Diabetes and peripheral arterial occlusive disease: prospective comparison of contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography.
OBJECTIVE
The purpose of this study was to compare contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography (DSA) for identifying and evaluating arteries of the distal calf and foot in diabetic patients with severe arterial occlusive disease who will undergo distal bypass surgery.


METHODS
Twenty-four feet of 24 consecutive patients with diabetes and limb-threatening lower extremity ischemia were prospectively imaged using an ultrafast three-dimensional fast low-angle shot sequence on a 1.5-T MR scanner. All patients also underwent DSA of the diseased extremity within 5 days. Images were interpreted in a randomized manner by two observers in conference. Each lower extremity was divided into seven potential arterial segments. Image analysis included the detection of patent, stenosed, or occluded vessel segments. A vascular surgeon formulated treatment plans on the basis of findings from DSA and then formulated treatment plans on the basis of findings from both DSA and MR angiography.


RESULTS
MR angiography was significantly better than DSA in revealing peripheral runoff vessels (p < 0.001). In nine (38%) of the 24 patients, MR angiography showed patent pedal vessels suitable for distal bypass grafting that were not revealed by DSA. Because of the results of MR angiography, treatment plans changed in seven of the nine patients in whom patent vessels were subsequently used as target vessels for distal pedal bypass grafts.


CONCLUSIONS
Contrast-enhanced three-dimensional MR angiography is superior to DSA in revealing patent vessel segments of the foot in diabetic patients with severe arterial occlusive disease. Contrast-enhanced three-dimensional MR angiography should be part of the diagnostic algorithm for patients in whom pedal bypass grafting is a therapeutic option.
Kreitner
K F
KF
Department of Radiology, Johannes Gutenberg-University Mainz, Germany.
Kalden
P
P
Neufang
A
A
Düber
C
C
Krummenauer
F
F
Küstner
E
E
Laub
G
G
Thelen
M
M
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D003287:Contrast Media; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D011446:Prospective Studies
D003287:Contrast Media