
Is not about iodine only, is about dose ! With CT you cannot do multiple acquisitions without "burning" patients...and this is mostly important when dealing with younger people !
By the way yes, we use SPGR sequences (average acquisition time: 4-6 sec.) Injection rate is not so important because with this technique we can obtain almost a real-time visualization of the filling of an AVM or fistula !
Check out this case to have an idea of what I am talking about:

http://www.radrounds.com/photo/1791588:Photo:16664?context=user
Comment by Eduardo Parra on October 29, 2008 at 4:57pm
Hi Michele. I don´t have experience in MRI. But it sounds good idea avoid using iodine. Do you use SPGR acquisition and smart prep/bolus tracking? if so, what is the Gd inyection rate? Thank you for comment.
Comment by Michele Anzidei on October 27, 2008 at 4:57pm
Hi Eduardo. How about putting this guy in the MR and do multiple fast 3D GRE acquisition during Gd acquisition ? We use this approach to rule out the point of fistula without DSA. Any experience?

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