title: Comparison of treatment plans for lower extremity arterial occlusive disease made with electrocardiography-triggered two-dimensional time-of-flight magnetic resonance angiography and digital subtraction angiography.
abstract: BACKGROUND
  The purpose of the study was to determine whether preoperative treatment plans for patients with lower extremity ischemia can be made with electrocardiography (EKG)-triggered two-dimensional (2D) time-of-flight (TOF) magnetic resonance angiography (MRA) as accurately as digital subtraction angiography (DSA).
  
  
  METHODS
  Forty patients were prospectively evaluated with the combination of EKG-triggered 2D TOF MRA, DSA, and pulse volume recordings. Blinded reviewers graded arterial segments for disease severity. Accuracy of separate MRA- and DSA-based treatment plans was compared with the procedures performed based on all available information.
  
  
  RESULTS
  There was an 86% exact match between MRA- and DSA-based plans (92% MRA and 94% DSA accuracy). The MRA-based plan accurately predicted 90% of suprainguinal and 95% of infrainguinal procedures, whereas the DSA-based plan accurately predicted 100% of suprainguinal and 85% of infrainguinal procedures. Two-year primary patency was 83% for all procedures. Radiologists' review of disease severity resulted in a mean exact correlation between studies of 81% (kappa = 0.64). The agreement between radiologists interpreting the MRA was 84% (kappa = 0.7) compared with 82% (kappa = 0.66) for the DSA.
  
  
  CONCLUSIONS
  MRA- and DSA-based preoperative management plans were of comparable efficacy. Significant interobserver variability was seen with the interpretations of both preoperative studies. EKG-triggered 2D TOF MRA can be used to plan arterial reconstructions; however, all patients require arterial pressure measurements prior to suprainguinal repair and confirmatory intraoperative angiography during infrainguinal revascularization.
authors.affiliation: Department of Surgery, Wm. S. Middleton VA Hospital, University of Wisconsin, Madison 53792-7375, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Hoch
authors.forename: T W
authors.initials: TW
authors.lastname: Kennell
authors.forename: M S
authors.initials: MS
authors.lastname: Hollister
authors.forename: I A
authors.initials: IA
authors.lastname: Sproat
authors.forename: J S
authors.initials: JS
authors.lastname: Swan
authors.forename: C W
authors.initials: CW
authors.lastname: Acher
authors.forename: J
authors.initials: J
authors.lastname: Burks
authors.forename: D M
authors.initials: DM
authors.lastname: Heisey
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology; D004562:Electrocardiography; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007264:Inguinal Canal / Q000098:blood supply; D007430:Intraoperative Care; D007511:Ischemia / Q000145:classification / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D015588:Observer Variation; D010347:Patient Care Planning; D011446:Prospective Studies; D011674:Pulse; D015641:Radiography, Interventional; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014654:Vascular Patency