The aim of this study was to optimize different magnetic resonance angiography (MRA) techniques and to evaluate MRA of the hand arteries compared to intraarterial digital subtraction angiography (IA-DSA). The MRA examinations were performed on a 1.5-T system equipped with a flexible surface coil. The protocol contained time-of-flight (TOF), rephased/dephased (Re/De), and contrast enhanced (CE) techniques. Maximum intensity projection (MIP) was used for postprocessing. The IA-DSA procedure was performed as pharmaco-angiography (after intraarterial injection of a vasodilatator) via a transbrachial approach. Nine patients suffering from peripheral vascular disease were examined with IA-DSA, TOF-MRA, and Re/De-MRA; six patients were examined with CE-MRA and IA-DSA. Best overall image quality was attained with IA-DSA, followed by TOF-MRA, Re/De-MRA, and CE-MRA. Selective arterial visualization of digital arteries was possible with IA-DSA and TOF-MRA. Rephased/dephased MRA showed venous overlay. Contrast-enhanced MRA was limited by inconstant quality of bolus timing. Appropriate arterial bolus timing was achieved in four of six patients; one examination showed venous overlay, one examination incomplete arterial enhancement. Time-of-flight MRA detected 96% of the digital artery segments that were identified with IA-DSA and revealed 34 segments that were failed on IA-DSA. Rephased/dephased MRA and CE-MRA were inferior to IA-DSA and TOF-MRA regarding detection of digital arteries. Magnetic resonance angiography with optimized protocols is a noninvasive procedure to visualize hand arteries in patients with ischemic disease. With TOF-MRA it is possible to detect angiographically occluded arterial segments of digital arteries.