Recently, a subtractionless Dixon method was proposed for first-pass stepping-table peripheral MRA, which relies on fat suppression instead of subtraction to reduce the background signal [1]. Advantages were shown to be higher SNR and CNR, robustness to motion, and a shorter scan time. Time resolved MRA of the lower legs has been shown to be beneficial as an add-on to multi-station peripheral MRA for patients with critical limb ischemia [2]. Time resolved MRA of the lower leg vessels using viewsharing techniques has been shown to be feasible [2,3] using subtraction of a mask to suppress background signal in all dynamic phases. Dixon has been applied on 3T with time resolved viewsharing techniques for dynamic contrast enhanced (DCE) MRI of the breast [4], and with time-resolved subtractionless CE-MRA using an interleaved variable density sampling pattern [5]. The purpose of this work is to investigate the feasibility and show the potential benefits of time resolved subtractionless contrast enhanced MRA on 1.5T with viewsharing and a large FOV in the lower legs, using mDixon with flexible (shortest) echo times and parallel imaging with high acceleration factors. The novel approach was compared to conventional subtraction-based time-resolved MRA.Seven patients with known or suspected peripheral vascular disease were examined on an Ingenia 1.5T scanner (Philips, Best, Netherlands) using the standard Anterior Body Coil and the built-in posterior coil. A single dose of Gadobutrol (Bayer Healthcare, Berlin, Germany) was used, with an injection speed of 1 mL/sec. 3D volumetric images were acquired with a FOV of 430 x 430 mm² and a volume thickness of 150 mm, using a T1-weighted spoiled dual-gradient-echo sequence with a bandwidth of 610 Hz/pixel and a TE₁/TE₂/TR of 1.8/3.6/5.6 ms. Acquired spatial resolution was 1.1 x 1.1 x 2.0 mm³; data was reconstructed to 1 x 1 x 1 mm³. An eightfold acceleration by parallel imaging (SENSE) was used, with a partial Fourier factor of 0.65, which together with the use of an elliptical k-space shutter resulted in a net acceleration of 15.5x. Viewsharing was applied with a keyhole percentage of 15% and a peripheral sampling density of 25% [3,4,6], resulting in an additional 2.76 fold increase in temporal resolution. Compared to fully sampled conventional scanning, this resulted in a total net acceleration factor of 43. The temporal resolution per dynamic phase was 5.5 sec, with a temporal footprint of 19.5 sec. To enable comparison with conventional subtraction, a mask was acquired at the beginning of the acquisition. 12-19 dynamic phases were acquired. Total scan time was 1:25-2:00 minutes. Water images were reconstructed using mDixon reconstruction capable of handling flexible echo times, using a multi-peak spectral fat model [7]. Source modulus images were obtained from the first echo. The comparison between water and subtracted modulus images could thus be made from the same acquisition.In 1/7 patients (14%) significant motion was observed, corrupting the subtraction images; in a further 2/7 patients (28%) only mild motion was observed. Compared to the subtracted modulus images, the SNR in the unsubtracted Dixon water images was increased by a factor of 1.89 (SD 0.19) on average. Coronal MIPs obtained in two patients with disease in the tibial and peroneal arteries are shown in Fig. 1, 2 and 3. The effect of bulk motion is shown in Fig. 4, where misregistration artifacts in the subtracted modulus images significantly increases the background signal. As can be seen from the water images in Fig. 4, the subtractionless mDixon method effectively eliminates these motion artifacts.Compared to the subtracted modulus images, the increase in SNR for the unsubtracted Dixon water images was a factor of 1.89 on average, which is in line with theoretical predictions [8]. No significant water-fat swap artifacts were observed, despite the echo spacing of 1.8 ms, which is relatively short for Dixon on 1.5T. The viewsharing and high acceleration factor allowed a sufficiently high temporal resolution with a relatively thick 3D volume, which facilitates easy planning. The feasibility of time-resolved subtractionless MRA with viewsharing, Dixon and parallel imaging with a high acceleration factor has been demonstrated in this work on patients at 1.5T. The main advantages of the subtractionless method are nearly doubled SNR and the elimination of misregistration artifacts due to bulk patient motion. Both advantages can contribute to better clinical imaging, since the main indication for time-resolved MRA of the lower legs is for patients with critical limb ischemia, which often find it difficult to lay still for a longer period, and in which it can be important to visualize small (collateral) vessels.