Non-Contrast-Enhanced MR Angiography at 3 Tesla in Patients with Advanced Peripheral Arterial Occlusive Disease

Kolja M Thierfelder,Konstantin Nikolaou,Daniel Theisen,Philipp M Kazmierczak,Georgios Meimarakis,Maximilian F Reiser,Peter Schmitt,Wieland H Sommer

doi:10.1371/journal.pone.0091078

Abstract

PurposeThe aim of this study was to assess the diagnostic performance of ECG-gated non-contrast-enhanced quiescent interval single-shot (QISS) magnetic resonance angiography at a magnetic field strength of 3 Tesla in patients with advanced peripheral arterial occlusive disease (PAOD).Method and MaterialsA total of 21 consecutive patients with advanced PAOD (Fontaine stage IIb and higher) referred for peripheral magnetic resonance angiography (MRA) were included. Imaging was performed on a 3 T whole body MR. Image quality and stenosis diameter were evaluated in comparison to contrast-enhanced continuous table and TWIST MRA (CE-MRA) as standard of reference. QISS images were acquired with a thickness of 1.5 mm each (high-resolution QISS, HR-QISS). Two blinded readers rated the image quality and the degree of stenosis for both HR-QISS and CE-MRA in 26 predefined arterial vessel segments on 5-point Likert scales.ResultsWith CE-MRA as the reference standard, HR-QISS showed high sensitivity (94.1%), specificity (97.8%), positive (95.1%), and negative predictive value (97.2%) for the detection of significant (≥50%) stenosis. Interreader agreement for stenosis assessment of both HR-QISS and CE-MRA was excellent (κ-values of 0.951 and 0.962, respectively). As compared to CR-MRA, image quality of HR-QISS was significantly lower for the distal aorta, the femoral and iliac arteries (each with p<0.01), while no significant difference was found in the popliteal (p = 0.09) and lower leg arteries (p = 0.78).ConclusionNon-enhanced ECG-gated HR-QISS performs very well in subjects with severe PAOD and is a good alternative for patients with a high risk of nephrogenic systemic fibrosis.

Highlights

Peripheral arterial occlusive disease (PAOD) has a prevalence of 12 to 20% in individuals of over 65 years and is one of the most important and cost-intensive vascular diseases [1]
As compared to CR-magnetic resonance angiography (MRA), image quality of HR-quiescent interval single-shot (QISS) was significantly lower for the distal aorta, the femoral and iliac arteries, while no significant difference was found in the popliteal (p = 0.09) and lower leg arteries (p = 0.78)
Contrast-enhanced MR angiography (CE-MRA) employing gadolinium-based contrast agents has shown to be accurate for the detection of vascular stenosis within the entire lower limb without a disturbing overlay from bone or calcified plaques [3]

Summary

Introduction

Peripheral arterial occlusive disease (PAOD) has a prevalence of 12 to 20% in individuals of over 65 years and is one of the most important and cost-intensive vascular diseases [1]. Cross-sectional diagnostic imaging can determine severity and localization of stenosis and is indispensable for planning of surgical and interventional procedures. CT angiography (CTA) offers a high spatial resolution without the risks of an invasive procedure [2]. Well known drawbacks of contrast-enhanced CT are the risk of iodinated contrast nephropathy and the ionizing radiation. Contrast-enhanced MR angiography (CE-MRA) employing gadolinium-based contrast agents has shown to be accurate for the detection of vascular stenosis within the entire lower limb without a disturbing overlay from bone or calcified plaques [3]. CE-MRA is used as the primary imaging modality for PAOD patients in many centers [4]

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