Abstract
This paper aimed to study the agreement and repeatability, both intra- and interobserver, of infrapopliteal lesion assessment with magnetic resonance angiography (MRA), using the TransAtlantic Inter-Society Consensus (TASC) II criteria, with perioperative digital subtraction angiography (DSA) as a reference. Sixty-eight patients with an MRA preceding an endovascular infrapopliteal revascularization were included. Preoperative MRAs and perioperative DSAs were evaluated in random order by three independent observers using the TASC II classification. The results were analyzed using visual grading characteristics (VGC) analysis and Krippendorff’s α. No systematic difference was found between modalities: area under the VGC curve (AUCVGC) = 0.48 (p = 0.58) or intraobserver; AUCVGC for Observer 1 and 2 respectively, 0.49 (p = 0.85) and 0.53 (p = 0.52) for MRA compared with 0.54 (p = 0.30) and 0.49 (p = 0.81) for DSA. Interobserver differences were seen: AUCVGC of 0.63 (p < 0.01) for DSA and 0.80 (p < 0.01) for MRA. These results were confirmed using Krippendorff’s α for the three observers showing 0.13 (95% confidence interval (CI) −0.07–0.31) for MRA and 0.39 (95% CI 0.23–0.53) for DSA. Poor interobserver agreement was also found in the choice of a target vessel on preoperative MRA: Krippendorff’s α = 0.19 (95% CI 0.01‒0.36). In conclusion, infrapopliteal lesions can be reliably determined on preoperative MRA, but interobserver variability regarding the choice of a target vessel is a major concern that appears to affect the overall TASC II grade.
Highlights
The prevalence of lower extremity artery disease (LEAD) is increasing worldwide [1,2].LEAD patients run a high risk of major cardiovascular and lower-limb events, which have a substantial effect on the long-term prognosis and healthcare costs [3]
The indication for revascularization is based on symptoms and clinical findings, while the revascularization strategy is based on non-invasive preoperative imaging techniques such as magnetic resonance angiography (MRA), computed tomography angiography (CTA) and duplex ultrasonography [4]
The examinations were assessed according to the infrapopliteal TransAtlantic Inter-Society Consensus (TASC) II classification [11]
Summary
The prevalence of lower extremity artery disease (LEAD) is increasing worldwide [1,2].LEAD patients run a high risk of major cardiovascular and lower-limb events, which have a substantial effect on the long-term prognosis and healthcare costs [3]. A subset of patients with more severe symptoms—chronic limb-threatening ischemia (CLTI)—are often eligible for revascularization procedures. The indication for revascularization is based on symptoms and clinical findings, while the revascularization strategy is based on non-invasive preoperative imaging techniques such as magnetic resonance angiography (MRA), computed tomography angiography (CTA) and duplex ultrasonography [4]. CTA is the preferred modality for studying lower-limb vessels, because of its non-invasiveness and accuracy but probably mainly due to its high availability [5]. MRA has the advantage of no radiation exposure and enables the visualization of peripheral arteries with high accuracy [6,7]. Due to its invasiveness and high radiation exposure, DSA is usually only performed during endovascular revascularizations and rarely as a stand-alone diagnostic procedure
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