Abstract
The entire vascular tree of 58 lower extremities with high-grade critical limb ischemia (CLI) was assessed with three-station time resolved imaging of contrast kinetics (TRICKS) magnetic resonance angiography (T-MRA) and correlated with digital subtraction angiography (DSA) examinations and Trans-Atlantic Inter-Society Consensus II (TASC II) guidelines. Kappa (κ) statistics were utilized to evaluate the agreement of stenosis scores (5-point scale; 0 normal to 4 occlusion) based on T-MRA and DSA. With DSA as the standard, significant stenosis instances (stenosis score ≥2) among vascular segments were compared. The κ-statistics of image quality (4-point scale; 1 nondiagnostic to 4 excellent) of T-MRA and TASC II classification assessed by a radiologist and a vascular surgeon were also evaluated. Among 870 vascular segments, excellent agreement was observed between T-MRA and DSA (mean κ = 0.883) in revealing stenosis (mean stenosis score, 2.1 ± 1.3 versus 2.0 ± 1.3). T-MRA harbored overall high sensitivity (99.5%), specificity (93.6%), positive predictive value (95.4%), negative predictive value (99.6%), and accuracy (97.7%) in depicting significant stenosis. Excellent interobserver agreement (mean κ = 0.818) of superb image quality (mean score = 3.5–3.6) of T-MRA and outstanding agreement of TASC II classification of aortoiliac and femoral-popliteal lesions (κ = 0.912–0.917) between two raters further verified the clinical feasibility of T-MRA for treatment planning.
Highlights
Due to its high risk of major tissue loss, critical limb ischemia (CLI) is one of the most severe complications for patients with peripheral arterial occlusive disease (PAOD) [1, 2]
Time-resolved imaging of contrast kinetics (TRICKS) allows repeated and rapid sampling of signals combined with temporal interpolation to generate time-resolved images from enhanced vessels, socalled TRICKS-MRA (T-MRA)
The purpose of this study is to assess the clinical feasibility of three-station three-dimensional (3D) T-MRA at 3-tesla, with low doses for each station, for the evaluation of the entire vascular tree of the lower extremity in patients with high-grade CLI with Digital subtraction angiography (DSA) and TASII correlation
Summary
Due to its high risk of major tissue loss, critical limb ischemia (CLI) is one of the most severe complications for patients with peripheral arterial occlusive disease (PAOD) [1, 2]. Measurements of the ankle-brachial index (ABI) and duplex ultrasonography are helpful to assess lower limb PAOD; they may not provide sufficient anatomic details for treatment planning [1, 3]. In patients with CLI, contrast-enhanced magnetic resonance angiography (CE-MRA) is a valuable alternative to DSA for treatment planning [1, 3, 5, 6]. InterSociety Consensus for the Management of Peripheral Arterial Disease (TASC II) provided the most important guidelines for the vascular surgeons in the treatment decision of PAOD [1]. The purpose of this study is to assess the clinical feasibility of three-station three-dimensional (3D) T-MRA at 3-tesla, with low doses for each station, for the evaluation of the entire vascular tree of the lower extremity in patients with high-grade CLI with DSA and TASII correlation
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