Abstract
Lower extremity peripheral arterial disease (PAD) is a chronic, debilitating disease with a significant global burden. A number of diagnostic imaging techniques exist, including computed tomography angiography (CTA) and contrast-enhanced magnetic resonance angiography (CEMRA), to aid in PAD diagnosis and subsequent treatment planning. Due to concerns of renal toxicity or nephrogenic systemic fibrosis (NSF) for iodinated and gadolinium-based contrasts, respectively, a number of non-enhanced MRA (NEMRA) protocols are being increasingly used in PAD diagnosis. These techniques, including time of flight and phase contrast MRA, have previously demonstrated poor image quality, long acquisition times, and/or susceptibility to artifacts when compared to existing contrast-enhanced techniques. In recent years, Quiescent-Interval Single-Shot (QISS) MRA has been developed to overcome these limitations in NEMRA methods, with promising results. Here, we review the various screening and diagnostic tests currently used for PAD. The various NEMRA protocols are discussed, followed by a comprehensive review of the literature on QISS MRA to date. A particular emphasis is placed on QISS MRA feasibility studies and studies comparing the diagnostic accuracy and image quality of QISS MRA versus other diagnostic imaging techniques in PAD.
Highlights
Lower extremity peripheral arterial disease (PAD) is a chronic, debilitating disease that can progress to intermittent claudication and critical limb ischemia with resulting tissue loss if left untreated.The worldwide prevalence of PAD is estimated to be between 3 to 10% of the population, and these estimates significantly increase for those over 70 years of age [1]
The remainder of this review this review will focus on Quiescent-Interval Single-Shot (QISS) MRA and its utility in peripheral arterial imaging, with a will focus on QISS
Initial study examining the technical considerations and feasibility of QISS in peripheral MRA, elucidated the technical factors associated with performing QISS at 1.5 Tesla (T), discovering the Edelman et al elucidated the technical factors associated with performing QISS at 1.5 Tesla (T), superiority of ECG gating versus pulse gating, which caused a loss of intravascular signal, and the discovering the superiority of ECG gating versus pulse gating, which caused a loss of intravascular inferior fat suppression of full Fourier acquisition when compared with partial Fourier acquisition [21]
Summary
Lower extremity peripheral arterial disease (PAD) is a chronic, debilitating disease that can progress to intermittent claudication and critical limb ischemia with resulting tissue loss if left untreated. It is limited by its ability to characterize a narrowing, i.e., the exact location and extent of stenosis or occlusion It can often give falsely-elevated measurements in the presence of calcified vessels in diabetics and those with end-stage renal disease [1]. >50% stenosis were shown to be 80% and 98% respectively [7]; the diagnostic accuracy of images can vary depending upon a number of factors including operator experience, anatomic location, irregular anatomy or extent of shadowing artifact. In a 2007 meta-analysis, Collins et al demonstrated that CEMRA is a more accurate diagnostic technique for the detection of significant stenosis or occlusion compared to duplex ultrasound or CTA [10].
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