Comparison of contrast-enhanced magnetic resonance angiography and digital subtraction angiography in patients with chronic critical ischemia and tissue loss.
OBJECTIVE
To compare the ability of intra-arterial digital subtraction angiography (IA-DSA) and total runoff contrast-enhanced magnetic resonance angiography (CE-MRA) to demonstrate peripheral arterial anatomy, specifically in patients with chronic critical ischemia and tissue loss.


METHODS
Twenty-three consecutive patients with chronic critical ischemia and tissue loss underwent CE-MRA and IA-DSA within 2 days. Two teams, consisting of an interventional radiologist and vascular surgeon who were blinded to each other's results, determined the number of named arteries (21 segments) and the presence of >/=50% stenosis or occlusion.


RESULTS
Compared with IA-DSA, both teams detected significantly more arterial segments with CE-MRA, both above and below the knee (team 1: above knee 7.0 versus 5.2, P = 0.002, and below knee 8.5 versus 5.4, P < 0.001; team 2: above knee 7.1 versus 5.4, P = 0.004, and below knee 8.3 versus 5.9, P < 0.001). Interobserver agreement between the 2 teams with regard to presence of arteries and the presence of stenoses and/or occlusions yielded kappa values of 0.76 (95% confidence interval 0.71-0.81) for IA-DSA and 0.73 (95% confidence interval 0.66-0.80) for CE-MRA. Treatment was changed based on the CE-MRA findings in 8/23 (35%) patients.


CONCLUSIONS
In the present study CE-MRA detected more patent arteries than IA-DSA in patients with chronic critical ischemia and tissue loss. CE-MRA can modify the choice of therapeutic strategy in these patients.
Leiner
Tim
T
Department of Radiology, Maastricht University Hospital, Maastricht, The Netherlands. leiner@rad.unimaas.nl
Kessels
Alphons G H
AG
Schurink
Geert Willem
GW
Kitslaar
Peter J E H M
PJ
de Haan
Michiel W
MW
Tordoir
Jan H M
JH
van Engelshoven
Jos M A
JM
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods*; D002908:Chronic Disease; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007511:Ischemia / Q000175:diagnosis*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged
D003287:Contrast Media