Intraarterial MR Angiography and DSA in Patients with Peripheral Arterial Occlusive Disease: Prospective Comparison

Abstract

To prospectively evaluate the accuracy of intraarterial magnetic resonance (MR) angiography in the depiction of significant stenoses and occlusions, with intraarterial digital subtraction angiography (DSA) serving as the reference standard. Approval of the local ethics committee and informed consent were obtained. Twenty patients (11 men; nine women; age range, 48-86 years; mean age, 69.5 years+/-11.2 [standard deviation]) with symptomatic peripheral arterial occlusive disease (PAOD) were prospectively enrolled. After percutaneous transluminal angioplasty (PTA), intraarterial MR angiography was performed in the thigh and the calf with a 1.5-T MR imager in two consecutive runs. Intraarterial MR angiography was performed with a low-dose injection protocol (ie, two 20-mL injections of a 50-mmol gadolinium-based contrast agent). Moderate stenoses (luminal narrowing<or=50%), significant stenoses (luminal narrowing 51%-99%), and occlusions (luminal narrowing of 100%) were identified on MR angiograms, which were compared with intraarterial DSA images. Intraarterial MR angiograms were analyzed for imaging artifacts. Sensitivity, specificity, accuracy, and positive and negative predictive values of intraarterial MR angiography with intraarterial DSA were determined for characterization of significant stenoses (>50%) or vessel occlusions; 95% confidence intervals (CIs) were calculated for sensitivity and specificity. Intraarterial DSA revealed 78 moderate stenoses, 57 significant stenoses, and 28 occlusions. Sensitivity, specificity, and accuracy of intraarterial MR angiography in the characterization of significant stenoses or occlusions were 92% (95% CI: 72%, 99%), 94% (95% CI: 82%, 98%), and 93%, respectively, in femoropopliteal arteries and 93% (95% CI: 83%, 98%), 71% (95% CI: 51%, 86%), and 86%, respectively, in infrapopliteal arteries. The main artifact observed with intraarterial MR angiography was venous contamination (12%). Intraarterial MR angiography is an accurate method used to depict significant stenoses and occlusions in lower extremity arteries with a low-dose injection protocol.