Because atherosclerosis is a systemic disease, existing MRI protocols permit assessment of the entire vascular system and at the same time include options for imaging the most important target organs affected by atherosclerotic conditions – the brain, the heart, and the kidneys. Early detection of stenosis (e.g., of the renal or carotid arteries) may have crucial clinical implications. Robust clinical protocols for a comprehensive routine evaluation of the coronary arteries are not yet available. In individual cases, however, imaging approaches that are still under investigation can be used.

In whole-body MRA, adequate timing is important to capture the first pass of the contrast medium bolus and to sample central k-space data during bolus passage. Since the optimal moment for image acquisition after contrast medium administration is influenced by many different factors (e.g., cardiac output, injection rate, saline chaser), it is recommended that individual circulation time after administration of a test bolus be estimated (1–2 mL of contrast medium administered at a defined flow rate of 1–3 mL/s).

MRA lends itself to combination with pulse sequences aimed at identifying postischemic changes in the brain and heart (Kramer et al. 2005; Fenchel et al. 2005). For the brain, we recommend a TOF MRA sequence, a precontrast FLAIR sequence, and postcontrast T1-weighted imaging. Postinfarction myocardial scars are best identified by hyperenhancement on delayed enhancement images acquired 10–15 min after administration of Gd-based contrast medium for MRA. If deemed useful for the diagnostic question to be answered, the interval between MRA and delayed enhancement imaging may be used for acquiring functional sequences (2D cine TrueFISP) for a full cardiovascular evaluation.

Table 4.2 presents an example of an established protocol for whole-body cardiovascular imaging using two contrast medium injections (Seeger et al. 2008).

Several alternative protocols have been proposed. These variants include protocols with single-dose contrast medium administration followed by rapid imaging of the neck/chest/abdomen/pelvis (Fenchel et al. 2009), use of a rolling table platform (AngioSURF™, see Chap. 3 (Ruehm et al. 2000)) or a continuously moving table (TIM-CT™, Siemens (Kramer et al. 2008)), and combinations of different techniques (Koziel et al. 2011). Recently, the application of high-resolution time-resolved four-dimensional MRA sequences with a triple injection protocol has been proposed (Kinner et al. 2013) and has shown good diagnostic quality without venous overlay.

The imaging strategy, including selection of pulse sequences and contrast medium administration, is largely determined by the patient’s primary tumor (Goyen and Schlemmer 2007). When imaging involves a body region for which an established dynamic MRI protocol exists, contrast medium administration is timed for optimized imaging of that region. Examples include dynamic liver MRI and late hepatocyte-phase imaging following administration of a hepatocellular contrast agent.

When whole-body MRI is performed for cancer screening, the protocol is planned according to the individual risk profile. Table 4.3 provides an overview of commonly used pulse sequences, introducing the abbreviations that will be used in the following. Table 4.4 presents examples of oncologic protocols for imaging patients with different primary malignancies. The tables have been modified from Schaefer and Schlemmer (2006).