MRA versus DSA in the assessment of occlusive disease in the aortic arch vessels: accuracy in detecting the severity, number, and length of stenoses.
OBJECTIVE
To compare the diagnostic accuracy of contrast-enhanced magnetic resonance angiography (MRA) to that of digital subtraction angiography (DSA) in the detection, grading, and measurement of atherosclerotic stenoses involving the aortic arch arteries.


METHODS
The MRA and DSA studies from 28 patients (16 women; mean age 61.6 years, range 24-83) being evaluated for possible aortic arch vessel disease were examined. The aortic arch vasculature was divided into 9 segments; within each segment, the presence and severity of stenotic or occlusive disease was determined based on a 5-point scale. In addition, stenosis length and distance to the branch were measured in 5-mm increments. Image quality was assessed using a 5-point scale. The accuracy, sensitivity, and specificity values, as well as the positive and negative predictive values in MRA's identification of lesions, were evaluated in comparison to DSA.


RESULTS
In 28 patients, 189 segments were assessed by both methods. Of these, 173 were correctly rated by MRA, resulting in an accuracy of 91.5%. The accuracy dropped slightly to 86.5% when 11 "not assessable" lesions were included. Sensitivity and specificity for severity measurement were 88.5% and 95.6%, respectively. In 39 of 45 lesions, stenosis length measurements were identical by both methods, but there was a difference of 0.5 cm each in 6 lesions.


CONCLUSIONS
MRA as compared to DSA shows high accuracy in the detection and grading of lesions involving the aortic arch vessels. The noninvasive nature of this method recommends its use for screening, treatment planning, and follow-up in known or suspected arterial disease in aortic arch arteries.
Loewe
Christian
C
Department of Radiology, Division of Angiography and Interventional Radiology, Vienna Medical School, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. christian.loewe@univie.ac.at
Schillinger
Martin
M
Haumer
Markus
M
Loewe-Grgurin
Maria
M
Lammer
Johannes
J
Thurnher
Siegfried
S
Fuchsjäger
Michael
M
Cejna
Manfred
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D012680:Sensitivity and Specificity