Peripheral arteries in diabetic patients: standard bolus-chase and time-resolved MR angiography.
OBJECTIVE
To prospectively determine the diagnostic performance of a combination of standard bolus-chase magnetic resonance (MR) angiography and MR angiography with time-resolved imaging of contrast kinetics (TRICKS) for depicting severity of peripheral vascular disease of the lower extremity, including the pedal arteries, in diabetic patients with digital subtraction angiography (DSA) as the reference standard.


METHODS
An ethical committee approved this study; written informed consent was obtained from patients. Standard three-station and TRICKS MR angiography of the calf and foot were performed in 31 consecutive diabetic patients (23 men, eight women; mean age, 67 years; range, 43-81 years). Two readers separately assessed images of arterial segments as diagnostic or nondiagnostic and graded stenosis. Results were compared with those at DSA when the corresponding arterial segments were considered diagnostic at DSA. Wilcoxon signed rank test was used to determine if a significant difference between imaging techniques existed, and kappa statistics were used to determine interobserver agreement.


RESULTS
The difference between standard MR angiography and DSA regarding the number of diagnostic segments in the thigh was not significant (P = .50). A significantly higher number of calf and foot segments was considered diagnostic at TRICKS MR angiography than at standard MR angiography (P < .025). Sixteen of 26 segments in the foot that were considered nondiagnostic at DSA were considered diagnostic at TRICKS MR angiography. Average sensitivity of standard MR angiography for depicting hemodynamically significant arterial stenosis was 84% (reader 1) and 83% (reader 2) in the thigh and 78% (reader 1) and 80% (reader 2) in the calf. For both readers, average specificity was 97% in the thigh and 90% in the calf. Sensitivity and specificity of TRICKS MR angiography in the calf and foot were improved compared with those at standard MR angiography.


CONCLUSIONS
TRICKS MR angiography of the distal calf and pedal vessels is superior to standard MR angiography regarding the number of diagnostic segments and assessment of the degree of luminal narrowing.
Andreisek
Gustav
G
Institute of Diagnostic Radiology, Department of Internal Medicine, Division of Angiology, and Department of Medical Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
Pfammatter
Thomas
T
Goepfert
Kerstin
K
Nanz
Daniel
D
Hervo
Patrice
P
Koppensteiner
Renate
R
Weishaupt
Dominik
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000175:diagnosis; D003251:Constriction, Pathologic / Q000175:diagnosis; D003287:Contrast Media; D003925:Diabetic Angiopathies / Q000175:diagnosis*; D005260:Female; D005528:Foot / Q000098:blood supply; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007866:Leg / Q000098:blood supply; D035002:Lower Extremity / Q000098:blood supply*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis*; D011446:Prospective Studies; D013848:Thigh / Q000098:blood supply; D013997:Time Factors
D003287:Contrast Media