Three-Station Non-Contrast MR Angiography of the Lower Extremities Using Standard and Centric Fresh Blood Imaging

<b>Background</b>: Peripheral artery disease (PAD) is a manifestation of atherosclerosis that affects the extremities, leading to reduced perfusion and functional impairment. Non-contrast magnetic resonance angiography (NC-MRA) provides a safe and quantitative approach for early detection of PAD without the risks associated with contrast agents. The purpose of this study was to demonstrate the application of standard and centric <i>ky</i>-<i>kz</i> FBI techniques for rapid three-station NC-MRA of the entire lower extremity. <b>Methods</b>: This prospective cross-sectional study compared standard three-station fresh blood imaging (sFBI) with centric <i>ky</i>-<i>kz</i> ordered fresh blood imaging (cFBI) sequences in 10 healthy subjects and 3 patients with PAD (age range: 23-79 years; 7 females) using a 3-Tesla magnetic resonance imaging (MRI) system. Both sequences were acquired at the iliac, femoral, and tibial stations. Image quality (0-4 scale), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were evaluated. Statistical analysis was performed using repeated-measures analysis of variance (ANOVA) with significance set at α = 0.05. <b>Results</b>: Image quality did not differ significantly between sFBI and cFBI (<i>p</i> = 1.0). The iliac station exhibited lower image quality than the femoral station (<i>p</i> < 0.01). In a PAD patient with an iliac stent, cFBI preserved good image quality in the femoral and tibial stations, whereas sFBI was affected by N/2 aliasing artifacts. Both methods failed to visualize the stented iliac segment. Compared to sFBI, cFBI yielded significantly lower SNR (<i>p</i> < 0.01) and CNR (<i>p</i> < 0.001) but reduced total scan time by approximately 40% (468 s vs. 291 s). <b>Conclusions</b>: Three-station non-contrast FBI MRA of the peripheral arteries is feasible. The cFBI sequence substantially shortens scan time without compromising diagnostic image quality, offering practical advantages for clinical implementation, improved patient comfort, and reduced motion artifacts.