title: 3-D magnetic resonance angiography versus conventional angiography in peripheral arterial disease: pilot study.
abstract: BACKGROUND
  Angiography is usually performed as the preoperative road map for those requiring revascularization for lower extremity peripheral arterial disease (PAD). The alternative investigations are ultrasound, 3-D magnetic resonance angiography (3-D MRA) and computed tomography angiography. This pilot study aimed to assess whether 3-D MRA could replace the gold standard angiography in preoperative planning.
  
  
  METHODS
  Eight patients considered for aortoiliac or infrainguinal arterial bypass surgery were recruited. All underwent both imaging modalities within 7 days. A vascular surgeon and a radiologist each reported on the images from both the 3-D MRA and the angiography, with blinding to patient details and each others reports. Comparisons were made between the reports for the angiographic and the 3-D MRA images, and between the reports of the vascular surgeon and the radiologist.
  
  
  RESULTS
  Compared to the gold standard angiogram, 3-D MRA had a sensitivity of 77% and specificity of 94% in detecting occlusion, and a sensitivity of 72% and specificity of 90% in differentiating high grade (>50%) versus low grade (<50%) stenoses. There was an overall concordance of 78% between the two investigations with a range of 62% in the peroneal artery to 94% in the aorta. 3-D MRA showed flow in 23% of cases where conventional angiography showed no flow.
  
  
  CONCLUSIONS
  In the present pilot study, 3-D MRA had reasonable concordance with the gold standard angiography, depending on the level of the lesion. At times it showed vessel flow where occlusion was shown on conventional angiogram. 3-D MRA in peripheral vascular disease is challenging the gold standard, but is inconsistent at present.
authors.affiliation: Department of Vascular Surgery, Royal Brisbane Hospital, Herston, Queensland, Australia. rsommerville@hotmail.com
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Sommerville
authors.forename: Jason
authors.initials: J
authors.lastname: Jenkins
authors.forename: Phillip
authors.initials: P
authors.lastname: Walker
authors.forename: Rino
authors.initials: R
authors.lastname: Olivotto
mesh_terms: D000368:Aged; D000792:Angiography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis*; D010865:Pilot Projects; D012680:Sensitivity and Specificity