Among non-atherosclerotic etiologies of peripheral artery disease (PAD), Buerger disease, known as thromboangiitis obliterans, is a rare cause and is an inflammatory condition of the small and middle-sized arteries in young patient with smoking history [1,2]. The Shionoya criteria are commonly used in diagnosis, and it consist of the followings: (1) Smoking history; (2) Onset before age 50; (3) Infrapopliteal arterial segments occlusions; (4) Presence of phlebitis migrans or upper limb involvement; (5) Exclusion of other risk factors for atherosclerosis [3]. There is no pathognomonic angiographic sign of Buerger disease but infrapopliteal involvement, normal appearance of uninvolved segments (all occlusions and almost no stenosis), skip lesions and corkscrew collaterals are common findings which help to differentiate it from other obstructive arterial diseases. The prognosis of Buerger disease mainly depends on the smoking cessation and early diagnosis. Management is limited to pain control and revascularisation in the advanced stages [1].

The radiologic evaluation of Buerger disease is crucial for diagnosis and following the disease’s progression. Infrapopliteal occlusions are usually diagnosed with imaging modalities. DSA (digital subtraction angiography) is considered as the gold standard in visualizing the obstructive arterial diseases because it can provide high-resolution images. However, DSA is invasive, uses ionizing radiation, and there is a risk of contrast-induced nephropathy [4,5]. On the other hand, CTA (computed tomography angiography) and MRA (magnetic resonance angiography) offer noninvasive options in the diagnosis. In addition to that, MRA does not use radiation and has less risk of contrast-induced nephropathy comparing to CTA and provides high sensitivities and specificities for the evaluation of the peripheral arteries [2,6].

To the best of our knowledge, there is no published study comparing MRA to DSA in the Buerger disease diagnosis. However, the studies about general PAD have pointed out that MRA is very efficient in the assessment of vascular occlusions [5-7]. Thus, this study aims to fill this gap in the literature by evaluating the diagnostic performance of MRA in identifying affected arterial segments in Buerger disease when compared to DSA.