The aim of this study was to compare diagnostic value of high spatial resolution time-resolved magnetic resonance angiography with interleaved stochastic trajectory (TWIST) using Gadobutrol to Computed tomography angiography (CTA) for preoperative evaluation of lower extremity tumors.This prospective study was approved by the institutional review board. Fifty consecutive patients (31 men, 19 women, age range 18-80 years, average age 42.7 years) with lower extremity tumors underwent TWIST magnetic resonance angiography (MRA) and CTA. Digital subtraction angiography was available for 8 patients. Image quality of MRA was compared with CTA by 2 radiologists according to a 4-point Likert scale. Arterial involvement by tumor was compared using kappa test between MRA and CTA. The ability to identify feeding arteries and arterio-venous fistulae (AVF) was compared using Wilcoxon signed rank test and McNemar test, respectively.Image quality of MRA and CTA was rated without a statistically significant difference (3.880.37 vs. 3.97 +/- 0.16, P=0.135). Intramodality agreement was high for the identification of arterial invasion (kappa=0.806 +/- 0.073 for Reader 1, kappa=0.805 +/- 0.073 for Reader 2). Readers found AVF in 27 of 50 MRA cases and 14 of 50 CTA cases (P<0.001). Mean feeding arteries identified with MRA were significantly more than that with CTA (2.08 +/- 1.72 vs. 1.62 +/- 1.52, P=.02).TWIST MRA is a reliable imaging modality for the assessment of lower extremity tumors. TWIST MRA is comparable to CTA for the identification of AVF and feeding arteries.